9th Asian Society for Pigment Cell Research Annual Meeting

On Friday 17th and Saturday 18th August I attended the Asian Society for Pigment Cell Research Annual Meeting in Colombo Sri Lanka. The meeting provided the opportunity to hear from world vitiligo experts and to exchange ideas on recent vitiligo research and treatments. Some of the highlights included:

Recent Advances in Pathogenesis of Vitiligo and Implications for Medical Treatment: Professor Davinder Prasad (India). Professor Prasad outlined that the ideal stage of vitiligo to commence treatment is referred to as the pre-depigmentation phase where the vitiligo areas are only just starting to show reduced pigmentation but not yet the total white colour that results when melanocyte destruction in the area is complete. Treatment at this stage includes both halting disease progression by targeting melanocyte stress (with appropriate antioxidants and herbal supplements), and autoimmunity (with an appropriate systemic medication), and inducing repigmentation (with topical and light therapy).

Optimizing Outcome of Cellular Grafting in Vitiligo: Dr Boon Kee Goh (Singapore). Dr Goh shared his thoughts, based on over 10-years’ experience, on the essentials required for optimal results when performing non-cultured autologous melanocyte transfer. OIf paramount importance is patient selection with disease stability (minimum 12 months) crucial to success. The donor skin must also be very thin such that it is translucent when held up to light whilst the recipient site must be prepared gently after laser or dermabrasion to an end point of mild pinkness and fluid release with anything more aggressive risking scarring. The epidermal keratinocyte and melanocyte suspension needs to be concentrated in a volume of not more than 0.5ml with the donor skin to vitiligo ratio no greater than 1:5

Efficacy of oral cyclosporine in treatment of progressive vitiligo: Prof Asit Kumar Mittal (Sri Lanka). Where vitiligo is unstable and spreading quickly, internal medication such as pulse steroids, methotrexate, azathioprine or minocycline is often considered. Cyclosporine is not usually considered as a first line agent, but as pointed out by Professor Mittal, Cyclosporine is known to inhibit cytotoxic T cells which are the immune cell responsible for the death of melanocytes in pigmentation and hence should be of benefit. In the study presented, 3mg per kilogram of Cyclosporine was given to 18 patients whose ages ranged from 7-28 years, over a 3-month period. In 11 out of 18 patients’ disease progression was completely halted and 9 of these 11 showed repigmentation despite no other treatment being given to them. Whilst the study was of open label, small sample size, limited duration, and there was no follow up after 3 months, the results certainly warrant cyclosporine being considered as a first line agent in unstable spreading vitiligo. The Vitiligo Centre is currently recruiting for a clinical trial comparing cyclosporine to another T cell inhibiting drug called mycophenolate in the treatment of unstable progressive vitiligo.

Oral compound glycyrrhizin promotes repigmentation of vitiligo in children: Miss Li Zhang (China). In this study, fifty children were randomly divided into two groups to receive either oral Glycyrrhizin (liquorice extract) or oral pulsed prednisone and then reviewed at 3 and 6 months. In the oral Glycyrrhizin group 55.6% children showed repigmentation at 6 months compared to the oral prednisone group that showed 47.1% showed repigmentation. There were no side effects experienced in the Glycyrrhizin group. The equivalent efficacy suggests Glycyrrhizin may be a safer option for oral treatment in children with vitiligo

Posted by Phillip Artemi, 31st August 2018

Vitiligo International Symposium 2018

Dr Artemi from The Vitiligo Centre Australia is excited to be attending the 2018 Vitiligo International Symposium in Detroit, Michigan from November 9-10th. The Vitiligo International Symposium (VIS) will gather world experts to present the latest scientific studies, and medical and surgical treatment information on vitiligo. In addition, the symposium provides a forum for exchange of research ideas and clinical care of Vitiligo as well as the gathering of information from patients on advocacy efforts, and quality of life, and perception of the disease. All the latest information will be available on our website soon after the Symposium.

Gingko Biloba for Vitiligo

One of the most frequent questions asked by my patients, is whether a “natural” product found on the internet or a dietary supplement, could be used to treat or perhaps even cure their vitiligo. Despite my explanations about the lack of science, the ever-present danger of charlatans and a warning that “if it sounds too good to be true it usually is” patients and their families all too easily part with their hard-earned money. Gluten free diets, vitamin B12 supplements, antioxidant and vitamin C infusions have all been recommended and tried in the hope that it just might work? Unfortunately, disappointment invariably follows.

