Vitiligo: Pathogenesis and New and Emerging Treatments
Abstract
:1. Introduction
2. Pathogenesis of Vitiligo
2.1. Autoimmunity
- Cell-mediated immunity drives vitiligo.
- Vitiligo pathogenesis acts through the activation of the JAK-STAT pathway.
- Resident memory T cells play an important role in the persistence and relapse of vitiligo.
- IL-15 has a central role in the maintenance and function of TRM cells.
- Humoral immunity does not play a central role in the pathophysiology of vitiligo.
2.2. Oxidative Stress
- The skin of patients with vitiligo shows alterations in the antioxidant system.
- ROS production triggers the activation of protective molecular pathways.
- Oxidative stress leads to T-cell activation.
3. Literature Search
4. Conventional Treatments
4.1. Phototherapy
4.2. Afamelanotide
4.3. Cyclosporine
5. New and Emerging Therapies
5.1. Phosphodiesterase 4 (PDE-4) Inhibitors
5.2. Trichloroacetic Acid (TCA)
5.3. Basic Fibroblast Growth Factor (bFGF)
5.4. TNF Inhibitors
5.5. Secukinumab
5.6. Pseudocatalase
5.7. JAK Inhibitors
5.7.1. Case Reports and Case Series
5.7.2. Clinical Trials
5.8. 5-Fluorouracil
5.9. Platelet-Rich Plasma
5.10. Other Regenerative Therapies
5.11. Conventional Therapies versus Emerging Therapies
6. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Drug | Publication Data (Author/Year/Country) | Report Data (Drug and Route of Administration/Patients (n)/Treatment Duration/Area Affected/Follow-Up) | Outcome | Side Effects |
---|---|---|---|---|
Tofacitinib | Craiglow et al. [85]/2015/USA | 5 mg tofacitinib citrate orally, initially 5 mg every other day; after 2 weeks, the dosage was increased to 5 mg/d 1 patient with forehead, torso and extremities vitiligo (10% BSA) treated and followed for 22 weeks (5 months) | Nearly complete repigmentation of the forehead and hands, partial repigmentation of extremities (5% BSA remained depigmented) | No adverse effects, no laboratory abnormalities |
Ruxolitinib | Harris et al. [86]/2016/USA | 20 mg ruxolitinib orally, twice daily. 1 patient with face, torso and extremities vitiligo treated for 20 weeks and followed for 16 more weeks | Improvement in facial pigmentation from 0.8% to 51%. 12 weeks after discontinuation of ruxolitinib, much of the regained pigment had regressed, from 51% to 16% | No side effects |
Tofacitinib | Liu et al. [92]/2017/USA | 5–10 mg tofacitinib orally QD-BID 10 patients treated for at least 3 months, an average of 9.9 months. 8 patients had generalized vitiligo and 2 patients had primarily acral involvement, with 1–100% BSA | A mean decrease of 5.4% BSA involvement with vitiligo was observed in 5/10 patients, while the other 5 patients did not achieve any repigmentation In the 5 patients who achieved some reversal of disease, repigmentation occurred only in sun-exposed areas of skin in 3 of them, diffusely in another patient undergoing concomitant full-body nbUVB phototherapy and to the dorsal hands in another patient after starting concomitant hand nbUVB phototherapy | Upper respiratory infection in 2 patients. 1 patient reported weight gain of 5 pounds and 1 patient reported arthralgias. Mild elevations of lipids were noted in 4 patients. There were no serious adverse events |
Tofacitinib | Vu et al. [88]/2017/Australia | 5 mg tofacitinib orally twice daily. 1 patient with multifocal vitiligo treated and followed for 6 months | Patient with concomitant atopic dermatitis and alopecia areata, both with great improvement. Marginal improvement in the vitiligo (decline in VASI score from 4.68 at baseline to 3.95 at 5 months) | Two episodes of self-resolving upper respiratory tract infections and diarrhea, no treatment interruption required |
Ruxolitinib | Joshipura et al. [97]/2018/USA | Topical 1.5% ruxolitinib cream, twice daily. 2 patients with face, torso and extremities vitiligo treated for 38 and 12 weeks, respectively | Improvement in sun-exposed areas only (face and forearms) | No side effects |
