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170: Vitiligo 101 + Alternative Treatment Options w/ Dr. Raja Sivamani

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This is my first episode on vitiligo, and my guest today is here to lay some groundwork about this condition, as well as other depigmentation conditions that are mistaken for vitiligo.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest today is Dr. Raja Sivamani, a board-certified dermatologist who practices at Pacific Skin Institute.

He is an Adjunct Associate Professor of Clinical Dermatology at the University of California, Davis and Director of Clinical Research and the Clinical Trials Unit. He is also an Adjunct Assistant Professor in the Department of Biological Sciences at the California State University, Sacramento.

Dr. Sivamani engages in clinical practice as well as both clinical and translational research that integrates bioengineering, nutrition, plant science, cosmetics, and skin biology. With training in both Allopathic and Ayurvedic medicine, he takes a holistic approach to his patients and in his research.

Join us as we talk about the causes of vitiligo, possible treatment options, and why it is so important to get an accurate diagnosis.

Have you been diagnosed with vitiligo? Tell me about it in the comments!

In this episode:

  • What is vitiligo?
  • How do you get an accurate vitiligo diagnosis?
  • Other conditions that can cause pigment loss in the skin
  • How to support skin that is losing pigment
  • Sun exposure considerations when your skin loses pigment
  • Integrative approach to vitiligo

Quotes

“You'll see patches of pigment loss, either on the face or on maybe, say, the arms or the trunk. And in some people, you can lose all of the pigment on the skin. But in most cases, that's not what happens. What happens is it's in set areas along the body.” [1:33]

“Vitiligo's actually perhaps several different diseases all wrapped into one umbrella, or different variants. The standard thought is there's an autoimmune component, but there are other thoughts as well that there's too much oxidative stress in the body.” [20:41]

Links

Find Dr. Sivamani online

Attend the 2020 Integrative Dermatology Symposium (for practitioners + now 100% online)

Healthy Skin Show episode 076: What You Need To Know About Acne, Accutane & Antibiotics w/ Dr. Raja Sivamani

Healthy Skin Show ep. 142: Psoriasis 101: What You Need To Know w/ Dr. Raja Sivamani

Healthy Skin Show ep. 159: Grover's Disease: Lifestyle + Diet Shifts To Implement w/ Dr. Raja Sivamani

Jennifer's appearance on the LearnSkin podcast: An Inside-Out Approach: The Role of Nutritionists and Nutrition in Healthy Skin

Follow Dr. Sivamani on Facebook | Instagram | YouTube | Twitter

170: Vitiligo 101 + Alternative Treatment Options w/ Dr. Raja Sivamani FULL TRANSCRIPT

Dr. Sivamani: Dr. Sivamani, thank you so much for coming back to the show and sharing with us all about vitiligo. As I said, this is our first episode on this particular topic, and I'm so glad to have you laying the groundwork for us on all of this.

Dr. Sivamani: Jennifer, it's fun to be back. I've always had fun with your podcast. You do such a good job of talking about many different topics. And vitiligo is a big one, so I think this is a really good one to talk about.

Jennifer: Yeah. I consider you one of the best people to explain and simplify things for the audience. What is it vitiligo for those who may not be sure about it? Because it has to do with the pigmentation of your skin and some people may be familiar with it, others may not. What is it? And then let's talk a little bit about how do you get an accurate diagnosis?

Dr. Sivamani: I think these are both super important questions. Just to take a very high level view of vitiligo, first and foremost, what you see is you do see loss of pigment. There are many conditions that can cause loss of pigment, so we'll jump into that later. But vitiligo itself, you lose pigment on the skin, so if you're darker, it becomes much more visible. But the natural pigment cells on your skin, the melanocytes, they're not there anymore. And it's considered an autoimmune condition. So what you'll see is you'll see patches of pigment loss, either on the face or on maybe, say, the arms or the trunk. And in some people, you can lose all of the pigment on the skin. But in most cases, that's not what happens. What happens is it's in set areas along the body.

