Advances in Vitiligo Treatment and Management

At Fall Dermatology Week, Dr Susan Taylor highlighted significant progress in vitiligo treatment, focusing on Janus kinase (JAK) inhibitors and their potential for repigmentation. She discussed Phase II trials of oral baricitinib combined with narrow-band UVB (NB-UVB) therapy, noting, “Oral baricitinib with NB-UVB showed significant repigmentation and may complement topical ruxolitinib as a treatment for non-segmental vitiligo.”

Dr Taylor emphasized a multidisciplinary approach to vitiligo care, involving primary care, dermatology, psychiatry, and other specialists to manage autoimmune and psychological aspects. She highlighted the importance of depression screening and support services, stating, “Collaboration ensures effective treatment and overcomes barriers to necessary care.” Pharmacists assist in accessing medications, with resources from the American Academy of Dermatology aiding in prior authorization for JAK inhibitors. Documenting body surface area involvement is key for coverage.

Vitiligo's economic burden is significant, with 2013 data showing over 150,000 patients seeking treatment, incurring costs of over $49 million. Individual medical costs were 3 times higher than for rosacea and double those for acne, including doctor fees, medication, sunscreen, and cosmetics. Indirect costs included psychosocial impacts and productivity losses. Patients with vitiligo had higher emergency room, inpatient, and outpatient visit rates, making these the largest cost contributors. People of color showed higher odds of diagnosis, likely due to earlier detection in darker skin tones and greater psychosocial impact. Dr Taylor urged timely diagnosis, particularly in underserved communities.

Advances in understanding JAK-mediated inflammation have positioned JAK inhibitors as promising treatments. While topical 1.5% ruxolitinib cream is US Food and Drug Administration approved, oral JAK inhibitors are being explored in clinical trials.

Dr Taylor concluded that managing vitiligo requires a multidisciplinary strategy due to its high costs and quality-of-life impact. She expressed hope for future treatments and encouraged continuous education and provider collaboration to support patients.

Reference

Taylor S. Beyond face value: targeted therapies for vitiligo and strategies for improving patient quality of life. Presented at: Dermatology Week; November 13–16, 2024; Virtual.