That said, Dermatologists and scientists are continuing to investigate the potential for herbal supplements to benefit vitiligo sufferers.

Gingko Biloba, from the leaves of the Ginkgo biloba tree, is one such herb which is showing some interesting results in small studies.

Gingko biloba has been shown to possess quite potent anti-inflammatory and antioxidant therapies and in medical studies has been tested using an extract of ginkgo, standardised to 24% flavone glycosides and 6% terpene lactones (60mg dosage form)

In one such trial, therapy with Ginkgo Biloba without any other treatment at 120mg daily for 2 months, arrested disease activity in all patients and led to an average re-pigmentation of 15%. Other studies have shown greater benefit when Ginkgo Biloba is combined with traditional vitiligo therapies particularly medically delivered phototherapy. This combination is best discussed and undertaken under the supervision of a vitiligo patient’s dermatologist

New Treatment Could Be ‘Breakthrough’ for Vitiligo Skin Condition

By Serena GordonHealthDay Reporter (consumer.healthday.com)

MONDAY, Feb. 5, 2018 (HealthDay News) — Doctors have discovered a combination of treatments that can return colour to skin that has been lightened by vitiligo — the skin disease that turned Michael Jackson’s skin white.

he new therapy includes the oral medication Xeljanz (tofacitinib) — a drug already approved for use in rheumatoid arthritis patients that dampens the body’s immune response — and ultraviolet-B light therapy.

The combination has only been used on two vitiligo patients, but according to a study author, the results have been dramatic. Experts add, however, that the findings need to be duplicated in studies with larger groups of people.

The treatment produces “results that are impossible to achieve with common therapies,” said Dr. Brett King, an Associate Professor of dermatology at Yale University School of Medicine.  “I think this is a breakthrough in vitiligo treatment,” he added.

One of King’s vitiligo patients, Shahanaj Akter, agreed. “My skin is so much better. I can use make-up and it blends nicely. I am so excited,” she said. Akter, 34, first noticed a white patch of skin above her eyebrow on her normally brown skin while she was pregnant in her 20s. That patch grew bigger and bigger, and then white patches showed up on her hands and neck.  Akter was living in her native country of Bangladesh when her condition first began, and vitiligo carries even more of a stigma there. Some people said unkind things to her.

“I cried a lot. I wanted to be my normal colour again,” she said. To that end, Akter tried treatment after treatment in Bangladesh and then in the United States. Some therapies caused intolerable side effects, and none brought the results she was hoping for.

“It was terrible. I tried so many things,” she said.

That’s when King suggested she try the new combination therapy.  At the time of treatment, Akter had white patches on about three-quarters of her face. She also had patches on her neck, chest, forearms, hands and shins. She was given 5 milligrams of tofacitinib twice daily, and full body UV-B light therapy twice weekly. After three months, Akter’s face was almost completely free of white patches. About 75 percent of her neck, chest, forearms and shins were re-pigmented with colour. Her hands had only minimal freckling.

How does this treatment work? Dr. Seemal Desai, a clinical Assistant Professor of Dermatology at the University of Texas Southwestern Medical Center in Dallas, explained it this way: “The immune system is attacking the melanocytes, so they go into hiding. Tofacitinib tells them it’s OK to come out of hiding, and the UV light brings them out of hibernation.”

King and his colleagues also reported on a white man in his 50s who had long-standing vitiligo. He had previously received treatment to remove all pigment so he would be uniformly white. But he still had patches of whiter skin on 90 percent of his face. He also had patches on his torso and arms.  After three months of treatment on his face, he had about 50 percent re-pigmentation. After six months, he had about 75 percent re-pigmentation of his face. King was surprised at how effective the treatment was because the man had previously undergone chemical destruction of the pigment cells.

Desai said the findings “look promising, and that new treatment options are great.”

But, he added, this study needs to be replicated in a larger group of people.

And he noted that right now, people will likely have a hard time getting reimbursed for tofacitinib because it’s not approved for treating vitiligo. Both King and Desai said the drug seems to be well tolerated. King said he doesn’t know how long people would need to take the drug, but suspects some would be on it long-term, possibly for life.

