In this video blog, Susan Taylor, MD, discusses highlights from her lecture Vitiligo in Skin of Color on July 25, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.
In this video
Dr. Taylor identifies three signs of clinical activity that flag patients who need immediate therapy: confetti lesions (one to five millimeter depigmented white macules), trichrome vitiligo (the white depigmented area, normal skin, and a hypopigmented zone giving three colors), and the Koebner phenomenon, where scratching or injuring the skin produces new vitiliginous lesions. Because vitiligo is an autoimmune disorder, she stresses screening for associated conditions — most commonly thyroiditis (TSH, T3, T4, anti-thyroglobulin and anti-peroxidase antibodies), as well as Addison's disease and diabetes — anchored by a thorough review of systems.
On depigmentation therapy, Dr. Taylor reserves it for patients with vitiligo universalis (more than 80% involvement) and treats it as a "really, really weighty decision," especially in skin of color where, as she puts it, a patient's "whole identity revolves around their skin color." She counsels involving the entire family and making sure patients understand the change is permanent and cannot be reversed.
- Look for three signs of active vitiligo — confetti lesions, trichrome vitiligo, and the Koebner phenomenon — and start therapy immediately in those patients.
- Screen for autoimmune comorbidities, most often thyroiditis, with thyroid function tests and thyroid antibodies; also consider Addison's disease and diabetes.
- Use a thorough review of systems to uncover the range of autoimmune conditions associated with vitiligo.
- Reserve depigmentation therapy for vitiligo universalis (>80% involvement).
- Counsel depigmentation candidates carefully, involve the family, and be clear that the result is permanent — particularly for patients in skin of color.
