Long-Term Strategies and Response Markers 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 first reviewed the importance of setting realistic expectations when initiating ruxolitinib cream (Opzelura; Incyte) therapy for vitiligo, emphasizing that repigmentation follows a gradual and highly individualized trajectory. He advised clinicians to frame treatment as a long-term commitment influenced by anatomical site, follicular density, and natural light exposure. Areas rich in hair follicles tend to repigment more predictably, while regions with fewer melanocyte reservoirs may progress more slowly.

Next, Serota pointed to long-term data demonstrating a steady, continuous improvement curve with ruxolitinib cream, distinct from fixed-response patterns seen with many psoriasis biologics. Rather than plateauing at a standard week-16 assessment, patients may show ongoing gains extending well past 36 weeks. This pattern supports consistent messaging around adherence, reinforcement of early expectations, and encouragement to remain on therapy long enough to reach clinically meaningful endpoints.

Early repigmentation can present in a “polka dot” or speckled pattern as islands of pigment reappear. While this may initially concern patients, Serota identified it as a positive biomarker of treatment activity, reflecting melanocyte stem cell activation and maturation. Educating patients about this phenomenon can help sustain confidence and reduce premature discontinuation.

Conversely, an absence of these early repigmented foci by key intervals—16, 24, or 36 weeks—may indicate suboptimal response and prompt consideration of adjunctive options. Serota noted that phototherapy remains a valuable complementary modality, working together with ruxolitinib’s localized immune modulation by promoting melanocyte proliferation and migration. For select cases, introducing a potent topical corticosteroid may help accelerate early response before transitioning back to ruxolitinib for safer long-term maintenance.

Overall, Serota emphasized patience, education, and individualized pacing. Effective vitiligo management with ruxolitinib cream relies on longitudinal monitoring, proactive counseling, and thoughtful integration of combination therapies when needed to optimize repigmentation outcomes.

“The take-home point is counsel your patient that this is going to be a consistent, slow, marathon of treatment, not something they’re going to experience instant results,” Serota said.