From the Guidelines
Vitiligo treatment should prioritize the use of Ruxolitinib cream (Opzelura), a topical JAK inhibitor, as it has shown promising results in repigmentation and reducing the immune response that destroys melanocytes. Recent advancements in vitiligo treatment include several promising options, such as topical calcineurin inhibitors like Tacrolimus and pimecrolimus, which can be used twice daily, particularly for facial vitiligo 1. Narrowband UVB phototherapy, administered 2-3 times weekly for several months, stimulates melanocyte production and is effective for widespread vitiligo, especially in patients with darker skin types, as recommended by the British Journal of Dermatology guidelines 1.
Key Treatment Options
- Ruxolitinib cream (Opzelura) for repigmentation
- Tacrolimus and pimecrolimus for facial vitiligo
- Narrowband UVB phototherapy for widespread vitiligo
- Combination therapy using corticosteroids with phototherapy for better results
- Oral JAK inhibitors like tofacitinib for extensive cases under close medical supervision
- Surgical options like skin grafting or melanocyte transplantation for stable vitiligo that hasn't responded to other treatments
Important Considerations
- Early intervention typically produces better results, so patients should consult dermatologists promptly after noticing depigmentation
- Treatment should be tailored to the individual patient's needs and skin type
- Regular monitoring and follow-up are crucial to assess treatment efficacy and adjust the treatment plan as needed, as recommended by the guidelines 1
From the FDA Drug Label
OPZELURA is a Janus kinase (JAK) inhibitor indicated for: the topical treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older. (1.2) Nonsegmental Vitiligo Apply a thin layer twice daily to affected areas of up to 10% body surface area. (2.3)
Ruxolitinib cream is a new treatment for nonsegmental vitiligo in adult and pediatric patients 12 years of age and older, applied topically twice daily to affected areas of up to 10% body surface area 2.
From the Research
New Treatments for Vitiligo
- Recent studies have investigated the effectiveness of topical tacrolimus monotherapy for repigmentation in vitiligo, with results showing good efficacy and tolerability 3.
- The combination of narrow-band UVB phototherapy and topical tacrolimus has also been shown to be an effective approach for refractory vitiligo, particularly for lesions located on the face, trunk, and limbs 4.
- A systematic review of randomized clinical trials found that tacrolimus, either as monotherapy or combined therapy, is a promising treatment option for vitiligo, with combination therapy showing better results than monotherapy in some cases 5.
- Other studies have also reported the efficacy and safety of tacrolimus ointment in adults and children with vitiligo, particularly when used in combination with other therapies such as narrow-band UVB or laser treatment 6, 7.
Key Findings
- Topical tacrolimus monotherapy can achieve 50% repigmentation of vitiligo patches, with the best results obtained on lesions of the cephalic region, especially the face 3.
- The combination of narrow-band UVB phototherapy and topical tacrolimus can result in variable repigmentation in over 70% of lesions, with clinical response (repigmentation more than 50%) observed in 42% of lesions 4.
- Tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy has been shown to be more effective than NB-UVB alone in inducing >75% repigmentation 5.
- The effect of tacrolimus ointment in combination with NB-UVB has been found to be tacrolimus total dose-dependent, with a significant reduction in the patients' subjective disease impact during the treatment period 7.