Balancing Act: Managing the Pigment-Loss Condition Vitiligo

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Dermatology Family Nurse Practitioner Christina Smitley, FNP-C with Advanced Dermatology PC, Provides Tips on Treatment Choices for Vitiligo

Christina Smitley, FNP-C

Vitiligo is not contagious and, in most cases, does not carry health risks.

Megawatt model Winnie Harlow’s striking appearance is in part due to her symmetrical dark-and-light skin pattern. The actor Jon Hamm, who entered millions of households as Don Draper in Mad Men, wore makeup on his hands to camouflage their sudden loss of pigment. “The public faces of vitiligo,” notes Christina Smitley, a board-certified family nurse practitioner specializing in dermatology with Advanced Dermatology PC, “have helped increase awareness.”

Research continues on vitiligo, which results in the skin’s loss of melanocytes: the specialized skin cells that produce melanin, which gives skin its color. “There may be a number of causes,” explains Smitley. “Genes, environment, disease, stress – perhaps in conjunction. Some cite a ‘convergence theory,’ with a number factors together triggering an autoimmune response.”

As many as two percent of the population develop vitiligo. “It typically onsets without warning,” says Smitley. “Patients will observe the sudden appearance of white patches of skin. For those with darker skin, the patches can be especially noticeable. Often, vitiligo starts on the hands and can also present on the face. Understandably, patients can be distressed.”

Most vitiligo is ‘generalized’ – also called ‘nonsegmental’ – with pigment loss occurring in corresponding patches on both sides of the body, and start-and-stop periods over time. In cases of ‘localized’ vitiligo, however, pigment loss is limited. Finally, in rare instances, some patients develop universal vitiligo: the skin loses almost all its pigment.

Vitiligo is not contagious and, in most cases, does not carry health risks. “However,” Smitley cautions, “it can occur alongside eye and autoimmune conditions, and, for that reason, is a medical condition that requires evaluation.”

“Also,” continues Smitley, “ongoing research is opening up future possibilities.”

With that in mind, she makes the following suggestions.

6 Tips for Managing Vitiligo:

1. Don’t ‘wait and see’: “Make an appointment with a specialist as soon as you notice any loss of skin pigment,” emphasizes Smitley. “The earlier vitiligo is identified, the greater the treatment choices the patient has.”

2. Get a diagnosis: “This is the first step in a management plan,” notes Smitley. “One of the reasons to work with a dermatologist with expertise in skin-pigment conditions is that there are different causes for pigment loss, with vitiligo being one. A specialist’s examination may include a skin biopsy: The absence of melanocytes in a skin sample is indicative of vitiligo.”

3. Understand your choices: “Location, extent, and progression,” lists Smitley, “are important factors when considering re-pigmentation options. For example, early onset on the face can respond to topical corticosteroids. For small areas, lasers can be an effective choice, while UVA and UVB phototherapy are often better suited for more extensive areas. Topical and light therapy can also be used in tandem – ‘PUVA’ refers to the use of topical or oral psoralen in conjunction with UVA light treatment. And for adults with ‘stable’ vitiligo – that is, no change in at least six months – skin-transplant surgery is an option.”

4. Make sure that you are aware of any side effects: “Light therapy, steroids, surgery,” Smitley enumerates. “These treatments carry varying side effects. For example, steroids can cause skin atrophy, and PUVA treatments can affect the eyes. Make sure you understand the risks of any treatment and follow your doctor’s monitoring plan to minimize those risks.”

5. Stay informed of your treatment’s timeline and its duration: “In some cases,” explains Smitley, “treatment requires a time commitment. For example, PUVA is typically a series of weekly sessions carried out over the course of a year. Also, treatments may last for varying times: Pigment restored by light treatment, for example, may begin to fade after a year. Being fully informed from the outset is an important factor in patient satisfaction.”

6. Build a partnership with your skin-care specialist: “There are promising treatments in the pipeline,” advises Smitley. “For example, the topical agent ruxolitinib is being evaluated as a re-pigmenting treatment. Make sure that you’re working with an expert who can keep you informed of new possibilities.”

“Growing awareness of vitiligo,” concludes Smitley, “supports patients’ access to timely care that can help them manage the condition.”

Bio: Christina Smitley, FNP-C, is a family nurse practitioner with Advanced Dermatology pc, and is board-certified through the American Academy of Nurse Practitioners.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

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