Treatment advances in Vitiligo: An Updated Review

Treatment advances in Vitiligo: An Updated Review

Authors

  • Ishrat Binti Ismail Department of dermatology venereology and leprosy GMC Srinagar
  • Yasmeen Jabeen Bhat Department of dermatology venereology and leprosy GMC Srinagar https://orcid.org/0000-0001-5171-6832
  • Mohd Shurjeel ul Islam Department of dermatology venereology and leprosy GMC Srinagar

Keywords:

active vitiligo, janus kinase inhibitor, CXCL10

Abstract

Introduction

Vitiligo is a common disorder of depigmentation caused by the progressive destruction of melanocytes that affects the skin, hair, and mucous membranes, clinically presenting as depigmented macules and leukotrichia. This condition, affecting millions of people worldwide, has a significant psychosocial burden on patients’ quality of life, particularly in relation to skin colour. The etiopathogenesis of this disorder is obscure, but multiple factors contribute to the loss of melanocytes in the skin, like oxidative stress, inflammation, genetics, and autoimmunity. The treatment of vitiligo has been challenging over the past years, but recent developments in understanding the etiopathogenesis of the disease have paved the way for the development of more effective and promising therapeutic treatment options.

Objective

The aim of this review was to provide an overview of the underlying mechanisms and highlight the latest advances in the treatment of vitiligo.

Methodology

This review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalyses) guidelines. A comprehensive search of the literature was carried out through the PubMed electronic database from inception to 31 December 2023 using the following search terms “vitiligo” AND “JAK inhibitors”, “vitiligo” AND “prostaglandin”, “vitiligo” AND “afamelanotide”, “vitiligo” AND “antioxidants”, “vitiligo” AND “vitamin D3”, “vitiligo AND “statins”, “vitiligo” AND “TNF-alpha”, “vitiligo” AND “interleukin”, “vitiligo” AND “light therapy”. Two independent reviewers screened titles, abstracts, and full texts to select papers dealing with vitiligo and its treatment.

Conclusion

The advent of treatment modalities like Janus kinase inhibitors, prostaglandin analogues, antioxidants, TNF-α inhibitors, targeted phototherapy, and excimer lasers has revolutionized the therapeutic possibilities, offering a ray of hope to the individuals suffering from this devastating condition.

 

Author Biography

Mohd Shurjeel ul Islam, Department of dermatology venereology and leprosy GMC Srinagar

NIL

References

Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of Vitiligo Among Adults in the United States. JAMA Dermatol. 2022;158(1):43-50. DOI: 10.1001/jamadermatol.2021.4724. PMID: 34787670

Iwanowski T, Szlązak P, Zabłotna M, Olszewska B, Sokołowska-Wojdyło M. Translation, cross-cultural adaptation and validation of the vitiligo-specific health-related quality of life instrument (VitiQoL) into Polish. Postepy Dermatol Alergol. 2021;38(4):636-643. DOI: 10.5114/ada.2021.108896. PMID: 34658707

Ezzedine K, Lim HW, Suzuki T, et al. Vitiligo Global Issue Consensus Conference Panelists. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012;25(3):E1-13. DOI: 10.1111/j.1755-148X.2012.00997.x. PMID: 22417114

Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology. 2020;236(6):571-592. DOI: 10.1159/000506103. PMID: 32155629.

Kundu RV, Mhlaba JM, Rangel SM, Le Poole IC. The convergence theory for vitiligo: A reappraisal. Exp Dermatol. 2019;28(6):647-655. DOI: 10.1111/exd.13677. PMID: 29704874

Spritz RA, Santorico SA. The Genetic Basis of Vitiligo. J Invest Dermatol. 2021;141(2):265-273. DOI: 10.1016/j.jid.2020.06.004. PMID: 32778407.

Dahir AM, Thomsen SF. Comorbidities in vitiligo: comprehensive review. Int J Dermatol. 2018;57(10):1157-1164. DOI: 10.1111/ijd.14055. PMID: 29808541.

Roberts GHL, Paul S, Yorgov D, Santorico SA, Spritz RA. Family Clustering of Autoimmune Vitiligo Results Principally from Polygenic Inheritance of Common Risk Alleles. Am J Hum Genet. 2019;105(2):364-372. DOI: 10.1016/j.ajhg.2019.06.013. PMID: 31327509.

Wong PM, Yang L, Yang L, et al. New insight into the role of exosomes in vitiligo. Autoimmun Rev. 2020;19(11):102664. DOI: 10.1016/j.autrev.2020.102664. PMID: 32942029.

