Lindsay Ackerman, MD, FAAD, Discusses Practical Tips for Ruxolitinib Application

In a recent discussion with Dermatology Times, Lindsay Ackerman, MD, FAAD, shared her clinical experience and insights on optimizing outcomes for patients using ruxolitinib cream (Opzelura; Incyte) in the treatment of vitiligo. Ackerman, a medical dermatologist at Medical Dermatology Specialists in Phoenix—now part of US Dermatology Partners—serves as the site’s president, medical director of clinical research, chief of inpatient dermatology at Banner University Medical Center, and associate professor at the University of Arizona College of Medicine.

Ackerman highlighted an important gap between clinical trial data and real-world application of ruxolitinib cream. “We study the drug as monotherapy—that’s the FDA requirement,” she explained. “But really, looking at this drug on the ground level, many of us are using it in an off-label fashion, in combination with other therapies.”

While ruxolitinib cream has demonstrated efficacy as a topical Janus kinase (JAK) inhibitor for repigmentation in nonsegmental vitiligo, Ackerman and other clinicians have observed enhanced outcomes when combining it with narrowband UVB phototherapy. “Combination with narrowband UVB seems to enhance, experientially, the response to ruxolitinib cream for repigmentation,” she said.

In her clinical practice, Ackerman has seen more robust results when pairing the two modalities compared with either treatment alone. “Getting patients on ruxolitinib plus narrowband UVB in my hands works better than either one of those therapies alone,” she noted.

When discussing practical strategies for clinicians, Ackerman emphasized the importance of treatment sequencing and patient education. She advises patients to complete their narrowband UVB sessions before applying the cream. “We like to grease them up with Vaseline ahead of time and then they wipe it off afterward,” she explained. “We don’t want them wiping off their therapy.” Since the recommended dosing for ruxolitinib cream is twice daily, She suggests applying it several hours before phototherapy to allow for optimal absorption without interference.

Ackerman’s approach underscores the evolving nature of dermatologic therapeutics, where real-world experience can help refine evidence-based practices. As research continues to explore combination regimens, she hopes to see formal studies examining the synergistic effects of ruxolitinib with narrowband UVB. “There are a lot of ways we should be creative in utilizing this cream and optimizing patient outcomes,” she concluded. “That’s a gap I’d like to see filled.”