Dr. Sivamani: And in terms of causes, what you're looking at there is it's thought of as being an autoimmune condition, where the body has somehow incorrectly identified itself as a foreign substance or a foreign invader. And sometimes this happens… We don't exactly know the reasons for why this happens, but one of the thoughts is that if you get sick and you're fighting off, say, whatever comes on board, whether it's a cold or a virus or whatever it is, your body then, based on fighting off that virus, your body, if you're unique enough to have these set of circumstances, the melanocytes, which are the pigment cells, they have a similar look compared to that virus. It's called molecular mimicry. And then your body accidentally thinks that you are still part of that invasion, and so then they'll start attacking your own skin or attacking your own pigment. So that's one of the theories. There's another theory. We can get into the theories that are involved, but it's the major theory that's put forth, which is that there's an autoimmune connection.

Jennifer: And so if you start noticing pigmentation loss in your skin, is it okay to just assume that you have some sort of issue? Like you said, there are other conditions that can also cause some depigmentation. In my opinion, if you have an autoimmune disease, you want to know about it. So do you feel it's best to go to a dermatologist? And what would they do to appropriately identify that vitiligo was the issue going on?

Dr. Sivamani: Yeah, I think this is a really important point in making sure you get an accurate diagnosis. And for starters, when you have pigment loss in the skin, there's actually different grades that you can have. You can have something known as depigmentation where you lose that pigment altogether in that area, so it'll look white. Or you can have what's known as hypopigmentation, so you start to decrease the color. And there are many different conditions that can look like vitiligo that you want to just be careful that it actually is vitiligo.

Dr. Sivamani: So when you go to see a dermatologist, this is one of the few conditions where a dermatologist typically doesn't have to do a biopsy. Actually, there are many conditions where a dermatologist won't need to do a biopsy, we know just from looking in the characteristic patterns. But this is one where you don't need a confirmation necessarily from a biopsy. Sometimes you do if it's a little bit of an unusual pattern. But many times what a dermatologist may do is use something called a Wood's lamp. A Wood's lamp is a light that's in the UVA spectrum. And usually they'll turn the lights off in the room and they'll go over the body with the Wood's lamp. And they can see areas where you're starting to lose pigment and it highlights areas where you don't have pigment. And so it'll allow them to see the characteristic areas.

Dr. Sivamani: It'll be a full skin exam, but typically you want to look in areas like the face, the hands, armpits, they'll look at the trunk and the back, and perhaps even in the genitalia, because that's another area that's affected. And then the feet and then on the knees and elbows. So there's a few areas where they'll look. But once they see those characteristic pattern that you're supposed to see for vitiligo, it's pretty much the diagnosis. There are things that can look like vitiligo that are very concerning for people. They'll come in saying, “Oh my God, I'm losing pigment. Is this vitiligo?” And in many cases, it's actually not. And Jennifer, if we wanted to talk about some of those more common scenarios, we can do that.

Jennifer: Yeah, I would love to know what those are, actually. I know that tinea versicolor is one where you can either have darker splotches or lighter splotches that will occur. That's the only one that I'm more, I guess, familiar with. But please share. I think that would be helpful for people to hear.

Dr. Sivamani: Yeah. So if you have a child and they're younger and you're worried about vitiligo, first and foremost, go see a dermatologist. They will help you piece it together. But some common conditions where you can start to have the pigment look a little less intense, or what we'd call hypopigmentation, not depigmentation. Some of the characters that conditions, there's a condition called pityriasis alba, where if you have a little bit of eczema or you have dry skin on the face, you can start getting these patches of hypopigmentation on the face. And it can be very concerning for vitiligo initially when you look at it, but a dermatologist can totally put you at ease. They can look at that and tell you that it's not vitiligo, it's not a concern. And so that's one.

Dr. Sivamani: Another one is if you have a child that has eczema that's all over the body, many times after they have the inflammation resolve, your body can have a temporary period where you lose pigment, or at least have decreased pigment for a little while. It's called post-inflammatory hypopigmentation. And that can also be a little bit concerning. That'll be in characteristic areas where you have eczema. So the front of the elbow is what we call the antecubital fossa. In little kids, it'll be on the cheeks, and then also sometimes behind the knees. And if they have eczema that's all over the body, you can get areas where you just lose pigment.