Abdallah M, El-Mofty M, Anbar T, et al. Egyptian Vitiligo Group. CXCL-10 and Interleukin-6 are reliable serum markers for vitiligo activity: A multicenter cross-sectional study. Pigment Cell Melanoma Res. 2018;31(2):330-336. DOI: 10.1111/pcmr.12667. PMID: 29094481.

Abdou AG, Maraee A, Yassien H, Sarhan M. Immunohistochemistry of Janus Kinase 1 (JAK1) Expression in Vitiligo. J Pathol Transl Med. 2018;52(6):363-368. DOI: 10.4132/jptm.2018.09.18. PMID: 30347972.

Oparaugo NC, Ouyang K, Nguyen NPN, Nelson AM, Agak GW. Human Regulatory T Cells: Understanding the Role of Tregs in Select Autoimmune Skin Diseases and Post-Transplant Nonmelanoma Skin Cancers. Int J Mol Sci. 2023;24(2):1527. DOI: 10.3390/ijms24021527. PMID: 36675037.

Richmond JM, Strassner JP, Rashighi M, et al. Resident Memory and Recirculating Memory T Cells Cooperate to Maintain Disease in a Mouse Model of Vitiligo. J Invest Dermatol. 2019;139(4):769-778. DOI: 10.1016/j.jid.2018.10.032. Epub 2018 Nov 10. PMID: 30423329.

Xuan Y, Yang Y, Xiang L, Zhang C. The Role of Oxidative Stress in the Pathogenesis of Vitiligo: A Culprit for Melanocyte Death. Oxid Med Cell Longev. 2022;2022:8498472. DOI: 10.1155/2022/8498472. PMID: 35103096.

Yang RL, Chen SY, Fu SP, at al. Antioxidant mechanisms of mesenchymal stem cells and their therapeutic potential in vitiligo. Front Cell Dev Biol. 2023;11:1293101. DOI: 10.3389/fcell.2023.1293101. PMID: 38178870.

Roy T, Boateng ST, Uddin MB, et al. The PI3K-Akt-mTOR and Associated Signaling Pathways as Molecular Drivers of Immune-Mediated Inflammatory Skin Diseases: Update on Therapeutic Strategy Using Natural and Synthetic Compounds. Cells. 2023;12(12):1671. DOI: 10.3390/cells12121671. PMID: 37371141.

Al Abadie MS, Gawkrodger DJ. Integrating neuronal involvement into the immune and genetic paradigm of vitiligo. Clin Exp Dermatol. 2021;46(4):646-650. DOI: 10.1111/ced.14490. PMID: 33098692.

Nada HR, El Sharkawy DA, Elmasry MF, Rashed LA, Mamdouh S. Expression of Janus Kinase 1 in vitiligo & psoriasis before and after narrow band UVB: a case-control study. Arch Dermatol Res. 2018;310(1):39-46. DOI: 10.1007/s00403-017-1792-6. PMID: 29127481.

Cunningham KN, Rosmarin D. Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol. 2023;24(2):165-186. DOI: 10.1007/s40257-022-00752-6. PMID: 36715849.

Hamzavi I, Rosmarin D, Harris JE, et al. Efficacy of ruxolitinib cream in vitiligo by patient characteristics and affected body areas: Descriptive subgroup analyses from a phase 2, randomized, double-blind trial. J Am Acad Dermatol. 2022;86(6):1398-1401. DOI: 10.1016/j.jaad.2021.05.047. PMID: 34089797.

Tavoletti G, Avallone G, Conforti C, et al. Topical ruxolitinib: A new treatment for vitiligo. J Eur Acad Dermatol Venereol. 2023 Nov;37(11):2222-2230. DOI: 10.1111/jdv.19162. PMID: 37147856.

Feng Y, Lu Y. Advances in vitiligo: Update on therapeutic targets. Front Immunol. 2022;13:986918. DOI: 10.3389/fimmu.2022.986918. PMID: 36119071.

Radi G, Simonetti O, Rizzetto G, Diotallevi F, Molinelli E, Offidani A. Baricitinib: The First Jak Inhibitor Approved in Europe for the Treatment of Moderate to Severe Atopic Dermatitis in Adult Patients. Healthcare (Basel). 2021;9(11):1575. DOI: 10.3390/healthcare9111575. PMID: 34828623.

Dong J, Huang X, Ma LP, et al. Baricitinib is Effective in Treating Progressing Vitiligo in vivo and in vitro. Dose Response. 2022;20(2):15593258221105370. DOI: 10.1177/15593258221105370. PMID: 35663493.