Tofacitinib | Gianfaldoni et al. [93]/2018/Italy | Tofacitinib citrate (10 mg orally every day) + cold light generator micro-focused phototherapy. 9 patients treated for at least 36 weeks | Repigmentation rate of 92% in the phototherapy + tofacitinib group, better than the phototherapy-alone group, in which only 72% obtained a repigmentation rate higher than 75% | No side effects |
Tofacitinib | Kim et al. [89]/2018/USA | 5 mg tofacitinib twice daily orally and narrow-band UV-B (360–500 mJ) 2 patients Patient 1: face (75% area affected), neck, torso and extremities vitiligo, results reported after 3 months Patient 2: face (90% area affected), torso and arms vitiligo, results reported after 6 months | Patient 1: complete repigmentation of her face, 75% or greater repigmentation of her neck, chest, forearms and shins, and only minimal freckling of the dorsal hands after full body phototherapy Patient 2: about 75% facial repigmentation. No repigmentation occurred at the other body sites (only facial phototherapy) Both had previously depigmented their faces using monobenzyl ether of hydroquinone (MBEH) | No side effects |
Tofacitinib | McKesey et al. [98]/2019/USA | 2% tofacitinib cream twice daily in conjunction with narrow-band ultraviolet B (NB-UVB) therapy thrice weekly 11 patients with face vitiligo treated for 12 ± 4 weeks and followed for a mean time of 112 days (range 84–154) | The mean facial VASI was 0.80 (range 0.1–2.25) at baseline and 0.23 (range 0.03–0.75) at follow-up, which is a mean improvement of 70% (range 50–87%) | No side effects |
Tofacitinib | Mobasher et al. [99]/2020/USA | 2% tofacitinib cream twice daily Concomitant treatment with topical steroids, topical calcineurin inhibitors, supplements (e.g., Polypodium leucotomos and Ginkgo biloba) or phototherapy was allowed 16 patients with “facial” or “non-facial” vitiligo followed for a mean time of 153 days (63–367) | 13 experienced repigmentation with 4 patients experiencing > 90% repigmentation, 5 patients experiencing 25–75% repigmentation and 4 patients experiencing 5–15% repigmentation. 2 patients experienced no change and 1 patient experienced slow progression of depigmentation in the target lesion. Facial lesions improved more than non-facial lesions (p = 0.0216) | Acne-like papules on the face were reported by 1 patient. These lesions resolved with cessation of the medication. 1 patient reported subtle skin contour changes on his chin, which led to cessation of treatment after 2 weeks |
Tofacitinib | Komnitski et al. [87]/2020/Brazil | 5 mg tofacitinib orally twice daily. 1 patient with face, neck, elbows, hands and feet vitiligo, treated and followed for 104 weeks (2 years) | Complete repigmentation of the forehead and perilabial macules could be noted, as well as partial repigmentation in the posterior region of the neck and upper chest. No exposition to any source of ultraviolet radiation | No side effects |
Tofacitinib | Olamiju et al. [100]/2020/USA | 2% tofacitinib cream twice daily + narrow-band ultraviolet B phototherapy using a handheld unit 1 patient with face (segmental vitiligo) treated for 6 months and followed for 1 year | Freckling was observed within 4 weeks, almost complete repigmentation after 3 months and complete repigmentation at 6 months. The patient discontinued treatment after another month, and the area remained fully repigmented for approximately 6 months before a few depigmented macules began to reappear | No side effects |
Ruxolitinib | Narla et al. [102]/2020/USA | 1.5% ruxolitinib cream twice daily, for 2 patients presenting non-segmental vitiligo | Unspecified | Myalgias, which caused self-discontinuation in both patients. One of the patients presented mild elevation of the phosphokinase level (CPK) |
