Vitiligo is a skin condition characterized by patches of skin losing their pigmentation which results in having areas that are lighter than normal skin color. Melanocytes, or pigment producing cells, are attacked and destroyed which can leave white patches on the skin, mucous membranes, eyes, inner ears or hair. This condition is rare, affecting about one percent of the world’s population. Vitiligo may not affect the health directly, however, patients who have it may be affected psychologically as this is usually traumatic for them.
Vitiligo typically starts on the hands, feet or face and becomes progressive throughout the body. It is thought that vitiligo is an autoimmune disorder since certain white blood cells can directly destroy the melanocytes and can be prone to other autoimmune diseases. Cause of vitiligo is unknown but it is believed that it is a hereditary condition.
Although vitiligo cannot be controlled, there are ways to restore the skin’s color by restoring healthy melanocytes (repigmentation) to the skin to regain normal appearance.
- Prescription steroid creams and non-steroid anti-inflammatory creams (tacrolimus and pimecrolimus) are the safest and simplest most initial treatment.
- Psoralen & Ultra-Violet Light A light (PUVA) which is light treatment typically done in a physician’s office.
- Autologous skin grafts
- Lasers
What is Opzelura?
Opzelura (ruxolitinib) is a Janus kinase (JAK) inhibitor indicated for topical treatment of nonsegmental vitiligo in both adults and pediatric patients 12 years and older. Previously, Opzelura was first approved for short term treatment of mild to moderate atopic dermatitis, however, recently has gained approval for treatment of non segmental vitiligo.
Opzelura works by inhibiting JAK1 and JAK2 which are responsible for mediating the signaling of a number of cytokines and growth factors that are important for hematopoiesis and immune function and may have a role in producing vitiligo. However, the mechanism is not known.
Patients who have received Opzelura have seen at least 75% improvement in their skin at 24 weeks.
How is Opzelura taken?
Opzelura comes in a 1.5% cream formulation and in either 60 or 100 gram tubes. A thin layer should be applied twice daily to affected areas.
What are the side effects of Opzelura?
For patients using for non segmental vitiligo adverse effects are:
- Application site acne, pruritus and erythema (redness)
- Nasopharyngitis
- Headache
- Urinary tract infection
- Pyrexia (fever)
What are the warnings and precautions of Opzelura?
There is a black boxed warning for Opzelura for serious infections, mortality, malignancy, major adverse cardiovascular events and thrombosis.
- Serious infections may lead to hospitalization or death. Some reported infections are: active tuberculosis, invasive fungal infections, bacterial and viral infections.
- Mortality
- Malignancies, specifically lymphoma and other types of malignancies have been reported with JAK inhibitors.
- Major adverse cardiovascular events (MACE) with oral JAK inhibitors.
- Thrombosis and thromboembolic events were observed in Opzelura trials. Pulmonary embolism (PE), deep vein thrombosis (DVT), and arterial thrombosis have all been reported in patients receiving JAK inhibitors medications.
Vitiligo can be a psychological detrimental disease for the patient, but being able to provide options for treatment is crucial. This might not be a cure for the disease but it can slow the progression and allow relief for patients suffering from this condition.
Reference:
- Opzelura. [package insert]. Wilmington, DE. Incyte, Inc. 2022
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