Facial Vitiligo Research Articles

Portrait of an old man with facial vitiligo by Adolph von Menzel.

Adolph von Menzel (1815–1905) is a very important German realism painter from the 19th century. In 1861 he painted, with great precision, a portrait of a sitter who we hypothesize had facial vitiligo.

Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo

BackgroundVitiligo is a chronic autoimmune disease that causes skin depigmentation. A cream formulation of ruxolitinib (an inhibitor of Janus kinase 1 and 2) resulted in repigmentation in a phase 2 trial involving adults with vitiligo.MethodsWe conducted two phase 3, double-blind, vehicle-controlled trials (Topical Ruxolitinib Evaluation in Vitiligo Study 1 [TRuE-V1] and 2 [TRuE-V2]) in North America and Europe that involved patients 12 years of age or older who had nonsegmental vitiligo with depigmentation covering 10% or less of total body-surface area. Patients were randomly assigned in a 2:1 ratio to apply 1.5% ruxolitinib cream or vehicle control twice daily for 24 weeks to all vitiligo areas on the face and body, after which all patients could apply 1.5% ruxolitinib cream through week 52. The primary end point was a decrease (improvement) of at least 75% from baseline in the facial Vitiligo Area Scoring Index (F-VASI; range, 0 to 3, with higher scores indicating a greater area of facial depigmentation), or F-VASI75 response, at week 24. There were five key secondary end points, including improved responses on the Vitiligo Noticeability Scale.ResultsA total of 674 patients were enrolled, 330 in TRuE-V1 and 344 in TRuE-V2. In TRuE-V1, the percentage of patients with an F-VASI75 response at week 24 was 29.8% in the ruxolitinib-cream group and 7.4% in the vehicle group (relative risk, 4.0; 95% confidence interval [CI], 1.9 to 8.4; P<0.001). In TRuE-V2, the percentages were 30.9% and 11.4%, respectively (relative risk, 2.7; 95% CI, 1.5 to 4.9; P<0.001). The results for key secondary end points showed superiority of ruxolitinib cream over vehicle control. Among patients who applied ruxolitinib cream throughout 52 weeks, adverse events occurred in 54.8% in TRuE-V1 and 62.3% in TRuE-V2; the most common adverse events were application-site acne (6.3% and 6.6%, respectively), nasopharyngitis (5.4% and 6.1%), and application-site pruritus (5.4% and 5.3%).ConclusionsIn two phase 3 trials, application of ruxolitinib cream resulted in greater repigmentation of vitiligo lesions than vehicle control through 52 weeks, but it was associated with acne and pruritus at the application site. Larger and longer trials are required to determine the effect and safety of ruxolitinib cream in patients with vitiligo. (Funded by Incyte; TRuE-V1 and TRuE-V2 ClinicalTrials.gov numbers, NCT04052425 and NCT04057573.)

Management of vitiligo with topical janus tyrosine kinase inhibitor therapy: An evidence-based review

