Up-and-Coming Drugs for the Treatment of Vitiligo

Abstract

Vitiligo is a chronic autoimmune disease that causes depigmented patches on the skin. It affects 0.5%–2.0% of the global population. It goes beyond physical appearance, often leading to stig- matization, low self-esteem, and depression, burdening patients with psychosocial challenges.

The pathogenesis of vitiligo involves the loss of melanocytes due to autoreactive CD8+ T cells, triggered by environmental stressors and exacerbated by cellular vulnerabilities and immune responses. The release of danger signals and pro-inflammator y factors initiates an immune cas- cade perpetuating melanocyte destruction, mainly driven by interferon-γ and the C-X-C motif chemokine ligand 9/10-chemokine receptor 3 axis. Long-lasting tissue-resident memor y T cells (Trms) and cytokines contribute to lesion persistence. Current treatments focus on topical ste- roids and tacrolimus, systemic steroids, and phototherapies, but their efficacy remains subop- timal, necessitating the development of new therapeutic options. Building on recent advance- ments in understanding the immunological mechanisms in vitiligo pathogenesis, with the ini- tiation of Food and Drug Administration approval of topical ruxolitinib, various potential treat- ment options such as JAK inhibitors, cytokine blockers, and Trm or regulator y T cell targeting agents are being clinically researched and anticipated for vitiligo based on both preclinical and clinical data. This review aims to categorize and summarize the diverse investigational drugs currently undergoing clinical trials for vitiligo. By examining clinical outcomes, it is anticipated that this review will bring hope to dermatologists and patients regarding vitiligo, a condition that has historically posed challenges and transform it into a realm of potential possibilities.