Ezzedine K, Peeva E, Yamaguchi Y, et al. Efficacy and safety of oral ritlecitinib for the treatment of active nonsegmental vitiligo: A randomized phase 2b clinical trial. J Am Acad Dermatol. 2023 Feb;88(2):395-403. DOI: 10.1016/j.jaad.2022.11.005. Epub 2022 Nov 9. Erratum in: J Am Acad Dermatol. 2023;89(3):639. DOI: 10.1016/j.jaad.2023.04.001. PMID: 36370907.

Yagi K, Ishida Y, Otsuka A, Kabashima K. Two cases of vitiligo vulgaris treated with topical Janus kinase inhibitor delgocitinib. Australas J Dermatol. 2021;62(3):433-434. DOI: 10.1111/ajd.13572.PMID: 33667323.

https://investor.incyte.com/news-releases/news-release-details/incyte-announces-positive-52-week-data-phase-2b-study-evaluating.

Diotallevi F, Gioacchini H, De Simoni E, et al. Vitiligo, from Pathogenesis to Therapeutic Advances: State of the Art. Int J Mol Sci. 2023;24(5):4910. DOI: 10.3390/ijms24054910. PMID: 36902341.

Nagui NA, El-Tartoushy SA, Rashed LA, Elmasry MF. Assessment of prostaglandin F2-alpha (PGF2α) in lesional and nonlesional skin of vitiligo patients. Int J Dermatol. 2022;61(11):1390-1396. DOI: 10.1111/ijd.16307.PMID: 35726457.

Jha AK, Prasad S, Sinha R. Bimatoprost ophthalmic solution in facial vitiligo. J Cosmet Dermatol. 2018;17(3):437-440. DOI: 10.1111/jocd.12443. PMID: 29034590.

Kanti V, Puder L, Jahnke I, et al. A Melanocortin-4 Receptor Agonist Induces Skin and Hair Pigmentation in Patients with Monogenic Mutations in the Leptin-Melanocortin Pathway. Skin Pharmacol Physiol. 2021;34(6):307-316. DOI: 10.1159/000516282. PMID: 34058738.

Stiegler J, Brickley S. Vitiligo: A comprehensive overview. Journal of the Dermatology Nurses' Association. 2021; 13:18-27. DOI: 10.1097/JDN.0000000000000589

Kubelis-López DE, Zapata-Salazar NA, Said-Fernández SL, et al. Updates and new medical treatments for vitiligo (Review). Exp Ther Med. 2021 Aug;22(2):797. DOI: 10.3892/etm.2021.10229. PMID: 34093753.

Alshiyab DM, Al-Qarqaz FA, Muhaidat JM, Alkhader YS, Al-Sheyab RF, Jafaar SI. Comparison of the efficacy of Tacrolimus 0.1% ointment and Tacrolimus 0.1% plus topical pseudocatalase/superoxide dismutase gel in children with limited vitiligo: a randomized controlled trial. J Dermatolog Treat. 2022;33(1):146-149. DOI: 10.1080/09546634.2020.1729952.PMID: 32048900.

Liu J, Li JY, Xu JJ, et al. Advances in the function of traditional medicine for vitiligo treatment. Tradit Med Res. 2024;9(3):17.DOI: 10.53388/TMR20230815002.

Białczyk A, Wełniak A, Kamińska B, Czajkowski R. Oxidative Stress and Potential Antioxidant Therapies in Vitiligo: A Narrative Review. Mol Diagn Ther. 2023;27(6):723-739. DOI: 10.1007/s40291-023-00672-z. PMID: 37737953.

Shakhbazova A, Wu H, Chambers CJ, Sivamani RK. A Systematic Review of Nutrition, Supplement, and Herbal-Based Adjunctive Therapies for Vitiligo. J Altern Complement Med. 2021;27(4):294-311. DOI: 10.1089/acm.2020.0292.PMID: 33337930.

Tóth F, Cseh EK, Vécsei L. Natural Molecules and Neuroprotection: Kynurenic Acid, Pantethine and α-Lipoic Acid. Int J Mol Sci. 2021;22(1):403. DOI: 10.3390/ijms22010403. PMID: 33401674.

Sun Y, Guan X, Wang H, et al. Randomized clinical trial of combined therapy with oral α-lipoic acid and NB-UVB for nonsegmental stable vitiligo. Dermatol Ther. 2021;34(1):e14610. DOI: 10.1111/dth.14610. PMID: 33258534.