To the Editor: Vitiligo is an acquired depigmenting skin disorder due to the absence of functional melanocytes affecting up to 1% of the general population.1Ezzedine K. Eleftheriadou V. Whitton M. van Geel N. Vitiligo.Lancet. 2015; 386: 74-84https://doi.org/10.1016/S0140-6736(14)60763-7Abstract Full Text Full Text PDF PubMed Scopus (449) Google Scholar Initial treatment typically involves topical corticosteroids, topical calcineurin inhibitors, and phototherapy; however, topical Janus kinase inhibitors (JAKi) are being explored as a potential treatment option. This systematic review examines the efficacy and safety of topical JAKi therapies in vitiligo. Following the PRISMA guidelines, MEDLINE and Embase Ovid searches were conducted, using variations and synonyms of keywords “Vitiligo” and “JAK inhibitor” (Supplementary File 1, available via Mendeley at https://data.mendeley.com/datasets/ngwr9gns95). After independent screening of 240 articles by 2 reviewers with no exclusion based on study type, 12 studies involving 213 patients were included. (Fig 1; Supplementary File 2, available via Mendeley at https://data.mendeley.com/datasets/ngwr9gns95). The mean age was 48.5 years (range: 4-73 years), with 108 males (50.7%) and 105 females (49.3%). Ruxolitinib (84%) was the most common therapy followed by tofacitinib (15%) and delgocitinib (1%). Treatment duration was described in 212 instances (mean: 44.9 weeks; range: 4.6-52 weeks). Facial Vitiligo Area and Severity Index (F-VASI) scores were measured in 159 cases, with 64.8%, 53.5%, and 29.6% of cases achieving ≥50% (VASI50), ≥75% (VASI75), and ≥90% (VASI90) reductions from baseline VASI, respectively. Total VASI (T-VASI) scores were measured in 83.6% of cases, with 33.5%, 11.2%, and 6.7% of cases achieving ≥50% (T-VASI50), ≥75% (T-VASI75), and ≥90% (T-VASI90) reductions from baseline T-VASI, respectively. Concurrent treatment with non-JAKi therapies was noted in 39 cases, with phototherapy and topical corticosteroids accounting for 23 and 6 of the concurrent treatments, respectively (Supplementary File 2). Adverse events were reported in 113 cases using JAKi, with pruritis (12.2%), upper respiratory tract infections (10.8%), and acne (8.5%) being the most documented adverse events. The appeal of topical JAKi is the potential to provide adequate response in patients no longer responding to older topical agents and to reduce adverse events of interest (eg, infections) that may present through oral JAKi administration.2Solimani F. Meier K. Ghoreschi K. Emerging topical and systemic JAK inhibitors in dermatology.Front Immunol. 2019; 10: 2847https://doi.org/10.3389/fimmu.2019.02847Crossref PubMed Scopus (101) Google Scholar Ruxolitinib was the most studied topical JAKi treatment for vitiligo, with 49.7% and 29.6% of cases achieving F-VASI50/T-VASI50, respectively. In a phase 2 randomized controlled trial of topical ruxolitinib for vitiligo, 45% and 30% of cases achieving F-VASI50/T-VASI50, respectively.3Rosmarin D. Pandya A.G. Lebwohl M. et al.Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial.Lancet. 2020; 396: 110-120https://doi.org/10.1016/S0140-6736(20)30609-7Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Ruxolitinub’s mechanism of action involves JAK mediated inhibition of IFNγ (interferon gamma) signaling. The IFNγ induced expression of C-X-C motif chemokine 10 in keratinocytes is an important mediator of depigmentation in vitiligo.3Rosmarin D. Pandya A.G. Lebwohl M. et al.Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial.Lancet. 2020; 396: 110-120https://doi.org/10.1016/S0140-6736(20)30609-7Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Topical tofacitinib resulted in 46.9% and 53.1% of cases achieving F-VASI50/T-VASI50, respectively. Tofacitinib works in a similar fashion to ruxolitinib, with any differences in efficacy owing to targeting of JAK1/3 as opposed to JAK1/2 with ruxolitinib.4Papp K.A. Menter A. Strober B. et al.Efficacy and safety of tofacitinib, an oral Janus kinase inhibitor, in the treatment of psoriasis: a phase 2b randomized placebo-controlled dose-ranging study.Br J Dermatol. 2012; 167: 668-677https://doi.org/10.1111/j.1365-2133.2012.11168.xCrossref PubMed Scopus (257) Google Scholar Ruxolitinib is currently the only topical JAKi to receive FDA approval for vitiligo treatment.5Sheikh A. Rafique W. Owais R. Malik F. Ali E. FDA approves ruxolitinib (Opzelura) for vitiligo therapy: a breakthrough in the field of dermatology.Ann Med Surg (Lond). 2022; 81: 104499https://doi.org/10.1016/j.amsu.2022.104499Crossref PubMed Scopus (2) Google Scholar Study limitations included lack of follow-up data and potential selection bias for cases with improved outcomes. Given the lack of standardized outcome measures and data heterogeneity, a meta-analysis could not be performed. Despite this, we highlight evidence for the effectiveness and safety of topical JAKi therapies, specifically ruxolitinib and tofacitinib, for treating vitiligo. Further long-term studies are warranted to establish practical clinical applications of topical JAK inhibitors. Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant, and Xenon. Abduelmula, Mufti, Chong, Sood, and Sachdeva have no conflicts of interest to declare.

