Noninvasive Imaging Maps Repigmentation and Melanocyte Activation in Ruxolitinib-Treated Vitiligo

A new real-world study found that topical ruxolitinib was associated with significant improvements in facial vitiligo severity, disease extent, and quality of life over 3 months.¹ The study also used several noninvasive imaging techniques to characterize treatment-associated changes, including evidence of repigmentation and the appearance of activated melanocytes.

Study Design

The multicenter, observational study enrolled 70 immunocompetent patients aged 12 to 80 years with nonsegmental vitiligo involving the face or face and body. There were 24 men and 46 women, with a mean age of 45.3 years. Most participants were Caucasian, with 47.1% classified as Fitzpatrick skin type II and 51.9% as type III. Patients were instructed to apply ruxolitinib cream 15 mg/g twice daily to affected facial areas. Clinical and instrumental assessments were performed at baseline, 30 days, and 90 days.

Clinical outcomes were assessed using the Facial Vitiligo Area Scoring Index (F-VASI), Facial Vitiligo Extent Score–Body Surface Area (F-VES BSA), Vitiligo Extent Score (VES) grade, Physician’s Global Vitiligo Assessment (PhGVA), Patient Global Vitiligo Assessment of the face (PaGVA), and Dermatology Life Quality Index (DLQI).

Improvements in Disease Severity and Quality of Life

F-VES BSA decreased significantly between baseline and 90 days, with a mean difference of 0.5761 (P<.0001). VES grade also decreased significantly, with a mean reduction of 0.4571 (P<.0001). Physician and patient global assessments showed mean reductions of 1.1571 and 1.0290, respectively, with both reaching statistical significance (P<.0001). The F-VASI also demonstrated a statistically significant change, although the investigators noted that its mean difference was relatively small. The mean difference was 0.9871, with a standard deviation of 0.5030 (P<.0001).

Quality of life improved during treatment. The DLQI showed a mean reduction of 3.1143 from baseline to 90 days (P<.0001), indicating a measurable improvement in the reported impact of vitiligo. VISIA 2D imaging and Wood’s lamp examination provided instrumental evidence of clinical improvement, including fewer pixels corresponding to areas affected by vitiligo and changes in brown spot detection. The investigators noted that the increase in brown spot counts reflected repigmentation because the imaging system identifies repigmented areas as brown spots.

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Cellular Analysis and RCM/LC-OCT Findings

The study also incorporated reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) to evaluate microstructural changes. These assessments were descriptive rather than quantitative.² Both techniques demonstrated new activated melanocytes in the basal and spinous layers of the epidermis, with the finding particularly noticeable around hair follicles. Perifollicular pigmentation was also observed following treatment.

RCM identified dendritic-like and starburst-like melanocytes, as well as changes in pigment distribution. LC-OCT provided cross-sectional images showing the reappearance of melanocytes and repigmentation patterns in vivo, including activated melanocytes in perifollicular areas at the dermoepidermal junction and spinous layer. The investigators noted that the RCM and LC-OCT findings were not confirmed through histologic or cytologic studies, representing a limitation. Additional limitations included the relatively small final sample and short-term follow-up for efficacy and safety.

Conclusions and Next Steps

Overall, the findings support the potential efficacy of topical ruxolitinib for facial vitiligo, with improvements demonstrated across multiple clinical measures and quality-of-life assessments. The imaging findings provided additional visualization of repigmentation and melanocyte activity. The investigators concluded that larger multicenter studies with longer follow-up are needed to further establish the efficacy and safety of JAK inhibitor treatment in this setting.

References

1. Greco ME, Feresin F, di Caro A, et al. Noninvasive imaging for the evaluation of JAK inhibitors efficacy in the management of facial vitiligo. J Dermatolog Treat. 2026;37(1):2705162. doi:10.1080/09546634.2026.2705162

2. Greco ME, Feresin F, Caro AD, et al. Management of adult vitiligo: approved topical JAK inhibitor and standard therapies. J Dermatolog Treat. 2026;37(1):2627721. doi:10.1080/09546634.2026.2627721