Buchi Neita, PA-C, and Diego Dasilva, MD, discuss highlights from their lecture Vitiligo: A Practical Approach for APPs at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

Dr. Dasilva frames this as "an exciting time" for vitiligo: while topical ruxolitinib 1.5% cream is the only FDA-approved therapy, a wave of phase 1, 2, and 3 trials makes the next three to five years "very bright." He stresses that comorbidities matter — hypothyroidism is the most common, alongside alopecia areata, pernicious anemia, and type 1 diabetes — but the psychosocial burden of anxiety, depression, and impact on confidence, relationships, and family planning is "even more important from our lens." Rather than defaulting to validated screening tools, he keeps it open-ended and simply asks patients how the disease makes them feel, staying patient-centered whether they're deeply affected or have "learned to live with it."

On diagnosis and workup, he calls the Wood's lamp "underutilized" for distinguishing depigmentation from hypopigmentation, and urges APPs not to fear a biopsy taken at the lesion edge (with a MART-1 stain) for definitive diagnosis and patient buy-in. Labs are guided by patient worry and symptoms — a thyroid antibody can flag patients who need serial monitoring even with a normal TSH. Treatment starts with what the patient wants: repigment or not. He builds combination, multimodal regimens — mini-pulse dexamethasone on two consecutive days, phototherapy (favoring home units and letters of medical necessity), and off-label JAK inhibitors, now favoring tofacitinib pushed toward higher dosing — while counseling patients up front that hair-dense areas repigment best and palms, soles, and mucosa lag. His closing advice: "do not be afraid of multimodal therapy" and be willing to "throw the kitchen sink."

  • Screen for both medical comorbidities (hypothyroidism, alopecia areata, pernicious anemia, type 1 diabetes) and the psychosocial burden — ask open-endedly how the disease makes patients feel.
  • Use the Wood's lamp to separate depigmentation from hypopigmentation, and don't fear an edge biopsy with MART-1 staining for definitive diagnosis and patient buy-in.
  • Tailor the workup to the patient — no labs for the unworried, a broader panel (CBC, CMP, TSH with thyroid antibody, A1C) for the anxious or symptomatic; a positive thyroid antibody warrants serial monitoring.
  • Counsel on the vitiligo "silver lining" — lower risk of common skin cancers — while still emphasizing regular SPF 30–50, protective clothing, and shade.
  • Combination therapy is key for moderate-to-severe disease: mini-pulse dexamethasone, home phototherapy (aiming for 200–300 treatments), and off-label JAK inhibitors, with a one-year trial and honest counseling that hair-dense areas repigment best.