Vitiligo: Ruxolitinib and Other Oral Treatment Options Beyond Ruxolitinib

Vitiligo is a chronic autoimmune disorder marked by the loss of melanocytes, causing depigmented patches across the skin. Affecting up to 2% of the global population, vitiligo presents significant psychological impacts, particularly in those with darker skin types. Current hypotheses attribute its etiology to autoimmune destruction, genetic predisposition, and environmental triggers like trauma and stress.

A comprehensive review of recent studies was conducted using PubMed and Google Scholar, focusing on systemic treatments for vitiligo, particularly JAK inhibitors (ruxolitinib, upadacitinib, tofacitinib, ritlecitinib, and baricitinib). Eligible studies included trials and case reports on adults with vitiligo evaluating treatment efficacy, safety, and tolerability.

Topical ruxolitinib has achieved the highest efficacy in repigmenting facial and sun-exposed areas, particularly when combined with phototherapy. Emerging evidence supports oral Janus kinase (JAK) inhibitors, especially upadacitinib and tofacitinib, for their repigmenting effects in refractory cases, though side effects like acne and neutropenia warrant monitoring. Limited evidence supports methotrexate and minocycline as adjunct therapies, with minor repigmentation observed.

Advances in systemic and topical JAK inhibitors have shown promising repigmentation effects in vitiligo, particularly for localized facial lesions. Ruxolitinib cream, the first FDA-approved therapy, and other JAK inhibitors highlight a growing therapeutic approach, with ongoing trials needed to optimize efficacy and evaluate long-term safety. Combination therapy with phototherapy shows enhanced repigmentation outcomes.