Latest advances in vitiligo treatment

Learn about the latest advances in vitiligo treatment available in 2022 and the therapies that were being investigated for the future.

Vitiligo is not contagious and does not usually cause physical pain. However, it is a chronic pigmentary disorder that can have a substantial impact on quality of life. Historically, its clinical and psychosocial significance has sometimes been underestimated because the most visible manifestation is a change in skin colour.

However, vitiligo can have a considerable emotional and psychosocial impact.

Some patients experience stress, anxiety, low mood or difficulties in social situations because of the visible depigmented patches affecting the face or body.

For this reason, Grupo Pedro Jaén has dermatologists specialising in vitiligo treatment with specific training and experience in managing this condition.

Can vitiligo be treated?

Yes. There are several treatment options for vitiligo, although response varies considerably between patients and between different areas of the body. There are no instant or universally effective treatments, so claims of rapid and permanent repigmentation should be treated with caution.

One reason treatment requires time is that melanocytes, the cells responsible for producing melanin, are highly specialised. Successful repigmentation requires viable melanocytes to proliferate, migrate into depigmented areas and begin producing pigment again. This process can take weeks or months. Even when treatment is effective, repigmentation may not be complete or permanent, and new areas of vitiligo may appear over time.

Early diagnosis is also important. Starting treatment while the disease is active and before melanocyte reservoirs are extensively depleted may improve the likelihood of response in selected patients.

Vitiligo can also resemble other conditions that cause lighter patches of skin, including pityriasis alba, pityriasis versicolor and idiopathic guttate hypomelanosis. An accurate diagnosis is therefore important before treatment is started.

Latest advances in vitiligo treatment

Below we review some of the main advances and treatment approaches available or under investigation in 2022, together with one of the most established conventional treatments: phototherapy.

Phototherapy for vitiligo

Phototherapy is one of the most established treatments for vitiligo. It may be used alone or combined with topical or systemic treatments depending on the individual case.

Ultraviolet radiation can stimulate melanocyte activity and melanin production. However, this does not mean that uncontrolled sun exposure is an appropriate treatment.

Narrowband ultraviolet B (NB-UVB) phototherapy delivers ultraviolet radiation in a controlled therapeutic range and is administered under medical supervision. Depending on the extent and location of vitiligo, NB-UVB may be delivered using handheld devices, targeted systems, panels or whole-body phototherapy units. Treatment usually requires repeated sessions over a period of months, and the degree of repigmentation varies between patients and anatomical areas.

Vitiligo surgery

In some patients, phototherapy and medical treatment do not achieve sufficient repigmentation. One reason may be that melanocytes have been extensively depleted from affected areas. In selected patients with stable vitiligo, surgical techniques designed to transfer pigment-producing cells from normally pigmented skin to depigmented areas may be considered. These procedures are often referred to as vitiligo surgery, melanocyte transplantation or melanocyte grafting.

What does melanocyte transplantation involve?

The principle is to obtain melanocytes from an unaffected area of the patient’s skin and transfer them to areas affected by vitiligo.

Depending on the technique used, cells may be harvested from donor skin, processed into a concentrated cellular suspension and then applied to previously prepared depigmented areas. The transplanted melanocytes can then proliferate and contribute to gradual repigmentation.

Melanocyte transplantation is not usually considered a first-line treatment. It is generally reserved for carefully selected patients, particularly those with stable disease and areas that have responded poorly to conventional medical therapy or phototherapy.

How effective is melanocyte transplantation for vitiligo?

The degree of repigmentation varies according to factors such as the type and stability of the vitiligo, the anatomical area treated and the surgical technique used.

Patients with segmental or localised stable vitiligo generally tend to achieve better results than those with more widespread or active disease.

In the studies available at the time this article was prepared, substantial repigmentation was reported in a significant proportion of appropriately selected patients, although outcomes were variable and complete repigmentation could not be guaranteed.

New treatments for vitiligo

In 2022, particular interest focused on a group of medicines known as Janus kinase (JAK) inhibitors, or inhibitors of the JAK–STAT signalling pathway.

These medicines modulate specific immune pathways involved in the autoimmune destruction of melanocytes.

JAK inhibitors were already being used or investigated in several immune-mediated diseases, including rheumatoid arthritis, inflammatory bowel disease, atopic dermatitis and alopecia areata. At the time this article was written, their use in vitiligo represented one of the most promising areas of research. Clinical studies were evaluating both topical and systemic JAK inhibitors, often in combination with phototherapy.

Other investigational approaches included treatments intended to stimulate melanocyte activity or influence pathways involved in pigmentation, including agents such as afamelanotide and prostaglandin E2.

Dr Gonzalo Segurado, a specialist in vitiligo and confocal microscopy at Grupo Pedro Jaén, was involved in clinical research evaluating some of these emerging therapeutic approaches. These developments reflected a broader shift towards understanding vitiligo as an immune-mediated disease and developing treatments directed at specific biological pathways involved in its progression.

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