Topical tofacitinib safe and effective for treatment of refractory vitiligo

USA: Topical tofacitinib 2% is effective for the treatment of refractory vitiligo, suggests a recent study published in the British Journal of Dermatology.

Vitiligo is a disease that causes the loss of skin color in blotches. It affects about 0.5% to 1% of the population and is associated with low self-esteem and social stigma. The medical approach to vitiligo patients is a complex process. Topical medications (corticosteroids and calcineurin inhibitors) and phototherapy are the mainstays of treatment. There are also other treatment options such as skin surgery and laser, but none of them has been able to provide consistent and satisfactory results in all patients.

Treatment options for vitiligo are limited and many cases remain refractory to first and second-line treatments. Interferon‐γ signaling mediated by Janus kinase (JAK) has been implicated in the pathogenesis of vitiligo. Systemic administration of tofacitinib, a potent JAK1/3 inhibitor, has been effective in treating vitiligo in case reports. However, it is associated with infections, malignancies, cytopenias, gastrointestinal perforations and hyperlipidemia in some patients with rheumatoid arthritis. Unintended systemic effects may be limited by using the topical administration of tofacitinib.

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Victor Huang, University of California, Davis, Department of Dermatology, Sacramento, CA, U.S.A., and colleagues presented their experience with topical tofacitinib 2% cream in the treatment of patients with nonsegmental vitiligo in this nonrandomized cohort study.

In this cohort study of 16 patients with vitiligo treated with topical tofacitinib 2% cream, 13 experienced some degree of improvement in pigmentation including 4 patients who had ≥90% repigmentation. Facial lesions and darker skin type were associated with more improvement in repigmentation. The only adverse events reported were acne-like papules in 1 patient and subtle contour change on the chin of another.

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"While this study is small and uncontrolled and occurred in the setting of concomitant treatments, it suggests that topical administration of tofacitinib is safe and efficacious. Future randomized controlled studies or larger cohort studies should be performed to confirm these observations and identify the patients most likely to benefit from JAK inhibition," concluded the authors.

The study, "Open‐label pilot study of tofacitinib 2% for the treatment of refractory vitiligo," is published in the British Journal of Dermatology.

DOI: https://doi.org/10.1111/bjd.18606