Comparing Corticosteroids vs JAK Inhibitors Post NCES Transplantation for Vitiligo

New research has analyzed the use of oral corticosteroids and Janus kinase (JAK) inhibitors following noncultured epidermal cell suspension (NCES) transplantation in patients with vitiligo.¹ At 6 months post transplantation, both methods had similar repigmentation rates but differing patterns of response. This transplantation method, which utilizes an autologous skin graft from a patient’s inner thigh, has gained popularity due to its broad applicability and simplicity.²

Methods and Materials

The single-center, retrospective, observational study included 12 participants between the ages of 18 and 42 years (4 women and 8 men). The mean age was 27.25 years. All had stable vitiligo for at least 1 year, but overall disease duration ranged from 2 to 24 years (mean = 8.75 years). The NCES transplantation procedure occurred at the Fourth Affiliated Hospital of Soochow University in China between June 2023 and December 2024. Prior to transplantation, participants were unsuccessfully treated with a combination of topical corticosteroids and/or phototherapy with narrowband UVB. These therapies were discontinued for at least 6 months before undergoing NCES.

A total of 36 lesions from 7 patients were treated with oral methylprednisolone (0.5 mg/kg), whereas 34 lesions from 5 patients were treated with extended-release upadacitinib (15 mg once a day). Regarding the total lesions, 15 were on the face (21.43%), 20 on the trunk (28.57%), 21 on the limbs (30.00%), and 14 on the distal extremities (20.00%). Treated area ranged from 24 cm² to 394 cm². Efficacy and safety were assessed via a 6-month follow-up period. Repigmentation rates were calculated based on improvement in body surface area, whereas treatment effectiveness was evaluated based on Vitiligo Area Scoring Index.

Results

Both groups saw similar mean rates of repigmentation at the 6-month mark (63.11 ± 30.69%). In total, 8 patients achieved repigmentation rates above 50%, and 5 participants achieved 75%. Patients treated with upadacitinib saw a more polarized pattern (repigmentation rate: 61.28 ± 32.38%). In this group, 38.2% (13/34) of lesions showed 25% to 50% improvement, 47.0% (16/34) showed more than 90% improvement, and only 2.9% showed less than 25% or 51% to 75% improvement.

“This suggests that, similar to their conventional use in vitiligo treatment, JAK inhibitors may not achieve ideal repigmentation in all patients in the postoperative setting but may exert enhanced effects in a subset of ‘sensitive’ individuals,” the authors wrote.

Patients treated with corticosteroids saw a more uniform pattern (repigmentation rate: 64.42 ± 31.99%). More specifically, 25.0% (9/36) of lesions showed less than 25% improvement, 25.0% (9/36) showed 51% to 75% improvement, and 22.2% (8/36) showed more than 90% improvement.

Better responses occurred in the face and trunk vs the acral areas, particularly in the corticosteroid group (P < .0001). Moreover, JAK inhibitors were effective in typically treatment-resistant areas, such as the limbs (P = .0001). The distal extremities responded relatively poorly in both cohorts. This is consistent with what was observed in previous research, according to the authors.

No serious adverse events or laboratory abnormalities were observed in either cohort. Approximately 4 patients experienced minor hypertrophic scarring, hyperpigmentation, and/or acne, making the overall incidence of adverse effects low.

Limitations and Next Steps

Several study limitations were present, including the retrospective design, small sample size, short follow-up, no control group, and lack of random assignment for the treatment cohorts. Future research can address these with larger, prospective, multicenter, randomized controlled studies. Despite this, the preliminary evidence demonstrated in this trial can aid in developing individualized immunomodulatory strategies, thus supporting the use of certain postoperative drugs in patients with vitiligo.

References

1. Zhang Y, Xu Y, Cui W, et al. Observational study on postoperative JAK inhibitor and corticosteroid therapy following non-cultured epidermal cell suspension transplantation in stable vitiligo patients. J Dermatolog Treat. 2025;36(1):2540014. doi:10.1080/09546634.2025.2540014

2. Vakharia PP, Lee DE, Khachemoune A. Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence. Int J Dermatol. 2018;57(7):770-775. doi:10.1111/ijd.13895