Dr. Sivamani: As you get older, another common condition is tinea versicolor. Now, that doesn't always have to be lighter in color. But it tends to occur in areas where you have more oil secreting glands, especially on the chest, perhaps on the neck, and on the upper back. And it'll be a little different than vitiligo because you won't lose the pigment entirely. What'll happen is you'll just have decreased pigment and there'll be scaling to it. With vitiligo, you don't usually have scaling. So there's these little characteristics that people look for that can really be helpful to differentiate. And then finally, as you get older, there are some other conditions that can come up. If you have really severe inflamed what we call seborrheic dermatitis on the face, sometimes you can temporarily lose some pigment, and that can make you feel like it's vitiligo.

Dr. Sivamani: Another common thing, I think this is the last one I really want to talk about because it's one of the more common conditions that we get asked about. If you have a lot of sun damage and you're going outside, and especially if you have darker skin… Sometimes people think if you have darker skin, you're protected. Actually, if you're of Indian descent, Latina, Latino, or if you're African American descent, what can happen is if you've got a lot of sun exposure, and it happens in Caucasian skin, light skin as well, what can happen is that you can get these spots that are just depigmented spots that show up in the areas where you had too much sun exposure.

Dr. Sivamani: And it's called idiopathic guttate hypomelanosis. And what that just refers to is the areas where you got a lot of sun exposure, you're starting to lose pigment in those areas. And it's not like you will lose pigment over the entire arm, for example, if we're talking about the arm. You'll just have speckled areas, what we call macules, which are flat lesions of loss of pigmentation. It can kind of look like vitiligo. But when you have the dermatologist look, they'll see the pattern. And it's all related to sun exposure in that case. But it can be concerning for vitiligo.

Jennifer: This is really helpful. And again, it underscores why it's important. I always tell people, I'm like, “I know that sometimes you want to just assume this is what it is.” And maybe they feel frustrated because maybe they have seen a dermatologist and they didn't really feel heard. But I do believe that it's important to get some sort of answer as to what's going on, especially when it's an autoimmune disease. Because from my understanding, having one autoimmune diagnosis predisposes you to an increased risk of developing more. So it is good to know if, for example, you have vitiligo over one of these other issues.

Jennifer: And so with that said, is there anything in particular with vitiligo that, I think from a conventional standpoint, is there anything that they normally do? And then as someone like yourself, who's much more integrative and you like to think outside of the box and look at this from a different lens, what are some of those options that we can do to help support someone who's starting to notice this change in pigmentation?

Dr. Sivamani: Yeah, I'd love to go down the treatment options that we typically do. I wanted to make a comment about the autoimmune conditions that can also run along with if you have one, you can have other ones. It's very true. And one of the things with that kind of a setup is that we think that the body, if you already are predisposed to developing an autoimmune reaction, you can do that in other areas as well. So some of the associated autoimmune conditions we can see with vitiligo, another couple are alopecia areata where you can lose hair, and that's an autoimmune condition. And also autoimmune thyroid conditions, like Hashimoto's is one example, can also run along with it.

Dr. Sivamani: And so I think that's why it's really important to see someone that can accurately diagnose either your vitiligo, or if you have alopecia areata or you have an autoimmune thyroid condition, you want to have them also think about the other associations. Because say someone comes in for vitiligo and they're telling me, “I'm feeling really tired,” or “I just don't seem to have the same energy.” That's a clue to me to check their thyroid status as well because we have to evaluate for that.

Dr. Sivamani: The other thing with it is if you don't think about that, then someone might just chalk that up to just being fatigued. But a dermatologist typically will know to look for that. And then if you can catch that early, then you can treat that as well and that can make a huge difference. And you may have come in for maybe a patch that you were losing on your hand, but in the end, you'll walk away getting a better understanding of why you might've been dealing with fatigue and why you might've been dealing with a change in just your general energy status. Sometimes that can happen. It doesn't mean everybody's going to have an autoimmune thyroid issue, but they need to check for it. So I think it's really important to make sure you look for these associations.