Details of the cases were published online Jan. 31 in a research letter in the journal JAMA Dermatology.

World Vitiligo Day

World Vitiligo Day was first celebrated in 2011. The overarching goal of the event has been to generate awareness of vitiligo in the general public, to educate health care providers about its appropriate care and treatment, and to raise funds needed for research. What started in Nigeria, has accomplished this and more, becoming a global event.

In 2018, World Vitiligo Day will be will be held at the University of Massachusetts Medical School in Worcester, Massachusetts on June 22nd-24th.

In partnership with the global medical community, our patients and supporters we too wish on World Vitiligo Day to focus on “Children, Research, and Hope for the Future” By highlighting our youngest who have been afflicted with vitiligo, as well as recent research that is bringing a wealth of new treatments just on the horizon, our shared goal is to end the medical neglect, bullying, social isolation, and suffering of vitiligo patients. Together we can continue to raise the alarm that:

1) Vitiligo is a skin disease worthy of attention.

2) Funding for research into the cause and cure of vitiligo is sorely needed.

3) Adequate coverage of proven treatments for vitiligo is a right for patients.

4) Federal and local government support for patient advocacy is needed.

Topical JAK inhibitor shown to be effective for facial vitiligo

Sadly, over the past decades there has been little to excite Dermatologists and Vitiligo patients with regard to potential new helpful treatments. A class of drug known as a JAK inhibitor however, may hopefully soon change that situation.

Skin conditions such as vitiligo, eczema and psoriasis all involve specific forms of abnormal inflammation beneath the skin’s surface. The chemicals in the skin responsible for promoting this unwanted inflammation are known as cytokines. Cytokines play key roles in controlling cell growth and the immune response within the skin. Many of these cytokines function by binding to and activating their targets by attaching to receptors on skin cells known as type I and type II cytokine receptors. A good analogy is to think of the cytokine as a key that fits a receptor which acts as the lock. Once the key (cytokine) fits the receptor (the lock) these receptors in turn rely on the Janus kinase (JAK) family of enzymes to enable the cytokine to activate the cell into action (this is called signal transduction) Hence JAK inhibitors are drugs that inhibit the activity of cytokines to cause unwanted inflammation in by blocking their target (receptor)

A recent study published in the Journal of the American Academy of Dermatology by Dr. David Rosmarin at Tufts University (June 2017, Volume 76, Issue 6, Pages 1054–1060) reported that a topical formulation of ruxolitinib 1.5% cream induced significant results in 12 vitiligo patients (see an example in the picture below). For reasons unclear, ruxolitinib 1.5% cream was most effective on the face, and not very effective on the hands.

Based on these results, further clinical trials are planned in the United States and will be commencing soon. We all await wit fingers crossed the results of these exciting studies

Excimer light treatment shows promise in vitiligo

The Vitiligo Centre Australia is excited to be trialling Excimer light treatment.

Whilst available overseas, the Excimer system has only recently arrived in Australia.  The Excimer lamp is a form of targeted phototherapy that delivers a specific wavelength (308 nm) of ultraviolet B radiation to the skin. The 308-nm wavelength is reported to be particularly effective at disrupting the immune cells (T-lymphocytes) responsible for destroying the pigment cells in the skin (melanocytes) resulting in the development of vitiligo. The 308nm wavelength has also been shown to stimulate pigment cell (melanocyte) proliferation and migration from within the hair follicles of the skin.

The Excimer 308nm system appears to have many potential advantages when compared to traditional phototherapy (light treatment) for vitiligo:

  • Only the vitiligo skin is treated without the normal surrounding skin being exposed to ultraviolet radiation
  • Different sized templates are available to treat difficult areas such as around the eyes ears, mouth and genitals
  • Since the treatment is targeted only to vitiligo areas, and only a specific wavelength (308nm) is utilised, a higher dose of ultraviolet radiation can be safely delivered to skin
  • The treatment duration is much less than traditional phototherapy (light treatment)
  • Being smaller and less “frightening” in appearance compared to traditional phototherapy, children can be more easily treated

The Vitiligo Centre Australia is currently trialling the 308 Excimer Lamp on a number of our paediatric and adult vitiligo patients. If we are happy with the results we will purchase the technology and offer this treatment to all suitable patients for the treatment of their vitiligo.