Cibinqo (Abrocitinib) for Vitiligo
Cibinqo (abrocitinib) is NOT approved for vitiligo and should not be used for this indication. Abrocitinib is FDA-approved exclusively for moderate-to-severe atopic dermatitis in patients who have failed other systemic therapies, and established vitiligo treatment guidelines do not include this medication 1.
Why Abrocitinib Is Not Recommended for Vitiligo
Lack of Guideline Support
- The British Association of Dermatologists' comprehensive vitiligo guidelines (which represent the most authoritative evidence-based recommendations) make no mention of JAK inhibitors, including abrocitinib, as treatment options 1.
- Established first-line treatments for vitiligo include potent topical corticosteroids (achieving 15-25% repigmentation in 43% of patients), topical calcineurin inhibitors, and narrowband UVB phototherapy 2.
FDA Approval Status
- Abrocitinib is approved only for atopic dermatitis at doses of 100-200 mg daily, with specific requirements for baseline laboratory monitoring (CBC with differential, liver enzymes, lipids, viral hepatitis, tuberculosis screening) 1.
- The FDA has applied class-wide warnings for JAK inhibitors regarding increased risks of serious cardiovascular events, cancer, blood clots, and death based on data from other JAK inhibitors in different populations 1.
Emerging Evidence on JAK Inhibitors in Vitiligo
Limited Case Report Data
- One case report describes a 61-year-old male with acrofacial vitiligo who achieved significant improvement with abrocitinib 100 mg daily for 2 months after plateauing on tacrolimus and oral prednisone 3.
- However, a single case report does not constitute sufficient evidence to recommend off-label use, especially given the serious safety warnings associated with JAK inhibitors 3.
Other JAK Inhibitors Show Promise
- Tofacitinib (oral and topical) and baricitinib have more extensive study in vitiligo, with a 2025 study showing that low-dose baricitinib 2 mg daily combined with NB-UVB achieved T-VASI50 response in 70.6% of patients versus 12.5% with NB-UVB alone 4, 5.
- Topical ruxolitinib has been studied more extensively than oral abrocitinib for vitiligo 4, 6.
Recommended Treatment Algorithm for Vitiligo
For Limited/Localized Disease
- Start with potent topical corticosteroids (clobetasol propionate 0.05% or betamethasone valerate 0.1%) for maximum 2 months to prevent skin atrophy 2, 1.
- Alternative: Topical calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus 1%) provide comparable efficacy with superior safety profile, particularly for facial involvement 2, 1.
For Widespread/Generalized Disease
- Narrowband UVB phototherapy is preferred over PUVA, offering superior efficacy and safety, with a maximum of 200 treatments for skin types I-III 2, 1.
- Document disease extent with serial photographs every 2-3 months using VASI or VETF scoring systems 2, 7.
Critical Pitfalls to Avoid
- Never use oral dexamethasone for vitiligo due to unacceptable side-effects (Grade B recommendation) 8, 1.
- Never perform surgical treatments unless disease has been completely stable for at least 12 months with no Koebner phenomenon 2, 7.
- Never extend potent topical steroid use beyond 2 months to avoid skin atrophy 2, 7.
Bottom Line
Use established, guideline-supported treatments for vitiligo rather than off-label abrocitinib. If considering JAK inhibitors for refractory vitiligo, baricitinib or tofacitinib have more supporting evidence, but these remain investigational and are not guideline-recommended 4, 5. The risk-benefit profile of abrocitinib specifically for vitiligo remains unknown, and the serious cardiovascular and thrombotic risks associated with JAK inhibitors warrant extreme caution 1.