A Case of Nonsegmental Vitiligo on the Face and Hands Treated With Combination  Topical JAK Inhibitor and Phototherapy

A Case of Nonsegmental Vitiligo on the Face and Hands Treated With Combination Topical JAK Inhibitor and Phototherapy

Case authors Mavra Masood, MD, Jennifer Creasor, BSN, and Iltefat Hamzavi, MD, present a case of a 74-year-old female with persistent generalized vitiligo on the face and body.

By Mavra Masood, MD [1], Jennifer Creasor, BSN [1], Iltefat Hamzavi, MD [1]

Case Presentation and Medical History Summary

A 74-year-old Black American female with a history of hypertension, type 2 diabetes, and dyslipidemia presented to the dermatology clinic as an established patient visit for treatment of persistent generalized vitiligo on the face and body. 

The patient had a longstanding history of generalized vitiligo first diagnosed in childhood. She had previously undergone successful melanocyte-keratinocyte transplantation surgery on the right lower leg in 2021 and 2022, which has remained stable. Her vitiligo remains controlled with a regimen of phototherapy, excimer laser, and a topical JAK inhibitor. Her vitiligo had affected her choices of clothing in the past. Her current treatment goal was to achieve repigmentation of her neck, back, forearms, legs, and shoulders to prevent further progression of her vitiligo. She previously worked as a mail carrier but now works part time.

Physical Exam and Lab Results

Focused exam of head and neck revealed depigmented macules with erythema on the scalp and back of neck with islands of pigmentation. The patient’s thyroid stimulating hormone, complete blood count with platelet count, and complete metabolic panel were all tested and within normal limits. 

Diagnostic review 

Given the patient’s known history of vitiligo and straightforward physical exam, clinical diagnosis was sufficient and straightforward.

Which of the following is FALSE regarding phototherapy and topical ruxolitinib?

Before & After Photos
Click to enlarge image
BEFORE: Depigmented macules with erythema on the scalp and back of neck with islands of pigmentation
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BEFORE: Depigmented macules with erythema on the scalp and back of neck with islands of pigmentation
Click to enlarge image
BEFORE: Depigmented macules with erythema on the scalp and back of neck with islands of pigmentation
Click to enlarge image
AFTER: Noted improvement of vitiligo to a facial VASI of 0.72 and drastic improvement of repigmentation at 3-month follow-up
Click to enlarge image
AFTER: Noted improvement of vitiligo to a facial VASI of 0.72 and drastic improvement of repigmentation at 3-month follow-up
Treatment Discussion and Outcome

The patient had previously responded well to topical ruxolitinib cream 1.5% applied to affected areas on the face twice daily. Phototherapy was also continued 3 times a week in clinic as well as excimer laser 2 times a week. Given that the patient had previously improved on topical ruxolitinib, it was continued in addition to light-based treatments to favor treatment stabilization along with the phototherapy. 

At a follow-up visit at 3 months , the patient was noted to have improvement of her vitiligo to a facial VASI of 0.72. The patient was continued on her current therapeutic regimen and saw drastic improvement in repigmentation for the duration of use.

References:
  1. Pandya AG, Harris JE, Lebwohl M, et al. Addition of narrow-band UVB phototherapy to ruxolitinib cream in patients with vitiligo. J Invest Dermatol. 2022;142(12):3352-3355.e4. doi:10.1016/j.jid.2022.05.1093 
  2. Hwang JR, Driscoll MS. Review of ruxolitinib for treatment of non-segmental vitiligo. Ann Pharmacother. 2023;57(8):948-955. doi:10.1177/1060028022114374 
  3. Joshipura D, Plotnikova N, Goldminz A, et al. Importance of light in the treatment of vitiligo with JAK-inhibitors. J Dermatolog Treat. 2018;29(1):98-99. doi:10.1080/09546634.2017.1339013 
  4. Zubair R, Hamzavi IH. Phototherapy for vitiligo. Dermatol Clin. 2020;38(1):55-62. doi:10.1016/j.det.2019.08.005 
  5. Yousefian F, Yadlapati S, Browning JC. The use of Janus kinase inhibitors and narrowband ultraviolet B combination therapy in non-segmental vitiligo. J Cosmet Dermatol. 2023;22(3):1105-1107. doi:10.1111/jocd.15537

 

Do you have a compelling patient case to share? Contact jnolan@dermsquared.com for details.

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