Clinical and dermoscopic evaluation of topical calcineurin inhibitors vs topical Janus kinase inhibitors in treatment of localized facial vitiligo

Background Topical Ruxolitinib 1.5% cream is the only approved topical treatment for vitiligo. Topical calcineurin inhibitors (CNIs), although not approved, is highly effective in localized vitiligo. Objective To compare the efficacy and safety of topical CNIs (Tacrolimus 0.1%) versus topical Janus kinase (JAK) inhibitors (Ruxolitinib 1.5%) in the treatment of adult cases with localized facial vitiligo. Patients and methods This comparative randomized study included 40 adult patients with localized, stable facial vitiligo disease, divided into two groups. Group I: 20 patients were treated with topical CNIs (Tacrolimus ointment 0.1%) every 12 h for 24 weeks. Group II: 20 patients were treated with topical JAK inhibitors (Ruxolitinib cream 1.5%) every 12 h for 24 weeks. All lesions were evaluated clinically and by dermoscopy before and after treatment and follow-up for 6 months. Results The percentage of improvement in the lesions treated by topical CNIs (Tacrolimus ointment 0.1%) in group I was about 45%, and the percentage of improvement in the lesions in group II treated by topical JAK inhibitor (Ruxolitinib cream 1.5%) was 75% with a significant difference ( P =0.041). Conclusion Ruxolitinib 1.5% cream is more effective than Tacrolimus 0.1% in the treatment of adult localized stable facial vitiligo.