Dr. Sivamani: So then you talked about treatment. Let me go over some of the conventional treatments that typically occur. So when you look at the conventional approach, anytime you have vitiligo, the first and foremost idea is to shut down that inflammation. And the way we do that is topical steroids. And they are extremely effective, especially in the early stages. If you can get the vitiligo early, you have a better chance of it coming back. Now, it's not 100% effective and it's not even close to being the panacea of vitiligo, because we know that when you use steroids that you can get repigmentation, but it depends where. If it's on the hands, especially the fingers, or it's on the feet and toes, that is more difficult to get the vitiligo to come back. Many times if it's on the face, that may respond a little bit faster, or if it's on the trunk, that may respond a bit faster. And so steroids is one part of it.

Dr. Sivamani: If the steroids aren't working, there are very few FDA approved approaches. So I do want to just make a comment here that there's not too many things that are FDA approved specifically for vitiligo, but your doctor may use things off label. There are other medications that are anti-inflammatories outside of steroids that people can use topically.

Dr. Sivamani: If it's widespread all over the body, there's one treatment that's a bridge between, I think, alternative medicine, or you would say integrative medicine, and then conventional, which is phototherapy. Phototherapy is something that people have known that if you go out in the sunlight and you're very careful about how you expose yourself, because you have to be careful. You don't have pigment anymore, so you can burn more easily and you have to watch it. But at the same time, there are treatments where you can put people into a photo booth with narrowband ultraviolet B therapy. Or if people are not able to access a booth, sometimes what they can do is they can go outside and just be really careful about not burning, but expose yourselves for small amounts of time. But you should really have that conversation with your doctor or whoever your care provider is before you make that decision. But that's another conventional approach.

Dr. Sivamani: And really at that point, that's where conventional medicine is for the most part. There are some other things you can give. The steroids systemically, or there are other anti-inflammatories that you can give as an oral agent that we will sometimes try, especially if the vitiligo is much more widespread. Other than that, there are some newer clinical studies now that are looking at some newer medications. We have a lot of hope that maybe one of these will start to also emerge as a more specific treatment for vitiligo. More to come on that, Jennifer. But the field has exploded with interest in trying to figure out new therapies and there are multiple clinical studies that are ongoing.

Jennifer: Yeah. Before we dive into some of those, I would like to just ask a question and circle back about the sun exposure piece. So you don't have as many melanocytes. And you said that you have to be careful now because you could more easily burn. Is that correct?

Dr. Sivamani: That's correct, yeah.

Jennifer: So what do you recommend for someone who, say, if they have pretty extensive vitiligo, how would they handle being out in the sun? What would be the recommendations if it's the summertime and you want to go out in the backyard or go to a pool? What do you suggest someone does?

Dr. Sivamani: Well, I think the best way to really do phototherapy is in a very controlled environment. So if you are able to find someone with a phototherapy booth, that is much better because then it's very standardized. You're not guessing based on the sun position or where it's located or where you live or your latitude, or perhaps how much reflection there is coming off the ground. So if you can get access to a phototherapy booth or talk to your doctor about getting a referral to someone that has a phototherapy booth, that is always better. And the lights are much more efficient at delivering the energy than, say, sunlight.

Dr. Sivamani: If you are going to expose yourself to sunlight, really, you have to be careful in the sense that it won't take long to burn. So being out there for anything more than five, 10 minutes is really going to end up being an overexposure. And if you are of very, very light skin tones, say Irish or Scottish descent, you have to be very careful too there. And if you have a history of skin cancer, you have to take that into account too. If you already have a history of forming skin cancers or melanomas, then you need to have a more careful conversation about whether this is the right treatment or not.

Jennifer: Gotcha. And just to also be clear, if someone wanted to say, “I'm just going to go to a tanning booth,” what would you say to that?

