Monday Pharmaceutical Mystery: September 30

SB is an female patient, age 11 years, at your pharmacy, and her mother is picking up a prescription for fluticasone cream.

When you go over to the consultation window to counsel, you explain that this medication is usually used for a rash and itching, and go over your usual counseling points. Mom explains that SB is actually being treated with topical fluticasone for vitiligo.

Mystery: Why is SB using a topical steroid for vitiligo?

Solution: Topical steroids, while most commonly used for allergic reactions, eczema and dermatitis, or similar skin conditions, can be useful in the treatment of vitiligo.

Vitiligo causes loss of skin color in blotches, and can affect the skin on any part of the body. Normally, hair and skin color is determined by melanin. In patients with vitiligo, the cells that produce melanin (melanocytes) die or stop functioning. The affected skin becomes white, or lighter. Vitiligo may be caused by an autoimmune disorder, may be inherited, or may be triggered by sunburn, stress, or chemical exposure. However, in many cases, there is no identifiable cause.

If an autoimmune cause is detected in the bloodwork, the underlying condition should immediately be treated.

Vitiligo treatment may involve topical corticosteroids (in an attempt to restore color), most commonly mometasone or fluticasone. These may be used alone or in combination with topical tacrolimus. Light therapy may be used as well. Results of treatment vary and are unpredictable.

An important counseling point for patients with vitiligo is that there is an increased likelihood of sunburn, and sunburn can also trigger worsening of the condition. Patients should be reminded to generously apply sunscreen and reapply frequently when they will be in the sun.

Reference

Mayo Clinic: Vitiligo. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912. Updated March 8, 2018. Accessed September 24, 2019.