Early dermoscopic and confocal features predict response to topical ruxolitinib in nonsegmental vitiligo: A prospective observational study

Early dermoscopic and confocal features predict response to topical ruxolitinib in nonsegmental vitiligo: A prospective observational studyVitiligo is a chronic skin disorder characterized by melanocyte loss, resulting in depigmented patches and significant psychosocial impact. 1 It affects 0.5% to 2% of the global population and is believed to involve an autoimmune mechanism, particularly interferongamma, CXCL9/10 chemokines, and JAK/STAT signaling pathways. 1,2Ruxolitinib, a JAK1/2 inhibitor, was Food and Drug Administration-approved in 2022 for nonsegmental vitiligo after promising results in the TRuE-V1 and TRuE-V2 clinical trials. 2 This 4-month prospective observational study evaluates whether combining dermoscopy with reflectance confocal microscopy (RCM) can improve prediction and monitoring of clinical responses. [3][4]4][5] It was conducted at 3 Italian dermatology centers, enrolling 44 nonsegmental vitiligo patients treated with 1.5% ruxolitinib cream (15 mg/g).Patients recently treated with conventional vitiligo therapies were excluded.Lesions were documented using dermoscopy and RCM at baseline (T0), after 1 month (T1), and after 4 months (T4).Clinical response, Vitiligo-specific Quality of Life (VitiQoL), and Vitiligo Noticeability Scale were assessed at each timepoint.Clinical improvement was defined by interfollicular pigmented islands or border repigmentation under Wood's lamp examination.Dermoscopy assessed perifollicular and interfollicular pigmentation and vascular structures (comma-shaped, linear, telangiectatic, or crown-like).RCM evaluated pigment ring patterns, perifollicular vascularity, and dendritic cells.Statistical analyses included Pearson chi-squared, Kruskal-Wallis, and t-tests.Patients were aged 23 to 68 years (mean 51.2); the face was the most affected site (70.5%).After 4 months, 54.5% showed clinical repigmentation under Wood's lamp; 52.3% had interfollicular pigment islands, and 31.8% had border repigmentation.VitiQoL scores improved from 64.1 to 47.3 at T4.The mean Vitiligo Noticeability Scale score at T4 was 3, indicating partial but visible repigmentation.Repigmentation was significantly associated with facial lesions (P = .0009995).Early perifollicular pigmentation at T1-seen as brown halos around follicles in dermoscopy and ring or half-ring patterns