Dr. Sivamani: Well, tanning booths are not very standardized and they're not very regulated in the sense of no one's keeping track of what dose you have, what does you did before. It's all going to be you keeping track. And also, tanning booths UVA, and it's not UVB. And narrowband UVB is the light that's been studied a bit more in clinical studies, and it's a more standardized. And also, when you come in for phototherapy treatments, you want the folks to know whoever delivering the treatment. And remember, at a tanning booth, you're doing it for yourself because they're not medically trained.

Dr. Sivamani: But you want to be able to tell, where was I before? Did I burn? Did I get sensitive? And then they have to adjust the dosing. You can't do that in a tanning booth because you might not know how to adjust it or you might not know how much to decrease something by or how much to increase at your next visit. All this is just a big guessing game at a tanning booth. And you don't want to do that necessarily when the chance of burning and the chance of overexposure is high. You want to be a bit more careful.

Jennifer: Thank you so much for that reminder. Because I think a lot of times, some people, and I've seen this suggested a lot in Facebook groups, just go to a tanning bed. And I'm like, there's a lot of risks with that. That isn't always best way forward. So let's talk a little bit about some interesting research. What are some of the interesting things that you are seeing for people who have been struggling with this that may be on the horizon ahead?

Dr. Sivamani: Well, there's a couple ways to approach this. Well, in terms of the actual treatments, there is now much more intense research around what's known as… Before I get into integrative treatments, I just want to talk about some of the biochemical pathways that are being looked at. There's something called the JAK-STAT pathway. And without getting into too much ornate detail, which as a nerd, I have a propensity to do that. I can jump into that definitely. But there's something known as the JAK-STAT pathway, and it's a new pathway that's being studied for multiple diseases. There's clinical studies in atopic dermatitis, there's clinical studies in vitiligo. They're looking at it for hydradenitis, suppurativa, and also in psoriasis. So it's this new pathway that's been identified. And when I say new, it's not really that new, it's been known about for a long time. But they're starting to develop agents that we are hoping will have an impact.

Dr. Sivamani: Now, we don't have enough results. I can't comment on whether they're working or not because we still have to conduct the studies. But there's a whole new line of biochemical pathways that they're looking at. So for anyone out there that's thinking, are we progressing with research? Well, at the molecular level and at the laboratory level, we are. And I think that is a real exciting and interesting development when it comes to just skin diseases in general. Let's see what happens as time goes on. Let's see if vitiligo is goes going to be part of that conversation. So we don't know yet, but I'm hopeful.

Jennifer: Yeah. That's really interesting to see all of these different… I think for everybody listening, no matter where you stand, if you're like, I would do medication, I wouldn't. Everybody has their own opinion about what they feel is their comfort level for addressing their skin issues, and that's fine. But I do think that it's really cool that we're getting to see and learn about so many new avenues in the body that could be impacting the way that your skin shows up, how healthy it is. And in this instance, how can we maintain pigmentation? So I apologize, we totally skipped over because I went on that sun tangent. But what are some of the integrative options that you see as far as helping people with vitiligo that you use in your practice?

Dr. Sivamani: Yeah. And to talk about the integrative approaches, I do want to make a mention on the cause of vitiligo. There's still a little bit of diversity in thought on what causes vitiligo, and it probably reflects that vitiligo isn't just one disease. Vitiligo's actually perhaps several different diseases all wrapped into one umbrella, or different variants. The standard thought is there's an autoimmune component, but there are other thoughts as well that there's too much oxidative stress in the body. And especially if you have what's known as segmental vitiligo where just one portion of the body is affected along what we'd call a dermatome, say it's on the right arm or perhaps it's a patch on the right abdomen or on the right leg. Vitiligo's considered non-segmental or segmental depending on if it's affecting the body symmetrically, or sometimes it doesn't affect the body symmetrically, it's one side. We think that oxidative stress is a bigger component in people that have segmental vitiligo. Still oxidative stress in general, we think, is also important.

