The race for a vitiligo cure

Last Updated on 7th July 2023 by Caroline Haye

3 front-runners and an outsider

Before you get too excited, there is no cure for vitiligo quite yet. But I am confident that a day will come pretty soon when we will read headlines like this one… “Scientists finally discover a cure for vitiligo”. (So I do think it’s OK to get a little bit excited.) In fact, it’s looking likely that the first new vitiligo medicines will become available some time within the next 2 – 5 years. And this isn’t just wishful thinking. My optimism is based on what is actually happening right now in the field of vitiligo research. War is currently being waged on this hard-to-treat skin condition, on several fronts. And, for the first time in history, it’s becoming realistic to talk in terms of the race for a vitiligo cure.

Current versus new vitiligo treatments

First, we should not forget that there are already medical and alternative treatments for vitiligo that work, to one degree or another… Medical treatments include phototherapy, steroids, immunosuppressants, surgical and cosmetic procedures… And natural treatments include nutritional, herbal and holistic healing therapies. Personally, I have had dramatic success using nutritional supplementation and UV light. So I am, not surprisingly, a huge fan of natural solutions. But every scientific advance I hear about excites me because of its potential to change the lives of millions.

Not everyone is as fortunate as I have been in finding a way to reverse and control their vitiligo. Even the most successful therapies we have today only work for some of the people some of the time. How wonderful it would be if there were one that worked for everyone… Not that such a thing is likely to be perfect. No medicine ever is. But how exciting to at least have the choice of how to treat your vitiligo and to know that, one way or the other, you stand a good chance of success.

That’s why all vitiligo research is a cause for optimism, as far as I’m concerned. And every scientific breakthrough is a reason to celebrate. What’s more, some of the projects that are going on currently are, in my opinion, especially promising. Four in particular will be the focus of this post. And each of these four approaches vitiligo in an entirely different and fascinating way.

JAK inhibitors

A Janus kinase (JAK) inhibitor is tipped to be the first FDA-approved drug for treating vitiligo. JAK inhibitors are a type of disease-modifying anti-rheumatic drug. They are already in use for treating rheumatoid arthritis and have also been the subject of vitiligo research for the past five years or so.

Janus Kinase is a family of enzymes which, in the case of vitiligo, are responsible for sending signals to your immune system to attack the pigment-producing cells (melanocytes) in your skin. As the name suggests, the JAK inhibitor is designed to inhibit this signalling pathway. And this has the effect of turning off the de-pigmentation process.

Tofacitinib is one JAK inhibitor that has demonstrated partial success in improving vitiligo. Another, called ruxolitinib, achieved better results and progressed to the clinical trial stage. Having now reached phase 3 of its clinical trials, which will take another two years, ruxolitinib cream looks likely to be the first new topical vitiligo treatment to cross the finishing line. Assuming the trials are as successful as results so far predict, Incyte (the company backing them) will be seeking FDA approval for its use with vitiligo patients as soon as possible. So doctors may be able to start prescribing ruxolitnib for vitiligo by the mid 2020s. [Since publication of this post, Ruxolitnib (Opzelura) has been approved in the US, Europe and, more recently, in the UK for the treatment of non-segmental vitiligo.]

Afamelanotide (Scenesse)

Afamelanotide, marketed under the name Scenesse by pharmaceutical company Clinuvel, already has both European and FDA approval… But only to treat erythropoietic protoporphyria, a condition that causes extreme sensitivity to UV light. The relevance of this drug to vitiligo is that is has shown potential to enhance re-pigmentation when used together with narrowband UVb therapy. So Clinuvel are now undertaking trials with a view to having afamelanotide approved for this use. From what I can tell, this would not in any way constitute a vitiligo cure or guarantee long-term results. But it might significantly improve the effectiveness of phototherapy. And this would be welcome news to many patients who have had limited or no success with UV treatment in the past.

IL-15 treatment

The trouble with all effective vitiligo treatments, including JAK inhibitors and complementary therapies, is that they are only effective as long as you keep using them. Some time after you stop phototherapy, for example, you will probably find that your white patches gradually start to reappear. Similarly, deviate for long from a successful nutritional programme, and your vitiligo will return. Most people find their vitiligo patches come back in the same places as before… A fact that scientists have discovered is due to so-called “vitiligo memory T-cells”. (For more detail on this subject see Our Skin Has A Vitiligo Memory.)

