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Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None declared.

Background: Vitiligo is a chronic autoimmune disorder characterized by depigmented patches of the skin., Objective: To evaluate the efficacy and safety of ritlecitinib, an oral JAK3 (Janus kinase)/TEC (tyrosine kinase expressed in hepatocelluar carcinoma) inhibitor, in patients with active nonsegmental vitiligo in a phase 2b trial (NCT03715829)., Methods: Patients were randomized to once-daily oral ritlecitinib ± 4-week loading dose (200/50 mg, 100/50 mg, 30 mg, or 10 mg) or placebo for 24 weeks (dose-ranging period). Patients subsequently received ritlecitinib 200/50 mg daily in a 24-week extension period. The primary efficacy endpoint was percent change from baseline in Facial-Vitiligo Area Scoring Index at week 24., Results: A total of 364 patients were treated in the dose-ranging period. Significant differences from placebo in percent change from baseline in Facial-Vitiligo Area Scoring Index were observed for the ritlecitinib 50 mg groups with (-21.2 vs 2.1; P < .001) or without (-18.5 vs 2.1; P < .001) a loading dose and ritlecitinib 30 mg group (-14.6 vs 2.1; P = .01). Accelerated improvement was observed after treatment with ritlecitinib 200/50 mg in the extension period (n = 187). No dose-dependent trends in treatment-emergent or serious adverse events were observed across the 48-week treatment., Limitations: Patients with stable vitiligo only were excluded., Conclusions: Oral ritlecitinib was effective and well tolerated over 48 weeks in patients with active nonsegmental vitiligo., Competing Interests: Conflicts of interest KE declares acting as a consultant for Incyte, La Roche Posay, Pfizer, Pierre Fabre, Sanofi, and Viela Bio. EP, YY, LAC, AB, AS, DY, and MSV are employees of Pfizer and hold stock and/or stock options with Pfizer. KG was an employee of Pfizer at the time of the study and held stock and/or stock options with Pfizer. GH declares being an investigator for Amgen, Athenex, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, Eli Lilly, Novartis, Janssen, MC2, PellePharm, Pfizer, and UCB; and a consultant, advisor, or speaker for AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Castle Biosciences, Dermavant, Dermtech, Eli Lilly, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi Genzyme, SUN Pharmaceuticals, and UCB. IH declares being a consultant for Galderma Laboratories and UCB; an investigator for Arcutis, Avita, Bayer, Lenicura, L’Oréal, and Unigen; and a consultant and investigator for Incyte and Pfizer; serving on scientific advisory boards for AbbVie; and being co-chair of Global Vitiligo Foundation in a non-funded capacity. AKG declares being a consultant for AbbVie, Allergan Aesthetics, and Viela Bio. MP declares being a consultant, advisor, or speaker for Incyte, Pfizer, Pierre Fabre, and PPM. DT declares being a consultant, investigator, speaker, and participating in scientific advisory boards for AbbVie, Almirall, Amgen, Biogen Idec, BMS, Janssen-Cilag, LEO Pharma, Eli Lilly, Novartis, Pfizer, Regeneron, Samsung, Sanofi, and UCB; and research/educational grants from AbbVie, LEO Pharma, and Novartis. JEH declares acting as a consultant and investigator for Pfizer, Genzyme/Sanofi, Incyte, Rheos Medicines, Sun Pharmaceuticals, Leo Pharma, Villaris Therapeutics, Dermavant, and TeVido BioDevices; and a consultant for Temprian Therapeutics, AbbVie, Inc, Janssen, Almirall, Methuselah Health, Pandion, AnaptysBio, Avita, NIRA Biosciences, Admirx, Granular Therapeutics, Platelet BioGenesis, Inc; he has equity in TeVido Biodevices, Rheos, Villaris Therapeutics, Inc, and NIRA Biosciences; and is a founder of Villaris Therapeutics, Inc, and NIRA Biosciences. JMB declares acting as a consultant for Pfizer, AbbVie, LaserOptek, and Ilooda. KT declares being a speaker for AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB. RS declares providing professional services to Amgen, Bayer, Boehringer Ingelheim, Celgene, Coherus Biosciences, Cutanea, Eli Lilly, GlaxoSmithKline, Janssen, LEO Pharma, MedImmune, Merck & Co, MSD, Novartis, Oncobiologics, Pfizer, Regeneron, Roche, Samson Clinical, and Sun Pharma. AGP declares acting as a consultant for AbbVie, Arcutis, Avita, Chromaderm, Immune Tolerance Network, Incyte, Pfizer, TWi, Viela Bio, and Villaris, and holds stock options with Tara Medical and Zerigo Health. BK declares receiving honoraria and/or consultation fees from Aclaris Therapeutics, Arena Therapeutics, Bristol-Myers Squibb, Concert Pharmaceuticals, Dermavant