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Skin colour of patients with vitiligo restored using arthritis medication, UVB light

The skin colour of patients with vitiligo was found to be restored using a combination of tofacitinib and narrowband ultraviolet B (UVB) light phototherapy, in a small study published in JAMA Dermatology (Jan. 31, 2018).

“These findings will define treatment of vitiligo in the future,” said study co-author Dr. Brett King, associate professor of dermatology at the Yale School of Medicine at Yale University in New Haven, Conn., in a press release.

The investigation was based on a previous study that suggested tofacitinib, which is used to treat rheumatoid arthritis, is a janus kinase inhibitor (JAK) 1/3 inhibitor that keeps the immune system from attacking skin cells that produce melanin. Results of the past study were published in JAMA Dermatology (June 2015; 151(10):1110–1112). UVB light, on the other hand, is known to stimulate pigment-making cells that restore colour to the epidermis.

Two patients with vitiligo with significant facial involvement were involved in the trial. In these cases, standard treatments such as steroid creams and light treatment have failed to restore pigmentation.

The first patient was a Hispanic woman in her 30s. Her treatment involved 5 mg of tofacitinib, twice daily and full-body narrowband UVB at 400 to 500 mJ administered twice per week.

After three months of therapy, the woman had nearly complete repigmentation of her face. Her neck, chest, forearms, and shins had 75% or greater repigmentaion. Her dorsal hands had only minimal freckling.

Left to right: Study participant with vitiligo at the beginning of treatment, at three months into the treatment and at six months into the treatment. Photo by Yale University News.

The other participant was a Caucasian man in his 50s.

He received a 5 mg dosage of tofacitinib twice daily and narrowband UVB at 360 to 500 mJ, two to three times weekly only to the face.

After three months, there was 50% repigmentation on his face. After six months, he had 75% facial repigmentation.

The participants continued with treatment. No adverse effects have been reported upon follow-up. The patients also had complete blood cell count. Tests on liver function, serum creatinine, and fasting lipids revealed no abnormalities.

Researches noted that repigmentation in the male participant is significant because he showed prior repigmentation success with monobenzyl ether of hydroquinone (MBEH). This suggests that melanocytes of the inter-follicular epidermis, not melanocyte stem cells, are destroyed by MBEH.

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