Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_348_2024

Ritlecitinib rescues exacerbated vitiligo during the JAK1 inhibitor therapy: More than a coincidence?

Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
Department of Central Laboratory, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.

Corresponding author: Dr. Chao Ji, Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. jichaofy@fjmu.edu.cn

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Tong Z, Wu Z, Zeng X, Huang F, Gong T, Ji C. Ritlecitinib rescues exacerbated vitiligo during the JAK1 inhibitor therapy: More than a coincidence? Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_348_2024

Dear Editor,

Recently, JAK inhibitors demonstrated promising effects in vitiligo treatment by targeting the IFN-γ-CXCL10 cytokine pathway, therefore reducing the production of CXCL10. 1-3 Moreover, a case-control study revealed the significant overexpression of JAK1 and JAK3 in the skin of vitiligo patients compared to normal control, demonstrating the potential effect of JAK1 and JAK3 inhibitors in treating vitiligo.4 Based on the current JAK expression profile observed in vitiligo, it seems that targeting JAK1 and JAK3 might be a potential treatment option for vitiligo. However, we present here a patient with exacerbated vitiligo after starting abrocitinib (a JAK1 inhibitor) for severe atopic dermatitis (AD) and with effective improvement after switching the therapy to ritlecitinib (a JAK3 inhibitor).

A 67-year-old male patient with severe AD presented to our department accompanied by white patches spreading over his back. Physical examination revealed several white patches with irregular shapes and blurred margins distributed across his chest and back. Additionally, pruritic erythematous patches with scales on both the trunk and extremities were noted: Eczema Area and Severity Index (EASI) = 26.4; Peak Pruritus Numerical Rating Scale (PP-NRS) = 9 [Figures 1a and 1b]. Laboratory test results showed a significant elevation in both immunoglobulin E (IgE) and eosinophil count. After excluding all the contraindications of JAK1 inhibitor and obtaining complete informed consent, treatment began with abrocitinib 100 mg daily; meanwhile, he was advised to enhance skin care. Pruritus disappeared within 24 hours after initiating abrocitinib (PP-NRS = 0) and lesions showed continuous improvement over the four months. Unexpectedly, although abrocitinib rapidly improved the symptom of AD, the existing vitiligo lesions expanded and depigmentation progressed, the white patches expanded rapidly and became clinically conspicuous, especially on his face [Figure 1c and 1d] (Total-Vitiligo Area Scoring Index [T-VASI] = 35; Facial-Vitiligo Area Scoring Index [F-VASI] = 16) [Table 1]. On suspicion of vitiligo exacerbated by abrocitinib, we performed a Wood lamp examination, revealing fluorescent achromatic patches, and a biopsy on his back demonstrated the absence of melanocytes in the basal layer of the epidermis along with perivascular infiltration of lymphocytes in the dermis. Besides, the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 4, indicating a possible relationship between the vitiligo exacerbation and the use of abrocitinib. Thus, the JAK1 inhibitor was discontinued. Meanwhile, considering the potential effect of targeting JAK3 in vitiligo lesions, the patient switched the therapy from abrocitinib to ritlecitinib, a JAK3 inhibitor. At the two-month follow-up visit, the physical examination suggested that no new white patches appeared and there was repigmentation on his face and trunk (T-VASI = 28; F-VASI = 5). Additionally, no recurrence of AD lesions has occurred [Figures 1e and 1f] and the patient is still under follow-up [Figure 2].

Clinical photographs of the patient during the follow-up (a,b) before the initiation of the treatments, (c,d) after 1 month treatment of abrocitnib, (e,f) after 2 month treatment of ritlecitinib.
Figure 1:
Clinical photographs of the patient during the follow-up (a,b) before the initiation of the treatments, (c,d) after 1 month treatment of abrocitnib, (e,f) after 2 month treatment of ritlecitinib.
Table 1: Four scores of the patient during the follow-up

Scores

Time

Scores of atopic dermatitis
Scores of vitiligo
EASI score PP-NRS score T-VASI score F-VASI score
2023.10.12 26.2 9 20 2
2023.11.12 9.2 1 35 16
2024.01.09 7.2 2 28 5

EASI: Eczema Area and Severity Index; PP-NRS: Eczema Area and Severity Index; T-VASI: Total-Vitiligo Area Scoring Index; F-VASI: Facial-Vitiligo Area Scoring Index.

The timeline of the disease course.
Figure 2:
The timeline of the disease course.

Given recent advancements in our understanding of vitiligo pathogenesis, JAK1 inhibitors are increasingly recognised as promising therapeutic candidates.5 To our best knowledge, our case appears to be the first report in the literature of exacerbated vitiligo during the therapy of JAK1 inhibitor. Notably, the curative effect was observed after the administration of JAK3 inhibitor, vitiligo stopped progressing after treatment and gradually repigmented. This observation suggested that diverse factors may interplay together to affect the clinical outcome of this disease. Despite the upregulation of JAK1 and JAK3 observed in the skin of active vitiligo patients, the imbalanced expression of JAK may contribute to the variation in therapeutic efficacy among patients receiving JAK inhibitors. While the molecular drivers of exacerbated vitiligo occurring during JAK1 inhibitor treatment remain unclear, further research is needed to elucidate the mechanism of vitiligo progression in patients undergoing JAK1 inhibitor therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of AI-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , . Tofacitinib citrate for the treatment of vitiligo: A pathogenesis-directed therapy. JAMA Dermatol. 2015;151:1110-12.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , , et al. Efficacy and tolerability of oral upadacitinib monotherapy in patients with recalcitrant vitiligo. J Am Acad Dermatol. 2023;89:1257-59.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Two phase 3, randomized, controlled trials of ruxolitinib cream for vitiligo. N Engl J Med. 2022;387:1445-55.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Cutaneous JAK expression in vitiligo. J Cutan Med Surg. 2021;25:157-62.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , . Vitiligo: Pathogenesis and new and emerging treatments. Int J Mol Sci. 2023;24
    [CrossRef] [Google Scholar]

Fulltext Views
3,106

PDF downloads
441
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections