Vitiligo is an chronic disorder of the skin in which immune cells destroy melanocytes, the skin cells that produce pigment. Researchers estimate that between 1.9 and 2.8 million adults in the United States have vitiligo; it is estimated 40 percent of adults with vitiligo going undiagnosed. This can be cosmetically very disabling, particularly in people with darker skin.
Vitiligo is the result of autoimmune destruction of melanocytes where the immune system attacks the skin pigmentation cells. There are relatively few treatments available for vitiligo.
Historically, dermatologists have treated vitiligo with topical steroids (such as desonide or clobetasol) or topical calcineurin inhibitors (such as tacrolimus ointment or pimecrolimus cream). These topical creams and ointments work by causing local immunosuppression preventing the immune cells from attacking the melanocytes. These treatments are not FDA-approved for vitiligo and have been used off-label.
Finally in 2022, Opzelura (ruxolitinib) is the first and only FDA-approved prescription treatment for vitiligo repigmentation. It is clinically proven to help restore some skin color over time. About 50 percent of people using ruxolitinib had significant repigmentation after one year. Ruxolitinib belongs to a class of drugs called Janus kinase (JAK) inhibitors. JAK inhibitors work by blocking certain enzymes that cause inflammation and are commonly used orally for the treatment of rheumatoid arthritis and alopecia areata. Ruxolitinib is the only topical JAK inhibitor approved in the United States and is FDA-approved for vitiligo.
Aside from topical medications, there are light based therapies that can help with vitiligo. Newport Beach Dermatology and Plastic Surgery has one of the most effective light based treatments for vitiligo called XTRAC which is a brand of excimer light therapy. Fortunately, XTRAC treatments can minimize, and in many cases, even eliminate vitiligo depigmented patches. Excimer delivers a wavelength of 308 nanometers and uses the same principles as phototherapy but with faster results. Studies have concluded that when XTRAC is used as monotherapy, repigmentation of rates greater than 75% are seen in more than 50% of patients but response rates as high as 95% have been achieved. It has also been noted that repigmentation can be seen in as few as 11 treatments.
We are excited to offer these new treatment options to our patients for vitiligo.