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• W2936702974 abstract "To the Editor: Current treatments for vitiligo are limited in efficacy, often producing suboptimal results. Recent studies have established that CD8+ T-cell and interferon γ signaling, mediated by the Janus kinase (JAK)–signal transducer and activator of transcription pathway, contribute to the pathogenesis of vitiligo.1Ciechanowicz P. Rakowska A. Sikora M. Rudnicka L. JAK-inhibitors in dermatology. Current evidence and future applications.J Dermatol Treat. 2018; : 1-22Google Scholar JAK inhibitors block this pathway and are currently Food and Drug Administration approved for autoimmune diseases, including psoriatic arthritis, rheumatoid arthritis, ulcerative colitis, and myeloproliferative disorders.1Ciechanowicz P. Rakowska A. Sikora M. Rudnicka L. JAK-inhibitors in dermatology. Current evidence and future applications.J Dermatol Treat. 2018; : 1-22Google Scholar Recently, treatment with oral tofacitinib, a JAK 1 and 3 inhibitor, was shown to improve vitiligo disease severity in case reports and a small series. Unfortunately, this medication carries risks of systemic side effects, including infections, malignancies, and cytopenias, and is expensive, with monthly costs >$4000 USD for sixty 5-mg tablets.2Xeljanz prices, coupons and patient assistance programs. Drugs.com; 2018 [cited December 4, 2018]. Available from: https://www.drugs.com/priceguide/xeljanz.Google Scholar Given these limitations, topical JAK inhibitors could serve as a safer, more cost-effective treatment for vitiligo. We report the use of topical 2% tofacitinib cream in a small series of patients with facial vitiligo. In this institutional review board–approved study, 11 patients with vitiligo seeking treatment at the Pigmentary Disorders Clinic of the University of Texas Southwestern Medical Center were treated with 2% tofacitinib cream twice daily in conjunction with narrowband ultraviolet B (NB-UVB) therapy thrice weekly over a period of 3 ± 1 months. NB-UVB dosing was performed as recommended by the Vitiligo Working Group consensus guidelines.3Mohammad T.F. Al-Jamal M. Hamzavi I.H. et al.The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo.J Am Acad Dermatol. 2017; 76: 879-888Google Scholar All patients had previously tried ≥3 months of treatment with topical corticosteroids or calcineurin inhibitors in addition to NB-UVB phototherapy or sunlight exposure 3 times weekly without improvement of their disease. The Vitiligo Area Severity Index (VASI) was used to measure the amount of depigmentation on each patient's face, also called facial VASI, before and after 3 ± 1 months of treatment.4Hamzavi I. Jain H. McLean D. Shapiro J. Zeng H. Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the vitiligo area scoring index.Arch Dermatol. 2004; 140: 677-683Crossref PubMed Scopus (285) Google Scholar Six patients were non-Hispanic white, 4 were Asian, and 1 was Hispanic. The male-to-female ratio was 5:6, and mean age was 44 years. The mean facial VASI was 0.80 (range 0.1-2.25) at baseline and 0.23 (range 0.03-0.75) at follow-up (Figs 1 and 2), which is a mean improvement of 70% (range 50%-87%). Mean time to follow-up was 112 (range 84-154) days. Because of the small area of involvement, a 30-g tube of tofacitinib 2% cream lasted each patient an average of 90 days and cost $320 USD. The cream was obtained from a compounding pharmacy in Pennsylvania and mailed to the patient. There were no reported side effects.Fig 2Nonsegmental vitiligo after 4 months of treatment with 2% tofacitinib cream twice daily and narrowband ultraviolet B phototherapy 3 times weekly.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Recent studies have shown better repigmentation in lesions exposed to sunlight compared to unexposed lesions in patients treated with oral and topical JAK inhibitors.1Ciechanowicz P. Rakowska A. Sikora M. Rudnicka L. JAK-inhibitors in dermatology. Current evidence and future applications.J Dermatol Treat. 2018; : 1-22Google Scholar, 5Rothstein B. Joshipura D. Saraiya A. et al.Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib.J Am Acad Dermatol. 2017; 76: 1054-1060.e1Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar The improvement seen in our patients with combination topical tofacitinib and phototherapy suggests a synergistic relationship. Repigmentation of facial vitiligo lesions was good to excellent in all 11 patients. The face was chosen in this pilot study because this region has the best response in patients with vitiligo, but future studies should include treatment of nonfacial areas. Other limitations of this pilot study are small sample size and lack of controls. Future controlled studies with larger sample sizes and long-term follow-up should be performed. If they are confirmatory, topical tofacitinib could become a useful addition to our therapeutic armamentarium for vitiligo." @default.
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• W2936702974 title "A pilot study of 2% tofacitinib cream with narrowband ultraviolet B for the treatment of facial vitiligo" @default.
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• W2936702974 doi "https://doi.org/10.1016/j.jaad.2019.04.032" @default.
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