V itiligo is as challenging to treat as it is to live with. There aren’t many therapies to choose from, and most have significant drawbacks. That could be changing. In June 2022, the U.S. Food and Drug Administration (FDA) approved the first Janus kinase (JAK) inhibitor to treat unsegmented vitiligo, the most common type of the condition, in people 12 and up.
The drug, ruxolitinib (Opzelura), is a topical cream that’s already used to treat eczema, which, like vitiligo, is an autoimmune skin condition. Now that the drug has gotten the green light from the FDA to treat vitiligo, it’s likely paving the way for other topical JAK inhibitors to become available for treating this challenging disease.
People of color may be especially interested in trying a topical JAK inhibitor. Although vitiligo isn’t more prevalent among them, it is more noticeable. “This is a huge win for the community and for dermatologists who treat vitiligo,” says New York City dermatologist Daniel Gutierrez, MD, vitiligo specialist with NYU Langone Health.
Which is all to say, it may be worth talking to your dermatologist about JAK inhibitors if your current treatment for vitiligo isn’t working as well as you’d like. The same is true if you have a teenager with the condition, as ruxolitinib is approved for kids as young as 12. Before you do, learn all you can about the drug.
6 Essential Facts About Topical JAK Inhibitors for Vitiligo
1. Topical JAK inhibitors can be effective when other treatments aren’t.
Because they work by interrupting the inflammatory process, topical JAK inhibitors are likely to be most effective when used early in the course of the disease, when inflammation is most active, says Dr. Gutierrez.
This isn’t to say that if you’ve been living with vitiligo for a long time, a topical JAK inhibitor won’t help you. “I have patients who have had vitiligo for years without a good response to traditional therapies start to see some of their pigment come back with ruxolitinib,” says dermatologist Nicole S. Gunasekera, MD, director of the vitiligo clinic at Brigham and Women’s Hospital in Boston.
2. It’s possible to see results relatively quickly with topical JAK inhibitors.
“Some people notice little speckles of normal pigment coming back within the first couple weeks of using ruxolitinib,” says Dr. Gunasekera, but others may not see significant changes for six months or more. For example, in clinical trials of ruxolitinib, 30 percent of people with vitiligo saw up to 75 percent improvement after 24 weeks, notes Gutierrez.
3. Topical JAK inhibitors tend to work better on some parts of the body than others.
Ruxolitinib is most effective on relatively small patches of skin, says Gunasekera, which is in keeping with the fact that it can only be used on 10 percent or less of the surface area of the body. So if you have vitiligo that affects more than 10 percent of your skin, you’ll pick the areas you feel most self-conscious about to treat with the cream. If these areas happen to be on your face, you may be in luck, as facial skin tends to respond better to topical medication than the skin on other parts of the body, says Gunasekera.
4. The side effects of topical JAK inhibitors tend to be mild.
Because the medication is applied directly to the skin, that’s where side effects are likely to show up. The most common ones from ruxolitinib, for example, include redness, itching, and acne-like breakouts. The medication also may bring on coldlike symptoms, headaches, fevers, and urinary tract infections.
Even so, the medication does have a black box warning, based largely on the potentially dangerous side effects associated with oral ruxolitinib (Jakafi):
- Serious infections
- Blood clots
- Heart attack
These warnings are primarily “a better-safe-than-sorry approach by the FDA. There’ve been no significant reports of serious side effects from people using the cream,” notes Gunasekera.
5. The first topical JAK inhibitor approved to treat vitiligo is likely to pave the way for more options.
Among those being studied:
- A topical version of tofacitinib, which is available as an oral medication (brand name Xeljanz), to treat rheumatoid arthritis (RA), ankylosing spondylitis, and ulcerative colitis, among others
- A topical version of baricitinib (Olumiant), an oral medication approved to treat RA and alopecia areata
Jakafi is being studied to treat vitiligo also.
6. A topical JAK inhibitor may be a great treatment option for kids.
Any condition that affects the skin can be especially detrimental to emotional health and quality of life, given that the symptoms are so visible. This is especially true for appearance-conscious teenagers. Ruxolitinib works just as well for kids 12 and over as it does for adults and is just as safe, according to a study presented at the American Academy of Dermatology’s 2022 annual meeting.
7 FAQs About Using a Topical JAK Inhibitor to Treat Vitiligo
Should You Try a Topical JAK Inhibitor?
Ask yourself these questions as a first step toward deciding if you’d like to talk to your dermatologist about trying a JAK inhibitor to treat vitiligo.
- Am I satisfied with my current treatment plan?
- Am I able to follow the plan as directed?
- Has my vitiligo improved as well as I’d hoped?
- Have new patches cropped up, even though I’ve been following my treatment plan?
- Does the appearance of my skin have negative effects on my quality of life, self-image, or mood?
- Have I tried all other treatment options available to me and not found one that works?
To make sure your discussion with your dermatologist gets you all the information you need about trying a topical JAK inhibitor for vitiligo, come prepared with specific questions to ask. Some examples:
- Do you think it’s possible for me to gain better control of my vitiligo?
- What else can I do to better manage these vitiligo areas?
- Do I need to take a break from certain treatments?
- Is there anything I can do to help make my treatment more effective?
- What do I need to know about sun exposure?
- What should I do if the vitiligo patches on my skin don’t improve or start to spread?
- Am I a good candidate for the topical JAK inhibitor ruxolitinib?