The same research team, led by Dr John Harris, who worked on the JAK inhibitor treatment, discovered that these autoimmune memory cells need something called IL-15 (Interleukin-15) to stay in the skin. So they began working on a treatment that would use antibodies to block IL-15 so that the vitiligo “memory” would be lost. If this medication fulfills its promise, it will prevent vitiligo returning every time you discontinue an effective treatment. The development of IL-15 treatment is not as far advanced as ruxolitnib. But its potential to deliver lasting results may be as close as anyone has come to an actual cure… A permanent solution to the condition, rather than a temporary one.

Having described three front-runners in the race for a vitiligo cure, I now want to mention an “outsider”. This field of research is still in its infancy, in comparison to JAK inhibitors, afamelanotide and IL-15 treatment. But, in many ways, it strikes me as the most exciting and promising one, not only for vitiligo but for a host of other autoimmune conditions too.

Microbiome therapy

In case you are not familiar with the term, the human microbiome refers to an entire “ecosystem” of microbial cells that live on, and inside, every one of us. These tiny cells (or microbiota) largely consist of bacteria and they inhabit the human (and other animals) in much the same way as we inhabit planet earth. And, just like the earth’s ecosystem, they exert a complicated and delicate balance of cause and effect on their host. In fact, they play an absolutely crucial role in protecting and regulating virtually every aspect of our physiology, including our immune response.

Over the last five years or so, researchers have been studying human microbiota in relation to various chronic diseases (including vitiligo). And they have found significant differences in the microbiome of people who have these diseases and those who do not… A discovery that suggests a novel approach to treating those diseases… Namely, the possibility that correcting the imbalance of microbiota (a state known as dysbiosis) could reverse the disease. In other words, it is possible that a specially formulated probiotic pill could correct a person’s gut flora. And this, in turn, might cure their condition.

As I understand it, the task of mapping the vastness and complexity of the human microbiome means that treatments like these are probably still some way off. But it is extremely encouraging to know that at least two clinical trials are currently underway… Both looking specifically into the microbiome in relation to vitiligo. These both began in 2019. One, led by Caroline Le Poole of Northwestern University, USA. (Due to complete in June 2021.) And the other, by Li Chunying-1, Xijing Hospital, China. (Due to complete by December 2020). So watch this space for their findings.

There will be more than one winner of the vitiligo race

In most races there is one winner and the rest are “also-rans”. But in the race to find more effective treatments for vitiligo, every new discovery is a win. And because vitiligo is a condition that evidently involves multiple, complex pathways (in other words, it is multifactorial), there is room for more than one winner. The development, side by side, of JAK inhibitors and IL-15 treatment is an example of this. The first drug aims to reverse vitiligo but will only work as long as you keep taking it. The second one is designed to make those results last.

Realistically, JAK inhibitors may not work well for everyone and the same may be said of Scenesse or any other drugs that come along. But the chances are that having a choice will increase everyone’s chances of getting a satisfactory outcome. And with IL-15 as a back-up to extend the results long-term, medical treatment options will hold a lot more promise than they currently do.

A personal viewpoint

Just as no one is sure that new drugs will work equally well for all cases of vitiligo, no one knows whether microbiome therapy will work for everyone either. But, from a personal viewpoint, I am instinctively drawn to our “outsider” as a potential winner, even if it is lagging behind the rest. Re-balancing the naturally-occurring micro-organisms in the gut so that our body can heal itself is a tempting proposition. It strikes me as the most natural and holistic of solutions… Especially as it seems more likely to address the wider issues of autoimmunity, rather than just focusing on a single symptom (loss of skin pigment).

I know from my many contacts in the vitiligo community that I am not alone in having a history of “tummy troubles”… Not forgetting various other chronic and unexplained syndromes. I have always suspected that these resulted from “something just not being right in my digestive system”. And I have always felt that my vitiligo was one of these effects. So, while a drug that reverses de-pigmentation will be a marvellous thing, I think I shall be even more excited to read the findings of the respective microbiome studies. For me, microbiome therapy is the proverbial dark horse in the race for a vitiligo cure. For the moment, it is way behind the front runners. But, ultimately, it might just be the first across the line in the holistic category.