Pigmentation Pipeline: Vitiligo and Melasma Treatment Advances

Vitiligo has moved from an underserved disease to one of dermatology's most active treatment areas, according to George Martin, MD, who discussed disorders of pigmentation at Maui Derm NP+PA Summer 2026.1 Martin, a dermatologist at the Dermatology and Laser Center of Maui and the co-founder of Scholars in Medicine and Maui Dermatology, structured his session around 2 categories: depigmentation disorders like vitiligo and hyperpigmentation disorders like melasma.

Vitiligo affects up to 1% of the population, and about half of cases begin before 20 years old.2,3 In an interview with HCPLive, Martin noted the disease carries a genetic association and was long considered an orphan condition before targeted therapies arrived.

Topical Ruxolitinib Shows Durable, Growing Benefit

Topical ruxolitinib, a JAK1/2 inhibitor, remains the only FDA-approved topical therapy for vitiligo.4 Martin said its effect does not plateau. Patients continue to show increasing repigmentation 2 and 3 years into treatment, a pattern he described as "the gift that keeps on giving."

The therapy's main limitation is body surface area. Martin said patients with more extensive involvement, generally above 50% body surface area, need systemic options layered on top of topical treatment.

Oral JAK Inhibitors Approaching Approval

Several oral JAK inhibitors are advancing through late-stage trials for vitiligo. Martin pointed to povorcitinib (a JAK1 inhibitor) and ritlecitinib (a JAK3/TEC inhibitor) as therapies positioned to expand systemic options.5,6 AbbVie announced topline phase 3 results of upadacitinib for vitiligo back in October 2025.7

Martin said these therapies will likely replace the current standard approach for widespread, active vitiligo: pulse-dose dexamethasone given twice weekly, often combined with narrowband UVB phototherapy. He cited an algorithm developed by John Harris, MD, PhD, now chair at Massachusetts General Hospital, as a framework many clinicians already follow for turning off active disease before starting repigmentation therapy.

Phototherapy Access Remains a Barrier

Not every practice has in-office narrow band UVB, Martin said, which pushes many clinicians toward topical and systemic regimens by default. He expects ruxolitinib to increasingly replace topical steroids in combination protocols, both for its efficacy and its safety profile.

Melasma Treatment Requires a Combined Approach

On the hyperpigmentation side, Martin focused on melasma, which he called one of the most common disorders clinicians see in daily practice. He said effective treatment requires combining skin-lightening topicals with procedures such as peels and lasers, rather than relying on a single modality.

Martin said that photoprotection remains equally important, but current sunscreens fall short. A recent consensus statement on visible light, led by Henry Lim, MD, established the need to block visible light in addition to UVA and UVB.8

“Sadly, all of our current sunscreens are ineffective at blocking visible light and require some combination of iron oxides or some other visible blocking molecules,” Martin said. “There is some really good science out there to show that we're now capable of blocking visible light, but this combination of minerals has not yet been commercialized.”

Editor’s note: Reported disclosures for Martin include AbbVie, Pfizer, Novartis Pharmaceuticals, Janssen Biotech, ER Squibb & Sons, Incyte Corporation, Organon, Galderma Laboratories, Genzyme Corporation, Amgen, LEO Pharma, UCB, Arcutis Biotherapeutics, Almirall, Biofrontera, Sun Pharmaceutical Industries, Lilly USA, and more.

References

1. Martin G. Disorders of Pigmentation. Session presented at Maui Derm NP+PA Summer 2026 in Colorado Springs.

2. Vitiligo Facts. Global Vitiligo Foundation. Accessed July 9, 2026. https://globalvitiligofoundation.org/vitiligo-facts/

3. Vitiligo. Yale Medicine. Accessed July 9, 2026. https://www.yalemedicine.org/conditions/vitiligo

4. Butera A. FDA Approves Ruxolitinib Cream 1.5% for Nonsegmental Vitiligo. HCPLive. Published on July 18, 2022. Accessed on July 9, 2026. https://www.hcplive.com/view/fda-approves-ruxolitinib-cream-for-nonsegmental-vitiligo

5. Smith T. HCPLive. Oral Povorcitinib for Extensive Nonsegmental Vitiligo Yields Positive Results in Phase 2b Trial. Published on October 11, 2023. Accessed July 9, 2026. https://www.hcplive.com/view/oral-povorcitinib-extensive-nonsegmental-vitiligo-positive-results-phase-2b-trial

6. Smith T. HCPLive. Ritlecitinib Efficacious for Non-Segmental Vitiligo Across Various Subgroups. Published on January 15, 2026. Accessed July 9, 2026. https://www.hcplive.com/view/ritlecitinib-efficacious-non-segmental-vitiligo-across-various-subgroups

7. AbbVie Announces Positive Topline Results from Phase 3 Pivotal Studies Evaluating Upadacitinib (RINVOQ®) in Adults and Adolescents with Vitiligo. AbbVie. Published on October 29, 2025. Accessed July 9, 2026. https://news.abbvie.com/2025-10-29-AbbVie-Announces-Positive-Topline-Results-from-Phase-3-Pivotal-Studies-Evaluating-Upadacitinib-RINVOQ-R-in-Adults-and-Adolescents-with-Vitiligo

8. Lim HW, Schalka S, Trautinger F, et al. International modified Delphi consensus statement on visible light photoprotection: Effects, measurement, and recommendations. J Invest Dermatol. Published online May 7, 2026. doi:10.1016/j.jid.2026.03.012