Every year, science develops a better understanding of difficult to treat conditions like vitiligo. And 2021 has been no exception, with lots of research in understanding the disease. And even the approval of new treatment by the US FDA.
Vitiligo remains a poorly understood condition that causes death or dysfunction of melanocytes, resulting in discoloration of skin and hair. It is a progressive condition. It would not physically harm a person, but it has a severe psychological impact. It affects about 0.1% to 2% of the population.
Medical treatment is still somewhat uncertain. Anti-inflammatory and immunosuppressive creams work for some cases but not others. Non-pharmacological means like light therapy may also help in some cases.
Improved understanding of vitiligo
To treat any disease condition, researchers need to understand what causes the particular ailment and how it develops. For example, vitiligo is now firmly classified as an autoimmune disorder. That is a condition when the body’s own immune cells start attacking melanocytes.
However, genetics play a considerable role, as it develops only in individuals with specific genetic defects and may run in families. Researchers now estimate that genetics play an 80% role in disease development, and 20% depends on the environment1.
They think that melanocytes of those living with vitiligo are prone to oxidative stress caused by the release of cytokines by immune cells. In addition, it appears that interferon-γ (IFN-γ) plays a particular role in the disease progression. It means that any therapy targeting it may help slow down its progress1.
Similarly, in 2021, there have been studies trying to understand the precise mechanism that causes the progression of vitiligo. In one of the studies, Gellatly et al. used single-cell RNA sequencing to understand the disease better. As a result, they could find that Type 1 cytokine signaling plays a vital role in the disease progression2. That might not mean much for patients. However, these findings can be used to find better treatments in the future.
Better drug penetration and improved effectiveness of treatment
One of the well-known therapies for vitiligo is using corticosteroid creams. These creams are cheaply available, and they work in some but not all people. However, the issue is that they have low effectiveness in many cases. The reason for low efficacy is that medications like prednisolone cannot penetrate the skin well. Thus, despite using these ointments, the disease continues to progress.
Moreover, there is no effective way of delivering synthetic melanin to the skin, thus reversing the depigmentation.
Researchers think that one way of boosting the effectiveness of existing treatments could be finding better ways of drug delivery.
In one of the studies, the researcher created a synthetic version of melanosomes. Melanosomes are vessels or granules that transport melanin. In the study, researchers encapsulated melanin-mimicking polydopamine (PDA), and prednisolone in a liposome made up of lysine–proline–valine. They found that using this technique could boost the drug deposition in the skin by 1.43 times. That is a considerable improvement3.
This medication can exert an anti-inflammatory effect and could deliver artificial melanin to the skin. Thus, it may help prevent the disease progress and reverse the skin depigmentation with the help of synthetic melanin.
This approach is being studied in animal models, and it will take a few years before it can be used in humans.
Covid-19 vaccine and vitiligo
Early studies have shown that environmental factors play about a 20% role in disease development. Some researchers think that changes in immune responses caused by the covid-19 vaccine may have varied effects on vitiligo.
There was a report of a person developing vitiligo one week after taking the covid vaccine. He was already living with another autoimmune disease (ulcerative colitis)4, so it can be argued that he was prone to developing vitiligo and that the timing was a coincidence.
Similarly, there was a report of a person developing lichen planus on areas affected by vitiligo soon after taking the vaccine, thus needing more aggressive treatment5.
However, here is the word of caution when interpreting these reports. Firstly, such events are sporadic and only occur in a few individuals genetically predisposed to the condition. Secondly, none of these events are life-threatening. Thus, these reports are not a justification for not getting vaccinated against the covid-19.
It must be stressed that the benefits of the covid-19 vaccine far outnumber any documented risks. After all, it is a lifesaving vaccine in many cases.
Approval of new treatment of vitiligo
Last but not least is the most encouraging news of the year 2021. The US FDA has approved the first-ever cream for repigmentation.
Till now, all the approved treatments were only for slowing down the progress of vitiligo or, at best, arresting its further growth. Unfortunately, however, no topical cream was approved by the US FDA that could help with repigmentation.
Ruxolitinib cream showed highly encouraging results in the clinical trial. Twice daily use of ruxolitinib cream 1.5% (Opzelura, Incyte) could considerably help. Studies show that 24 weeks of treatment could help in about 30% of the cases. It helped improve pigmentation by as much as 75% in these patients. It appears to be especially good for mild to moderate vitiligo6.
Though that may not sound much, as the cream was good for only about one-third of the patients nevertheless, it is a significant step forward. It means that researchers have ultimately found a way to increase repigmentation. It is just a matter of time before they can come up with a treatment that is considerably more effective and is US FDA approved.
To conclude, the year 2021 has been really exciting for vitiligo research. There has been considerable progress in understanding the disorder, managing it, and even reversing it. There is a high probability that a number of more efficacious medications would be introduced in the coming years.
BREAKING: Maverick Vitiligo Researcher Claims to Have Discovered The Real Cause of Vitiligo
David Paltrow, an unconventional vitiligo researcher, has recently hit the news with his claim that he has discovered the real cause of vitiligo…according to him, it has nothing to do with melanin.
He is also claiming that by targeting this underlying cause, he is able to cure vitiligo in 45 days flat.
Check out his video presentation below:
1. Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. The Journal of Dermatology. 2021;48(3):252-270. doi:10.1111/1346-8138.15743
2. Gellatly KJ, Strassner JP, Essien K, et al. scRNA-seq of human vitiligo reveals complex networks of subclinical immune activation and a role for CCR5 in Treg function. Science Translational Medicine. 2021;13(610):eabd8995. doi:10.1126/scitranslmed.abd8995
3. Sun MC, Xu XL, Du Y, et al. Biomimetic Melanosomes Promote Orientation-Selective Delivery and Melanocyte Pigmentation in the H2O2-Induced Vitiligo Mouse Model. ACS Nano. 2021;15(11):17361-17374. doi:10.1021/acsnano.1c05321
4. Aktas H, Ertuğrul G. Vitiligo in a COVID‐19‐vaccinated patient with ulcerative colitis: coincidence? Clin Exp Dermatol. Published online August 3, 2021:10.1111/ced.14842. doi:10.1111/ced.14842
5. Piccolo V, Mazzatenta C, Bassi A, et al. COVID vaccine-induced lichen planus on areas previously affected by vitiligo. Journal of the European Academy of Dermatology and Venereology. 2022;36(1):e28-e30. doi:10.1111/jdv.17687
6. Ruxolitinib effective in vitiligo repigmentation. Accessed December 22, 2021. https://www.healio.com/news/dermatology/20211006/ruxolitinib-effective-in-vitiligo-repigmentation