Disorders of Hypopigmentation

March 2019 | Volume 18 | Issue 3 | Supplement Individual Articles | 115 | Copyright © March 2019


Yemisi Dina BS,a Jacqueline McKesey MD MS,b Amit G. Pandya MDb

aSchool of Medicine, Meharry Medical College, Nashville, TN bDepartment of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX

Figure2Figure3antioxidant properties, vitamins C, E, and alpha lipoic acid may also be useful in reducing triggering factors that lead to depigmentation when used in combination with topical and systemic treatments as well as phototherapy.11 Emerging therapies for vitiligo include topical and oral Janus kinase (JAK) inhibitors. Topical ruxolitinib and oral tofacitinib have both been found to be potentially effective in achieving repigmentation in small pilot studies.12,13 These medications interrupt IFNγ signaling via the JAK STAT pathway, which is crucial in the pathogenesis of vitiligo.13 Other potential therapeutic targets include IFNγ, CXCL9/10, and CXCR3.3,13 In patients with resistant depigmentation that has been stable for 6 months to 2 years, surgical therapy may be considered.7 Mini-punch grafting, blister grafting, and non-cultured epidermal graft suspension (NCES) are all viable options for patients.7 The choice of procedure is dependent on the body area involved, surface area of depigmentation, and affordability. NCES has been proven to be most efficacious, however mini-punch and blister grafting techniques are less expensive and easier for practitioners to master.7 In patients with widespread vitiligo (>50% body surface area involvement) that is refractory to therapy, depigmentation of the remaining pigmented areas with monobenzylether of hydroquinone may be considered.7 Patients should be educated that this process is irreversible and be comfortable with the permanent nature of this treatment prior to initiation.7

CONCLUSION

In summary, vitiligo is a common autoimmune disorder that causes depigmentation and significantly impacts the quality of life of affected individuals.3,4 A careful history and physical examination should be performed in order to differentiate vitiligo from other conditions that may cause hypopigmentation or depigmentation. Physicians should be wary of signs of activity that mandate prompt treatment.5,6 Current mainstays of treatment include topical corticosteroids and phototherapy.7 Emerging therapies that may be life changing for patients with refractory disease include the JAK inhibitors ruxolitinib and tofacitinib as well as new JAK inhibitors that are being studied. Further studies exploring the pathogenesis of vitiligo are warranted in order to optimize treatment options for patients.

REFERENCES

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