Vitiligo at UC Irvine

What is Vitiligo?

Vitiligo is a chronic, autoimmune disease that involves three components that are not completely understood. The disease is initiated when some pigment cells are “more sensitive to damage”. When these cells become damaged, they set off an autoimmune reaction that removes more pigment cells. Pigment cells in the skin can be restored when stem cells migrate from the hair to the skin to repigment the skin. The good news is there is hope to repigment the skin if surrounding hairs still have pigment (indicates that the pigment stem cells are there).

How does Vitiligo affect me?

The effect of vitiligo goes much deeper than the skin.  Patients with vitiligo often have itching, can present with hearing loss, and can have a poor quality of life.   Patients can experience difficulty with relationships, have a higher risk of suicide, a higher risk of suicide, and high anxiety.   Often patients feel misunderstood and alone.   It is important that patients maintain hope during treatment and minimize their levels of stress.   One way to help achieve all of these goals is for patients to support each other, and to provide information for family members and friends that don’t understand the disease.   To address this important need, we have partnered with our patients to establish a Vitiligo Support Group, a forum where patients can learn more about the latest treatments and offer support for each other.

Step up for Vitiligo

Step up for Truth, Hope and Change (By Global Vitiligo Foundation)

 In March 2016, the Global Vitiligo Foundation launched a public awareness campaign, “Step Up for Vitiligo,” designed to heighten the understanding of vitiligo and to generate support amongst the dermatologic and greater medical communities, individuals with vitiligo and their loved ones, as well as the media and public at large. Step Up for Vitiligo is built around a compelling educational video, “Vitiligo: Truth, Hope and Change”, featuring a wide range of vitiligo patients of many different races, ethnicities, skin types, and ages. The powerful and enlightening video has both full length and short-form versions to meet the needs and interests of a variety of audiences. (By Global Vitiligo Foundation)

How do we treat Vitiligo? 

We treat vitiligo using an integrative approach that seeks to block the process that cause the disease to progress (pigment cell damage and autoimmune destruction) while stimulating processes that make the disease go away (repigmentation). Specifically, we seek to use the following general strategies:

• Reduce pigment cell damage- To reduce the amount of pigment cell damage, we give the pigment cells vitamins to make them stronger. In addition to the vitamins, light therapy also protects the pigment cells from damage by stimulating them to produce more melanin, which can protect them.
• Reduce autoimmune destruction- To reduce the amount of autoimmune destruction, we need to inhibit the brisk immune response that is observed in vitiligo. We reduce the amount of autoimmune destruction in one of several ways: Light therapy, topical and systemic immunomodulators.  We use a personalized approach to select the right immunomodulator for each patient- this involves considering the nature of each patient’s vitiligo and potential side effects of each immunomodulatory approach.
  
  
• Speed repigmentation- A central goal of vitiligo therapy is to stimulate cells to migrate from the hair to the skin. While there are several drugs in development to stimulate this process, the only known method to speed regimentation is light therapy and excimer laser.

How do I know my Vitiligo will respond to therapy? 

The majority of patients that undergo therapy for vitiligo have some improvement.   The improvement is slow- on average patients need over 50 light treatments to see significant improvement over 70% improvement.  This improvement can be quite dramatic, but it is important to remember that vitiligo is a chronic disease like other chronic diseases (psoriasis, high blood pressure).  While it can improve significantly, often periodic or continuous treatment may be required to keep the disease in remission.   Sometimes, there are areas that don’t respond partially because there is an absence of stem cells in the area that needs to be treated.   When this is the case, surgical approaches can be used to treat stable, treatment resistant areas. 

What are some surgical therapies for Vitiligo? 

Surgical vitiligo treatments can be subdivided into tissue grafting methods and cellular grafting methods. In the tissue grafting methods, which include split-thickness tissue grafting, punch grafting, and suction-blister roof grafting, intact pieces of uninvolved epidermis are used to transfer melanocytes from normally pigmented parts of a patient's body to vitiliginous areas. This is contrasted with cellular grafting, in which epidermal cells are extracted from an unaffected skin sample and transplanted as a suspension.  We perform both the punch grafting procedure and the melanocyte keratinocyte transplant procedure in our practice.

