Advances in Vitiligo Treatment Focus on Immunomodulatory Pathways, Cellular Grafting, and Emerging Drug Targets

A recent study published in Skin Health and Disease explored the evolution of advances, therapies, and management tactics for vitiligo.¹

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Background and Methods

Review authors made note of a limited number of existing or effective options for patients with vitiligo and believe a greater understanding of the pathways associated with vitiligo will open the door for future drug targets.

Pathak et al conducted a search strategy via PubMed and relevant search terms, such as "vitiligo interventions," "vitiligo pathophysiology," and more. Researchers sought to assess studies published in English from within the past 10 years. Studies included for review examined the pathophysiology of vitiligo and involved meta-analyses and reviews, cohort studies, and case reports/studies/series exploring non-pharmacological and pharmacological interventions.

Findings

Phototherapy remains a cornerstone of vitiligo management, with narrow-band ultraviolet B (NB-UVB) and psoralens combined with ultraviolet A being the most commonly-used modalities. A meta-analysis involving 35 studies found that approximately 62.1% of patients responded to NB-UVB treatment within three months, with response rates increasing over time.²

In addition to phototherapy, various procedural modalities have been explored for vitiligo treatment. These include dermabrasion, laser therapy, micro-needling, and suction blister grafting, which can be beneficial for patients with stable vitiligo. Epithelial tissue grafting, has shown high success rates, with some studies reporting up to 70% repigmentation.³

Antioxidants have emerged as a crucial area of research in the management of vitiligo, given their role in mitigating oxidative stress, which is believed to contribute to the disease's pathogenesis. Several studies have highlighted the therapeutic potential of antioxidants in restoring melanocyte function and promoting repigmentation. Notably, topical agents such as vitamin E and ascorbic acid (vitamin C) have shown promise in enhancing the effects of phototherapy.

Moreover, research suggests that oral supplementation of antioxidants like glutathione may benefit patients by reducing oxidative stress and supporting overall skin health. While further studies are needed to establish standardized protocols for antioxidant use, initial findings indicate that integrating antioxidants into treatment regimens could enhance the efficacy of existing therapies.

Emerging research also points to the involvement of noncoding RNAs, particularly microRNAs (miRNAs), in vitiligo susceptibility. For instance, altered expression of miRNA-211 may affect cellular metabolism and contribute to the disease's progression.

Furthermore, polymorphisms in toll-like receptors have been associated with the inflammatory response in vitiligo patients, indicating that genetic variations can significantly impact the disease’s clinical manifestation and response to treatment.

Conclusions

"Current therapies are aimed at drug pathways to restore melanocyte function and restore pigment in the affected areas," according to authors Pathak et al.

Moving forward, they recommended additional research and studies aimed at understanding implicated pathways. This, they noted, may lead to better multimodal approaches and pave the way for new or expanded drug development targets.

References

1. Pathak GN, Tan IJ, Bai G, Dhillon J, Rao BK. Vitiligo: from mechanisms of disease to treatable pathways. Skin Health Dis. September 30, 2024. https://doi.org/10.1002/ski2.460
2. Bae JM, Jung HM, Hong BY, Lee JH, Choi WJ, Lee JH, et al. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017; 153(7): 666–674.
3. Maleki M, Banihashemi M, Sanjari V. Efficacy of suction blister epidermal graft without phototherapy for locally stable and resistant vitiligo. Indian J Dermatol. 2012; 57(4): 282–284.