Brittany Craiglow, MD: Managing Expectations for Vitiligo Therapies

Among the myriad of complications related to the management of vitiligo, treatment adherence appears to be one the most prevalent. For years, patients have yearned for rapid and effective therapies, but even the most effective topicals and light therapies require months of commitment before any repigmentation of the skin can be observed.

In an interview with HCPLive, Brittany Craiglow, MD, of Yale School of Medicine, spoke of how dermatologists can set expectations with their patients regarding the effectiveness and timeliness of current therapies, and what the proposed approval of ruxolitinib cream could mean for patients with limited surface area vitiligo.

“This is a long game, and so a lot of patients will come in and you'll offer something, and they'll say, ‘oh, I already tried that,’ but actually, they only use it for a month, and a month is not long enough,” Craiglow said. “I think people tire up these things pretty quickly, which you understand -especially if you're not seeing results. But I think just really saying like, ‘okay, if you want to do this, we have to really commit to it, and we're going to reevaluate not in a month, but in three or four months’, and even then, we will not be all the way there.”

Typically, dermatologists can determine whether topic therapies will effective for patients based on pigmented hair on their body, as hair tends to be the last area of the skin in which the melanocytes will disappear. If a patient has pigmented hairs within a patch of vitiligo, they often have a better chance of repigmentation.

Craiglow has utilized phototherapy for patients with more severe cases of vitiligo, though she noted the time-intensive nature of this particular strategy. Not every patient is able to carve out the time in their schedule to get to and from the dermatologist to receive phototherapy, which is why she has advocated for home units for patients whose insurance will cover it.

When asked about the upcoming ruxolitinib approval, Craiglow noted that patients with limited surface area would benefit greatly from the topical, which would likely only require twice daily application.

Regardless of what therapeutic strategies are being utilized (often in conjunction with one another), Craiglow has been determined in offering patients the best, most appropriate care possible.

“Combining therapies, being creative, reinforcing that it's going to take time, those are all important,” Craiglow said. “It's really fun to help (patients with vitiligo), and they're very grateful, and I think we should not be shy when thinking about being more aggressive with treatment.”