The use of Janus kinase inhibitors and narrowband ultraviolet B combination therapy in non‐segmental vitiligo

Abstract

Vitiligo is a depigmentation disorder of the skin that occurs secondary to the destruction of melanocytes by an immune‐mediated process. Vitiligo clinically presents with depigmented macules and patches, most commonly on the face, acral sites, and genitalia. It can be characterized as generalized or localized based on distribution. The localized form can be further divided into segmental (linear, band‐like, or Blaschkoid) and non‐segmental vitiligo. The classical treatment of vitiligo includes topical steroids, pulsed oral steroids in unstable vitiligo, phototherapy, a combination of steroid therapy and phototherapy, surgical grafting, as well as intentional depigmentation therapy in severe cases. However, recent advances in understanding the immune mechanisms implicated in the pathogenesis of vitiligo have led to the use of an FDA‐approved topical Janus kinase (JAK) inhibitors for vitiligo. Despite this novel therapy advancement, we recommend the addition of narrowband ultraviolet B (NB‐UVB) to JAK inhibitors in patients with extensive and progressive lesions, or those not fully responsive to JAK inhibitor monotherapy.

Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature

“…104 NBUVB decreases the expression of JAK1 and CXCL10, and combination of JAK inhibitors including baricitinib and tofacitinib, and NBUVB has shown promising repigmentation outcomes. [105][106][107][108][109] In a study involving 86 patients with progressive vitiligo, treatment groups received oral mini pulse steroids (OMP) + PUVA, OMP + NBUVB, OMP + BBUVB, or OMP alone. Marked improvement was most pronounced in OMP + NBUVB (37.03%) and OMP + PUVA (18.51%) highlighting the superiority of NBUVB over BBUVB and almost comparable efficacy between NBUVB and PUVA.…”

“…NBUVB decreases the expression of JAK1 and CXCL10, and combination of JAK inhibitors including baricitinib and tofacitinib, and NBUVB has shown promising repigmentation outcomes 105–109 . In a study involving 86 patients with progressive vitiligo, treatment groups received oral mini pulse steroids (OMP) + PUVA, OMP + NBUVB, OMP + BBUVB, or OMP alone.…”