Vitiligo, the disfiguring condition that leaves sufferers with white patches of skin on their hands and face, may be more common than you think. About 1 percent of the world’s population — about 50 million people — have the condition. In the United States, that translates to between 2 and 5 million people. Now, hope comes from scientists at Yale School of Medicine who have used medication for treating rheumatoid arthritis to restore skin color in a patient suffering from vitiligo.
Seen and not seen
Vitiligo is a progressive yet unpredictable dermatological condition that causes patches of skin to lose pigmentation. The condition can also affect the hair, the inside of the mouth and even the eyes. The condition doesn’t always cause direct physical harm but, because it can significantly affect appearance — it can affect any part of the body, including the face and hands — the psychological effects can be severe. All skin contains melanin and therefore vitiligo affects people of all skin types. It may, however, be more noticeable in people with darker skin.
Skin color is determined by melanin, the body’s naturally occurring pigment — the more melanin, the darker the skin. Vitiligo occurs when the cells that produce melanin (melanocytes) stop working. Though it is not completely clear why the melanocytes begin to malfunction, it’s thought that one type of the disease — non-segmental vitiligo — may be the symptom of an auto-immune reaction where the body attacks its own cells. Vitiligo can be hereditary and the condition has also been linked to eye problems and hearing loss.
Treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease. The American Academy of Dermatology (AAD) outlines the options that are available to sufferers that include using cosmetics to add lost color, corticosteroid applications, light therapy and even surgery. Unfortunately, current treatments such as these are not reliably effective in reversing the disease. Now, new advances in vitiligo research have prompted scientists to consider an existing class of FDA-approved medications known as Janus kinase (JAK) inhibitors, as a possible treatment.
Last year, Dr. Brett King, assistant professor of dermatology and principal investigator of the research at Yale, published a paper showing how the JAK inhibitor tofacitinib citrate could be used to treat hair loss caused by alopecia areata — sudden hair loss that starts with one or more circular bald patches that may overlap. After apparent success reversing the alopecia, King and co-author Dr. Brittany Craiglow thought the same medicine might be effective against vitiligo. To test this, King and Craiglow tried the medication on a patient who had been developing vitiligo patches on her face, hands and body for more than a year.
An important breakthrough
Within two months of treatment, the patient found that some pigmentation had returned on her face, arms, and hands — the most visible areas. After five months, the white spots on her face and hands were nearly gone with only a few spots remaining on other parts of her body. Notably, the scientists discovered, the medication caused no adverse side effects during the course of treatment. The results, they say, could represent an important breakthrough in the treatment of vitiligo.
“While it’s one case, we anticipated the successful treatment of this patient based on our current understanding of the disease and how the drug works,” says King. Although there is optimism about the prospects for developing a commercially available treatment, King says further research is necessary to confirm the drug’s safety and efficacy. “It’s a first, and it could revolutionize treatment of an awful disease,” he says. “This may be a huge step forward in the treatment of patients with this condition.” King hopes soon to conduct a clinical trial using tofacitinib, or a similar medicine, ruxolitinib. The team’s findings were published June 24 in JAMA Dermatology.