Meaningful Changes in What Matters to Individuals with Vitiligo: Content Validity and Meaningful Change Thresholds of the Vitiligo Area Scoring Index (VASI).

IntroductionThis study explored patients’ and dermatologists’ priority outcomes for treatment to address, clinical outcome assessments (COA) for use in vitiligo clinical trials, and perceptions of within-patient meaningful change in facial and total body vitiligo.MethodsSemistructured, individual, qualitative interviews were conducted with patients living with non-segmental vitiligo in the USA and with expert dermatologists in vitiligo. Concept elicitation discussions included open-ended questions to identify patient priority outcomes. Vitiligo COAs were reviewed by dermatologists. Tasks were completed by patients to explore their perceptions of meaningful changes in vitiligo outcomes; dermatologists’ opinions were elicited. Data were analyzed using thematic methods; meaningful change tasks were descriptively summarized.ResultsIndividuals with vitiligo (N = 60) included adults (n = 48, 63% female) and adolescents (n = 12, 67% female). All Fitzpatrick Skin Types were represented. Eight (13%) were first- or second-generation immigrants to the USA. Expert dermatologists (N = 14) participated from the USA (n = 8), EU (n = 4), India (n = 1), and Egypt (n = 1). All individuals with vitiligo reported experiencing skin depigmentation; an observable clinical sign of vitiligo. Most confirmed that lesion surface area (n = 59/60, 98%) and level of pigmentation (n = 53/60, 88%) were important to include in disease assessments. Following an explanation, participants (n = 49/60, 82%) felt that the Facial Vitiligo Area Scoring Index (F-VASI) measurement generally made sense and understood that doctors would use it to assess facial vitiligo. Most participants felt that a 75% (n = 47/59, 80%) or 9 0% improvement in their facial vitiligo would be indicative of treatment success (n = 55/59, 93%). In the context of evaluating a systemic oral treatment for vitiligo, dermatologists perceived a 75% improvement on the F-VASI as successful (n = 9/14, 64%). Regarding the Total VASI (T-VASI) score, n = 30 participants considered 33% improvement as treatment success; an additional n = 10 endorsed 50% improvement and a further n = 5 endorsed 75% improvement. Clinicians most frequently identified 50% (n = 6/14, 43%) or 75% (n = 4/14, 29%) improvement in T-VASI as successful.ConclusionRepigmentation is a priority outcome for patients. The VASI was considered an appropriate tool to assess the extent of vitiligo. A minimum 75% improvement from baseline in the F-VASI and minimum 50% improvement from baseline in the T-VASI were identified as within-patient clinically meaningful thresholds.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00752-8.

CO130 Subgroup Analysis of Quality-of-Life Outcomes in Patients Achieving F-VASI75: Pooled Results from Two Randomized Phase 3 Studies of Ruxolitinib Cream for the Treatment of Vitiligo

Vitiligo is a chronic autoimmune skin disease associated with quality-of-life (QoL) burden. Ruxolitinib (Janus kinase [JAK] 1/JAK2 inhibitor) cream demonstrated clinically meaningful repigmentation and was generally well tolerated in the 52-week TRuE-V1/TRuE-V2 phase 3 vitiligo studies. Pooled interim subgroup analyses of QoL outcomes are reported in patients who achieved the primary endpoint of ≥75% improvement in facial Vitiligo Area Scoring Index (F-VASI75), since QoL improvements often require a high degree of repigmentation in vitiligo.

