番茄社区

An expert panel has released more than 40 recommendations on managing vitiligo in pediatric, adolescent, and young adult patients.

In their top-line finding, experts identified topical calcineurin inhibitors, topical corticosteroids, and topical JAK inhibitors as effective therapeutics for vitiligo in these populations, with additional decision-making based on location, body surface area, age, and other factors. The consensus statement was published in .

Co-author Nanette Silverberg, MD, is chief of pediatric dermatology for the Mount Sinai Health System and a clinical professor of pediatrics and dermatology at the Icahn School of Medicine at Mount Sinai in New York. She also chairs the Skin of Color and Pigmentary Disorders Study Group of the Pediatric Dermatology Research Alliance. Silverberg discussed the new recommendations with the Reading Room. The exchange has been edited for length and clarity.

What was the impetus for this investigation? How and why did it come about and what were your specific objectives?

Silverberg: We had guidelines for vitiligo from the AAD in the late 1980s, and that was geared as a paper to help physicians get products covered and to support off-label usage -- at that point, of topical corticosteroids. These guidelines are reasonable, but not always applicable completely to today's environment.

Today -- still -- there are really only off-label usages of products for kids under age 12. Our study group was fortunate to receive a grant for this project, which will occur in three parts and is something I hope will evolve into broader AAD guidelines for clinicians as more and more products become approved by the FDA.

We know that only about a third of pediatric or adult patients with vitiligo actually receive treatment from a doctor when they see one. And some of that is about delays. Some of that is because people don't necessarily know that treatments are much more effective than they were years ago.

Would you summarize your conclusions?

Silverberg: The suggestions apply to pediatric, adolescent, and also young adult patients. We did that mindfully because we wanted to be sure that kids were addressed as they go through college years, when they sometimes get lost and don't receive care.

When you boil down our recommendations, it's that any of the treatments -- all the topical therapeutics -- can be effective when used properly.

Are there any takeaways you want to share with clinicians based on the results of this investigation?

Silverberg: We also really want people to understand the nature of how we define vitiligo. Untreated vitiligo can really affect quality of life. It's important to remember that vitiligo is an acquired and progressive disease that includes relapses. It's also important that clinicians think about the chronicity of disease and not just to tell patients 'here's a product.'

We encourage clinicians to pick something that they're comfortable with and then treat. If you're not going to treat, prescribe something you're comfortable with so that there was at least some intervention, and then refer. These kids really do deserve the option for therapy.

Broadly, we have many classes of products that can be used, and the products are individualized. For example, topical calcineurin inhibitors don't atrophy skin, so they're very good for thin skin. They're less effective on thick skin.

I think physicians will find what we discussed and how we looked at it very helpful. But medicine is an art. Vitiligo in particular is an art.

Ultimately, the aspect of time is hard to quantify in an article, but it can take quite some time for vitiligo to re-pigment. We always encourage physicians to counsel patients about this issue.

Over time, we need to think about having patients come back and talk about how they're responding. If they've been treated with therapies that included ultraviolet light, we should be talking about skin exams when they hit adulthood or adolescence. We have to think about the patient, not just who they are today -- but over a lifetime.

Key points

• Recommendations: all common topical vitiligo treatments effective in kids and young adults.
• Remind patients that re-pigmentation takes time.
• Experts: clinicians are encouraged to either offer some kind of therapy to these patients and/or refer.