Vitiligo involves paler, less pigmented patches of skin
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A first-of-its-kind cream that targets the underlying cause of vitiligo will be made available at the National Health Service in England. In clinical trials, the cream significantly increased pigmentation in the white skin patches caused by the condition, but the treatment has previously been described as controversial, as vitiligo is not painful or dangerous.
“Typically, people (with vitiligo) are asymptomatic in terms of physical symptoms, but it can cause a lot of emotional distress,” says David Rosmarin of Indiana University, who led two trials of the new ruxolitinib cream treatment.
The cream, which is already available in the US, is sold under the name Opzelura. It treats non-segmental vitiligo, which occurs when symmetrical white patches appear on both sides of the body. This is thought to be caused by the immune system attacking melanocytes, the cells that make the pigment melanin, which gives skin color.
The treatment is the first drug to be robustly tested to act directly on the pathway that causes vitiligo, says Emma Rush of Vitiligo Support UK. “That’s why this (decision) is such a landmark,” she says.
Ruxolitinib works by inhibiting two enzymes that cause immune cells to destroy melanocytes. Existing treatments, such as steroid creams, can restore some pigment but suppress immune function more broadly.
Two studies, published in 2022, found that the drug increased pigmentation and reduced the noticeableness of vitiligo patches compared to a placebo cream. This happened regardless of people’s skin tones (vitiligo is more noticeable on darker skin), and was maintained for at least a year in more than a third of those who stopped taking the drug after the trial.
The National Institute for Health and Care Excellence (NICE) previously weighed up these results, but considered that ruxolitinib was not cost-effective for use on the NHS. Now it says that the cream must be made available to people aged 12 and over with non-segmental vitiligo when other current treatments have not worked or are unsuitable.
Vitiligo, which affects around 1 percent of the world’s population, varies in severity. Some people only have a few small spots, while for others they can be large, red, inflamed or discolored.
“Patients and clinicians sometimes think we shouldn’t treat vitiligo, (because) it doesn’t kill you (and) it’s not painful,” says Viktoria Eleftheriadou of the British Association of Dermatologists. But vitiligo can have serious complications, such as a higher risk of depression and anxiety.
Natalie Ambersley – a vitiligo ambassador for the charity Changing Faces, which supports people with physical differences – says people should not feel judged for treating the condition, but adds that after spending several years on existing treatments, she will not seek ruxolitinib. “I’ve learned to accept my skin,” she says. “We are (all) unique and we can embrace how we look.”
“It’s great that there are people who love the skin they’re in, but it’s not for everyone,” says Rush.
An oral version of ruxolitinib, used to treat some cancers and rheumatoid arthritis, has been linked to serious side effects, including lymphoma, heart problems and serious infections. But these are not reported with the current version. In the two vitiligo studies, ruxolitinib caused only mild side effects, including acne and itching. “There is super minimal systemic absorption,” says Eleftheriadou.
Ruxolitinib is also believed to be safer than steroid creams, which can lead to thinning of the skin with long-term use. People with severe vitiligo may also be offered ultraviolet therapy, but this is not widely available.
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