MKTP (Melanocyte Keratinocyte Transplantation Procedure):

Patients with stable vitiligo (minimal active inflammation) are good candidates for this procedure.  Patients who reports histories of vitiligo spreading after injury (koebnerization), have a tendency to form large scars (keloid), have involvement around the nails, or have skin involvement of greater than 30% of their body surface area (BSA) are not good candidates for this procedure.  We have examples of responses to therapy (before and after photos) that can be discussed with the patient during the initial consultation.   For patients traveling from out of town, they will need to stay in town for one week for dressing changes and initial follow-up visits. 

Graft harvesting: The recipient areas are identified, surface areas measured, and a donor area on the lateral aspect of the thigh or gluteal region, approximately one tenth the size of the recipient area, will be selected.  After local anesthesia, a superficial layer of skin will be removed, using a special surgical blade or a suction blister technique. The resulting wound will be covered with special dressing.

Epidermal cell separation: The resulting skin sample will be immersed in a special enzyme and heated to 37 degrees centigrade. Using forceps, the epidermis will be broken down into multiple, smaller pieces, washed with the medium, and then transferred to centrifuge tube. After centrifuging the cell pellet containing melanocytes and keratinocytes will be separated from the rest of the epidermal pieces. The latter will then be discarded, and the resulting melanocyte-keratinocyte cell pellet will be resuspended in the medium. A syringe will then be used to deliver the cell suspension to the recipient sites.

Suspension transplantation: In preparation for the melanocyte-keratinocyte transplantation, the recipient site will be cleaned and treated by a special resurfacing laser (Er:YAG) that removes the top layer of the skin. The cell suspension will be applied evenly to the denuded area and the area will be covered by special dressings. The patients are allowed to go home immediately after the dressing is applied; they will be cautioned against any activities that could displace the dressing or cause the dressing to get wet. Dressings will be removed 7 days post-procedure depending on the treatment location.

Reference :
1- Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: The experience of an academic medical center in the United States
Richard H. Huggins MD, Marsha D. Henderson MD, Sanjeev V. Mulekar MD, David M. Ozog MD, Holly A. Kerr MD, Gordon Jabobsen MS, Henry W. Lim MD, Iltefat H. Hamzavi MD

2-Advances in Vitiligo: An update on medical and surgical treatments
Alexander B. Dillon, MD, Andrew Sideris, MSC,[…], and Nada Elbuluk, MD,MSC

What are we doing at UCI to improve Vitiligo care and therapy?  

Dr. Ganesan is one of the few vitiligo experts worldwide that is also a melanocyte biologist.   UC Irvine is pioneering vitiligo care by:

1) developing new methods to visualize melanocytes that migrate before they can be seen with naked eyes;

2) using the latest genomic methods to identify the molecular signatures of melanocytes that migrate and identify factors that inhibit melanocyte migration into vitiligo skin;

3) developing new methods to separate the right population of melanocytes during grafting procedures in order to improve outcomes of surgical therapies. 

Dr. Ganesan has assembled a multidisciplinary team composed of medical students, graduate students, residents, fellows, and researchers from disciplines as diverse as bioengineering, bioinformatics, and material sciences to develop new approaches to treat vitiligo.   Often, patients will be offered the opportunity to participate in one of the ongoing clinical trials. 

What usually happens at the first appointment?

The first visit usually involves assessing a patient’s vitiligo and determining the severity of their disease.  We usually assess the level of immune involvement and select the best immunomodulatory approach.   We can offer either in office phototherapy or home phototherapy as an option depending on the extent of disease.  Photos are usually taken at the first visit as well.  When appropriate, surgical therapies are discussed.  In addition, we often discuss the psychosocial aspects of the disease, and offer patients support either through online resources or provide them resources about the vitiligo support group.

