Vitiligo
new therapeutic approaches based on immune pathophysiology
Keywords:
Dermatology, Immunological Factors, Immunomodulation, Janus Kinase Inhibitors, VitiligoAbstract
Vitiligo is a chronic autoimmune skin disease characterized by the progressive destruction of melanocytes,
resulting in a profound psychosocial impact. Historically challenging, therapeutic management has
been revolutionized by recent discoveries in the field of immune pathophysiology, as the disease is
mediated by autoreactive cytotoxic CD8+ T cells and the Janus Kinase/Signal Transducer and Activator of
Transcription (JAK/STAT) signaling pathway, activated by interferon-gamma (IFN-γ). Therefore, the present
literature review aimed to analyze new therapeutic approaches based on this immune pathophysiology,
encompassing studies from 2016 to 2026 selected from the PubMed/MEDLINE, Embase, Cochrane, and
Web of Science databases. The findings demonstrate that the recognition of the JAK/STAT pathway has
enabled the development of targeted immunomodulators with highly promising results. Topical ruxolitinib
stands out as the first JAK inhibitor drug approved for the treatment of vitiligo, showing consistent and
clinically significant repigmentation, particularly in facial lesions. Concurrently, systemic JAK inhibitors,
such as baricitinib, ritlecitinib, and upadacitinib, show promising clinical results, with even more notable
synergistic effects when combined with phototherapy. Biological therapies and mesenchymal stem cells
are also emerging as viable alternatives. It is concluded that the transition from empirical treatments to
interventions targeted at the pathophysiology of the disease represents a transformative advancement in
the treatment of vitiligo. However, gaps in clinical evidence persist, especially regarding long-term outcomes
and pediatric populations, demanding the need for further and deeper research, primarily focused on
identifying biomarkers and eliminating resident memory T cells, in order to prevent long-term relapses.
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