Pharmacological Management of Vitiligo: Efficacy of Topical and Systemic Therapies

Abstract

Vitiligo is a chronic autoimmune depigmenting disorder with substantial psychosocial burden, driven by genetic susceptibility, oxidative stress, and T‑cell–mediated immune responses centered on the IFN‑γ–CXCL10–CXCR3 axis. This thesis reviews current pharmacological management, evaluating the efficacy and safety of established topical and systemic therapies and the emerging role of Janus kinase (JAK) inhibitors. A systematic literature review of randomized controlled trials, meta‑analyses, and clinical guidelines covers topical corticosteroids, calcineurin inhibitors, phototherapy-based regimens, systemic immunosuppressants, antioxidants, and novel targeted agents. Topical corticosteroids and calcineurin inhibitors remain first‑line for localized disease, while systemic corticosteroids are key for rapidly progressive cases. Among recent advances, JAK inhibitors such as topical ruxolitinib and systemic ritlecitinib show meaningful repigmentation with acceptable safety. Combination strategies, particularly pharmacologic agents plus NB‑UVB, generally achieve higher repigmentation rates than monotherapy. Persistent limitations include variable and site‑dependent responses, adverse‑effect profiles and relapse risk, and restricted access to newer targeted therapies. Overall, the thesis highlights the need for individualized, combination-based strategies and for broader, equitable access to emerging targeted drugs.