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Optimizing Clinical Decision-Making and Competence in JAK Inhibitor Therapy for Vitiligo

Recognizing and Treating Unstable Vitiligo

Supported by an independent educational grant from Incyte

A 28-year-old man with nonsegmental vitiligo reports several new depigmented macules over the past month, along with confetti-like lesions at the periphery of older patches. He reports no recent illnesses or medication changes, but describes increased emotional stress over the past few months. He also expresses concern about the recent acceleration of lesions and wonders what he can do moving forward.

Case Image - Recognizing and Treating Unstable Vitiligo V2

Image Credit: James Song, MD

According to international consensus criteria, what is the most appropriate next management step?

A. Begin narrowband UVB phototherapy immediately.

B. Start topical JAK inhibitor twice daily to the affected areas.

C. Observe and re-evaluate in 3 months once lesions stabilize.

D. Initiate a short course of systemic corticosteroids (eg, oral mini-pulse) to stabilize disease activity before repigmentation therapy with topical and phototherapy