A bright future for vitiligo patients

The treatment landscape in vitiligo is rapidly evolving due to an improved understanding of the disease’s pathogenesis. JAK inhibitors, particularly when combined with UV light, currently appear to be the most effective option, and many other therapies are in the pipeline. Prof. Julien Seneschal (University of Bordeaux, France) and Dr Thierry Passeron (CHU Nice, France) guided the audience through the latest developments in the field [1,2].

“About 10 years ago, vitiligo was largely a neglected disease with no available treatments,” said Prof. Seneschal. “Thanks to an improved understanding of the pathogenesis, the community has been able to develop effective therapies.” Currently, ruxolitinib and tacrolimus are approved drugs for patients with vitiligo [3,4].

The global lifetime prevalence of this condition has recently been estimated at 0.36% [5]. “To better manage the clinical heterogeneity of the disease, 5 clinical phenotypes have been identified [6],” noted Prof. Seneschal. These phenotypes can be linked to specific management strategies. Patients with the ‘highly active’ and ‘extensive’ phenotypes benefit from systemic treatment plus narrowband UVB therapy. Those with ‘moderate to severe type 2A Koebner’ or ‘mild types 2A Koebner’ phenotypes can be managed with topical treatment with or without narrowband UVB therapy, while patients with a ‘mild’ disease phenotype may respond sufficiently to topical therapy alone. Dr Passeron added that active vitiligo can be recognised by the Koebner sign, hypochromic borders, and confetti-like depigmentation.

Prof. Seneschal outlined three primary goals in vitiligo treatment: to halt depigmentation, to induce repigmentation, and to prevent relapses. A treatment algorithm has been developed for non-segmental vitiligo, based on treatment pros and cons, disease impact, activity, and lesion location [7,8]. “Oral mini-pulse therapy with oral dexamethasone 5 mg, taken twice weekly, has been effective in stopping vitiligo progression,” said Dr Passeron. “Methotrexate, cyclosporine, and minocycline are also useful, and narrowband UVB remains a cornerstone therapy for halting progression and promoting repigmentation.” Other effective treatment options include combination therapies using topical calcineurin inhibitors or potent corticosteroids alongside sun exposure or narrowband UVB [9]. Tacrolimus 0.1%, applied twice weekly, has been shown to reduce the relapse risk from 40.0% to 9.7% in patients with localised vitiligo [10]. “Narrowband UVB, however, did not improve relapse rates [11],” added Dr Passeron.

JAK inhibitors have emerged as promising agents in vitiligo. “As I mentioned earlier, ruxolitinib is a newly approved topical JAK inhibitor for this indication,” said Prof. Seneschal. Applied twice daily, it led to F-VASI75 and T-VASI50 response rates of 50.3% and 51.1% at week 52 [3]. “Ruxolitinib cream was most effective on the face, followed by the head/neck, extremities, trunk, and the hands and feet [12],” Dr Passeron added. Application site reactions, including acne, were the most frequently treatment-emergent adverse events but were generally mild to moderate [13]. “Importantly, responses continued to improve with time [14],” said Dr Passeron. “About one-third of patients who hadn’t reached F-VASI90 by week 52 did so by week 104.”

Several systemic JAK inhibitors are under investigation. Ritlecitinib, upadacitinib, and povorcitinib are in phase 3 trials. In a phase 2b trial with 364 patients, ritlecitinib did not outperform placebo at week 24 but showed better results by week 48 [15]. It was well tolerated, with only 1.1% experiencing a serious adverse event. In a phase 2 study (n=171), povorcitinib also showed efficacy versus placebo and was generally well tolerated, with no serious adverse events attributed to the treatment [16].

Next to these monotherapy studies, baricitinib and the TYK2 inhibitor deucravacitinib are being evaluated in combination with narrowband UVB therapy in phase 2 studies. “Optimal outcomes may be achieved by combining advanced therapies with narrowband UB therapy,” according to Prof. Seneschal. A study among patients with vitiligo allocated 55 patients to arm A or arm B; patients with T-VASI25 scores below 25 received ruxolitinib plus narrowband UVB therapy (arm A), and patients with T-VASI scores ≥25 received ruxolitinib monotherapy. The addition of narrowband UVB therapy appeared to accelerate response rates. At week 48, F-VASI75 was achieved by 84.6% and T-VASI50 was reached by 57.7% of the patients on combination therapy [17].

“Another study is evaluating the combination of baricitinib with narrowband UVB therapy in patients with more severe disease,” said Prof. Seneschal. At week 36, the investigators observed a 44.8% change in T-VASI score. In addition, 52.9% achieved a T-VASI50 score at week 36, and 26.5% and 5.9% of the patients had reached T-VASI75 or T-VASI90 at this time point, respectively [18].

Prof. Seneschal also pointed to  evidence that early intervention may be warranted to prevent accumulation of vitiligo-specific T-cells [19]. These data align with the paradigm of ‘hit early, hit hard,’ as a way to control various inflammatory conditions.

Finally, many other drugs with divergent mechanisms-of-action are currently being tested in vitiligo. Some of these investigational agents include afamelanotide, an α-melanocyte-stimulating hormone analogue currently in phase 3 in combination with narrowband UVB therapy; anifrolumab, a type 1 interferon receptor inhibitor currently in phase 2 in combination with narrowband UVB therapy; and various IL-15 inhibitors.

“In short, topical and systemic JAK inhibitors offer new hope for our patients with vitiligo,” Prof. Seneschal concluded. “And combining these treatments with UV light appears to lead to quicker responses and improved outcomes.” Dr Passeron added that we must not forget the time required, often several months, to achieve a treatment result.

1. Seneschal J. Vitiligo. SPIN Dermatology Congress, Paris, France, 2-4 July 2025
2. Passeron T. Vitiligo: Treatment options. SPIN Dermatology Congress, Paris, France, 2-4 July 2025
3. Rosmarin D, et al. NEJM. 2022;387:1445-1455
4. Seneschal J, et al. Dermatol Pract Concept. 2023;13(4)S2:e2023313S
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8. Van Geel N, et al. JEADV. 2023;37(11):2173-2184
9. Lee J, et al. JAMA Dermatol. 2019;155(8):929-938
10. Cavalle M, et al. J Invest Dermatol. 2015;135:970-974
11. Attia MS. 2024 Vitiligo International Symposium, 13-15 December, Cairo, Egypt.
12. Passeron T, et al. JEADV. 2025;39:e251-e254
13. Wolkerstorfer A. Oral presentation FC01, 2022 EADV, 7-10 September, Milan, Italy.
14. Rosmarin D. Late-breaking abstract, 2023 AAD, 17-21 March, New Orleans, LA, USA.
15. Ezzedine K, et al. JAAD. 2022;S0190-9622(22)02989-9
16. Pandya AG, et al. JAAD. 2025; June 13. DOI: 1016/j.jaad.2025.06.027.
17. Kornacki D. 2024 Vitiligo International Symposium, 13-15 December, Cairo, Egypt.
18. Seneschal J, et al. JAMA Dermatol. 2025;161(4):375-382
19. Boniface K, et al. Exp Dermatol. 2019;28:656-661

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Posted on 21 August 202525 August 2025