Tofacitinib | Berbert-Ferreira et al. [101]/2021/Brazil | 2% tofacitinib ointment twice daily only on facial lesions, combined with NB-UVB phototherapy, 3 times a week. The total dose for the face vitiligo was 1000 mJ/cm2 1 patient presenting stable non-segmental vitiligo with acrofacial involvement treated for 9 months | Significant repigmentation of the forehead, nose, eyes and lips was observed | Minor adverse events such as erythema and transient acne |
Tofacitinib | Fang et al. [94]/2021/Taiwan | 5 mg tofacitinib orally once daily concomitant with nbUVB phototherapy. 4 patients with torso, arms, hands and leg vitiligo treated for 16 weeks | 3 out of the 4 patients presented minimal or no change on vitiligo lesions. Only 1 of the patients had a partial response, with 14/42 (33%) of lesions showing signs of repigmentation. The results indicate that 5 mg daily tofacitinib concomitant with nbUVB phototherapy for 16 weeks is not sufficient for treating patients who showed an inadequate response to previous treatments | No side effects |
Tofacitinib | Fang et al. [95]/2021/Taiwan | 5 mg tofacitinib orally daily and 308 nm excimer light three times weekly 3 patients with torso, arms, hands, legs and feet vitiligo treated for 12 weeks | All patients had repigmentation and the mean reduction in VES was 32.7% (decreases of 38%, 44% and 16% in patients 1, 2 and 3, respectively). Of the 44 lesions, 14 (32%) showed follicular-patterned repigmentation, and of these, 6 repigmented lesions (43%) were in areas that were not sun-exposed regions. Acral lesions showed poor response | No side effects |
Baricitinib | Li et al. [90]/2022/China | 2 mg baricitinib orally twice daily + phototherapy + topical tacrolimus + topical steroids 2 patients with face, torso and extremities vitiligo treated for 6 months and 8 months, respectively | In patient 1, significant repigmentation after 8 months; in patient 2, over 75% repigmentation after 6 months | No side effects |
Upadacitinib | Pan et al. [91]/2023/China | 15 mg upadacitinib orally daily, combined with crisaborole. 1 patient with face, torso and extremities vitiligo treated for 4 months and followed for 7 months | After 4 months, there was nearly 90% repigmentation of his face and neck, 60% repigmentation of the chest and only a little repigmentation of the extremities | Worsening of acne |
Drug | Study Data (Authors/Year/Country/NCT) | Study Design | Results | Side Effects |
---|---|---|---|---|
Ruxolitinib (topical) | Rothstein et al. [103]/2017/USA/NCT02809976 | 1.5% topical ruxolitinib cream, twice daily Single group, open-label, phase 2 11 patients followed for 20 weeks, presenting facial, upper limbs, torso or acral vitiligo | 23% improvement in overall VASI in all patients. The 4 patients with facial involvement presented 76% improvement in fVASI. 3/8 patients responded on body surfaces. 1/8 responded on acral surfaces | Minor (erythema, hyperpigmentation and transient acne) |
Ruxolitinib (topical) | Josahipura et al. [104] (open-label extension study of Rothstein’s)/2018/USA/No registration | 1.5% topical ruxolitinib cream, twice daily (all 8 patients) + optional UVB phototherapy (3/8 patients chose it) Open-label extension study Phase 2 8 patients followed for 32 weeks, presenting facial, upper limbs, torso or acral vitiligo | Mean improvement in overall VASI of 37.6% ± 31.2% (p < 0.011). 5/8 had treatment response. 4 patients with facial vitiligo had mean 92% improvement. 3/6 had a response on their nonacral upper extremities (2 of these 3 had been treated with combination phototherapy). 2/3 patients (both of whom had opted for combination phototherapy) responded on the torso with a mean VASI improvement of 16.7% ± 16.7% | Minor (erythema and transient acne) |
