Recent Advances in Vitiligo and Melasma Treatment

Conclusions

• Vitiligo management is shifting toward a combination of topical JAK inhibition, phototherapy, systemic options, and surgery tailored to disease extent and activity.
• Topical ruxolitinib is effective and generally well tolerated for vitiligo, with facial skin responding best but meaningful repigmentation also occurring at nonfacial sites.
• A lack of meaningful improvement by 6 months does not necessarily mean treatment failure, because some patients continue to improve with longer ruxolitinib treatment.
• Adding narrow-band UVB phototherapy can accelerate or enhance repigmentation when topical ruxolitinib alone is insufficient.
• Multiple oral JAK inhibitors, including ritlecitinib, povorcitinib, and upadacitinib, show promising efficacy signals for vitiligo and may expand future treatment options.
• Upadacitinib demonstrated significant efficacy versus placebo in phase 3 vitiligo trials with no major new safety concerns.
• Autologous skin cell suspension transplantation appears to be an effective procedural option for stable, treatment-refractory vitiligo, often with strong repigmentation outcomes.
• For melasma, first-line treatment remains topical therapy, with hydroquinone limited in duration and non-hydroquinone alternatives increasingly supported by evidence.
• Oral tranexamic acid can be a useful adjunct for melasma in appropriately screened patients, and available data suggest low short-term thromboembolic risk.
• Newer depigmenting agents such as cysteamine, thiamidol, and 2-MNG can provide efficacy comparable to hydroquinone with potentially better tolerability or as useful alternatives.
• Combining topical agents with oral tranexamic acid and procedural approaches may improve melasma outcomes when faster or greater improvement is needed.
• Overall, the field of pigmentary disorders has made substantial progress, with expanding evidence-based options for both repigmentation in vitiligo and depigmentation control in melasma.