Although the cause remains unknown, strong evidence points to a triad of genes that make people more susceptible to the physically harmless yet socially distressing and hard-to-treat condition. When patients are upset by their appearance, months-long use of topical lotions and carefully controlled exposure to laser rays or light boxes may help stop the immune system attack and coax cells to grow back and re-pigment the area, says Dr. Kroshinsky. Others opt to cover up faded areas with skin dyes, medical-grade cosmetics, and self-tanning creams.

RESEARCH HIGHLIGHTS

Advances in surgical techniques hold promise for treating vitiligo, according to information presented at American Academy of Dermatology’s 70th Annual Meeting in March 2012 by Rebat M. Halder, MD, FAAD, professor and chair, department of dermatology, Howard University, Washington, D.C.

Skin Grafts

· What it is: Normal skin is transplanted to areas affected by vitiligo and begins producing pigment. Phototherapy is often used to boost pigment production in treated areas.

· Who is eligible: Patients with limited and extensive vitiligo that has been stable for at least six months.

· Success rate: 80 to 90 percent in most patients.

· Availability: Uncommon in the United States, this outpatient procedure is widely available in South America, Europe, Southeast Asia, India and China.

Melanocyte Transplants

· What it is: Cells (melanocytes and keratinocytes) found in the top layer of skin are obtained surgically under local anesthesia and grown overnight in the lab. Then cells are placed or applied on the skin’s vitiligo patches. Phototherapy is often used to boost pigment production in treated areas.

· Who is eligible: Patients with limited vitiligo that has been stable for at least six months.

· Success rate: 95 percent in most patients.

· Availability: Few dermatologic centers in the U.S. are currently offering this specialized outpatient procedure, but Dr. Halder expects that it will be more available in the future.

 “It is important for anyone who notices any unusual changes in the pigmentation of their skin to see a dermatologist, as vitiligo treatments are more successful the earlier they are started,” said Dr. Halder. “The newest surgical grafting techniques and transplant procedures hold a lot of promise for successfully treating vitiligo, and I think we’ll see more dermatologists offering these cutting-edge procedures in this country in the future.”

For more about vitiligo and to find a board-certified specialist contact the American Academy of Dermatology.

Disappearing Act? The Saturday Evening Post

Psoriasis, an autoimmune disorder that occurs when skin cells grow too quickly, affects about 6 million Americans. And nearly 1 million adults might be candidates for the new treatment, which is not indicated for children. Stelara disables proteins released by the immune system that play a role in the overproduction of skin cells and inflammation.

At the close of a busy afternoon at his dermatology practice, Dr. Lebwohl, who was involved in the clinical testing of the new drug, discussed with us the promise (and potential drawbacks) of Stelara and other drugs that treat disease by targeting the immune system.

Q: What sets Stelara apart from conventional therapies for moderate-to-severe psoriasis?

Dr. Mark LebwohlCourtesy of Dr. Mark Lebwohl

Dr. Lebwohl: We have never had anything that works precisely this way. It is the first drug therapy that requires just four shots a year, and the overwhelming majority of patients improve dramatically. The approved treatment schedule is two injections four weeks apart, followed by maintenance injections every 12 weeks. Other injectable therapies are given weekly, twice a week, or every other week.

Q: What type of benefit have you observed with Stelara in your patients or study participants?

Dr. Lebwohl: We have seen benefit in many patients. In fact, it would be unusual for it not to work. On day one, people get the first injection. Four weeks later, there is a dramatic benefit. They get the second injection at that time and then return three months later for a third shot. At that visit, most patients are clear or close to clear.

Q: Has Stelara been tested for the type of psoriasis that affects people’s joints?

Dr. Lebwohl: It has been studied for joint disease, and it was beneficial. The study dose was higher than the one used for skin disease, and given once a week for four weeks.

Q: Do people inject themselves with Stelara or come to the doctor’s office?

Dr. Lebwohl: It is approved for administration in the doctor’s office. If you review the FDA deliberations on this approval, it seems their conclusion is based on the fact that Stelara is a systemic drug, it affects the immune system, and patients ought to be seen by doctors at least four times a year.

Q: Any word yet on insurance coverage?

Dr. Lebwohl: We expect approval from federal insurers, and the drugmaker, Centocor Ortho Biotech, has set up a phone line for physicians to check with the other insurances. However, the insurers have not yet had time to respond.

Q: What do people considering treatment with Stelara need to know?

Dr. Lebwohl: Clinical trials of Stelara were conducted in more than 2,000 patients. Some have taken the drug for longer than three years, and many for a shorter period of time. No clear side effect that emerged.

Stelara is an antibody that blocks a component of two chemicals: IL (interleukin) 12 and IL 23. It turns out that some people are born without that target component. In other words, they are born as though they had Stelara on board. Research on 41 of these people shows that their main problem has been susceptibility to Salmonella infections and also mycobacterial infections, such as tuberculosis.

In the studies of Stelara, there were no cases of either kind of infection–perhaps because we are giving the drug intermittently as opposed to having a lifelong genetic abnormality.

Nonetheless, people should be tested for tuberculosis prior to initiating Stelara therapy. In addition, they should never receive BCG (bacille Calmette-Guérin) vaccines, a type of vaccine used in other countries (but not in the United States) that contains mycobacteria. The usually harmless bacteria caused serious infections in those 41 people; that’s how their genetic abnormality was discovered. People on Stelara should get flu vaccines, but not one containing the live virus. For example, patients on this treatment should not get the seasonal flu vaccine in the inhaled form that has a live virus. They should instead get the shot that contains inactive virus and has no chance of infecting them.

Q: Are you involved in clinical trials of other dermatologic treatments or promising research projects?

Dr. Lebwohl: Yes. At least two experimental biologic agents for psoriasis act upon newly identified molecular targets and appear to be effective. We will be seeing more biologics as time goes on.

Highly targeted biologic therapies are very effective and safe. The drawback, however, is they are very expensive to make. The same is true for biologics to treat diseases other than psoriasis. For example, some cancer drugs target the tumor and spare normal cells that are nearby. Biologics are very costly but have the potential of significantly changing our lives for the better. It’s important that we figure out better ways to develop and manufacture these promising therapies.

Dr. Mark Lebwohl is president of the New York State Society of Dermatology and has served as chairman of the Section on Dermatology of the New York Academy of Medicine. Dr. Lebwohl is a member of the medical advisory board of the National Psoriasis Foundation and editor of Psoriasis Forum as well as medical editor of The Bulletin of the National Psoriasis Foundation.

New & Effective Psoriasis Drug The Saturday Evening Post