Ruxolitinib (topical) | Rosmarin et al. [84]/2020/USA/NCT03099304 | 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 A randomized, double-blind, dose-ranging study. Phase 2. 157 patients with vitiligo affecting at least 0.5% of the total body surface area (BSA) on the face and at least 3% of the total BSA on nonfacial areas; followed for 52 weeks | The primary endpoint at week 24, F-VASI50, was reached by significantly more patients given the two highest doses of ruxolitinib cream (1.5% twice daily, 15 (45%) of 33 patients, odds ratio (OR) 24·7, 95% CI 3.3–1121.4; p = 0.0001; 1.5% once daily, 15 (50%) of 30 patients, OR 28.5, 95% CI 3.7–1305.2; p < 0.0001) and also by more patients who received the two lowest doses of ruxolitinib cream (0.5% once daily, eight (26%) of 31; 0.15% once daily, ten (32%) of 31) compared with the vehicle (one (3%) of 32 patients). T-VASI50 at week 52, a key secondary endpoint, was reached by patients in the total population in a dose-dependent manner (1.5% twice daily, 12 (36%) of 33; 1.5% once daily, 9 (30%) of 30; 0.5% once daily, 8 (26%) of 31) | Application site pruritus was the most common treatment-related adverse event among patients given ruxolitinib cream (1 (3%) of 33 in the 1.5% twice daily group; 3 (10%) of 30 in the 1.5% once daily group; 3 (10%) of 31 in the 0.5% once daily group; and 6 (19%) of 31 in the 0.15% once daily group), with 3 (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 1 (3%) of 32 patients who received vehicle cream. All treatment-related adverse events were mild or moderate in severity and similar across treatment groups. No serious adverse events were related to study treatment |
Ruxolitinib (topical) | Hamzavi et al. [105]/2022/USA/NCT03099304 | 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 A randomized, double-blind, dose-ranging study. Phase 2. 157 patients with vitiligo affecting at least 0.5% of the total body surface area (BSA) on the face and at least 3% of the total BSA on nonfacial areas; followed for 52 weeks | Among patients with vitiligo affecting ≤ 20% of T-BSA at baseline, both doses of ruxolitinib cream (1.5% once daily and twice daily) produced notable T-VASI50 and T-VASI75 responses at week 52. The 1.5% ruxolitinib cream twice-daily dose produced the highest proportion of T-VASI50 responders in the head/neck region (60.0%), followed by the upper and lower extremities (52.9% and 52.6%, respectively). T-VASI50 of the hands and feet was noted for 15.0% and 29.4% of patients, respectively, who received 1.5% ruxolitinib cream twice daily | Unspecified |
Ruxolitinib | Pandya et al. [106]/2022/USA/NCT03099304 | Ruxolitinib cream with concomitant narrow-band UVB (NB-UVB) phototherapy during the open-label phase after week 52 A randomized, double-blind, dose-ranging study. Phase 2. 19 patients with vitiligo affecting at least 0.5% of the total body surface area (BSA) on the face and at least 3% of the total BSA on nonfacial areas; followed for 52 weeks | After the addition of NB-UVB phototherapy, F-VASI and T-VASI scores improved in 15 of 19 patients (78.9%) and 18 of 19 patients (94.7%), respectively. In these 19 patients, the mean percentage improvement at week 104 was 50.2% for F-VASI and 29.5% for T-VASI versus the improvement at the last visit before the addition of NB-UVB phototherapy. Postcombination therapy response parameters were similar to data at week 104 from 70 patients who remained on ruxolitinib cream alone from day 1; responses were higher at week 104 versus week 52 among patients who received ruxolitinib cream alone | No adverse events considered to be related to the treatment |
Ruxolitinib | Rosmarin et al. [107]/2022/USA/TRuE-V1 (NCT04052425) and TRuE-V2 (NCT04057573) | 1.5% ruxolitinib cream or matching vehicle cream twice daily to all depigmented vitiligo lesions, on a 2:1 ratio Two multinational, phase 3, double-blind, vehicle-controlled trials of identical design conducted across 101 centers 661 patients (330 TRuE-V1 and 331 TRuE-V2) with face and body vitiligo followed for 24 weeks | 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 (F-VASI50, F-VASI90, T-VASI50 and F-VASI75 in the 52-week extension study) | Among patients who applied ruxolitinib cream for 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%) |
