SF Derm Society Annual Meeting Pearls

Filling in the Knowledge Gaps: A Summary of Dr. Amit Pandya and Dr. Iltefat Hamzavi's Panel on Vitiligo

Part I: Dr. Amit Pandya

Authors: Akachukwu Eze and Payton Smith

At the recent San Francisco Derm Society expert panel on vitiligo, Dr. Amit Pandya and Dr. Iltefat Hamzavi, leaders in vitiligo research and treatment, shared insights into the evolving landscape of vitiligo management. Their discussion touched on important clinical updates, treatment options, and the significant psychosocial impact the condition has on patients.

Dr. Amit Pandya:

Vitiligo is a common skin condition characterized by the progressive loss of pigmentation, affecting between 0.5-2% of the global population. Although all races are affected, individuals with darker skin types may experience a more significant impact due to the contrast between normal and depigmented skin. Despite growing acceptance of vitiligo by some, many patients face emotional distress due to the stigma associated with their condition.

Vitiligo is often accompanied by an increased risk of autoimmune diseases. The condition tends to peak between the ages of 10 and 30, and there are currently no biomarkers to predict its progression or response to treatment.

Dr. Pandya emphasized two pillars of vitiligo therapy:

  1. Reducing the activity of pro-inflammatory T cells
  2. Addressing melanocyte stress and dysfunction, which includes autophagy and keratinocyte adhesion defects.
  3. Increasing melanocyte migration from the hair follicle and margins.

Dr. Pandya also highlighted how prognosis varies by patient factors:

  • Younger patients with darker skin types tend to have better outcomes, especially if they've had vitiligo for a shorter duration.
  • Older patients with lighter skin or long-standing vitiligo often have a worse prognosis.

Successful treatment outcomes are defined as 80-100% repigmentation of the target lesion. Additionally, special conditions like trichrome vitiligo—characterized by a light brown hue—may indicate a complete loss of melanocytes but retained melanin, which is essential to recognize when setting treatment expectations.

Clinical Pearls from Dr. Pandya:

  • Always listen to the patient's concerns and goals.
  • Obtain a detailed history and examine the areas of involvement, often using a Wood's Lamp to detect subtle areas of depigmentation.