Translated from the original German version.
The use of artificial intelligence (AI) is essential for accurately monitoring the success of the therapy. This determines the total area of skin affected by vitiligo using a previously created 3D photographic model of the respective patient. The 3D photographic models are analysed using MeshCNN. MeshCNN is a neural convolutional network that was specially developed for polygonal networks. The polygonal meshes offer an efficient visualisation of 3D shapes. They capture both the surface and the topology of the shape. This allows the most precise percentage deviations to be determined during subsequent analyses. In addition, AI can be used to determine the exact localisation of skin changes at each doctor's visit. Dr Zink emphasised that this examination method would provide suitable objective markers for therapy monitoring.1,2
Dr Zink presented the treatment algorithm for vitiligo from the S1 guideline on the diagnosis and treatment of vitiligo to his audience. The treatment options in the treatment algorithm initially differentiate between the presence of segmental or non-segmental vitiligo.
In the treatment of segmental vitiligo, a distinction should also be made between acute and chronic cases. The acute form of SV is treated with systemic CS, targeted light therapy and TCS/TCI. If there is no response to therapy and the disease is stable, the next step would be surgical treatment. In the chronic form of SV, either TCS/TCI, targeted light therapy or a combination of both is used. Surgical intervention is also a further treatment option here if there is no response to therapy and the disease is stable.
Treatment of NSC is based on the BSA (body surface area). If the BSA is below 3 %, TCS/TCI, targeted light therapy or a combination of both is recommended. If there is no response to therapy and the disease is stable, surgical treatment is recommended. If the BSA is above 3 % and the disease is both acute and rapidly progressive, treatment should be carried out using systemic CS with NB-UVB and TCS/TCI. If the disease is chronic, the S1 guideline recommends NB UVB and TCS/TCI. Supportive therapy modalities for SV and NSC include UV protection, psychotherapy, self-help groups and dermatocosmetics. Dr Zink emphasised in his presentation that surgical therapy for vitiligo would no longer play a role in Germany.1
The three pillars of vitiligotherapy include halting melanocyte destruction, promoting melanocyte proliferation and preventing relapse. Melanocyte destruction can be kept in check with dexamethasone 5mg (2 consecutive days per week for a total of 3-6 months), topical potent steroids and ruxolitinib. Melanocyte proliferation can be stimulated with narrow spectrum UVB (2-3 times a week for 6-24 months) and the dietary supplement GP-SOD 500-1000 mg daily. Tacrolimus 0.1 % can be used to prevent a relapse. According to Dr Zink, this has been shown in studies to reduce the relapse rate from 40% to 10%.1
Ruxolitinib is a non-steroidal selective and potent JAK1/JAK2 inhibitor that has been approved in Europe for the treatment of vitiligo since April 2023. It has an anti-inflammatory effect and can be applied as a cream to support repigmentation in NSCs.1,3 Due to its low molecular weight and low polarity, ruxolitinib can penetrate the uppermost layers of the skin. The lipophilicity promotes absorption even in complex skin layers. Reduced phototoxicity can be achieved by the presence of less than 4 aromatic rings.1
The results of the two randomised, double-blind phase 3 studies TruE-V1 (NCT04052425) and TruE-V2 (NCT04057573) led to the approval of topical ruxolitinib for the treatment of NSCD in patients aged ≥ 12 years. Until week 24, the study was placebo-controlled (topical ruxolitinib 1.5 % versus vehicle). From this point onwards, all study participants received topical ruxolitinib. The use of topical ruxolitinib led to significantly better repigmentation in NSC (compared to vehicle).
After 24 weeks, 29.8 % and 30.9 % of study participants in the ruxolitinib therapy group achieved an F-VASI75 response in TruE-V1 and TruE-V2, respectively. Compared to the placebo group, these results were significant. Dr Zink emphasised that the F-VASI75 response continued to increase and was almost 50 % after 52 weeks. An F-VASI90 response was achieved after 24 weeks in 15.3 % and 16.3 % (TruE-V1 and TruE-V2 respectively) of the study participants in the ruxolitinib therapy group. At week 52, this was 32.9 % and 27.7 % in TruE-V1 and TruE-V2 respectively.1
The topical ruxolitinib was well tolerated. No clinically significant changes in mean haemoglobin and platelet levels occurred during the course of the study (pooled analysis up to week 52). Under real-world conditions (13833 patient-years), the most frequently reported adverse event (2.7%) was a mild burning sensation at the application site. Dr Zink emphasised that there was not a single case of infection. Neither thromboses nor malignant diseases occurred.1
esanum reported on the 29th FOBI 2024, a training week for practical dermatology and venereology (in German: FOBI, Fortbildungswoche), which took place from 8-12 July at the ICM International Congress Center Munich and the Clinic and Polyclinic for Dermatology and Allergology in Munich.