Tofacitinib (oral) | Song et al. [111]/2022/China/No registration | Oral tofacitinib at 5 mg twice daily. Both control and treatment group were treated with halometasone cream applied externally to the lesions on the torso and limbs twice a day, and 0.1% tacrolimus ointment or pimecrolimus cream applied externally on the face and neck twice a day. In addition, NB-UVB therapy was administered three times weekly for a period of 16 weeks Real-world clinical practice out-of-label tofacitinib clinical trial 15 patients in treatment group and 19 controls with face and body vitiligo followed for 16 weeks | From eighth week, the repigmentation level was significantly higher in the combination than the control group (p < 0.05). The repigmentation improved in the tofacitinib group on acral lesions, torso and extremities No significant differences in lesions on the face and neck were observed between the combination and control groups during 16 weeks of treatment (p > 0.05), probably because both groups had great improvement | One patient treated with tofacitinib developed mild pain in his right thumb and right hallux after 3 weeks of treatment, but the pain resolved with cessation of tofacitinib 1 week later. Mild effects related to phototherapy |
Ritlecitinib (oral) | Ezzedine et al. [110]/2023/USA/NCT03715829 | Patients were randomized to once-daily oral ritlecitinib ± 4-week loading dose (200/50 mg, 100/50 mg, 30 mg or 10 mg) or placebo for 24 weeks (dose-ranging period). 187 patients subsequently received ritlecitinib at 200/50 mg daily in a 24-week extension period Phase 2b, randomized, double-blind, placebo-controlled, parallel-group, multicenter and dose-ranging study 364 patients with face and body vitiligo treated for a 24-week dose-ranging period and 24-week extension period | Significant differences from placebo in percent change from baseline in Facial-Vitiligo Area Scoring Index were observed for the 50 mg ritlecitinib groups with (−21.2 vs. 2.1; p < 0.001) or without (−18.5 vs. 2.1; p < 0.001) a loading dose and 30 mg ritlecitinib group (−14.6 vs. 2.1; p = 0.01). Accelerated improvement was observed after treatment with 200/50 mg ritlecitinib in the extension period (n = 187) | The 3 most common TEAEs were nasopharyngitis (15.9%), upper respiratory tract infection (11.5%) and headache (8.8%). 4 patients had confirmed cases of herpes zoster (all non-serious), 2 patients had malignancies (nonmelanoma skin cancers) and there were no thromboembolic events. No serious adverse events |
Upadacitinib (oral) | No results published/2023/USA/NCT04927975 [112] | Oral upadacitinib (dose ranging) vs. placebo A multicenter, randomized, double-blind, placebo-controlled, dose-ranging study to evaluate the safety and efficacy of upadacitinib in subjects with non-segmental vitiligo. Phase 2 185 patients with face and body vitiligo followed for at least 24 weeks, up to 52 weeks | Ongoing. No results published | Ongoing. No results published |
Ruxolitinib (topical) | No results published/2023/USA/NCT05247489 [109] | Group A: 1.5% ruxolitinib cream + narrow-band ultraviolet B phototherapy (NB-UVB). Group B: 1.5% ruxolitinib cream monotherapy A randomized, phase 2, open-label interventional study. 55 patients with face and body vitiligo follows for 48 weeks | Ongoing. No results published | Ongoing. No results published |
Ruxolitinib (topical) | No publications available/2023/USA/NCT04530344 [108] | 1.5% ruxolitinib cream or matching vehicle cream twice daily A double-blind, vehicle-controlled, randomized withdrawal and treatment extension study to assess the long-term efficacy and safety of ruxolitinib cream in participants with vitiligo Phase 3 458 patients with face and body vitiligo followed for 52 weeks | Completed. No publications available | Completed. No publications available |
