Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
No White Lies: The Truth About Vitiligo
A white patch on the skin shouldn’t erase someone’s story—or their options. Live at the Science of Skin Summit, Dr. Seemal Desai breaks down what vitiligo really is: an autoimmune skin disease, not a cosmetic issue or something contagious. We trace his family’s journey from the anxiety of early PUVA treatments to today’s advanced options—topical ruxolitinib, phototherapy, oral JAK inhibitors, and promising IL-15–blocking biologics.
We bust myths, explain autoimmune links, and share practical tips for care—sun protection, gentle skincare, and avoiding skin trauma. Dr. Desai also tackles stigma and insurance barriers that mislabel vitiligo as cosmetic, spotlighting the Global Vitiligo Foundation’s advocacy for access and support.
In many communities and cultures around the world, vitiligo is still viewed as a very socially stigmatizing and ostracizing condition. Uh, was something called PUVA therapy, which was you take a pill and then you go in a tanning booth to stimulate your color, and it worked for a while. And then over time, his disease just relapsed and got vitiligo is a cosmetic thing. So that's out there. Uh no. False, false, false. Vitiligo is not simply cosmetic.
SPEAKER_00:The second myth is that Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.
SPEAKER_02:Welcome to the Dermot Trotter Don't Swear About Skin Care Podcast. It's an exciting episode because we're actually doing this live at the Science of Skin Summit here in Austin, Texas. I'm Dr. Shannon C. Trotter, board certified dermatologist, and I'm here with a special guest today, Dr. Samal Desai. Welcome to the podcast, Dr. Desai.
SPEAKER_01:Thank you so much for having me, Shannon. It's an honor to be here, especially to do this live. So I'm looking forward to the next several minutes spending time with you.
SPEAKER_02:Well, we want to touch on a topic that I know has a personal side for you. Yes. Vitiligo. I wanted you to talk more with our audience about your personal connection to Vitiligo and really just explain what it is. Because I'm sure there's some people scratching their heads out there saying, I've never even heard of this before.
SPEAKER_01:Yeah, and I want to just first of all thank you for giving Vitiligo this platform to be able to really reach out to the public and talk about this. Vitiligo is an autoimmune skin disease. It is not a cosmetic condition. I just want to preface by saying that first and foremost.
SPEAKER_02:Yeah.
SPEAKER_01:Vitiligo is a disease where your body's own immune cells attack and kill the cells in our body that give us our own natural skin color. Those cells are called melanocytes. And vitiligo is the same disease that Michael Jackson suffered from, that other famous celebrities like Winnie Harlow and John Hamm and many others have suffered from. The other thing I want to begin by saying is that Vitiligo is not a rare disease. The prevalence of vitiligo is quite high. We recently published a paper that in the US, up to 3 million individuals are affected with Vitiligo. So when you see someone who's got white patches, particularly if they're a darker skin tone individual, you've probably seen someone at a grocery store and on an airplane or on a bus ride. That is what vitiligo is, where you lose your own color. Now, with that comes lots of other issues, which we can dive into. But the most important thing to start off with is autoimmune skin disease. An award-certified dermatologist can help with discussing treatment options and especially what's new on the horizon.
SPEAKER_02:I'm glad you point that out because I'm sure there's people listening that thought, I may have seen somebody with that, but I had no idea what it was or what it was even called. And for you, there is that personal connection to Vitiligo as well. Am I right?
SPEAKER_01:There is. And actually, Vitiligo is the reason I became a dermatologist, now specializing in pigmentary diseases. In the mid-1980s, my younger brother was diagnosed with vitiligo. We were, we grew up in Atlanta, Georgia. I have a younger brother who's now a physician and practice in Atlanta and doing very well in his late 30s, early 40s. But in the mid-1980s, he was diagnosed with vitiligo. And at that time, for our family and for my parents in particular, it was a devastating time. A disease that has always had significant psychological and sociological burden. In many communities and cultures around the world, vitiligo is still viewed as a very socially stigmatizing and ostracizing condition. And in many parts of the world, vitiligo in the mid-1980s was viewed as a contagious disease, kind of like leprosy. And fast forward to 2025, we've made lots of progress to dispel those horrible myths. But we're still at a point where vitiligo in many cultures, particularly in communities of color, Indian subcontinent, Southeast Asia, Africa, and Latin America, et cetera, where vitiligo is still oftentimes viewed as a very uh stigmatizing condition. Uh, for example, you have someone in your family with vitiligo, oh, we don't want to get married to someone in that family. Uh, job opportunities, educational opportunities, social standing. And so for my family, it was a very traumatic journey. And I remember the stress and anxiety my patient my parents felt with my brother as a patient. And so I've kind of been involved with dermatology since I was 11 years old and even younger. And so now, fast forward, that's really why I've been able to focus my career on pigmentary disorders. And I'm happy to say that we're at a place now with this disease that I've never been in my entire career, and there's so much of hope on the horizon.
