Tofacitinib ± NB-UVB in Vitiligo: Case Series and Open-Label Evidence

Key Takeaways

Topical and oral tofacitinib show signals of repigmentation in case series/open studies, with best facial responses.
NB-UVB appears to accelerate and potentiate outcomes vs monotherapy, especially for non-facial sites.
Safety depends on route: topical has mainly local AEs; oral requires systemic risk assessment and labs per JAK class cautions.
Mechanistic fit with IFN-γ–JAK–STAT pathway overlaps ruxolitinib data; evidence base remains non-randomized.

Abstract

Evidence for tofacitinib in vitiligo consists chiefly of case reports, series, and open-label cohorts using topical or oral formulations. Facial repigmentation is most consistent, with adjunct NB-UVB improving speed and magnitude on non-facial areas. Safety profiles differ by route; randomized trials are limited.

Mechanism & Rationale

Tofacitinib inhibits JAK1/3, attenuating IFN-γ–driven chemokine signaling (CXCL10) implicated in CD8⁺ T-cell recruitment and melanocyte targeting. This aligns with observed benefits in inflammatory vitiligo activity.

Dosing & Regimens

Table 1. Commonly reported regimens (illustrative; tailor per local guidance).

Formulation	Example use	Notes
Topical tofacitinib (compounded 2%)	Thin layer BID to lesions	Best tolerability on face/neck
Oral tofacitinib	Reported low-dose regimens	Requires systemic monitoring
With NB-UVB 311 nm	2–3×/week phototherapy	Often superior to monotherapy

Efficacy Signals

Facial lesions: earlier perifollicular islands, higher F-VASI responder rates in series.
Body lesions: slower change; benefit more evident with adjunct NB-UVB.
Relapse risk: maintenance strategies (continued topical, intermittent light) may sustain gains.

Role of NB-UVB Combination

Across reports, combining tofacitinib with NB-UVB shortens time-to-visible pigment and improves magnitude, consistent with synergy: immune down-modulation plus melanocyte stimulation.

Safety

Table 2. Safety considerations.

Route	Typical AEs	Monitoring
Topical	Mild burning, erythema, acneiform	Local skin checks
Oral	Class JAK risks (lipids, infections, cytopenias)	Labs, infection vigilance, risk-benefit review

Prefer topical for limited facial disease; reserve oral use for selected cases under specialist oversight.

Data Tables (framework)

Table 3. Populate with cohort numerics when available.

Outcome	Topical	Oral	With NB-UVB	Interpretation
F-VASI % change (12–24 wks)	—	—	—	Greater with combination
F-VASI50/75 responders	—	—	—	Higher on face
Time to islands (weeks)	Earlier	—	Earliest	Adjunct phototherapy benefit
Relapse at 6–12 mo	—	—	—	Maintenance needed

Limitations

Evidence base largely non-randomized, small and heterogeneous; compounded topical formulations vary; long-term off-drug durability and standardized endpoints are limited.

References

Case reports/series and open-label cohorts of topical/oral tofacitinib in vitiligo, alone and with NB-UVB.
Mechanistic studies on IFN-γ–CXCL10 and JAK–STAT signaling in vitiligo.
Safety communications and guidance for JAK inhibitors (topical vs systemic use considerations).