Design: Phase 2, randomised, double-blind, vehicle-controlled mechanism study
Population: 60 adults with vitiligo (41 ruxolitinib, 19 vehicle)
Primary outcome: Change in serum and skin biomarkers, with VASI response
Effect: Facial VASI −49.1% and total VASI −21.2% at week 24 on ruxolitinib; CXCL10 fall correlated with total VASI improvement

This phase 2 mechanism study randomised 60 adults with vitiligo 2:1 to 1.5% ruxolitinib cream or vehicle twice daily for 24 weeks, followed by open-label cream to week 52.

Ruxolitinib reduced interferon-gamma-related proteins, including CXCL10, in serum and lesional skin from week 12 onwards. Facial VASI improved by about 49% at week 24 and total VASI by about 21%. Falls in CXCL10 correlated with improvement in total VASI, and rising melanocyte counts in the skin tracked facial repigmentation.

The findings support the interferon-gamma–CXCL10 pathway as the target of treatment and suggest CXCL10 could one day help judge response. They do not change how the cream is used, and facial skin responds better than the body.

Topical ruxolitinib is not yet widely available in India and is costly. Topical steroids, calcineurin inhibitors and phototherapy remain the mainstays.

Expect better repigmentation on the face than on the trunk and limbs with topical JAK inhibitors
Set expectations of months, not weeks, before judging response
CXCL10 measurement is research-stage and not a clinical test for vitiligo
Continue topical calcineurin inhibitors, steroids and phototherapy as first-line options where ruxolitinib is unavailable

Why it matters

It links a measurable blood marker to repigmentation, which could later guide treatment choice.

The statistics, in plain English

The correlations show CXCL10 and repigmentation moved together, but correlation in 41 treated patients does not show one causes the other, and the study was not powered for clinical efficacy.