A groundbreaking cream targeting the underlying cause of vitiligo is set to be available through the UK’s National Health Service (NHS). In clinical trials, this cream significantly improved pigmentation in white skin patches associated with this condition. Despite previous controversies surrounding vitiligo treatment, it is important to note that vitiligo is neither painful nor dangerous.

“Typically, individuals with vitiligo exhibit no physical symptoms, but the condition can lead to significant psychological challenges,” stated David Rosmarin from Indiana University, who led two trials for the new ruxolitinib cream treatment.

The cream, already marketed in the United States under the name Opzelura, is indicated for treating non-segmental vitiligo, characterized by symmetrical white patches on both sides of the body. This condition is believed to result from the immune system mistakenly attacking melanocytes—the cells responsible for producing melanin, which gives skin its color.

According to Emma Rush from Vitiligo Support UK, this treatment represents the first rigorously tested medication that directly addresses the mechanisms causing vitiligo. “This is a significant milestone in vitiligo treatment,” she remarked.

Ruxolitinib functions by inhibiting the activity of enzymes that destroy melanocytes. While existing treatment options like steroid creams may restore some pigmentation, they have broader immune-suppressing effects.

A recent study published in 2022 revealed that ruxolitinib enhanced pigmentation and decreased the visibility of vitiligo patches compared to a placebo cream. The effects were noted irrespective of the individual’s skin color (vitiligo tends to be more conspicuous on darker skin tones), and these results were sustained for at least one year after treatment cessation for over a third of participants.

The National Institute for Health and Care Excellence (NICE) has previously reviewed the efficacy of ruxolitinib and concluded that it is not cost-effective for NHS provision. However, it is now recommended that this cream be available to individuals aged 12 and older with non-segmental vitiligo when other topical treatments have proven ineffective or unsuitable.

Vitiligo affects approximately 1% of the global population, with severity ranging from a few small patches to larger, inflamed, or discolored areas of skin.

“Patients and clinicians may sometimes believe that vitiligo does not require treatment since it is not life-threatening or physically painful,” noted Victoria Eleftheriadou of the British Association of Dermatologists. However, vitiligo can lead to serious complications, including depression and anxiety.

Natalie Umbersley, a vitiligo ambassador for the charity Changing Faces, stated that support groups encourage individuals with visible differences to seek treatment without fear of judgment but expressed her reluctance to pursue ruxolitinib after years of using existing therapies. “I have learned to embrace my unique skin,” she said. “It’s all about celebrating our individuality.”

“While it’s wonderful to have individuals who love their appearance, this is not the reality for everyone,” commented Rush.

While an oral form of ruxolitinib has been used to treat certain cancers and rheumatoid arthritis, it is associated with serious side effects such as lymphoma, heart disease, and infections. However, these risks are not reported with the topical formulation. In two vitiligo trials, ruxolitinib was linked to only mild side effects, including acne and itching. “Systemic absorption is minimal,” Eleftheriadou noted.

Ruxolitinib is also considered to be safer than long-term use of steroid creams, which can cause skin thinning. Additionally, ultraviolet light therapy may be an option for individuals with severe vitiligo, although it is not widely accessible.