How do I make an appointment or get more information?

You can make an appointment by calling this number: 949-824-0606.

In addition, you can get more information about vitiligo by e-mailing the following e-mail address: VitiligoOC@health.uci.edu. 

Psoriasis at UC Irvine

Psoriasis is one of the most common skin diseases, affecting one percent to three percent of the U.S. population. Although the exact cause is still unknown, psoriasis is believed to be an immune-mediated disease in which the immune system is inappropriately triggered, causing skin cells to reproduce and accumulate at a hyperactive rate. This hyperactivity results in the formation of raised, red plaques and white scales across the skin that may be itchy and painful. Although there is no known cure, many treatments exist to help prevent psoriasis flare-ups and manage the severity of the disease. UC Irvine is proud to offer a comprehensive range of these treatments to suit your particular condition.

Treatment

We specialize in providing personalized and effective treatments for psoriasis patients by considering the psoriasis type, severity and location, as well as your personal lifestyle and other medical conditions. Our wide range of therapies include:

Topical creams and ointments

These are applied to the surface of the skin. Topicals may reduce psoriasis inflammation and excessive skin cell production. In  addition, some varieties are effective in moisturizing and soothing the skin, as well as reducing itching and removing psoriasis scales.

Systemic medications

These include methotrexate, cyclosporine and acitretin. Systemic medications may be given orally or by injection, and have been used to combat psoriasis for several years.

Biologics

These are protein-based injections or intravenous (IV) formulas made from organic sources. They work by modulating the immune system to reduce the extent and severity of psoriasis. There are several different biologics available, each targeting a unique component of the immune system.

Phototherapy

This is the application of concentrated ultraviolet light to the skin. Professional phototherapy utilizes the healing nature of sunlight by selecting a single or narrow spectrum of light with the optimal ability to reduce psoriasis. UC Irvine is proud to offer a comprehensive Phototherapy Center with the following therapeutic options:

• Narrowband Ultraviolet B (NB-UVB) photo booths: NB-UVB penetrates the skin to slow the overproduction of skin cells. The patient’s entire body is bathed in UVB light for a few minutes on a regular schedule. NB-UVB has been highly effective at treating psoriasis, with rare and minimal side effects.
• Ultraviolet A (NB-UVA) photo booth: The process of UVA is similar to NB-UVB, but also includes a topical medication called psolaren. This process is called PUVA, and may be more appropriate for certain cases of psoriasis than NB-UVB.
• Localized Excimer Laser: Excimer laser has similar healing properties as NB-UVB photobooths; however, it is a hand held device that is capable of localizing treatment to specific areas of the patient’s body. This option is ideal for patients who do not need a full body immersion. 
• Hand and Foot Ultraviolet A: This option combines the benefits of Psolaren and UVA (PUVA) with the localized treatment received from an Excimer laser. Your dermatologist will help you select which option is best suited to your condition.

UC Irvine Dermatology offers well-known and effective treatments as well as promising, novel therapies and drugs that may or may not yet be available on the market. The Dermatology Clinical Research Center conducts several ongoing studies to assess the safety and efficacy of innovative treatments for psoriasis and other skin conditions. Learn more about our current studies ›

Treating your psoriasis is critical to good disease management and overall health. Work with one of our expert doctors to find a treatment—or treatments—that reduce or eliminate your symptoms. What works for one person with psoriasis might not work for another. Our physicians will guide you step by step in learning and understanding the different treatment options and keep trying until we find the right regimen for you.

Our physicians have extensive experience in treating psoriasis and understand how psoriasis can impact your life.  Whether you are a new patient looking to consult with one of our highly qualified dermatologists or a previously diagnosed patient referred by your physician, UC Irvine is the ideal place to receive personalized treatment from one of our expert dermatologists.

Appointments and more information

If you are a patient seeking an appointment, please call 949-824-0606 or 714-456-7070.

Learn more about UC Irvine Health Dermatology Services ›