1. How does this type of drug compare to other treatments for vitiligo ?
3. Can I use a topical JAK inhibitor for vitiligo long-term?
4. Will ruxolitinib work for me?
5. Can my child use a topical JAK inhibitor for vitiligo?
6. Is it safe to use a topical JAK inhibitor if I’m pregnant?
2. How is a topical JAK inhibitor used?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
4. Why do I need to get certain vaccinations first?
3. Will taking a JAK inhibitor shut down my immune system?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
1. Which JAK inhibitor is most likely to help me?
FAQs About Using a Topical JAK Inhibitor to Treat Vitiligo
7
7. What can I do if I can’t afford a topical JAK inhibitor?
Understanding the key differences between traditional vitiligo medications and therapies and topical JAK inhibitors can help you decide if you’re interested in trying ruxolitinib alone or adding it to your current treatment plan. • Topical steroid creams help calm inflammation, but can only be used for 6 months or less, says Gunasekera, due to side effects. JAK inhibitors can be used for more than 6 months; in fact, in clinical trials, participants used the cream for 28 weeks beyond the 24 weeks. • Topical calcineurin inhibitors, such as tacrolimus ointment (Protopic is a common one) and pimecrolimus cream (Elidel), act on the immune system. Like JAK inhibitors, they work best on small areas of skin and they may work a little faster — research has found they’re effective for around 55 percent of people after three months. But, at least when first used, they can cause a burning sensation, says Gunasekera. • Phototherapy can target larger areas of skin than topical medications, so it's a bit tricky to compare the two types of treatment. A key difference: Phototherapy requires going to a doctor’s office, typically twice a week, for weeks or even months, says Gunasekera.
Treating vitiligo with the ruxolitinib cream is pretty straightforward. If more than 10 percent of your skin is affected, you and your dermatologist will choose which areas to treat. Once you’ve identified your priority patches, you’ll apply a thin layer of the cream to each, twice a day. If more than 10 percent of your skin is affected, you may still be able to use a topical JAK inhibitor on certain areas, along with a calcineurin inhibitor on remaining areas, or phototherapy. Notes Gutierrez, vitiligo typically has to be treated with multiple therapies to get the best possible outcomes overall.
Understanding the key differences between traditional vitiligo medications and therapies and topical JAK inhibitors can help you decide if you’re interested in trying ruxolitinib alone or adding it to your current treatment plan. • Topical steroid creams help calm inflammation, but can only be used for 6 months or less, says Gunasekera, due to side effects. JAK inhibitors can be used for more than 6 months; in fact, in clinical trials, participants used the cream for 28 weeks beyond the 24 weeks. • Topical calcineurin inhibitors, such as tacrolimus ointment (Protopic is a common one) and pimecrolimus cream (Elidel), act on the immune system. Like JAK inhibitors, they work best on small areas of skin and they may work a little faster — research has found they’re effective for around 55 percent of people after three months. But, at least when first used, they can cause a burning sensation, says Gunasekera. • Phototherapy can target larger areas of skin than topical medications, so it's a bit tricky compare the two types of treatment. A key difference: Phototherapy requires going to a doctor’s office, typically twice a week, for weeks or even months, says Gunasekera.
In clinical trials, most people had good results after 24 weeks, but continued to use it for 28 weeks beyond that. Expect a similar scenario if you try the cream: You should see improvement in your skin after 6 months. If you don’t, your doctor may have you continue to use it for another 6 months, or have you try another treatment.
Vitiligo is unpredictable and so is how it responds to any type of treatment. But there is one clue: “It does not work very well in areas of vitiligo where the hair has also turned white,” Gunasekera says. That’s usually a sign that even the precursor cells (or stem cells) for melanocytes have been depleted, she adds, noting that’s true for all topicals, not just ruxolitinib.
In clinical trials, most people had good results after 24 weeks, but most participants continued to use it for 28 weeks beyond that. Expect a similar scenario if you try the cream: You should see improvement in your skin after 6 months. If you don’t, your doctor may have you continue to use it for another 6 months, or have you try another treatment.
Absolutely, as long as they’re 12 or older and use the cream as directed, says Gunasekera, whose clinic treats teens 15 and up. (If your child is on the younger side, you may want to keep an eye on how they’re applying the medication). And for most teens, as for adults, the side effects are mild — cold symptoms or breakouts, redness, or itchiness where they apply the medication. And it works just as well and as quickly for kids as it does for adults.
Vitiligo is unpredictable and so is how it responds to any type of treatment, says Gunasekera. But there is one clue: “It does not work very well in areas of vitiligo where the hair has also turned white,” Gunasekera says. That’s usually a sign that even the precursor cells (or stem cells) for melanocytes have been depleted, she adds, noting that’s true for all topicals, not just ruxolitinib.
Experts aren’t sure: Topical ruxolitinib hasn’t been studied on pregnant animals (or humans), but oral ruxolitinib has been studied in pregnant animals, and some gave birth to low-weight babies. If you get pregnant while using ruxolitinib, let your dermatologist know right away so you can discuss whether you should keep using it. Topical ruxolitinib has been found to get into breast milk in lab animals, so you shouldn’t use it if you’re breastfeeding. Once you stop nursing, wait a month before you start applying it again.
New medications can be expensive, and the first topical JAK inhibitor for vitiligo is no exception. If you don’t have insurance, one tube of Opzelura could run you thousands of dollars. Even if you have insurance, there’s a good chance the company will require you to try other treatment options before it will cover the drug, says Gutierrez — a drawback if you’re newly diagnosed, since it’s most effective in the early stages of the disease. If your insurance balks, ask your dermatologist to contact them to explain why you need it, suggests Gutierrez, who’s done that successfully for his patients. It also may pay to check out the Opzelura website, where you’ll find information about a copay card that could save you money, as well as advice for other ways to cut costs.
Experts aren’t sure: Topical ruxolitinib hasn’t been studied on pregnant animals (or humans), but oral ruxolitinib has been studied in pregnant animals, and some gave birth to low-weight babies. If you get pregnant while using ruxolitinib, let your dermatologist know right away so you can discuss whether you should keep using it. Topical ruxolitinib has been found to get into breast milk in rats, so you shouldn’t use it if you’re breastfeeding. Once you stop nursing, wait a month before you start applying it again.
