Potential future biologic therapies for the treatment of vitiligo: focus on phase 2 and 3.

Introduction: Vitiligo is a chronic autoimmune skin disorder characterized by the loss of melanocytes, leading to depigmented patches on the skin and mucous membranes. Its increasing prevalence and impact on patients' quality of life highlight the need for updated therapeutic strategies.

Areas covered: This review discusses recent advances in the understanding of vitiligo pathogenesis, focusing on genetic predisposition, environmental triggers, and immune dysregulation-particularly the role of autoreactive CD8+ T cells and inflammatory cytokines such as IFN-γ. The literature search included recent clinical trials and emerging therapies. Novel approaches, including JAK inhibitors (e.g. povorcitinib, upadacitinib) and monoclonal antibodies (e.g. anifrolumab), are evaluated for their efficacy and safety based on phase II and III clinical trial data.

Expert opinion: Targeted therapies that address immune mechanisms and oxidative stress represent promising advances in vitiligo management and may substantially improve patient outcomes in the near future.