Translated article] Facial Vitiligo After SARS-CoV-2 Vaccination

Translated article] Facial Vitiligo After SARS-CoV-2 Vaccination

Periorificial lesions associated with poor prognosis in patients with localized vitiligo: A retrospective study of 126 patients

Periorificial lesions associated with poor prognosis in patients with localized vitiligo: A retrospective study of 126 patients

Subjective versus objective recognition of facial vitiligo lesions: detection of subclinical lesions by Wood’s light

Subjective versus objective recognition of facial vitiligo lesions: detection of subclinical lesions by Wood’s light

Skin conditions among 20th century politicians and world leaders.

The health of world leaders is a legitimate source of concern for the global population, and for historians. Cognitive disorders may impact their mandate decisions, particularly when occurring early in office [1]. Cancer and cardio-vascular diseases may lead to disability with impossibility to carry out expected duties or unexpected death with power vacuum [2]. World history has repeatedly showed that politicians tended to keep their illnesses hidden from the public long before they became obvious [2].

Development and validation of the fingertip unit for assessing Facial Vitiligo Area Scoring Index

Facial involvement of vitiligo is an important factor in a patient's life and has often been evaluated separately from body surface area in clinical trials. However, no reliable tools to measure facial vitiligo specifically are available thus far. To develop and validate a practical instrument for assessing facial vitiligo. The ratios of a hand to a fingertip unit (FTU) of 98 healthy volunteers (age range, 2-69years) were calculated to define the FTU. Facial Vitiligo Area Scoring Index was measured as the sum of all FTUs of each vitiligo lesion on the face (range, 0-112 FTU). In the validation study, 6 raters evaluated 11 patients with facial vitiligo twice at an interval of 2weeks. One hand was measured at 32.1±1.3 FTU, which was highly consistent among subjects across different age groups, sexes, and races. Facial Vitiligo Area Scoring Index showed remarkably high accuracy (concordance correlation coefficient, 0.946; smallest detectable change, 2.2 FTU) as well as high intrarater reliability (intraclass correlation coefficient, 0.903; inter-rater reliability, 0.903). Lack of dynamic validation of responsiveness. Facial Vitiligo Area Scoring Index using the FTU is an intuitive, precise, and reliable instrument for assessing the extent of facial involvement in vitiligo patients.

Efficacy and Safety of Tacrolimus 0.1% for the Treatment of Facial Vitiligo: A Multicenter Randomized, Double-Blinded, Vehicle-Controlled Study

Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use. This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo. This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension. Participants included were adult patients with recent facial vitiligo target lesions (<2 years) without changes in pigmentation or size over the previous 3 months. Patients received either tacrolimus 0.1% ointment or vehicle twice daily. The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians' global assessment scores and patients' satisfaction scores, safety data, and the rate of relapse at week48. A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P < 0.0001). Only 40% of relapse was observed at 48 weeks. Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo. This study was registered at ClinicalTrials.gov (identifier: NCT02466997).

The additive efficacy of therapeutic low-intensity pulsed ultrasound in the treatment of vitiligo: A randomized, left-right comparison clinical trial.

