A team of Yale researchers has successfully restored natural skin tones to large portions of two vitiligo patients’ faces and bodies. The team, led by School of Medicine professor Brett King, used a combination of medication and phototherapy to combat the skin disease, which is believed to impact up to three percent of the world’s population. The results were published in JAMA Dermatology on Jan. 31.
“I liken it to treating your lawn,” said John Harris, director of the Vitiligo Clinic and Research Center at the University of Massachusetts Medical School. “If you want a green lawn with no weeds, you can buy a weed killer that kills weeds and spares grass, because weeds are very different from your grass. The problem is, crab grass is a type of grass, so there’s no way to target it. Developing a treatment that would kill crab grass and spare your grass is very difficult because they’re just so similar.”
Vitiligo is an autoimmune condition that causes skin cells to lose their pigment, leaving people suffering from the condition with blotches of pale skin on their face and body. Like other autoimmune disorders, vitiligo is caused by the body’s immune system attacking its own cells, Harris said. As a result, doctors have struggled to find a cure because there is no external contaminant — such as a virus or bacteria — that can be singled out from the body’s normally functioning cells.
King and his team treated the two vitiligo patients with a relatively new medication in conjunction with phototherapy. The medication prevented the body’s immune system from killing pigment-making cells, while the phototherapy stimulated those cells to produce skin pigment. By administering the two treatments in tandem, the researchers successfully helped two patients return a sizable amount of their skin back to its original tone, Harris said. Harris has worked with King on previous studies on vitiligo treatment, the results of which were incorporated into King’s recent paper.
Phototherapy has been in use as a treatment for skin conditions for thousands of years, Harris said. However, the medication used in this experiment was the result of a flurry of vitiligo-related studies in the past few years. King first identified a medicinal means of blocking a signaling pathway that is related to vitiligo in 2015. In the years since, a number of researchers, including both King and Harris, have been working on how best to incorporate these new medicines into existing vitiligo treatment.
In recent years, researchers have made significant progress toward understanding the condition on a molecular level and formulating treatments for it, said Seemal Desai, dermatologist and president of the Skin of Color Society. The future of vitiligo research is uncertain, though, as many insurers and government agencies often view the condition as more of a cosmetic issue than a medical one, he continued.
Even some doctors view vitiligo as simply cosmetic and does not account for the condition’s serious psychological impacts, said Patricia Rossy, vice president of VITfriends, a vitiligo support community.
Patients with vitiligo often have low self-esteem, depression and suicidal thoughts due to their uneven complexion and negative responses from others, she said. Rossy, who has vitiligo herself, recalled being told she looked like a “monster” when the disease first began to affect her appearance.
Many vitiligo sufferers struggle to access treatments that could help them manage the disease, often due to high costs or lack of accessibility, Desai said. Many with the condition are not even aware that potential treatments exist, he added, stressing the need for more global awareness of the disease.
“This is something that is real, it is out there, and it needs to be addressed,” Desai said. “We need to let people know that there is hope.”
Receiving regular treatment is often not financially feasible, Harris said. The medication used in King’s paper currently costs around $40,000 a year, but insurance often does not cover the fee, since the Federal Drug Administration has not yet approved the drug for the treatment of vitiligo. Harris believes that if clinical trials demonstrate the drug’s effectiveness, insurers will cover it, thereby reducing the out-of-pocket cost for patients.
Phototherapy is, by contrast, is relatively inexpensive, but requires the patient to live near a phototherapy provider and have the time to receive regular treatments. According to Desai, even the price of topical medications has increased over the past few years.
Regardless of whether or not individuals with vitiligo receive treatment, Rossy encouraged them to find a community of others with the condition and to try not to be worn down by others’ negativity and cruelty.
While the progress made on treating vitiligo is promising, there remains no cure, Desai said. And while patients may see their skin color restored due to ongoing treatments such as the ones detailed in King’s work, if they stop receiving regular treatment, the condition returns, often within a year.
Nonetheless, Desai said he is “very hopeful” that a cure for vitiligo will be found. Until then, King’s team will continue to work to find a course of treatment that can mitigate the disease’s effects.
Maya Chandra | maya.chandra@yale.edu