Vitiligo. Novel Treatment Modalities. Small Molecule Inhibitors and Cytokine-Targeted Treatments

Abstract

Background: This review presents the mechanisms responsible for vitiligo and acknowledges the new agents of vitiligo, such as Janus kinase (JAK) inhibitors, Wingless and Int (Wnt) response inhibitors, microRNAs, rapamycin, and various cytokine-targeted treatments, which are currently being successfully studied and evaluated concerning their safety and efficacy. Methods: We searched for scientific work on vitiligo treatment and pathophysiology using PubMed, finding 92 relevant articles. Results: Vitiligo is a systemic disease, and accordingly systemic approach should always be considered in combination with local treatments. Nowadays, JAK inhibitors are the most promising vitiligo treatment, particularly when combined with phototherapy. Cytotoxic T lymphocytes (CD8⁺ T lymphocytes) and CD4⁺ T helper lymphocytes participate in developing vitiligo. Other relevant factors are endoplasmic reticulum (ER) stress and 78-kDa glucose-regulated protein (GRP78) activation, and adhesion deficit. Conclusions: Vitiligo is a chronic disease affecting not only ones appearance but also ones mental well-being. The treatment can be life-long; therefore, it should be effective and tolerable since compliance and, consequently, the quality of the outcomes rely on that. For these aspects of treatment to satisfy the recognition and understanding of numerous signalling pathways taking part in vitiligo pathogenesis is essential.