Repigmentation of vitiligo relies on the proliferation and migration of melanoblasts from hair follicles to the epidermis to replenish epidermal melanin. Our previous study has demonstrated low-intensity pulsed ultrasound (LIPUS) can stimulate melanoblast migration in vitro. We sought to evaluate the potential additive efficacy and safety of LIPUS for repigmentation of vitiligo. Twenty-seven adult patients with stable generalized vitiligo on the face or trunk were recruited in this randomized, open, left-right comparison study. In each patient, two symmetric lesional sites were randomly selected; one was assigned as the target lesion, which was treated with add-on LIPUS twice weekly for 24 weeks, and the other as the control lesion, which was administrated with sham sonification. The primary outcome was the difference of repigmentation degree between the target and control lesions at week 24, based on the 7-point physician global assessment score. At the end of study, 23 patients with vitiligo on the face (n = 10) or trunk (n = 13) completed the 24-week treatment course. Enhanced repigmentation for vitiligo receiving LIPUS as compared to sham sonification was observed in 38.5% (5/13) of the patients with truncal vitiligo, but none of those with facial vitiligo. Truncal vitiligo (P = .046) and higher intensity of LIPUS administered (P = .01) were statistically significantly associated with the effectiveness of additive LIPUS treatment. The LIPUS treatment was well-tolerated without remarkable adverse effects. This pilot study showed that LIPUS could provide therapeutic benefits and could be considered as a treatment adjunct for truncal vitiligo.

Clinical outcomes of topical bimatoprost for nonsegmental facial vitiligo: A preliminary study.

Vitiligo is a common acquired pigmentary disorder. Bimatoprost ophthalmic solution was indicated in the treatment of open-angle glaucoma and eyebrow hypotrichosis. However, lid hyperpigmentation was reported as a complication. To study the efficacy and safety of 0.01% bimatoprost solution compared with 0.1% tacrolimus ointment in patients with nonsegmental facial vitiligo. Patients with more than 2 vitiliginous patches on the face were enrolled. Vitiliginous patches were randomized to receive topical 0.1% tacrolimus ointment or 0.01% bimatoprost ophthalmic solution, applied twice daily for 12weeks. The vitiligo surface area (VSA, cm2 ) was calculated, and the percentage of repigmentation was assessed. Ten patients completed the study. At the baseline, the mean VSA was comparable between the two groups. By week 12, the VSA decreased at a statistically significant level among both groups compared to the baseline (P<.05). However, there was not a statistically significant difference between both groups. In terms of repigmentation at week 12, 20% of the patients in the bimatoprost group and 10% in the tacrolimus group achieved >50% repigmentation; the overall grading score between two groups were not different at a statistically significant level. The side effects of bimatoprost were reported as itching and burning. There were no changes in intraocular pressure in 2 patients who had lid involvement. Topical bimatoprost solutions were safe and effective for the treatment of nonsegmental facial vitiligo with comparable results to tacrolimus ointment. It can be considered as an alternative treatment for facial vitiligo.

Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial

Vitiligo is a chronic autoimmune disease resulting in skin depigmentation and reduced quality of life. There is no approved treatment for vitiligo repigmentation and current off-label therapies have limited efficacy, emphasising the need for improved treatment options. We investigated the therapeutic potential of ruxolitinib cream in patients with vitiligo and report the efficacy and safety results up to 52 weeks of double-blind treatment. We did a multicentre, randomised, double-blind, phase 2 study for adult patients with vitiligo in 26 US hospitals and medical centres in 18 states. Patients with depigmentation of 0·5% or more of their facial body surface area (BSA) and 3% or more of their non-facial BSA were randomly assigned (1:1:1:1:1) by use of an interactive response technology system to receive ruxolitinib cream (1·5% twice daily, 1·5% once daily, 0·5% once daily, or 0·15% once daily) or vehicle (control group) twice daily on lesions constituting 20% or less of their total BSA for 24 weeks. Patients in the control group in addition to patients in the 0·15% once daily group who did not show a 25% or higher improvement from baseline in facial Vitiligo Area Scoring Index (F-VASI) at week 24 were re-randomised to one of three higher ruxolitinib cream doses (0·5% once daily, 1·5% once daily, 1·5% twice daily). Patients in the 0·5% once daily, 1·5% once daily, or 1·5% twice daily groups remained at their original dose up to week 52. Patients, investigators, and the study sponsor (except members of the interim analysis and primary endpoint analysis data monitoring teams) remained masked to treatment assignment throughout the study. The primary endpoint was the proportion of patients achieving a 50% or higher improvement from baseline in F-VASI (F-VASI50) at week 24, assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT03099304. Between June 7, 2017, and March 21, 2018, 205 patients were screened for eligibility, 48 were excluded and 157 patients (mean age, 48·3 years [SD 12·9]; 73 [46%] male and 84 [54%] female) were randomly assigned to either an intervention group or the control group. 32 (20%) of 157 were assigned to the control group, 31 (20%) to the 0·15% once daily group, 31 (20%) to the 0·5% once daily group, 30 (19%) to the 1·5% once daily group, and 33 (21%) to the 1·5% twice daily group. F-VASI50 at week 24 was reached by significantly more patients given ruxolitinib cream at 1·5% twice daily (15 [45%] of 33) and 1·5% once daily (15 [50%] of 30) than were treated with vehicle (one [3%] of 32). Four patients had serious treatment-emergent adverse events (one patient in the 1·5% twice daily group developed subdural haematoma; one patient in the 1·5% once daily group had a seizure; one patient in the 0·5% once daily group had coronary artery occlusion; and one patient in the 0·5% once daily group had oesophageal achalasia), all of which were unrelated to study treatment. Application site pruritus was the most common treatment-related adverse event among patients given ruxolitinib cream (one [3%] of 33 in the 1·5% twice daily group; three [10%] of 30 in the 1·5% once daily group; three [10%] of 31 in the 0·5% once daily group; and six [19%] of 31 in the 0·15% once daily group)with three [9%] of 32 patients showing application site pruritis in the control group. Acne was noted as a treatment-related adverse event in 13 (10%) of 125 patients who received ruxolitinib cream and one (3%) of 32 patients who received vehicle cream. All treatment-related adverse events were mild or moderate in severity and similar across treatment groups. Treatment with ruxolitinib cream was associated with substantial repigmentation of vitiligo lesions up to 52 weeks of treatment, and all doses were well tolerated. These data suggest that ruxolitinib cream might be an effective treatment option for patients with vitiligo. Incyte.

First step in a new era for treatment of patients with vitiligo

First step in a new era for treatment of patients with vitiligo

866 Baseline differences in circulation between early vs late responder patients with vitiligo treated with ruxolitinib cream

Vitiligo is a chronic, inflammatory skin disease characterized by increased interferon-gamma signaling through Janus kinase (JAK) 1 and JAK2 and subsequent activation of CD8+ T cells, which target melanocytes resulting in areas of depigmentation. Ruxolitinib cream, a JAK1/JAK2 inhibitor, is under investigation for vitiligo treatment in a 52-week, randomized, double-blind, phase 2 study (NCT03099304). Significantly more patients treated with ruxolitinib cream vs vehicle achieved ≥50% improvement in facial Vitiligo Area Scoring Index (F-VASI50) at Week 24 (primary endpoint); at Week 52, patients treated with ruxolitinib cream 1.5% twice daily (BID) attained the highest F-VASI50 response (57.6%). This analysis investigated the differences between early and late responders (ER and LR, respectively) following treatment with ruxolitinib cream. Patients were classified as ER if they achieved F-VASI50 or greater at Week 24; all other patients were classified as LR. In ER, F-VASI improved by 79.9%±4.0% and 91.9%±1.5% at Weeks 24 and 52, respectively. In contrast, F-VASI improved by 1.1%±7.3% and 25.1%±13.4% in LR at Weeks 24 and 52. Broad serum proteomics of 54 patients identified 76 out of 1104 proteins were differentially expressed between ER and LR at baseline at p < 0.05. Eleven proteins were up-regulated in ER while the rest were down-regulated in ER. Overall, this analysis identified significant differences between ER and LR that require deeper scientific interrogation and may be important in stratifying the therapeutic benefit for patients with vitiligo.

Effectiveness of a combined 308-nm excimer lamp and topical mid-potent steroid treatment for facial vitiligo: a preliminary, randomized double-blinded controlled study.