ARQ-252 (topical) | No results published/2022/USA/NCT04811131 [113] | 0.3% ARQ-252 cream BID or vehicle cream BID, and active phototherapy or sham phototherapy for 24 weeks Phase 2a, parallel-group, double-blind, vehicle-controlled study of the safety and efficacy of 0.3% ARQ-252 cream in combination with NB-UVB phototherapy treatment in subjects with non-segmental facial vitiligo 114 patients with face and body vitiligo followed for 24 weeks | Terminated. No publications available | Terminated. No publications available |
Cerdulatinib (topical) | No publications available/2022/USA/NCT04103060 [114] | 0.37% cerdulatinib gel applied topically twice daily vs. vehicle cream A phase 2a, randomized, double-blind, vehicle-controlled study to assess the safety, tolerability and systemic exposure of 0.37% cerdulatinib gel in adults with vitiligo 33 patients with face and body vitiligo followed for 6 weeks | No publications available | No publications available |
ATI-50002 (topical) | No publications available/2020/USA/NCT03468855 [115] | ATI-50002 topical solution, high dose active, twice daily, 24 weeks An open-label pilot study of the safety, tolerability and efficacy of ATI-50002 topical solution administered twice daily in adult subjects with non-segmental facial vitiligo. Phase 2 34 patients with face vitiligo followed for 24 weeks | Mean change in facial depigmentation in quantified area of interest (AOI) from baseline (Visit 2) to week 24 worsened after treatment: mean change + 2 (standard deviation 8.41) | Alcoholic pancreatitis and acute myocardial infarction (in 1 patient, not related to the drug), application site acne, other minor local adverse events |
Treatment Modality | Conventional versus Emerging | Advantages/Data That Favor Its Use | Main Disadvantages |
---|---|---|---|
Topical corticosteroids (TCSs) | Conventional | Recommended for vitiligo, particularly for extrafacial locations and more limited treatment areas Wide experience on its use | More effective for stabilization of vitiligo than for repigmentation Local side effects if applied continuously (skin atrophy, telangiectasia, hypertrichosis, acneiform eruptions and striae) |
Topical calcineurin inhibitors | Conventional | As affective as TCS on face and neck, with better safety profile in these locations No serious adverse events detected in patients with vitiligo treated with topical calcineurin inhibitors | Less effective than TCS on extrafacial lesions Off-label use |
Narrow-band ultraviolet B phototherapy (NB-UVB) | Conventional | Preferred first-line therapy for widespread or rapidly progressing disease No significant association with greater incidence of basal cell carcinoma, squamous cell carcinoma or melanoma | Bad response of acral lesions and areas lacking melanocyte reservoir Erythema and xerosis are common Multiple sessions are required, so patients have to attend their healthcare center two or three times a week for several months |
Excimer devices | Conventional | Equally effective or even superior compared to NB-UVB Safety and tolerability of excimer laser therapy is comparable to NB-UVB | The cost of therapy is higher than NB-UVB Long-term adverse events not well-established |
Home phototherapy | Conventional | Better compliance, similar repigmentation outcomes, similar frequency of adverse effects and less time investment | Shortage of home phototherapy units, high initial cost, low energy output of the device over time, lack of mechanical servicing and unfamiliarity of patients with the modality |
Oral steroid minipulse therapy (dexamethasone, metilprednisolone or prednisone) | Conventional | Useful to stop disease progression | Not suitable for repigmentation on monotherapy Relapse after discontinuation Systemic corticosteroid-class side effects: weight gain, insomnia, agitation, acne, menstrual disturbances, hypertrichosis, growth retardation in children and immunosuppression |
