Treatment of vitiligo with topical ruxolitinib: a narrative review

Vitiligo is a chronic autoimmune disorder characterized by the selective destruction of melanocytes, leading to depigmented patches of skin. Whilst its pathogenesis is not fully understood, genetic predisposition, environmental triggers, oxidative stress, metabolic dysfunction and impaired cell adhesion are all implicated. Vitiligo occurs in two primary forms - non-segmental and segmental - and affects approximately 0.5-2% of the global population. Beyond its physical manifestations, vitiligo imposes a significant psychosocial burden on patients. Current treatments include topical corticosteroids, calcineurin inhibitors, systemic immunosuppressants and narrowband UVB phototherapy. More recently, Janus kinase (JAK) inhibitors have emerged as promising targeted therapies. Topical ruxolitinib 1.5% cream has been approved by both the FDA and EMA for the treatment of non-segmental vitiligo in adolescents and adults, following its demonstrated efficacy and favourable tolerability in clinical trials. Although some risks, such as infection, malignancy, major adverse cardiovascular events and thrombosis, have been raised due to class-wide JAK inhibition concerns, these events appear to be rare with topical use, as no systemic drug accumulation has been reported. Given its safe and therapeutic profile, ruxolitinib is an effective targeted therapy for non-segmental vitiligo. This narrative study aims to review and synthesize the current evidence on the safety, efficacy and therapeutic impact of topical ruxolitinib cream in vitiligo.