SPEAKER_02:Well, I do want to touch upon treatment, but one of the things I wanted to have you highlight is just how it really impacts the person. And maybe you can speak to how it made your brother feel because you mentioned that social stigma and how it impacts people's ability to function in society. One of the things that a friend of mine who said that her parents are from India, yeah, and she said that one of the dentists developed Vitiligo. And she said that her parents actually didn't trust the dentist's skill set anymore to perform dental procedures when that vitiligo developed, thinking that somehow is a reflection of their skill set or who they were as a person.
SPEAKER_01:You know, I'm devastated to hear that, but I'm not shocked. Uh, I'm not at all surprised. And, you know, for my younger brother at the time, I will admit, when he first got diagnosed, I'm sure if he was here and we would ask him, he really didn't care about it. But sensing the household anxiety, the tension, the uh the tears, the unpredictable nature, uh certainly affected him psychologically. His treatments at the time involved going to a tanning booth because that's all there was at the time uh was something called PUVA therapy, which was you take a pill and then you go in a tanning booth to stimulate your color. And it worked for a while. And then over time, his disease just relapsed and got worse. And now, if you see him, he's three shades lighter than me. He's fully depigmented. The vitiligo is he has no normal pigment of an Indian skin tone individual like me left. He's come to terms with it, our families come to terms with it, but uh, I know for a fact that he has had comments like that made to him. Recently, he posted on his social media a comment that was made to him by a patient in the hospital as well, uh, saying, Oh, I don't want you to treat me. And he was a he's a hospitalist. I don't want you to treat me because I don't want to get that. Or um someone staring at his skin and saying, Oh, is that contagious?
SPEAKER_00:Wow.
SPEAKER_01:Or I do remember him very clearly pointing out uh people being concerned about shaking his hands because they they thought that they were gonna get it, you know, it was it was something that could be passed along.
SPEAKER_02:So we have a lot of work to do.
SPEAKER_01:We have a lot of work to do. And actually, to be honest, platforms like this and talking with you as part of that. So and and the Global Vitiligo Foundation, by the way, I have to plug them because I'm the president now of the Global Vitaligo Foundation, which is the largest international organization dedicated to Vitiligo. And for anyone listening, go to the Global Vitiligo Foundation website. There are free patient resources and amazing patient support group resources, most importantly, to get support and connect with individuals.
SPEAKER_02:Well, that kind of leads us into the treatment conversation because you talked a little bit about what resources your brother had. So I wanted you to maybe take a little historical dive as to kind of where we were with treatment with Vitiligo, sort of kind of where we are, and then of course, what's in store for the future.
SPEAKER_01:Great question. And, you know, I what I will say is now more than ever, if you are someone suffering from VitilIGO, you should feel hope and optimism that there are things that we can do to change that. I have, if we did this podcast, Shannon, 10 years ago, I would say I'm hopeful, but I don't have anything new to tell you right now. Now I can tell you we have finally an FDA-approved topical treatment, which is called Ruxolitonib. My conflict of interest, I was involved in those studies and we published them in the New England Journal of Medicine. But we have an FDA-approved treatment, which is a cream. We have new advances in phototherapy now. So we don't send people to tanning booths anymore. We do the medical treatments in our offices. I know you do this as well in your practice. Uh, we have especially now three clinical studies happening at the exact same time on oral treatments for Vitiligo called oral jack inhibitors. And I, if I were willing to bet, and let if we were in Las Vegas and we needed to go gamble, I would bet that by 2026, at some point next year, we will have at least one, if not three, FDA-approved treatments, which are pills for VitilIGO. Are they going to be overnight fixes? No. Do we have anything to rapidly get the color back? No. Everything we do in Vitiligo still will take time and patience. The point is we finally have tools, and then we can go to our insurance companies and advocate to get those tools approved. And I could spend a lot of time with you talking about the challenges there as well, because there are unfortunately insurance companies in this country that have reclassified Vitiligo as cosmetic.
SPEAKER_02:That's unbelievable.
SPEAKER_01:It's unbelievable, it's a travesty, it's a tragedy. I'm fighting it tooth and nail. I want every patient out there listening to get involved with advocacy with your insurance companies, with your legislators. There is no reason it's unacceptable that a skin disease that's autoimmune, that has comorbidities, is being told that it's cosmetic. And having the research for these new treatments, I think, is going to really help us. So oral treatments are on the way, you new treatments in UV light, new topical creams are on the way. And then finally, there's also a biologic that's being studied right now. And so that blocks something called interleukin-15. Uh, and not to get too science-y about it, but this is a biologic. Just like you see commercials for biologics for psoriasis and eczema. Maybe one day we'll have a biologic for vitiligo where you give yourself one monthly shot, let's say, and it keeps your disease away. So I am so optimistic. And and I am also, by the way, optimistic that one day, hopefully in my lifetime, we will have a cure for this disease.