Calzari P, Vaienti S, Nazzaro G. Uses of Polypodium leucotomos Extract in Oncodermatology. J Clin Med. 2023;12(2):673. DOI: 10.3390/jcm12020673. PMID: 36675602.

Pacifico A, Damiani G, Iacovelli P, Conic RRZ; Young Dermatologists Italian Network (YDIN); Gonzalez S, Morrone A. NB-UVB plus oral Polypodium leucotomos extract display higher efficacy than NB-UVB alone in patients with vitiligo. Dermatol Ther. 2021;34(2):e14776. DOI: 10.1111/dth.14776. PMID: 33433041.

Dai T, Xiaoying S, Li X, Hongjin L, Yaqiong Z, Bo L. Selenium Level in Patients with Vitiligo: A Meta-Analysis. Biomed Res Int. 2020;2020:7580939. DOI: 10.1155/2020/7580939. PMID: 32626761.

Beyzaee AM, Goldust M, Patil A, Rokni GR, Beyzaee S. The role of cytokines and vitamin D in vitiligo pathogenesis. J Cosmet Dermatol. 2022;21(11):6314-6325. DOI: 10.1111/jocd.15272. PMID: 35871394.

Agarwal K, Podder I, Kassir M, et al. Therapeutic options in vitiligo with special emphasis on immunomodulators: A comprehensive update with review of literature. Dermatol Ther. 2020;33(2):e13215. DOI: 10.1111/dth.13215. PMID: 31891450.

Zahoor M, Shaukat S, Khan MS, Ahmad TJ. Comparison of efficacy and safety of 0.005% calcipotriol ointment versus 0.05% betamethasone dipropionate ointment versus calcipotriol plus betamethasone ointment for the treatment of vitiligo. J Pak Assoc Dermatol [Internet]. 2017;27(1):30-6. Available from: http://jpad.com.pk/index.php/jpad/article/view/1023

Liu X, Yao Z, Wang Y, Chai L, Zhou X. Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies. Int Immunopharmacol. 2022;109:108789. DOI: 10.1016/j.intimp.2022.108789.PMID: 35468365.

Salloum A, Bazzi N, Maalouf D, Habre M. Microneedling in vitiligo: A systematic review. Dermatol Ther. 2020;33(6):e14297. DOI: 10.1111/dth.14297. PMID: 32940387.

Salem MW, Adel Abd El Azim A, Galal SA. Efficacy of topical vitamin D combined with microneedling in the treatment of vitiligo: A comparative study. J Cosmet Dermatol. 2023;22(5):1521-1527. DOI: 10.1111/jocd.15621. PMID: 36718834.

Al-Kuraishy, Hayder M.; Hussian, Nawar R.; Al-Naimi, Marwa S.; Al-Gareeb, Ali I.. Statins Role in Vitiligo: A Mini-Review. Turkish Journal of Dermatology 14(1):p 1-7, Jan–Mar 2020. | DOI: 10.4103/TJD.TJD_38_19.

Shaker ESE, Allam SH, Mabrouk MM, Elgharbawy NM, Salaam SFA. Simvastatin and non-segmental vitiligo: A new potential treatment option? Dermatol Ther. 2022;35(12):e15969. DOI: 10.1111/dth.15969. PMID: 36346030.

Feng Y, Lu Y. Advances in vitiligo: Update on therapeutic targets. Front Immunol. 2022;13:986918. DOI: 10.3389/fimmu.2022.986918. PMID: 36119071.

Karagaiah P, Schwartz RA, Lotti T, Wollina U, Grabbe S, Goldust M. Biologic and targeted therapeutics in vitiligo. J Cosmet Dermatol. 2023;22(1):64-73. DOI: 10.1111/jocd.14770. PMID: 35029034.

Custurone P, Di Bartolomeo L, Irrera N, et al. Role of Cytokines in Vitiligo: Pathogenesis and Possible Targets for Old and New Treatments. Int J Mol Sci. 2021;22(21):11429. DOI: 10.3390/ijms222111429. PMID: 34768860.

Mikhael NW, Hamed AM, Elfallah AA, Ahmed AA. Assessment of serum level of interleukin-17 in patients with vitiligo. Benha Journal of Applied Sciences. 2021 May 1;6(3):173-6.DOI: 10.21608/bjas.2021.188835.

Karagün E, Baysak S. Levels of TNF-α, IL-6, IL-17, IL-37 cytokines in patients with active vitiligo. Aging Male. 2020;23(5):1487-1492. DOI:10.1080/13685538.2020.1806814.PMID: 33191834.

