Topical therapies are applied directly to the skin at the site of the vitiligo lesion (i.e. white patch). A dermatologist will prescribe a cream that a patient can apply at home.
There are three types of topical therapies used to treat vitiligo:
Topical Ruxolitinib (Opzelura) is a Janus Kinase 1,2 (JAK) inhibitor approved by the FDA in 2022 for treatment of vitiligo in individuals aged 12 and older. It has shown significant results for repigmentation of facial and non-facial areas of involvement.
JAK inhibitors typically show meaningful improvement in repigmentation after about 3-6 months of treatment. Treatment is usually continued as long as repigmentation continues to improve.
Tacrolimus and pimecrolimus are both classified as immunomodulators, and are prescribed in their topical form for vitiligo. An immunomodulator is not the same as a steroid; it works by modulating (reducing) the immune response (where applied), allowing the melanocytes to once again grow and flourish.
Immunomodulators are especially useful on the face, beck, and skin folds because they do not thin the skin the way steroids can. They can be used for longer periods than steroids, including for children.
Steroid creams can be effective, especially for limited vitiligo and for new patches on the face or neck. Facial skin is thin, so strong steroid use on the face is usually done for limited periods of time and under close supervision.
Generally, use of topical steroids in widespread vitiligo is considered impractical because of the greater risk of side effects including thinning skin. To avoid adverse side effects, steroids are often used in on-off cycles rather than continuously.
Most physicians prescribe milder topical steroids for use by children.
Some insurance companies require the attestation of a physician before approving coverage of phototherapy for the treatment of vitiligo. GVF offers resources to make this process easier for physicians and patients.
Resources Disclaimer: The information provided on this page and in the linked resources should only be used under the guidance of your physician or another licensed medical professional. Use your topical therapy as you would any prescription medication under the direction of a physician. Like any medication, topical therapy can be harmful if not used properly.
Resources
Sample Letter of Medical Necessity for Ruxolitinib (Opzelura)
GVF wishes to acknowledge that Incyte Corp, maker of ruxolitinib (Opzelura), is a financial supporter of the Global Vitiligo Foundation. We are posting this letter of medical necessity (LOMN) because this is the first, and currently the only, FDA-approved drug for vitiligo repigmentation, and not because they are a financial sponsor. As other drugs are approved by the FDA, we will review the data and, if warranted, create a LOMN for that drug as well.