Q&A: Building Patient Partnerships in Vitiligo Management

As treatment options for vitiligo continue to expand, topical ruxolitinib has emerged as a pivotal development in clinical dermatology, offering, for the first time, an FDA-approved topical therapy for this chronic autoimmune pigmentary disorder. With growing real-world experience, clinicians are refining how to set patient expectations, integrate combination approaches, and interpret long-term outcomes.

At the 2025 Fall Clinical Dermatology Meeting, Dermatology Times spoke with Lindsay Ackerman, MD, FAAD, a board-certified medical dermatologist and Medical Director of Clinical Research at Medical Dermatology Specialists in Phoenix, Arizona, part of US Dermatology Partners. Ackerman shares her clinical insights on optimizing ruxolitinib use, addressing safety concerns, and identifying future directions in pigmentary and inflammatory skin disease research.

Q&A

Dermatology Times (DT): What are your observations on the use of topical ruxolitinib in patients who have failed prior therapies — and how do you set realistic expectations for treatment timelines?

Lindsay Ackerman, MD, FAAD: Setting expectations and providing anticipatory guidance are absolutely essential. Ruxolitinib cream has been a real game changer—it’s the first FDA-approved treatment for vitiligo, and importantly, it allows for long-term use with a well-understood safety profile.

However, patients need to understand from the outset that this is not an overnight process. Repigmentation occurs gradually, and successful treatment typically unfolds over months to years, not weeks. I emphasize to patients that we’re embarking on a journey together. Managing vitiligo requires consistency, patience, and an ongoing partnership between the patient and provider.

DT: How do you reliably track progress, patient satisfaction, and make decisions about continuing or adjusting topical therapy?

Ackerman: We can be very objective in our assessment using photographic documentation and standardized outcome measures that capture repigmentation, often beginning peri-follicularly. But we also have to connect this with what is meaningful to the patient.

Vitiligo is a disfiguring and life-altering disease, so while clinical photos may show measurable improvement, the patient’s perception of progress can differ. I integrate both objective and subjective measures—what we see clinically and how patients feel about those changes—to guide decisions about whether treatment is worthwhile to continue or adjust.

DT: In teenagers and younger patients, how do adherence, psychosocial expectations, and quality-of-life factors influence your decision to initiate or persist with topical ruxolitinib?

Ackerman: Adherence and psychosocial factors are central in this population. Teenagers often have heightened emotional investment in visible improvement, so setting the right expectations early helps sustain engagement. I focus on transparency about timelines and realistic outcomes, reinforcing that improvement takes time. Regular follow-up and involving parents or caregivers in the process also help support adherence and consistency.¹

DT: Have you seen in real-world settings any safety signals or adverse effects that differ from those observed in clinical trials?

Ackerman: To date, I haven’t seen any unexpected safety signals in practice that differ meaningfully from trial data. The boxed warning associated with ruxolitinib stems from data on oral JAK inhibitors used systemically, not the topical formulation.

In real-world use, major adverse cardiovascular events, malignancy, or venous thromboembolism have not been observed as safety concerns with the topical product. A few cases of herpes zoster were reported in trials, but these were uncommon and difficult to interpret as definitively drug-related. I always make it a point to explain the context of the boxed warning to patients or parents. It can be done succinctly but helps build trust and understanding.

DT: What gaps in the evidence or practice do you see around topical therapies for vitiligo, and how can clinicians or research networks help fill them?

Ackerman: There’s still a significant gap between the data we have and what we observe in practice. The drug was studied as monotherapy for FDA approval, but many clinicians, myself included, are using it off-label in combination with other treatments.

For example, combining topical ruxolitinib with narrowband UVB phototherapy appears to enhance repigmentation outcomes. In my practice, applying ruxolitinib hours before UVB treatment, rather than immediately after, optimizes absorption without interference from emollients like petrolatum. I’d like to see more structured studies evaluating such combination regimens, since they reflect real-world management and may optimize results.²

DT: Considering complicated regulatory scrutiny, what is your standard conversation with patients about the ruxolitinib boxed warning?

Ackerman: I believe in absolute transparency. Before prescribing any drug with a boxed warning, I take time to explain where the warning originated. The ruxolitinib warning comes from studies of systemic JAK inhibitors like tofacitinib used in rheumatoid arthritis populations, patients who are typically older and have other comorbidities.

When contextualized, patients and parents generally understand that topical exposure is minimal and that these risks haven’t been seen with the cream. It’s an important conversation, but it doesn’t need to be long; a clear explanation builds confidence and helps patients feel informed.

DT: Outside of currently available or on-label treatments for vitiligo, what are you most excited about in the dermatology pipeline?

Ackerman: I think 2026 will be an exciting year for medical dermatology. We’re anticipating several new approvals for conditions like hidradenitis suppurativa, where current therapies don’t meet all patients’ needs.

I’m also encouraged by the exploration of existing molecules for new indications—conditions like chronic pruritus of unknown origin (CPUO) are now being studied systematically. The field is rapidly expanding, and with drugs like ruxolitinib demonstrating the ability to alter disease pathways at the skin level, we’re entering an era where pigmentary and inflammatory diseases alike can be addressed in far more precise and meaningful ways.

References

1. Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol. 2014;31(3):309-318. doi:10.1111/pde.12226
2. Pandya AG, Harris JE, Lebwohl M, et al. Addition of narrow-band UVB phototherapy to ruxolitinib cream in patients with vitiligo. J Invest Dermatol. 2022;142(12):3352-3355.e4. doi:10.1016/j.jid.2022.05.1093