Vitiligo: novas abordagens terapêuticas baseadas na fisiopatologia imunológica

Vitiligo is a chronic autoimmune skin disease characterized by the progressive destruction of melanocytes,resulting in a profound psychosocial impact. Historically challenging, therapeutic management hasbeen revolutionized by recent discoveries in the field of immune pathophysiology, as the disease ismediated by autoreactive cytotoxic CD8+ T cells and the Janus Kinase/Signal Transducer and Activator ofTranscription (JAK/STAT) signaling pathway, activated by interferon-gamma (IFN-γ). Therefore, the presentliterature review aimed to analyze new therapeutic approaches based on this immune pathophysiology,encompassing studies from 2016 to 2026 selected from the PubMed/MEDLINE, Embase, Cochrane, andWeb of Science databases. The findings demonstrate that the recognition of the JAK/STAT pathway hasenabled the development of targeted immunomodulators with highly promising results. Topical ruxolitinibstands out as the first JAK inhibitor drug approved for the treatment of vitiligo, showing consistent andclinically significant repigmentation, particularly in facial lesions. Concurrently, systemic JAK inhibitors,such as baricitinib, ritlecitinib, and upadacitinib, show promising clinical results, with even more notablesynergistic effects when combined with phototherapy. Biological therapies and mesenchymal stem cellsare also emerging as viable alternatives. It is concluded that the transition from empirical treatments tointerventions targeted at the pathophysiology of the disease represents a transformative advancement inthe treatment of vitiligo. However, gaps in clinical evidence persist, especially regarding long-term outcomesand pediatric populations, demanding the need for further and deeper research, primarily focused onidentifying biomarkers and eliminating resident memory T cells, in order to prevent long-term relapses.