Future Therapeutic Pathways and Combination Strategies in Vitiligo Management

In a recent Dermatology Times Expert Perspectives custom video series, Marc Serota, MD, a dermatologist also board-certified in pediatrics, allergy and immunology, and obesity medicine at Epiphany Dermatology in Littleton, Colorado, recently discussed his key considerations for treating vitiligo and the evolving role of topical agents.

Serota discussed the evolving therapeutic landscape in vitiligo care, emphasizing growing enthusiasm around systemic options currently under investigation. While ruxolitinib cream (Opzelura; Incyte) remains the central FDA-approved topical JAK inhibitor for nonsegmental vitiligo, Serota noted that systemic JAK inhibition represents the next frontier. Drawing parallels to the transformative impact of systemic JAK inhibitors in alopecia areata, he expressed optimism about the potential for future indications, pending supportive data and regulatory review.

In clinical practice, Serota stressed the importance of individualized treatment planning, as repigmentation patterns vary significantly from patient to patient. He emphasized that certain sites—particularly the hands—remain challenging due to lower follicular density and limited melanocyte reservoirs. In these cases, he often integrates phototherapy to enhance repigmentation potential. Localized, portable phototherapy units can be an effective and practical solution, offering targeted exposure while remaining accessible and easy to incorporate into daily life.

Serota frequently employs a combination strategy, using what he describes as an “all-hands-on-deck” or “kitchen sink” approach when single modalities fall short. Layering therapies, including ruxolitinib cream plus targeted phototherapy, can improve outcomes by addressing multiple aspects of disease biology simultaneously. He noted several patients with incomplete hand repigmentation who achieved meaningful progress once appropriate localized phototherapy was added.

Although the primary discussion centered on vitiligo, Serota also briefly reflected on his Fall Clinical 2025 session addressing GLP-1 agonists in dermatology. He underscored the relationship between obesity, inflammation, and psoriatic disease, encouraging clinicians to recognize adipocyte-driven inflammatory signaling as part of the pathophysiology. Although this concept was discussed in the context of psoriasis rather than vitiligo, he reiterated the importance of addressing systemic inflammatory contributors when managing complex dermatologic conditions.