Sciences, Eli Lilly, Pfizer, Regeneron, and Viela Bio, and serving on a speakers bureau for Pfizer. The other authors have no conflicts of interest to declare., (Copyright © 2022 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest Dr Hamzavi has served as an advisory board member for AbbVie; a consultant for Incyte Corporation, Pfizer, and UCB; a principal investigator for AbbVie, Allergan, Bayer, Clinuvel Pharmaceuticals, Estée Lauder, Ferndale Laboratories, Galderma Laboratories LP, GE Healthcare, Incyte Corporation, Janssen, Janssen Biotech, Johnson & Johnson, Lenicura, LEO Pharma, Pfizer, and Unigen; a subinvestigator for Amgen, Bristol Myers Squibb, Foamix Pharmaceuticals, and Janssen; president of the HS Foundation; and cochair of the Global Vitiligo Foundation. Dr Rosmarin has received honoraria as a consultant for AbbVie, Celgene, Dermavant Sciences, Dermira, Eli Lilly and Company, Janssen, Kyowa Kirin, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharmaceuticals, UCB, and VielaBio; research support from AbbVie, Amgen, Bristol Myers Squibb, Celgene, Dermira, Eli Lilly and Company, Incyte Corporation, Janssen, Merck, Novartis, Pfizer, and Regeneron Pharmaceuticals; and has served as a paid speaker for AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, Regeneron Pharmaceuticals, and Sanofi. Dr Harris has served as a consultant for AbbVie, Aclaris Therapeutics, BiologicsMD, EMD Serono, Genzyme/Sanofi, Janssen, Pfizer, Rheos Medicines, Sun Pharmaceuticals, TeVido BioDevices, The Expert Institute, 3rd Rock Ventures, and Villaris Therapeutics; has served as an investigator for Aclaris Therapeutics, Celgene, Dermira, EMD Serono, Genzyme/Sanofi, Incyte Corporation, LEO Pharma, Pfizer, Rheos Medicines, Stiefel/GSK, Sun Pharmaceuticals, TeVido BioDevices, and Villaris Therapeutics; holds equity in Rheos Medicines, TeVido BioDevices, and Villaris Therapeutics; is a scientific founder of Villaris Therapeutics; and has patents pending for IL-15 blockade for treating vitiligo, JAK inhibition with light therapy for vitiligo, and CXCR3 antibody depletion for the treatment of vitiligo. Dr Pandya has served as an investigator for Aclaris Therapeutics, Immune Tolerance Network, Incyte Corporation, and Pfizer; a consultant for Arcutis, Avita Medical, Chromaderm, Immune Tolerance Network, Incyte Corporation, Pfizer, Viela Bio, and Villaris; and a board member who also holds stock options for Clarify Medical and Tara Medical. Dr Lebwohl is an employee of Mount Sinai Hospital, which receives research funds from AbbVie, Amgen, Arcutis, Avotres, Boehringer Ingelheim, Dermavant, Eli Lilly, Incyte Corporation, Janssen Research & Development, LLC, Ortho Dermatologics, Regeneron, and UCB, Inc; and is a consultant for Aditum Bio, Almirall, AnaptysBio, Arcutis, Aristea, Arrive Technology, Avotres Therapeutics, BioMX, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Castle Biosciences, Corrona, Dermavant Sciences, Dr. Reddy's Laboratories, Evelo, Evommune, Facilitate International Dermatologic Education, Forte, Foundation for Research and Education in Dermatology, Helsinn, LEO Pharma, Meiji Seika Pharma, Mindera, Pfizer, and Verrica. Dr Gottlieb has received honoraria as an advisory board member and consultant for AnaptysBio, Avotres Therapeutics, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Incyte Corporation, Janssen, LEO Pharma, Novartis, Sun Pharmaceuticals, and UCB; has stock options in Xbiotech; and has received institutional research/educational grants from Boehringer Ingelheim, Incyte Corporation, Janssen, Novartis, UCB, Xbiotech, and Sun Pharmaceuticals to Mount Sinai School of Medicine. Drs Butler, Kuo, and Sun are employees and shareholders of Incyte Corporation. Dr Grimes has served as a consultant for Aclaris Therapeutics, Clarify Medical, DermaForce, Incyte Corporation, Proctor & Gamble, and Versicolor Technologies and a principal investigator for Aclaris Therapeutics, Allergan/SkinMedica, Clinuvel Pharmaceuticals, Incyte Corporation, Johnson & Johnson, L'Oreal, Merz Pharma, Pfizer, Thync Global Inc, and VT Cosmetics.

Background: Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time., Objective: The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography., Methods: Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached., Results: The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described., Conclusions: This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment., (Copyright © 2019 American Academy of Dermatology, Inc. All rights reserved.)

