The Consumer’s Guide to JAK Inhibitors for Vitiligo

Because they work by interrupting the inflammatory process, topical JAK inhibitors are likely to be most effective when used early in the course of the disease, when inflammation is most active, says Dr. Gutierrez.

This isn’t to say that if you’ve been living with vitiligo for a long time, a topical JAK inhibitor won’t help you. “I have patients who have had vitiligo for years without a good response to traditional therapies start to see some of their pigment come back with ruxolitinib,” says dermatologist Nicole S. Gunasekera, MD, director of the vitiligo clinic at Brigham and Women’s Hospital in Boston.

“Some people notice little speckles of normal pigment coming back within the first couple weeks of using ruxolitinib,” says Dr. Gunasekera, but others may not see significant changes for six months or more. For example, in clinical trials of ruxolitinib, 30 percent of people with vitiligo saw up to 75 percent improvement after 24 weeks, notes Gutierrez.

Ruxolitinib is most effective on relatively small patches of skin, says Gunasekera, which is in keeping with the fact that it can only be used on 10 percent or less of the surface area of the body. So if you have vitiligo that affects more than 10 percent of your skin, you’ll pick the areas you feel most self-conscious about to treat with the cream. If these areas happen to be on your face, you may be in luck, as facial skin tends to respond better to topical medication than the skin on other parts of the body, says Gunasekera.

Because the medication is applied directly to the skin, that’s where side effects are likely to show up. The most common ones from ruxolitinib, for example, include redness, itching, and acne-like breakouts. The medication also may bring on coldlike symptoms, headaches, fevers, and urinary tract infections.

Even so, the medication does have a black box warning, based largely on the potentially dangerous side effects associated with oral ruxolitinib (Jakafi):

• Serious infections
• Blood clots
• Cancer
• Heart attack

These warnings are primarily “a better-safe-than-sorry approach by the FDA. There’ve been no significant reports of serious side effects from people using the cream,” notes Gunasekera.

Among those being studied:

• A topical version of tofacitinib, which is available as an oral medication (brand name Xeljanz), to treat rheumatoid arthritis (RA), ankylosing spondylitis, and ulcerative colitis, among others
• A topical version of baricitinib (Olumiant), an oral medication approved to treat RA and alopecia areata

Jakafi is being studied to treat vitiligo also.

Any condition that affects the skin can be especially detrimental to emotional health and quality of life, given that the symptoms are so visible. This is especially true for appearance-conscious teenagers. Ruxolitinib works just as well for kids 12 and over as it does for adults and is just as safe, according to a study presented at the American Academy of Dermatology’s 2022 annual meeting.