Dr. Amy McMichael
Wake Forest Baptist Medical Center, North Carolina, USA
Dr. Amy McMichael is a Board-Certified Dermatologist with clinical and research interests in hair and scalp disorders as well as dermatological conditions in skin of color. She has published over 100 journal articles and given over 250 lectures nationally and internationally on myriad topics in Dermatology.
In today’s appearance-conscious society, visible skin conditions such as Vitiligo can be a source of emotional and psychological stress, especially in teens who are more conscious of their looks.
Here, Amy shares her recommendations to help children and teenagers with Vitiligo care for their skin.
Behind the Woman
Tell us about your career and the people who inspired you…
I came to Dermatology early on at medical school and adored that it gave me a different day, every day!
From the varied pathologies that cross all age ranges and ethnicities, to performing surgical procedures, Dermatology brings a diversity of challenges. I also love that I get the opportunity to follow my patients, see them improve and help them to understand and live better with their condition.
The turning point of my career was during my residency at the University of Michigan when I really recognized how much work there was still to do around skin of color in Dermatology. I saw that people were being given recommendations that they didn’t feel comfortable with because of their cultural behaviors and as a person of color myself, I realized that I could give something back. Today, I treat patients of varying ethnicities but the skin of color niche is very important to me.
Many people have inspired my journey and continue to do so today. I really admire my program director Chuck Ellis who encouraged me to start giving lectures while I was a resident. This is what sparked my interest in the educational side of Dermatology.
But it was the magical Dr. Joe Jorizzo — my Chair at the Wake Forest School of Medicine — who gave me the gentle guidance and support I needed to specialize in Hair Disorders. In this field, I am privileged to work with a lot of women specialists from across the world: Maria Hordinsky, Elise Olsen, Jerry Shapiro, Wilma Bergfeld, Antonella Tosti, Valerie Callender, Len Sperling…
Focus: Children with Vitiligo
Does Vitiligo affect children differently than it does adults?
There appears to be a lower incidence of Vitiligo in children, in comparison to adults. The prevalence varies between 0.1% and 4% of the world’s population, 1 versus 0.1% to 8% in adults 2. In children, we usually see the condition localized to specific areas which is called Segmental Vitiligo.
Are there any differences across ethnicities?
This is a difficult question — I’m not sure that anyone has done that study yet…The effect of living with Vitiligo can be just as severe for those with brown skin, where the condition is more noticeable, as it can for other ethnicities, where the Vitiligo is very hard to see. I have seen some fair-skinned patients be extremely distressed about the way they look, and conversely, some who are brown be much more accepting of it.
What is your treatment approach for Vitiligo in children?
For children under 16, I tend to start out with tried and tested topical medications, like topical corticosteroids — anywhere from mid to high potency. I won’t often prescribe ultra-potent topical steroids at this age because you can only use them for a short time. After a month or two, I begin implementing topical steroids at the weekend and add topical tacrolimus ointment during the week.
I also encourage all my patients to try narrowband UVB phototherapy. Usually, we’ll do a few in-office sessions to make sure that they tolerate it before trying to get approval for an at-home unit.
In the USA today, there are so many options for at-home UVB treatments that I advise parents to either get a handheld (for smaller areas) or a lightbox. For the moment, dermatologists are limited to topical treatments and light therapy. But I am looking forward to trying the topical JAK inhibitor treatment that is currently under evaluation.
Skincare Tips for Children with Vitiligo
What are your recommendations for children with Vitiligo?
Along with medical treatments, adopting a special skincare routine and preventing sun exposure will ease the severity of Vitiligo.
For all my patients, especially those with visible Vitiligo, protecting affected areas from direct sun exposure is a cornerstone of managing the condition. I advise minimizing tanning on skin that has retained pigment, so that there is not as much of a contrast, as well as, of course, protecting the skin without pigment.
Using waterproof, broad-spectrum (against UVA and UVB rays) products with a high SPF (at least 30) is essential. These must be properly applied at least 15 minutes before any exposure to sunlight—even on overcast days—and reapplied as necessary, if the children love watersports, for example.
I usually recommend mineral sunscreens. They are more effective, don’t contain as many chemicals and it doesn’t matter if children look a little chalky!
Sun protection is a top priority and a large part of caring for Vitiligo, but there are also ways to improve to the skin’s appearance.
White patches of the skin can be sensitive or inflamed so it is important to treat skin gently — not scrubbing or scratching these areas. Using a fragrance-free cleanser and moisturizer will minimize irritation. I don’t condone scrubs in general, but especially not for patients with Vitiligo.
-Avoid tanning beds
Depigmented skin is particularly susceptible to sunburn, so tanning beds or sunlamps should be avoided at all costs.
-Consider corrective make-up
This can be really helpful for teens. Choosing the right color for your skin tone will help blend things out, especially when Vitiligo is visible on the face and neck. Durable, hypoallergenic and waterproof products are preferable.
-Stay away from tattoos
Tattoos are essentially wounds that can cause discoloration to spread.
Does covering up Vitiligo with corrective make-up improve a child’s quality of life?
Treatment can take a while to work — I tell my patients to wait around 9 to 10 months before deciding on another path. But for a teenager, 9 to 10 months is forever! And often, a shorter attention span makes longer stints of treatment challenging.
Corrective make-up can skillfully disguise the skin patches while the treatment is ongoing. Some studies have shown that cosmetic camouflage significantly improves lifestyle factors—leisure, sleep and personal relationships 3—in children and adolescents.
Can herbs and supplements help?
Oral supplements, including vitamins, minerals and botanicals, are being investigated more because of their antioxidant and immunomodulatory benefits. They could be favored as adjuncts to conventional therapy with the aim of achieving stabilization and re-pigmentation of vitiliginous lesions.
To date, the results of oral supplementation studies are promising, and deserve further study in larger, well-designed trials 4.
And finally, what is your definition of healthy skin?
Skin that is smooth and asymptomatic. Skin that serves the purpose of keeping all the bad things out and all the good things in!