Dr. Sivamani: So getting to some of these agents that are being studied for vitiligo. It's not nearly going to be as widely studied as some of these FDA approved products or these clinical studies that are coming out. So let me just start by saying the studies that look at the integrative approach, or perhaps looking at some botanical or an antioxidant, are much smaller studies. But that being said, some of the ones that seem to be interesting, I'll go over a few of them.

Dr. Sivamani: Polypodium leucotomos. This is a fern, and the extract from this fern has been used to help reduce your chance of sun burning. It boosts your SPF a tiny bit, your natural SPF. It's not a replacement for sunscreen. You still have to use sunscreen if you're going to be outside. But they looked at this for vitiligo and they found that if you supplement with this, it seems to help in the response of vitiligo for people that are undergoing light therapy, as one example. So for phototherapy, if you include polypodium, it seems to provide a small little benefit.

Dr. Sivamani: There's also Gingko biloba. I think a lot of people know about Gingko. It's been used in traditional Chinese medicine for many, many years. And also in herbal medicine, it's been there for a long time. That is an antioxidant. And again, if you take it in small doses, they've shown that it can be helpful for people that have vitiligo, and especially if they're undergoing phototherapy. So that's pretty interesting as well. And another one, alpha-lipoic acid. It's used in a lot of these supplement formulations for vitiligo. We think, again, it's an antioxidant, and somehow that antioxidant is counteracting the oxidative stress that may come with vitiligo. And so when you supplement with that, they've shown that folks on that sometimes will respond better as well.

Dr. Sivamani: So these are never used in place of a conventional treatment or in place of, say, a topical approach or phototherapy, but they're used in conjunction with. But we've seen that our patients, when we use them, they feel like their pigment comes back. And there are some small studies to show that it can be helpful. But I do have to just say again, the hands and the feet are very hard to repigment, and sometimes the knees and elbows can be resistant to.

Jennifer: I appreciate you helping to, and I like to use this term manage, expectations. Because how often do you go online, and I'm sure we could find 20 websites that are like, heal your skin in 10 days or less. And it leads people to believe that there are a lot of quick fixes. Or that one supplement or one nutrient like alpha-lipoic acid is going to solve all the problems, and that's not quite the case. But it is also, I think, equally refreshing to hear that it's possible to see some level of repigmentation, though there are those areas that may be more stubborn.

Dr. Sivamani: Right. Exactly. And I think that's exciting. I should also mention, there are some devices now that are newer innovations, especially when it comes to phototherapy. So a phototherapy booth, usually you have to expose the entire body. But there are new lasers that are called excimer lasers, or you would say phototherapy lasers, that deliver the same energy that a booth would deliver, which is narrowband ultraviolet B, but you can do it in concentrated areas. Because some people come in, they don't have vitiligo all over the body. They just have it on certain areas, like say the face or the eyelids or maybe it's on the cheek, and you don't really need to expose their full body to phototherapy. The laser allows you to really pinpoint. And the advantage of the laser is you can actually increase the energy much more quickly than you would on a full body photo therapy because now you don't have the extra exposure to the rest of the body. You just are really exposing where you need to get that exposure.

Dr. Sivamani: And what's to be expected when vitiligo starts to come back? I think it's one of the most beautiful patterns that you see in dermatology is you see the hair follicles starting to repigment. And so what you'll get is you'll get the speckled repigmentation within that deep pigmented patch. And I can tell you that there is nothing more exciting to a patient than to see this speckled pigmentation coming back. You can just see the excitement in their eyes. Every time I walk into a room… I've seen many, many vitiligo patients, I still get that little, can I say it's like a puppy dog excitement? I do. And I'm like, “Yes, it's working. You're on the path to getting better.” But you have to realize that repigmentation, it's unlike psoriasis or an inflammatory condition where you can put a treatment on and by one week or two weeks, you get a big response. Vitiligo's different. Before you start seeing a response, it's going to be about six weeks in or two months in. So you have to be a bit patient.

