Vitiligo Exchange: An Expert Panel Discussion of Two Clinical Cases

This article is based on a roundtable discussion in which three panelists review clinically relevant insights about vitiligo and discuss two cases that illustrate the multiple challenges faced by both patients and clinicians in managing this complex disease. The first is a 32-year-old White female patient with Fitzpatrick Skin Type III/IV with extensive depigmentation in the trunk area. The patient achieved 90-percent repigmentation with a combination therapy approach. Treatment included systemic corticosteroids, oral antioxidants, narrowband ultraviolet B phototherapy, and topical therapy initially with tacrolimus ointment followed by topical ruxolitinib cream. Patient counseling around variable rates of progressive repigmentation over time, the significance of combining therapeutic approaches, and the importance of treatment consistency are discussed. The second case is that of a White pediatric female patient with vitiligo, who was treated from the ages of 5 to 11 years, with a break in treatment due to the patient's desire to discontinue treatment. Once treatment recommenced, the patient ultimately achieved 75-percent repigmentation within six months using a combination of narrowband ultraviolet B phototherapy, topical corticosteroids, and topical calcineurin inhibitors. The emotional burden of pediatric vitiligo for patients and their caregivers are discussed, along with joint decision making with this patient and her parents. This was followed by a discussion of the significance of the patient's anti-nuclear antibody positivity and how this affects treatment approach in patients with vitiligo.