Vitiligo is an autoimmune disease, like lupus or multiple sclerosis, in which the body attacks itself. And even though, in principle, the fact that the immune system destroys the melanocytes – which give their skin or hair their color – does not threaten the physical integrity of the person, the disappearance of the pigment and the change in appearance can cause considerable stress, partly because of the social reaction that these changes produce.
Until now, some of the treatments used to relieve this discoloration of the skin that affects (approximately, and with different degrees of severity) 1% of people, consist of a combination of drugs and exposure to UVA rays to stimulate the pigment cells that remain in the skin to recover the lost tone. In some cases, it is possible to temporarily use corticosteroids to control the immune response and reduce the impact of the disease.
The New England Journal of Medicine recently published the results of two clinical trials in which a cream was tested to reverse skin discoloration. The cream is made with ruxolitinib, a substance capable of inhibiting the attack against the melanocytes. In the two trials, an improvement of 75% was achieved in about 30% of cases, well above the 10% seen in those who received a placebo.
The trials, conducted by an international team led by David Rosmarin from Tufts Medical School in Boston, showed better results on the face, where it is easier to correct the effects of vitiligo, than on other parts of the body, which are more difficult to treat.
Maite Truchuelo, dermatologist and member of the Spanish Academy of Dermatology and Venereology (AEDV), admits that it could be considered a useful tool, but points out that “its real effectiveness in routine clinical practice would have to be better determined, or its efficiency when the cost, which is higher, is factored in.” The authors themselves acknowledge in the publication that larger and longer trials are required to determine the effectiveness and safety of the treatment.
Regarding the cost, Lluís Puig, director of the department of dermatology of the Hospital de la Santa Creu i Sant Pau, in Barcelona, points out in a statement to the Science Media Center that the price of the cream in the United States is $50 per gram, “like gold, approximately.”
“With half a gram you can treat an area equivalent to the surface of two hands,” the doctor continues. “A patient with vitiligo on the face should apply 0.5 grams twice a day for six months, which is equivalent to 180 grams,” at a cost of $9,000. In addition, given the results, to achieve an improvement of 75% or more in one patient, five would have to be treated. According to Puig’s estimate, that would mean about $45,000.
Among the negative aspects of the results of this treatment, Truchuelo highlights the fact that, when compared with the placebo, it does not significantly improve the quality of life of the patients, something very important when evaluating treatments for vitiligo. The authors also point out that as a side effect, it produces itching and acne.
For Truchuelo, ruxolitinib could be considered as an alternative for “patients who have tried other treatments without improvement, and combining it with other standard treatments, such as phototherapy or lasers, antioxidants or other immunomodulators, could be considered.” In July, the Food and Drug Administration (FDA) authorized the use of ruxolitinib for vitiligo, and the European Medicines Agency (EMA) is also considering its approval.