SPEAKER_02:I mean, that's got to give people hope out there that are just thinking about it, that are struggling with it. Or, like you mentioned, they may not even actually know they have it or appreciate that it's going on. So, you know, we've talked about a little bit about the treatment, the journey, and the last kind of part here, you know, with the podcast. I wanted to ask you more about if somebody has vitiligo, are there other things they should be thinking about that they should be worried about that they might actually have? Because I think a lot of people think, again, a lot of skin diseases people assume are just skin deep. And we know so much more, obviously, about psoriasis and other things we treat. How do you approach that with your patient if you think they have vitiligo? What else are you worried about or working them up for?
SPEAKER_01:So glad you asked that. And that question is really important as we continue to paint the narrative about this being an autoimmune condition. Vitiligo is associated with other autoimmune conditions. I do screen all of my patients for thyroid disease. I screen them for vitamin D deficiency, I screen them for iron deficiency. And then depending on their symptoms and family history or personal history, even things like rheumatoid arthritis, certain types of diabetes, particularly type one, uh, pernicious anemia, which is a type of anemia where your blood count gets lowered. But we do check lab work, we do take detailed medical history, and it's very important to realize that these underlying systemic diseases may be within a family who, and you may have someone who doesn't have vitiligo. So, for example, I have a lot of patients who say, Why did I get this? No one in my family has it. Then you take a family history and you realize, okay, well, they had a grandmother with type 1 diabetes, and then their sister has thyroid disease. Neither the grandmother or the sister have vitiligo, but the patient has vitiligo, but doesn't have thyroid disease or diabetes. And so within that one family tree, three different autoimmune diseases, each showing up a different way, but in that same genetic family. So we do a lot of that. And then the other thing I do want to mention, which we don't talk about as much. So I'm really glad you're letting me do this. We have comorbidities, but we also have other skin conditions that co-localize with vitiligo, like lupus, lycanplantis, alopecia ureata, so types of hair loss and rashes that can also show up in our vitiligo patients. So really important to know.
SPEAKER_02:And I think patients would, you know, appreciate that because they're just thinking, this is, oh, it's just affecting my skin, right?
SPEAKER_01:It's just color or something.
SPEAKER_02:Could it be associated with something else? Or, like you said, could it just be shared amongst family members? And for somebody with vitiligo, if they're thinking about, you know, kind of circling back to treatment, what do you talk about with them about skin care, some protection? What other measures do you kind of include in their treatment to make sure that's kind of comprehensive, in addition to actually tackling that vitiligo and trying to reverse it?
SPEAKER_01:Oh, that's so good. Uh yes. So, number one first and foremost is uh photo protection and sunscreen is a must. You never want to have a sunburn. Well, as both of us as board-certified dermatologists, we don't want anyone to have a sunburn. No one wants a sunburn. But if you're a vitiligo patient, a sunburn can be devastating, extremely painful. Remember, your skin doesn't have its own color. Our color is our own natural defense in many ways against sunlight and sun damage. And so these vitiligo patients are more prone to sunburn, broad spectrum sunscreen, reapplication constantly, especially if you're gonna be on the sun, every two hours at minimum, if not more frequently, is critical. And I tell patients that. Some people say, Oh, well, I just read on a blog, I should go out and get some sun. I should go, I should go lay out. And my answer is you're not gonna lay out. If you need to do a little bit of sun exposure, 10 to 15 minutes three times a week, is what I recommend reasonable exposure. The minute your skin starts to get pink, you're out of that sunlight. The challenge with letting patients do that is no one ever is precise about 10 to 15 minutes. I mean, listen, I'm a dermatologist, you're a dermatologist. Sometimes we forget to do stuff, right?
SPEAKER_02:Like don't like to admit it, but we forget.
SPEAKER_01:Right. I don't like to admit it, but I do. Like I was on a recent trip to Mexico with my family, and it was two hours and I was in the pool, and an hour later, I'm like, oh man, I forgot to reapply my sunscreen. And I'm a dermatologist. So, but yes, and then in terms of skincare, uh gentle skincare, uh, I don't recommend aggressive scrubs, I don't recommend ablative cosmetic treatments. We actually published a paper where uh laser resurfacing, uh uh micro-needling, those things, you'd want to be cautious. Anything that's gonna damage or burn or traumatize the skin could potentially spread your vitiligo. So then people ask me, well, can I not get a facial? Light things, I'm still reasonable and I let patients do. Light chemical peel, a facial, uh a laser hair removal. Yes, you can do it, but again, slight risk of it spreading because you're giving heat and damaging those cells. So I think you really have to customize the approach, and that's kind of what we try to do at our center in Dallas.
