Pearls from “The Pearl”: A Time Capsule of Knowledge & Experience with Vitiligo

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Pearl Grimes, MD, to discuss the latest understanding and management of vitiligo, a field experiencing significant scientific and therapeutic momentum. With the approval of topical ruxolitinib and multiple oral JAK inhibitors on the horizon, these developments are enabling clinicians to better tailor therapy to the diverse needs of their patients. They begin with a discussion on setting patient expectations around treatment duration. With vitiligo therapies requiring long-term commitment, Dr Grimes explains that it is a chronic disease requiring ongoing management, whether using older therapies or newer JAK inhibitors. By establishing realistic expectations early, patients are less likely to abandon therapy prematurely when repigmentation is not yet visible. They also address common misconceptions around skin type. While vitiligo is more noticeable in darker skin, its prevalence is similar across all skin tones. In her clinical experience and in ruxolitinib trials and emerging oral JAK data, Dr Grimes has observed meaningful repigmentation across phototypes, with no major response differences that would warrant altering expectations for lighter-skinned patients. They next discuss practical therapeutic considerations, including typical timelines for assessing response and the role of regimen adjustments during the first year.  When using ruxolitinib, she considers disease extent, anatomic site, and expected repigmentation patterns, noting that the face and neck tend to respond best, with the hands remaining challenging. She also reviews her approach to initial workup, including autoimmune screening, particularly for thyroid disease, as well as her use of supplements to mitigate oxidative stress pathways implicated in melanocyte destruction. Tune in to the full episode to hear Dr Grimes share additional clinical pearls, discuss combination strategies, and offer guidance on setting patients up for long-term success in vitiligo management.