Background: The shared medical appointment (SMA) allows patients with a similar diagnosis to be simultaneously cared for and educated by 1 provider, which has had success in dermatology and other fields of specialty. The SMA provides a potential solution to improve patient access to dermatologists., Objective: The purpose of this study was to implement the SMA for patients with vitiligo and compare it to traditional appointments with regard to patient satisfaction, time to appointment, number of new patients seen per month, and generated revenue., Methods: A vitiligo SMA was implemented, and a 12-question survey was used to assess satisfaction in both SMA and traditional appointment settings. Satisfaction, revenue, and appointment logistic data for SMAs were compared with those for traditional appointments for new patients., Results: Patients were highly satisfied with both SMAs and traditional appointments (P > .05). Time to appointment was faster for the SMA, and significantly more new patients were seen monthly with the SMA (P = .009)., Limitations: Limitations include small sample size, inability to correlate responder characteristics with survey responses, potential response bias, and selection bias due to absence of randomization., Conclusion: SMAs were successful in a vitiligo clinic for both patient and provider. The SMA is a solution to improve access to dermatologists without compromising patient benefit, experience, or satisfaction., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Vitiligo is an autoimmune disease in which cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors., Objective: To evaluate the efficacy of the JAK 1/3 inhibitor tofacitinib in the treatment of vitiligo., Method: This is a retrospective case series of 10 consecutive patients with vitiligo treated with tofacitinib. Severity of disease was assessed by body surface area of depigmentation., Results: Ten consecutive patients were treated with tofacitinib. Five patients achieved some repigmentation at sites of either sunlight exposure or low-dose narrowband ultraviolet B phototherapy. Suction blister sampling revealed that the autoimmune response was inhibited during treatment in both responding and nonresponding lesions, suggesting that light rather than immunosuppression was primarily required for melanocyte regeneration., Limitations: Limitations include the small size of the study population, retrospective nature of the study, and lack of a control group., Conclusion: Treatment of vitiligo with JAK inhibitors appears to require light exposure. In contrast to treatment with phototherapy alone, repigmentation during treatment with JAK inhibitors may require only low-level light. Maintenance of repigmentation may be achieved with JAK inhibitor monotherapy. These results support a model wherein JAK inhibitors suppress T cell mediators of vitiligo and light exposure is necessary for stimulation of melanocyte regeneration., (Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Vitiligo is an autoimmune disease of the skin characterized by patchy depigmentation. Current treatments are moderately effective at reversing disease by suppressing autoimmune inflammation in the skin and promoting melanocyte regeneration. Recent basic and translational research studies have significantly improved our understanding of disease pathogenesis, which is now leading to emerging treatment strategies based on targeted therapy. Here we discuss important clinical characteristics of vitiligo, current therapies and their limitations, advances in understanding disease pathogenesis, emerging targeted treatments, and strategies to optimize clinical trials to efficiently and effectively test these new treatments., (Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Clinicians should be aware that vitiligo is not merely a cosmetic disease and that there are safe and effective treatments available for vitiligo. It is important to recognize common and uncommon presentations and those with active disease, as well as their implications for clinical management; these were discussed in the first article in this continuing medical education series. Existing treatments include topical and systemic immunosuppressants, phototherapy, and surgical techniques, which together may serve to halt disease progression, stabilize depigmented lesions, and encourage repigmentation. We discuss how to optimize the currently available treatments and highlight emerging treatments that may improve treatment efficacy in the future., (Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.)

