Vitiligo's stigma greater for patients with richly pigmented skin, says an expert
Greater visibility, stigma, and treatment barriers make pigment loss more significant for patients with darker skin types (1,300 words, 6 minutes)
For patients with vitiligo, the most unpleasant part of the experience might be the stigmas accompanying the condition. That stigma can affect patients with darker skin more intensely, said Dr. Lionel Bercovitch in an episode of the health and science podcast The Pulse.
“I have vitiligo on half my face—I have a white eyebrow,” said Dr. Bercovitch, professor of dermatology at Warren Alpert Medical School at Brown University. “That’s the only really visible part of it. It has zero impact on my life. Nobody recoils when they see my face.”
Dr. Bercovitch is the director of pediatric dermatology at Hasbro Children’s Hospital in Providence, R.I.
“But someone who has dark skin, who is very white [at the site of their vitiligo lesions]—they’re ivory white; they’re not just lighter skin patches—on dark skin, [these patches are] very conspicuous.”
He noted that “just by the nature of the disease,” vitiligo’s impact on patients with skin of colour is far out of proportion compared to how it impacts patients with lighter skin.
This discrepancy is compounded by treatment availability, Dr. Bercovitch noted, saying that vitiligo treatments were not covered by many health insurance providers in Rhode Island as recently as 2021.
This resulted from two main factors: topical agents for repigmenting skin were not approved by the U.S. Food and Drug Administration (FDA), and treating vitiligo was considered cosmetic and not medically necessary.
“Every time we would request prior authorization for treatment, we couldn’t get it,” he said.
The out-of-pocket costs for a patient could be prohibitive, with estimates for a single tube of topical vitiligo treatment ranging from US$300 to $2,500.
Even though the FDA approved a cream for treating vitiligo in 2022—the Janus kinase inhibitor ruxolitinib (Opzelura, Incyte)—barriers to equitable treatment access remain, Dr. Bercovitch said.
“[Ruxolitinib] is so expensive,” he said. “Even though it’s FDA approved for vitiligo—it’s unlikely that patients will easily get coverage for it.”
Bottom line: Vitiligo is more apparent in patients with darker skin types, leading to more exposure to stigma. High costs and difficulties accessing treatments compound the problem.
From the literature on depigmenting disorders in skin of colour
The mental health associations of vitiligo: UK population-based cohort study
This retrospective observational study used general practice data from the UK (2004-2020) to assess the risk and impact of psychological comorbidity in people with new-onset vitiligo. Adults diagnosed with vitiligo (n=7,224) were matched 1:4 with controls (n=28,880).
Overall, the researchers found that at the time of diagnosis, people with vitiligo had a similar prevalence of mental health conditions as controls, except for anxiety disorder (cases 7.9%, controls 7.0%; p=0.014). Incident recurrent depressive disorder (RDD) and anxiety disorder were more common in people with vitiligo. The risk was highest in Black and minority ethnic individuals (RDD: adjusted hazard ratio (ahr) 1.72, 95% CI 1.06-2.79; depressive episodes: aHR 1.56, 95% CI 1.03-2.37). No association was found between vitiligo and other mental health conditions. People with vitiligo and psychological comorbidity had more primary care encounters, more time off work, and higher unemployment.
Efficacy of narrowband UVB with or without OMP in the stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study
In this multicentre study, 80 patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either narrowband ultraviolet B (NB-UVB) and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for six months. Sixty-four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group.
While control of disease activity was observed earlier in the NB-OMP group, it was comparable in both groups by the end of the study period.
The researchers found that disease activity before therapy, but not extent, influenced activity control in both groups.
They conclude that NB-UVB is a safe sole therapeutic tool in vitiligo management that efficiently achieves repigmentation and is comparable to systemic corticosteroids for stabilization.
Pityriasis alba in pediatric patients with skin of colour
In this article, the authors discuss the existing literature on pityriasis alba (P.A.) in children with skin of colour.