SPEAKER_02:And I think patients understand that that's important. If you have it alligo, you might need a little special care, but may not just think of it right away. And yes, as you heard, as dermatologists, we do sometimes forget uh to reapply. So we're all human. I think that's what's important to point out. Even as dermatologists, we're not perfect, although we might proclaim to be at times. That's right, that's right. So I I will, you know, kind of you know, talk more about, you know, being at this, you know, the summit here, social media is obviously a big, big thing. We talked about some of the stigma associated with vitiligo. Are there any types of like myths or just sort of like crazy claims or outrageous claims you've seen on social media that you think kind of just you want to really emphasize aren't true? Be the myth buster for us here.
SPEAKER_01:Oh, yeah, I love busting myths. Okay, the first myth I will want to bust is that bitiligo is a cosmetic thing. So that's out there. Uh no. False, false, false. Vitiligo is not simply cosmetic. The second myth is that uh certain foods can make bitiligo worse. I get a lot of questions about oh, should I change my diet? Um, I get a lot of questions, oh, I have leaky gut. That's causing my vitiligo. We have no data to prove that. Now, 10 years from now, could could we be doing an episode of your podcast and I may change my answer? Yes. But right now, we don't have any data that shows foods make vitiligo worse. What do I tell my patients? I say balanced healthy diet. You know, the Mediterranean diet, there's a reason it works. It's a good diet. So if people ask me for really specifics, I say Mediterranean or balanced healthy diet. The other myth is that oh, creams don't work. Uh yeah, why why is my doctor keep giving me a cream? Now that we have Ruxolitinib, especially, and and by the way, but even before Ruxalitin, when we had off-label uh calcinurine inhibitors or topical steroids, they did help. Uh, but now that we have Ruxolitinib and new stuff in development, creams can help. And then I would say the the the final myth is that uh there there is this sense that for patients who are suffering from vitiligo, that uh you you need to seek treatment right away in order to see improvement. Oh, I've had meaning, in other words, oh, I've had it for 10 years. Right. No point in me trying to get any treatment.
SPEAKER_02:Really common. Really common, right?
SPEAKER_01:Oh, I've had it for 10 years. No one told me I could do anything, so I've just let it be and I don't have anything I can do. I never withhold treatment for someone, no, if they've had disease for a long time. Doesn't matter how long you had it, if you want to try to improve it, we will improve it.
SPEAKER_02:I love that. I think that's such a positive spin, you know, for patients that probably historically, if they've had it that long, thought there was nothing, no hope. And I think it's always great to give patients, you know, that sense of optimism that we're gonna try and see what we can do. Yeah. So just to kind of we wrap up here, conclude, if you have a patient that comes in, you know, that has Vitiligo, what would be sort of your elevator pitch or say to them about their disease and where you think you can go from here?
SPEAKER_01:What I would say is that you have an autoimmune skin disease that is one that should not give you the feeling of total despair. You have a disease that is being studied, that's being researched, that's being invested in, that's being recognized, and that you are seen. You're seen for your normal skin tone, quote unquote, you're seen for your spots, quote unquote. And that the vitaligo should not define your beauty or how you feel or viewed by others. This disease, no matter if you want treatment or you don't want treatment, is one that requires respect and care and diligence. And that we, as the dermatologists, are the true experts as board-certified dermatologists, FAAD experts to help treat your condition and seek the care that you deserve.
SPEAKER_02:What a great way to kind of end our conversation. I mean, I really want to thank you, Samal, for coming on, sharing your expertise, that personal history, you know, with your brother that inspired you to be sitting here with us here today. Thank you. I just think that's utterly amazing. He's got to be so proud to see what you're doing.
SPEAKER_01:And it's really great for my family. They they they were all at our recent AAD meeting where I concluded my term as president. You were there. And it's great for everyone to see, you know, our family's devotion to this. But I also want to just say thank you to you because it's platforms like this that are helping to spearhead the message to the public. And you all, as a public, are our patients. And so I'm so excited and proud of you for everything you're doing, Shannon. And I know your listeners are loving every episode.
SPEAKER_02:Well, thank you. I appreciate that. I also want to thank the Science of Skin Summit for allowing us to do this podcast here today. It's been fantastic to connect with you here again. If you love this episode, please hit like and subscribe, of course, and stay tuned for the next episode of Dermot Trotter. Don't swear about skincare.
SPEAKER_00:Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