Jennifer: That is so important. I think with most skin conditions, patience is a part of the process. And it's an important part of the process because as we have said, nothing usually happens super duper fast for a lot of these things. Hopefully sometimes if you're really suffering, some of these topical treatments can be really helpful in getting someone out of that urgent emergency scenario where they're really uncomfortable. But a lot of times, to really fully help support someone through something, it can take time and it's important to know that.

Jennifer: So I just want to thank you so much for sharing all of this. This is so great, because I think it gives people hope, it helps set up expectations. And it also underscores the reason why having an integrated approach to this, and even maybe a team approach instead of saying, “Oh, I'm just on my own with this,” could really be helpful in this particular case. Especially given the way that, as you were saying, dermatologists are starting to address and see vitiligo show up. It's like, hey, there's probably some other pieces to this, not just autoimmunity in and of itself.

Jennifer: First of all, I want to make sure that everyone knows where they can find you. So first of all, you are the cohost of the Learn Skin podcast, which is excellent and amazing. It's a great resource for practitioners, physicians, anybody in that. You and Dr. Hadar have this amazing podcast together that helps educate professionals. I think that's a really great option. And then also too, the learnskin.com platform, which there is some education there on vitiligo, correct?

Dr. Sivamani: Yes, there is. And thanks for mentioning the podcast. Really appreciate it. Yeah, we have a lot of fun with the podcast. We try to bring in a variety of perspectives, so you'll see things from naturopathic medicine to conventional to Ayurvedic medicine. We had one on hypnotherapy. So there's just a lot of different approaches that are out there which are also being studied, and we like to highlight that as much as we can.

Dr. Sivamani: And then in terms of the Learn Skin platform itself, we do. So the Learn Skin platform is meant for professional education, so anybody that wants to get more in depth education that's from an integrative perspective. We do have some articles on things like light-based therapy or natural treatments or what is the role of the microbiome and what are the causes, the autoimmune causes, or how does vitiligo differ from one type to the next. So you can come check it out. And a lot of it may actually end up being free because everything isn't necessarily under what we call continuing medical review or medical education. You can come and access a lot of these articles. Just go in there and put in Learn Skin and vitiligo in Google and you'll find a few of these articles, which I think you can start learning right away.

Jennifer: Yeah. And this is available, because I checked, everyone, no matter where you live in the world. So don't feel like you have to just be in the US. Dr. Sivamani told me, yes, this is available to anybody. Because I know that people listen all over the world, and so that's great that we can share this information and really help other people. That's what this is all about. And like I said, the Learn Skin podcast is also an amazing resource as well. So I just want to thank you so much for coming back on the show. I really, really appreciate it, and I hope we can have you back again sometime.

Dr. Sivamani: I'd love to, Jennifer. Let me just also say we just opened a clinic, if anyone is interested in connecting. We already have a medical clinic called Pacific Skin Institute, but we've just opened an integrative dermatology clinic, and we do online consultations, called Zen Dermatology. And we have a naturopathic doctor that works with us. We truly want to be integrative. So if anyone wants to get in touch, look us up. Zen Dermatology. And Jennifer, it's such a pleasure every time I come on. You ask such great questions. I think the conversation is so pertinent to people that are listening. So thank you for doing what you're doing.

Jennifer: Thank you.

“You'll see patches of pigment loss, either on the face or on maybe, say, the arms or the trunk. And in some people, you can lose all of the pigment on the skin. But in most cases, that's not what happens. What happens is it's in set areas along the body.”


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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Skinterrupt offers health, wellness, fitness and nutritional information which is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnois, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health care professional. Do not disregard, avoid, or delay obtaining medical or health related advise from your physician or other health care professional because of something you may have seen or read on our site, or in our advertising, marketing, or promotional materials. The use of any information provided by Skinterrupt is solely at your own risk.

Nothing stated or posted on our site, or in our advertising, marketing or promotional materials, or through any of the services we offer, as intended to be, and must not be taken to be, the practice of medicine or counseling care. For purposes of this disclaimer, the practice of medicine or counseling care includes, without limitation, nutritional counseling, psychiatry, psychology, psychotherapy, or providing health care treatment, instruction, diagnosis, prognosis, or advice.