El Sohafy M, Ghanem B, Mitwally S, State A, Elshawaf R. Effect of Narrow Band –UVB Phototherapy on Circulating T-Regulatory cells and Serum IL-17 Level in Egyptian Patients with Non-Segmental Vitiligo. The Egyptian Journal of Hospital Medicine, 2021; 85(1): 3098-3103. DOI: 10.21608/ejhm.2021.194064.

Elkady A, Bonomo L, Amir Y, Vekaria AS, Guttman-Yassky E. Effective use of ustekinumab in a patient with concomitant psoriasis, vitiligo, and alopecia areata. JAAD Case Rep. 2017;3(6):477-479. DOI: 10.1016/j.jdcr.2017.07.009. PMID: 28971137.

Liu T, Li S, Ying S, et al. The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside. Front Immunol. 2020;11:594735. DOI: 10.3389/fimmu.2020.594735. PMID: 33281823.

Park SJ, Ahn GR, Park JW, Seo SJ. The First Case of Ustekinumab-Associated Hair Repigmentation and a Proposed Mechanism of Action. Ann Dermatol. 2021;33(3):300-301. DOI: 10.5021/ad.2021.33.3.300.PMID: 34079196.

Yu Z, Wolf P. How It Works: The Immunology Underlying Phototherapy. Dermatol Clin. 2020;38(1):37-53. DOI: 10.1016/j.det.2019.08.004. PMID: 31753191.

Grochocka M, Wełniak A, Białczyk A, Marek-Jozefowicz L, Tadrowski T, Czajkowski R. Management of Stable Vitiligo-A Review of the Surgical Approach. J Clin Med. 2023;12(5):1984. DOI: 10.3390/jcm12051984. PMID: 36902772.

Mohammad TF, Al-Jamal M, Hamzavi IH, et al. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017;76(5):879-888. DOI: 10.1016/j.jaad.2016.12.041. PMID: 28216034.

Li C, Hu Y, Mu Z, et al. Comparison of various excimer laser (EL) combination therapies for vitiligo: a systematic review and network meta-analysis. J Dermatolog Treat. 2024;35(1):2302064. DOI: 10.1080/09546634.2024.2302064.PMID: 38230424.

Do HT, Nguyen HT, Kanekura T. Efficacy of 308-nm Monochromatic Excimer Lamp and Topical Tacrolimus Combination Therapy in Localized Vitiligo: A Study in Vietnam. International Journal of Dermatology and Venereology. 2023;6:224-8. DOI: 10.1097/JD9.0000000000000326.

Dellatorre G, Antelo DAP, Bedrikow RB, et al. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol. 2020;95 Suppl 1(Suppl 1):70-82. DOI: 10.1016/j.abd.2020.05.007. PMID: 33153826.

Gharib K, Ibrahim A, El Sharkawi Y, Elmegrab N, Attia M. Methotrexate Gel Either Alone or Combined with Narrow Band Ultraviolet B or Excimer Light for the Treatment of Vitiligo. J Clin Aesthet Dermatol. 2023;16(3):32-36. PMID: 36950044.

Frączek A, Owczarczyk-Saczonek A, Placek W. The Role of TRM Cells in the Pathogenesis of Vitiligo-A Review of the Current State-Of-The-Art. Int J Mol Sci. 2020;21(10):3552. DOI: 10.3390/ijms21103552. PMID: 32443482.

Yang L, Yang S, Lei J, et al. Role of chemokines and the corresponding receptors in vitiligo: A pilot study. J Dermatol. 2018;45(1):31-38. DOI: 10.1111/1346-8138.14004. PMID: 29115683.

Migayron L, Boniface K, Seneschal J. Vitiligo, From Physiopathology to Emerging Treatments: A Review. Dermatol Ther (Heidelb). 2020;10(6):1185-1198. DOI: 10.1007/s13555-020-00447-y. PMID: 32949337.

Lambert C, Zappia J, Sanchez C, Florin A, Dubuc JE, Henrotin Y. The Damage-Associated Molecular Patterns (DAMPs) as Potential Targets to Treat Osteoarthritis: Perspectives From a Review of the Literature. Front Med (Lausanne). 2021;7:607186. DOI: 10.3389/fmed.2020.607186. PMID: 33537330.

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Published

2025-01-29

How to Cite

1.
Binti Ismail I, Jabeen Bhat Y, Shurjeel ul Islam M. Treatment advances in Vitiligo: An Updated Review. Dermatol Pract Concept. 2025;15(1):4600. doi:10.5826/dpc.1501a4600

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