Vitiligo has become one of the hottest topics in dermatology now that a medication is finally approved for repigmentation of vitiligo, and others are in the pipeline. In this highly anticipated session, Seemal R. Desai, MD, provided clinical pearls for the management of vitiligo and reviewed important data on the efficacy of these newer therapies. Dr Desai began by sharing his strategy for stabilizing active vitiligo, which is three months of oral mini-pulse dexamethasone 4 mg on two consecutive days per week.

Moving on to repigmentation strategies, Dr Desai reviewed long-term efficacy data for ruxolitinib cream 1.5%. After 104 weeks of treatment, 66.1% of patients on twice-daily ruxolitinib cream achieved a 75% improvement in facial Vitiligo Area Scoring Index (F-VASI75) and 33.9% of patients achieved F-VASI90. Patients should be educated that repigmentation takes time and to not give up on ruxolitinib cream if early improvement is not visualized. Continuous improvements in total body vitiligo scores (T-VASI) were also seen between 52 and 104 weeks of ruxolitinib treatment. Forty-two percent of patients achieved T-VASI50 at Week 52, increasing to 63.8% of patients achieving T-VASI50 at Week 104 of twice-daily ruxolitinib use.

Dr Desai also discussed oral JAK inhibitors for vitiligo repigmentation. Upadacitinib 15 mg once daily for 12 weeks led to improvements in VASI scores and patient-reported quality-of-life outcomes in a small study. Povorcitinib, an oral JAK1 inhibitor, is currently in Phase 3 clinical trials for vitiligo and demonstrated improvements in T-VASI scores with continuous povorcitinib 75 mg once daily for 52 weeks. To conclude, Dr Desai briefly discussed laser therapy for recalcitrant vitiligo. Q-switched lasers such as the Ruby, Alexandrite, and Nd:YAG have all demonstrated efficacy in treating vitiligo. Dr Desai recommended the Q-switched Nd:YAG laser, as the 1064 nm wavelength penetrates deeper and has less potential for post-inflammatory hyperpigmentation.