The Role of Systemic Treatments in Vitiligo

Although the mainstay of treatment for vitiligo has been centered on topical agents and phototherapy, systemic treatments had begun to show significant benefit in the disease in recent research, according findings from a review article published in Clinical and Experimental Dermatology.

The use of systemics corticosteroids for up to 6 months maybe an effective strategy for mitigating the progression of unstable vitiligo, according to retrospective studies. Disease progression may be halted or reduced with betamethasone or dexamethasone with varying repigmentation rates in some patients. Oral corticosteroids have also shown some success in vitiligo when combined with topical tacrolimus and excimer laser.

Case series data show weight-based dosed ciclosporin for 12 weeks can also halt vitiligo progression in a majority of patients. Another small open-label study reported low-dose oral methotrexate with oral dexamethasone may also reduce progression and the Vitiligo Disease Activity score.

Small research studies suggest some Janus kinase (JAK) inhibitors could also hold potential as a treatment for vitiligo. Based on the pathogenesis of the disease, researchers have posited the JAK inhibitor tofacitinib can lead to repigmentation by blocking IFNy signaling and downstream CXCL10 expression.

Some small case series have shown success with oral tofacitinib and ruxolitinib with respect to repigmentation. Another study showed repigmentation with oral tofacitinib is only successful if the therapy is administered alongside light exposure for regenerating melanocytes.

There has also been some scrutiny on the use of dietary supplements as an adjuvant approach to vitiligo. Gingko biloba, for instance, has been implicated in repigmentation and depigmentation cessation in some patients with vitiligo. Mice studies have also shown the use or application of selenium, zinc, polyphenols, as well as vitamins A, C and E may induce visible repigmentation.

Although the current data are promising, the researchers noted “combinations of systemic treatments with other treatments appear to be more effective at halting disease progression and achieving repigmentation than systemic monotherapy” in patients with vitiligo.

Reference

Searle T, Al-Niaimi F, Ali FR. Vitiligo: an update on systemic treatments. Clin Exp Dermatol. 2021;46(2):248-258. doi:10.1111/ced.14435