Vitiligo is a common autoimmune disease that progressively destroys melanocytes in the skin, resulting in the appearance of patchy depigmentation. This disfiguring condition frequently affects the face and other visible areas of the body, which can be psychologically devastating. The onset of vitiligo often occurs in younger individuals and progresses for life, resulting in a heavy burden of disease and decreased quality of life. Presentation patterns of vitiligo vary, and recognition of these patterns provides both diagnostic and prognostic clues. Recent insights into disease pathogenesis offer a better understanding of the natural history of the disease, its associations, and potential for future treatments. The first article in this continuing medical education series outlines typical and atypical presentations of vitiligo, how they reflect disease activity, prognosis, and response to treatment. Finally, we discuss disease associations, risk factors, and our current understanding of disease pathogenesis., (Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.)

Background: Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world., Objective: To create phototherapy recommendations to facilitate clinical management and identify areas requiring future research., Methods: The Vitiligo Working Group (VWG) Phototherapy Committee addressed 19 questions regarding the administration of phototherapy over 3 conference calls. Members of the Photomedicine Society and a group of phototherapy experts were surveyed regarding their phototherapy practices., Results: Based on comparison and analysis of survey results, expert opinion, and discussion held during conference calls, expert recommendations for the administration of NBUVB phototherapy in vitiligo were created., Limitations: There were several areas that required further research before final recommendations could be made. In addition, no standardized methodology was used during literature review and to assess the strength of evidence during the development of these recommendations., Conclusion: This set of expert recommendations by the VWG is based on the prescribing practices of phototherapy experts from around the world to create a unified, broadly applicable set of recommendations on the use of NBUVB in vitiligo., (Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies., Objective: To investigate potential biomarkers of disease activity directly in the skin of vitiligo subjects and healthy subjects., Methods: Patient skin was sampled via a modified suction-blister technique, allowing for minimally invasive, objective assessment of cytokines and T-cell infiltrates in the interstitial skin fluid. Potential biomarkers were first defined and later validated in separate study groups., Results: In screening and validation, CD8 + T-cell number and C-X-C motif chemokine ligand (CXCL) 9 protein concentration were significantly elevated in active lesional compared to nonlesional skin. CXCL9 protein concentration achieved greater sensitivity and specificity by receiver operating characteristic analysis. Suction blistering also allowed for phenotyping of the T-cell infiltrate, which overwhelmingly expresses C-X-C motif chemokine receptor 3., Limitations: A small number of patients were enrolled for the study, and only a single patient was used to define the treatment response., Conclusion: Measuring CXCL9 directly in the skin might be effective in clinical trials as an early marker of treatment response. Additionally, use of the modified suction-blister technique supports investigation of inflammatory skin diseases using powerful tools like flow cytometry and protein quantification., (Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)