Surgical interventions | Conventional/emerging | Many different techniques A treatment option for segmental vitiligo and other localized and stabilized forms of vitiligo (non-segmental) after the documented failure of medical interventions | Koebner phenomenon is possible High cost Pros and cons depend on the technique, but this topic exceeds the subject of this review and should be discussed separately |
Afamelanotide | Conventional | Potential benefit for use in combination with phototherapy | Subcutaneous administration More data need to be collected |
Cyclosporine | Conventional | Useful for arresting vitiligo progression Might be useful as adjunctive treatment in autologous noncultured melanocyte–keratinocyte cell transplantation procedure | Not suitable for long-term treatment |
Phosphodiesterase 4 (PDE-4) inhibitors | Emerging | Case reports of improvement with apremilast or crisaborole in monotherapy | Conflicting data on its use in combination with phototherapy |
Trichloroacetic acid | Emerging | Good response on face vitiligo in combination with microneedling or phototherapy | More data need to be collected |
Basic fibroblast growth factor (bFGF) | Emerging | Could improve repigmentation when combined with phototherapy or tacrolimus ointment | More data need to be collected |
TNF inhibitors | Emerging | Isolated case reports showing efficacy in repigmentation | Most studies show no response or even TNFα inhibitor-induced vitiligo |
Secukinumab | Emerging | A suitable option to replace a TNFα inhibitor after new-onset vitiligo related to TNFα inhibitors | Not recommended for the treatment of isolated vitiligo |
Pseudocatalase | Emerging | Oxidative stress plays a role in vitiligo pathogenesis Initial data supported its efficacy | All recent data show no improvement in repigmentation |
JAK inhibitors | Emerging | Multiple case reports and clinical trials support its efficacy Ruxolitinib cream already approved for vitiligo Several ongoing clinical trials with promising results | Long-term efficacy and long-term safety data need to be assessed More expensive than conventional treatments Results when used in combination with other treatment modalities need to be studied |
5-fluorouracil | Emerging | Useful to achieve repigmentation when used alongside phototherapy, microneedling and dermabrasion Intradermal infiltrations of 5-FU have also been tested | Local side effects (burning, pruritus, blistering) |
Platelet-rich plasma | Emerging | Synergistic effect in conjunction with laser, phototherapy and surgical treatments | Limited data on monotherapy More data need to be collected |
Microneedling | Emerging | Could improve repigmentation in monotherapy or when combined with phototherapy or 5-fluorouracil | More data need to be collected |
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Perez-Bootello, J.; Cova-Martin, R.; Naharro-Rodriguez, J.; Segurado-Miravalles, G. Vitiligo: Pathogenesis and New and Emerging Treatments. Int. J. Mol. Sci. 2023, 24, 17306. https://doi.org/10.3390/ijms242417306
Perez-Bootello J, Cova-Martin R, Naharro-Rodriguez J, Segurado-Miravalles G. Vitiligo: Pathogenesis and New and Emerging Treatments. International Journal of Molecular Sciences. 2023; 24(24):17306. https://doi.org/10.3390/ijms242417306
Chicago/Turabian StylePerez-Bootello, Javier, Ruth Cova-Martin, Jorge Naharro-Rodriguez, and Gonzalo Segurado-Miravalles. 2023. "Vitiligo: Pathogenesis and New and Emerging Treatments" International Journal of Molecular Sciences 24, no. 24: 17306. https://doi.org/10.3390/ijms242417306
APA StylePerez-Bootello, J., Cova-Martin, R., Naharro-Rodriguez, J., & Segurado-Miravalles, G. (2023). Vitiligo: Pathogenesis and New and Emerging Treatments. International Journal of Molecular Sciences, 24(24), 17306. https://doi.org/10.3390/ijms242417306