The Landscape for Vitiligo: An Interview with Larry Green, MD

Practical Dermatology® Chief Medical Editor Neal Bhatia, MD, FAAD, talked with Larry Green, MD, a board-certified dermatologist in private practice in Rockville, Maryland, about the latest in vitiligo treatment and what practitioners can tell their patients about recent advances in treatment for this condition.Watch the full interview and others at practicaldermatology.com.

What’s the current treatment landscape for patients with vitiligo?

Larry Green, MD: The standard treatment we’ve done for many years is light therapy. Narrowband ultraviolet B [NB-UVB]) is what’s used most frequently with topical steroids now. We had the introduction of ruxolitinib cream about a year ago for vitiligo, and that’s really changed the way I treat vitiligo a lot, because we have a nonsteroidal cream that you’re not worried about using anywhere on the body from head to toe, whether it be the ears, the eyelids, or the elbows and knees. That makes it very easy compared to topical steroids, and especially for small-focus areas of vitiligo where NB-UVB would be maybe a little more difficult.

L to R: Larry Green, MD, and Neal Bhatia, MD

When talking to patients about the risks of steroids around the eyes, hands, and other areas treated for vitiligo, what conversations do you have about these newer agents?

Life is much easier with these newer agents because you don’t have to have the conversations about the possible side effects with steroids. I tell my patients who are using ruxolitinib cream that they can use it on vitiligo on the eyelids just as easily. You can use it on your elbows, knees, on the backs of the hands, and also in the genital area. It’s a twice-a-day product, but it does take a while to pigment. It’s not like they pigment overnight. It takes months, just like with UVB or just like with topical steroids, but they do pigment without the use of steroids.

Do you have any insights into what’s coming in clinical trials?

The most common trials are focused on the Janus kinase (JAK) inhibitors, and there are many big pharma companies looking at trials with that. I can start with two JAK-1 inhibitors: that’s ritlecitinib, an oral once-a-day pill, and also upadacitinib. This is not an overnight thing. It takes months, but they do work and do pigment people with extensive vitiligo.

What are your thoughts on how to bring updates on safety and efficacy data to the vitiligo patient who’s waiting for treatment to work?

We’re hoping for something soon. It will take a few years. These are in phase 3, and they’re all looking at 1-year safety data. All of these trials will be extended out to at least one year, but you don’t necessarily have to have the full 1-year safety data for them to get approved. They can look at the interim data, but the interim data are at least six months, so there’s not that much of a difference. We’ve got long-term safety data with ruxolitinib cream now, and that goes out a few years. I just finished a clinical trial with ruxolitinib cream and NB home units of UVB that the patient took home. I look forward to seeing the results of that clinical trial. Maybe the combination of a JAK inhibitor cream and NB-UVB will lead to an even speedier depigmentation process.