The landscape of vitiligo in Latin America: a call to action

Abstract

Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10–12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.

Keywords:

• Vitiligo
• Latin America
• vitiligo diagnosis
• vitiligo access

Acknowledgments

The authors would like to thank Ms. Thais Vidal, BA, for English language editing.

Ethical approval

This is a narrative review with no patient information.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

This is a narrative review, with results taken from the literature and professional experience of the panel. The data from the survey is available from the corresponding author.

Box 1. Recommendations to improve the landscape of vitiligo in Latin America.

1. CREATE REGIONAL DISEASE AWARENESS

   • Recognize vitiligo as a high-impact chronic and systemic disease requiring dermatological management and multidisciplinary care for psychosocial consequences and comorbidities.

   • Develop widespread awareness campaigns to educate the public on the non-contagious nature of the condition, advocate inclusivity, and fight discrimination and stigmatization. Videos, disease days, celebrities, and social media are examples.

2. INCREASE PHYSICIAN TRAINING

   • Primary Care Level (PCPs and pediatricians)

     •     ^ Recognize vitiligo and be aware of possible comorbidities

     •     ^ Recognize appropriate referral situations and understand the importance of referring to a dermatologist to decrease diagnostic delays and allow for early intervention

     •     ^ Dispel misconceptions surrounding vitiligo, including that it is untreatable

   • Dermatologists

     •     ^ Obtain a complete medical history and classify the disease based on its clinical characteristics (7)

     •     ^ Carry out a differential diagnosis from other entities that lead to hypopigmentation (8)

     •     ^ Actively investigate mental health impact and other comorbidities to involve the necessary specialists to provide a holistic approach posteriorly

     •     ^ Use clinimetric instruments to assess the impact on QoL and disease severity, as they allow objectivity in evaluating progression and treatment response. Using apps available for mobile phones may facilitate the use of these tools

     •     ^ Ensure adequate follow-up and reevaluation of disease progression and impact on QoL continuously throughout the disease course to guide treatment decisions

     •     ^ Provide comprehensive education to patients and caregivers on the disease course, proper care, and preventive measures, and create realistic treatment expectations.

3. ADDRESS MALDISTRIBUTION OF RESOURCES AND SPECIALISTS

   • Create job opportunities for dermatologists within public healthcare systems and provide incentives to work in non-central cities in need of specialists

   • Teledermatology can be implemented as a tool to increase access to specialized care in distant and rural areas when in-person visits are not an option (62,63). It can potentially be a tool for the early detection and intervention of vitiligo (9)

   • Increase local training opportunities for aspiring dermatologists

4. INCREASE ACCESS TO VITILIGO MANAGEMENT

   • Ensure continuous access to multidisciplinary care and follow-up

   • Ensure continuous access and reimbursement of indicated treatments, psychosocial support, and complementary measures

5. DEVELOP NATIONAL OR REGIONAL CPG

   • Develop CPG for vitiligo to promote evidence-based and standardized care through collaboration between medical societies, government, and academia. If this is not possible in the short-to-medium term, each country’s leading medical society should recommend an international guideline to adopt.

6. CREATE PATIENT ORGANIZATIONS

   • Create an official PO dedicated to advocating for vitiligo to be recognized as a chronic disease, providing peer support, informing, and advising its members on disease-related issues, advocating for treatment approvals and reimbursement, and sensitizing society on the

7. GENERATE LOCAL DATA

   • Encourage local and regional research regarding vitiligo epidemiology, patient outcomes, disease course, disease burden, impact on QoL, and genetic, environmental, and immunologic dynamics.

Additional information

Funding

Funding for this narrative review was provided by Americas Health Foundation through an unrestricted grant from the Pfizer Foundation.