Emerging treatments
Afamelanotide
A synthetic analog of the naturally occurring melanocortin peptide hormone. Preliminary results suggest that afamelanotide in combination with narrowband UV-B phototherapy promotes faster and more extensive repigmentation compared with phototherapy alone.[55] A subsequent study conducted in Asian patients with nonsegmental vitiligo suggested that subcutaneous afamelanotide implants may enhance rates and total surface area of repigmentation in patients receiving narrowband UV-B.[56] The study was limited by low recruitment rates and withdrawal of patients allocated to the afamelanotide group.[56] Further studies are required.
Janus kinase (JAK) inhibitors
Janus kinases are a family of intracellular proteins involved in the signal transduction of several cytokines, including interferon gamma. In a randomized double-blind phase 2 study, the primary end point (proportion of patients who had a 50% or higher improvement from baseline in facial Vitiligo Area Scoring Index [F-VASI score] at week 24) was reached by significantly more patients receiving topical ruxolitinib compared with vehicle.[57] Application-site pruritus was the most common treatment-related adverse event among patients given ruxolitinib cream.
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