Upadacitinib Plus Excimer Laser Is Efficacious in Treating Refractory Vitiligo With Moderate to Severe Atopic Dermatitis

Treatment with upadacitinib (Rinvoq; AbbVie) plus a 308-nm excimer laser demonstrated efficacy and safety in patients with refractory vitiligo with moderate to severe atopic dermatitis (AD), according to a recent study. The study, published in Dermatologic Therapy,¹ reported high rates of remission after 4 months of therapy, with greater improvements observed in the face and neck areas.

Background and Methods

Approved for moderate to severe AD, upadacitinib has also demonstrated promise in the treatment of vitiligo. A 2024 case series published in JAAD Case Reports outlined its efficacy in a cohort of 10 patients with nonsegmental vitiligo, in which patients were treated with 30 mg daily for a maximum duration of 24 weeks.² Researchers observed that 90% of patients achieved repigmentation, denoted by improvements in Vitiligo Extent Score.

Additionally, combination therapy with Janus kinase (JAK) inhibitors plus laser use has demonstrated efficacy in vitiligo. During the extension phase of a clinical trial evaluating ritlecitinib (Litfulo; Pfizer Inc) plus narrowband ultraviolet B light phototherapy, the combined treatment demonstrated enhanced results.³ Patients receiving the combination therapy saw greater facial repigmentation (69.6%) compared with ritlecitinib alone (55.1%), and the regimen was well tolerated.

The present open-label, single-arm trial evaluated 19 patients with refractory vitiligo and moderate to severe AD treated between March 2023 and May 2024. Patients received oral upadacitinib (15 mg daily) combined with 308-nm excimer laser therapy twice weekly for 4 months, with follow-up lasting an additional 3 months.

Findings

Over the 4-month treatment period, the average Vitiligo Area Scoring Index score decreased by 58.26%, with more significant repigmentation observed during the final 2 months of therapy.

Facial and neck lesions were particularly responsive, with 1 patient achieving complete clearance and others showing greater than or equal to 70% improvement, whereas the hands and feet remained the most treatment-resistant areas.

Furthermore, sex, skin type, and disease duration had no significant influence on treatment outcomes; however, age negatively correlated with repigmentation, suggesting younger patients may respond more favorably.

Alongside pigmentary improvements, patients experienced a substantial reduction in AD severity, with SCORing Atopic Dermatitis scores declining by 41.04% and Dermatology Life Quality Index scores improving by 50.09%, reflecting better symptom control and enhanced quality of life.

The combination therapy was generally well tolerated. Reported adverse events included mild acne and transient upper respiratory symptoms in isolated cases, which all resolved without intervention. No serious adverse events occurred.

Conclusions

This study highlights the potential of combining upadacitinib, a selective JAK1 inhibitor, with 308-nm excimer laser therapy as an effective strategy for treating refractory vitiligo in patients with moderate to severe AD. The dual approach not only improved pigmentation outcomes but also reduced AD severity and improved patient quality of life.

Despite promising results, limitations such as the small sample size, absence of a control group, and short follow-up period may impact the generalizability of these findings.

"Further large-scale prospective studies are needed to determine the safety and stability of this combinatorial approach, as well as the possible synergistic relationship between the drug and phototherapy," wrote study authors Zhou et al.

References

1. Zhou F, Li W, Liu Y, et al. Clinical efficacy and safety of upadacitinib combined with a 308 nm excimer laser in the treatment of refractory vitiligo complicated with atopic dermatitis. Dermatol Ther. Published online June 16, 2025. doi:10.1155/dth/9949035
2. Magdaleno-Tapial J, Hernández-Bel P, Esteve-Martínez A, et al. Upadacitinib and its role in the treatment of vitiligo: a new possible therapeutic perspective. JAAD Case Rep. 2024;46:57-58. doi:10.1016/j.jdcr.2024.01.033
3. Yamaguchi Y, Peeva E, Adiri R, et al. Response to ritlecitinib with or without narrow-band ultraviolet B add-on therapy in patients with active nonsegmental vitiligo: results from a phase 2b extension study. J Am Acad Dermatol. 2025;92(4):781-789. doi:10.1016/j.jaad.2024.11.064