JAK inhibitors reshape vitiligo treatment approaches

Janus kinase (JAK) inhibitors are transforming vitiligo treatment, with topical and oral agents serving distinct clinical roles. According to Iltefat Hamzavi, MD, of Henry Ford Health, topical ruxolitinib cream is a preferred option for localized, stable disease affecting less than 10% of the body surface area due to its strong safety profile.

Oral JAK inhibitors, such as upadacitinib, ritlecitinib, and povorcitinib, are better suited for patients with rapidly progressive disease or those where vitiligo affects more than 10% of the body surface area. While phase 3 trials involving nearly 3,000 patients showed few systemic adverse effects, clinicians are advised to exercise caution when prescribing oral agents to patients with high cardiovascular risk, high BMI, smoking histories, or high cholesterol.

Clinical markers of unstable or progressive vitiligo include trichrome lesions, confetti-like depigmentation, and koebnerization. The emergence of these targeted therapies provides more long-term safety data compared to previous off-label treatments like steroids or calcineurin inhibitors.