Adding NB-UVB phototherapy to ruxolitinib cream speeds vitiligo repigmentation process

It was found that adding NB-UVB light therapy to ruxolitinib (Opzelura) 1.5% cream helped many vitiligo patients who did not respond early to treatment achieve faster and more noticeable skin repigmentation, without new safety concerns, according to a study published in the Journal of Investigative Dermatology in December 2025.

Vitiligo is a long-term autoimmune condition where the body attacks melanocytes, or cells that give skin its color, leading to white patches that can strongly affect a person’s emotional and social well-being. Ruxolitinib 1.5% cream is a topical JAK1/JAK2 inhibitor approved to treat nonsegmental vitiligo in patients ages 12 years and older.

In past studies, this cream has led to clear improvements in facial and total body repigmentation within six months, with continued improvements over one year. Narrow-band UVB phototherapy is also widely used and is recommended for those with widespread or fast-progressing vitiligo, though results can take months or longer.

To look at whether combination therapy could improve outcomes for patients at risk of stopping treatment early, researchers of the Palo Alto Foundation Medical Group in California, the Lynde Institute for Dermatology in Ontario, Canada, the SimcoDerm Medical & Surgical Dermatology center also in Canada and other institutions examined whether adding NB-UVB to ruxolitinib 1.5% cream could help patients who didn’t see at least 25% improvement after 12 weeks of cream alone. This time point reflects patient expectations that treatment should show visible progress within three months.

This open-label phase 2 study was conducted at 10 centers in the United States and Canada from May 5, 2022, through January 15, 2024. Patients aged 12 years or older with nonsegmental vitiligo affecting 10% or less of total body surface area were enrolled.

All patients applied ruxolitinib 1.5% cream twice daily to affected areas. After 12 weeks, patients who achieved at least 25% improvement in the total Vitiligo Area Scoring Index continued cream alone through Week 48. Those who did not meet the end date added at-home full-body NB-UVB phototherapy three times per week while continuing the cream.

The key outcome was change in total VASI score at Week 48, with safety and facial and body repigmentation assessed throughout the study.

Out of the 55 patients enrolled with vitiligo, most did not respond early to the topical cream and had to add light therapy after 12 weeks. Among those who completed combination treatment, skin repigmentation improved gradually over time, with more than half reaching at least 50% improvement in total body vitiligo scores by week 48 and nearly one in five reaching 75% improvement.

Facial repigmentation improved even more, with most patients achieving high response levels by the end of the study. Some patients still showed little response despite having combination treatment. Patients who continued ruxolitinib 1.5% cream alone also improved; however, fewer completed treatment, limiting comparisons.

Blood levels of the cream remained low and were not affected by adding NB-UVB. Both treatment approaches were generally well-tolerated, with mostly mild to moderate side effects and no new safety concerns identified.

This study showed that adding light therapy to ruxolitinib 1.5% cream can speed up repigmentation in patients who don’t respond early, with strong facial and total body outcomes and no new safety signals or changes in drug exposure. The study also includes some limits, such as its being a small, early-stage study.

Many patients dropped out, and results were based only on those who stayed. The study also didn’t directly compare combination therapy with ruxolitinib alone. Lastly, only patients who didn’t respond early were given combination therapy, which may have affected the results.

Adherence to home-based NB-UVB was also inconsistent.

The authors of the study suggest real-world and comparative studies, earlier evaluation of NB-UVB use and further research to identify characteristics of patients who remain nonresponsive despite combination therapy.