Facial vitiligo has considerable psychological and emotional impacts. Though topical corticosteroids are the mainstay treatment, adverse reactions are a concern for prolonged use. Additionally, 308-nm excimer lamps have been widely used in vitiligo. This study aimed to assess the effectiveness of a combined 308-nm excimer lamp and topical steroid therapy compared with the lamp alone for treating facial vitiligo. Symmetrical, nonsegmental facial vitiligo subjects were recruited. All facial lesions were irradiated with a 308-nm excimer lamp twice weekly for a total of 24 sessions. The lesions on each side of the face were randomly allocated to have topical mometasone furoate cream or the cream base alone applied once daily for 12weeks. Clinical improvement was evaluated by a blinded dermatologist and the participants. A total of sixteen sides of the face were assessed in the study. By the 12th week, 87.5% of the lesions treated with the combination regimen and 50% of the lesions treated with monotherapy showed good to excellent repigmentation. From the subjects' perspectives, there were significant differences between both treatments at week 4 and week 8 (p = 0.05) but not at week 12. No serious adverse effects were reported. A combination of excimer lamp therapy and once-daily application of topical mometasone cream was effective and could accelerate the treatment outcomes without serious adverse reactions. This may be an alternative regimen for treating facial vitiligo.

Repigmentation in vitiligo using janus kinase (JAK) inhibitors with phototherapy: systematic review and Meta-analysis

Introduction Vitiligo is an autoimmune disorder characterized by progressive loss of melanocytes, leading to cutaneous depigmentation. Vitiligo has significant psychosocial impacts on patients and is challenging to manage with limited treatment options. Recent studies have suggested promising results for JAK1/3 inhibitors including tofacitinib and ruxolitinib. Objective To determine the expected response of vitiligo to JAK inhibitor therapy and factors which influence response rates. Methods A systematic review and meta-analysis was performed according to PRISMA guidelines. Good response was defined as repigmentation >50% or a ‘good’ or ‘excellent’ outcome as described by authors. Partial response was defined as some repigmentation <50%. Results From the 9 eligible studies, individual patient data from 45 cases were pooled. Good response was achieved in 57.8%, partial response in 22.2%, and none or minimal response in 20% of cases. When subgrouped according to site, facial vitiligo had the highest good response rate (70%), compared to extremities (27.3%) and torso/non-sun exposed areas (13.6%). Concurrent phototherapy was significant associated with higher rates of good overall response (p < .001) and good facial response (p < .001). Conclusions There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in vitiligo. Concurrent UVB phototherapy appears to improve efficacy of JAK inhibitors for vitiligo.

Semi-Automatic Tool for Vitiligo Detection and Analysis

Vitiligo vulgaris is an autoimmune disease which causes a strong reduction of the cells producing melanin, which is the main skin pigment. This results in the growth of white patches on patients’ skin, which are more or less visible, depending on the skin phototype. Precise, objective and fast detection of vitiligo patches would be crucial to produce statistically relevant data on huge populations, thus giving an insight on the disease. However, few methods are available in literature. In the present paper, a semi-automatic tool based on image processing to detect facial vitiligo patches is described. The tool requires pictures to be captured under black light illumination, which enhances patches contrast with respect to healthy skin. The user is only required to roughly define the regions of interest and set a global threshold, thus, no specific image-processing skills are required. An adaptive algorithm then automatically discerns between vitiligo and healthy skin pixels. The tools also allow for a statistical data interpretation by overlapping the detected patches of all patients on a face template through an occurrence map. Preliminary results obtained on a small population of 15 patients allowed us to assess the tool’s performance. Patch detection was checked by an experienced dermatologist, who confirmed the detection for all the studied patients, thus supporting the effectiveness of the proposed tool.

A pilot study of 2% tofacitinib cream with narrowband ultraviolet B for the treatment of facial vitiligo

A pilot study of 2% tofacitinib cream with narrowband ultraviolet B for the treatment of facial vitiligo