They also touch on research and educational needs in this area.
In their recommendations, they write that curricula on skin conditions in pediatric patients with skin of colour should focus on the diverse presentations of P.A. and the potential ramifications that may be unique in this patient population. They mention potentially increased social stigma due to hypopigmentation being more noticeable on darker skin.
The authors also discuss the importance of training on the differential diagnosis of hypopigmented lesions.
A deep learning-based hybrid artificial intelligence model for the detection and severity assessment of vitiligo lesions
This paper describes validating an A.I. model for shape- and colour-based assessment of vitiligo lesions. Researchers validated the model using curated image sets from Chinese patients with Fitzpatrick skin types III or IV. This included 2,720 images for the study of lesion localization and 1,262 images for lesion segmentation.
The authors also used a smaller test set of 145 images of vitiligo lesions in other skin types (I, II, or V).
The A.I. model works in three stages. First, researchers trained and validated YOLO v3 (You Only Look Once, v3) architecture to classify and localize vitiligo lesions. A deep convolutional neural network (DCNN) assesses segmentation. Three add-on metrics, VAreaA, VAreaR, and VColor, measure absolute, relative size changes and pigmentation, respectively.
Tests showed the YOLO v3 model had a sensitivity to detect lesions of 92.91% with an error rate of 14.98%.
Of the three DCNNs tried in the segmentation study, UNet++ architecture outperformed the others and was integrated into the model.
However, when tested on the additional set of images in Fitzpatrick skin types I, II, and V, the model had a lower detection sensitivity and a lower segmentation score.
Researchers observed no difference regarding size changes between the A.I. model, trained dermatologists (w=0.812, p<0.05), and Photoshop analysis (p=0.075, p=0.212, respectively), which all displayed good concordance.
VIDEO: Dr. Vanita Rattan—How to treat vitiligo in skin of colour
At the intersection of skin and society
The Black Business and Professional Association (BBPA) has announced the 41st BBPA Harry Jerome Awards Honorees.
Established in 1983 in memory of the late Harry Jerome, a Canadian Olympian and social advocate, the BBPA Harry Jerome Awards recognize and honour achievements within the Canadian Black community.
Honourees will be further recognized at the BBPA Harry Jerome Awards Gala on April 29, 2023. This fundraising event supports the BBPA's work promoting professional and business advancement.
The 2023 honourees include:
Lifetime Achievement Award–Spider “Chuck” Jones, Pickering, Ont.–Sponsored by BBPA
President's Award–Rick Gosling, Toronto–Sponsored by BBPA
Leadership Award–Rosemarie Powell, Toronto–Sponsored by E.& J. Gallo Winery Canada
Business Award–Frantz Saintellemy, Montreal–Sponsored by Bell
Health Sector Award–Jennifer Bernard, Toronto–Sponsored by Nursing Homemakers Inc (NHI)
April is National Minority Health Month in the U.S.
April 17 to 23 is National Feet Week in the U.K.
April 22 is International Mother Earth Day
Something to think about in the week ahead…
Tom Stoppard, U.S. dramatist
Researchers Under the Scope: Dr. Rachel Netahe Asiniwasis
Researchers Under the Scope is a podcast series that profiles the research community at the University of Saskatchewan College of Medicine. Guests talk about what excites them about their jobs and the details of their current projects.
On a recent podcast episode, Dr. Rachel Asiniwasis talks about why so many Indigenous children have atopic dermatitis, why she prescribes 'tubs over tubes' and why physicians cannot ignore this disease.
In a webinar on March 30, 2023, as part of the Sunnybrook Research Institute’s Evaluative Clinical Sciences rounds, Csilla Kalocsai, MPhil, Ph.D., and Maclite Tesfaye, BSc, discussed what was learned from a pilot mentorship program for Black and Indigenous medical students—the Sunnybrook Program to Access Research Knowledge (SPARK).
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