Lorenzo Maria Pinto

Background: Vitiligo affects 0.5–2% of the global population and carries a substantial psychosocial burden. Topical ruxolitinib 1.5% cream is approved for nonsegmental vitiligo based on phase III trial data, but real-world evidence across heterogeneous populations remains limited. Objectives: To evaluate the real-world effectiveness, safety and patient-reported outcomes of topical ruxolitinib across 34 Italian dermatology centres, and to identify possible clinical predictors of treatment response. Methods: Multicentre retrospective cohort study (July 2024–October 2025). Patients (≥ 12 years of age) with nonsegmental vitiligo received ruxolitinib 1.5% cream twice daily. Primary outcomes were ≥ 75% improvement in Facial Vitiligo Area Scoring Index (F-VASI 75) 75 and ≥ 90% improvement in F-VASI (F-VASI 90) at 24 and 52 weeks. Secondary outcomes were Vitiligo Noticeability Scale, Dermatology Life Quality Index (DLQI), the vitiligo-specific quality-of-life instrument (VitiQoL), Generalized Anxiety Disorder 7-item scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Results: In total, 860 patients (mean age 47 years; 58% female sex; disease duration 13.5 years; 84% previously treated) completed a 24-week assessment; 229 (26.6%) had reached 52 weeks at the time of data lock. F-VASI 75 was achieved by 18.5% at 24 weeks, increasing to 38.4% at 52 weeks; F-VASI 90 rose from 5.7% to 25.8%. In multivariable logistic regression, summer treatment initiation [adjusted odds ratio (OR) 6.7, 95% confidence interval (CI) 2.7–16.8] and Koebner phenomenon (adjusted OR 1.6, 95% CI 1.04–2.66) were independent predictors of F-VASI 75 at 24 weeks. At baseline, 37% of patients had moderate-to-severe anxiety (GAD-7 ≥ 10); this fell to 11% at 24 weeks and 2% at 52 weeks. VitiQoL, DLQI and PHQ-9 improved at all timepoints. Adverse events were mild in 99% of cases (86 of 87). The treatment discontinuation rate was 1.5%. Conclusions: In a large real-world population considerably more heterogeneous than registration-trial cohorts, topical ruxolitinib showed progressive repigmentation through 52 weeks with excellent tolerability. Summer initiation and Koebner phenomenon independently predicted early response, findings that may inform patient counselling and the design of prospective studies. The parallel sustained reduction in anxiety and depression supports the use of standardized mental health assessment as a routine component of vitiligo care.

Background: Vitiligo is a chronic depigmenting disorder characterized by the selective loss of melanocytes, leading to the progressive development of hypopigmented macules and patches. Line‐field confocal optical coherence tomography (LC‐OCT) is a novel imaging technique that combines the advantages of optical coherence tomography (OCT) and reflectance confocal microscopy (RCM), delivering near‐histologic vertical and en‐face images with 3D reconstructions. LC‐OCT has demonstrated a promising role in multiple dermatological conditions, including neoplastic, infectious and autoimmune conditions. Objectives: The aim of this pilot study was to evaluate whether LC‐OCT can capture structural correlates of vitiligo activity and response to therapy. Methods: This observational pilot study included 20 adults with non‐segmental vitiligo (12 males; mean age 34 years; mean disease duration 6.1 years) treated with ruxolitinib 1.5% cream twice daily for 6 months. LC‐OCT (deepLive, DAMAE Medical) was acquired at baseline and follow‐up from lesional core, perilesional border and distant healthy skin. Prespecified descriptors were dermo−epidermal junction (DEJ) ring loss; partial ring preservation as ‘half‐rings’ aligned into scalloped outlines; superficial hyperreflective inflammatory cell clusters with associated vessel dilation; and repigmentation assessed by the reappearance of junctional/basal bright cells with progressive ring reconstitution. Results: Lesional cores showed complete DEJ ring loss in all cases (20/20) with DEJ flattening and reduced basal reflectivity; these findings persisted in non‐repigmenting lesions (8/8). Clinically active borders (7/20) displayed superficial hyper‐reflective inflammatory clusters and dilated papillary vessels. Perilesional scalloped half‐rings were frequent (15/20). In repigmenting lesions (12/20), early repigmentation featured irregular, low‐density junctional/basal bright cells and incomplete ring restoration in 7/12; activated dendritic melanocytes were observed in four patients. Five fully repigmented areas showed a continuous, homogeneous DEJ ring pattern and normalized basal reflectivity, resembling healthy skin. Conclusions: LC‐OCT provides signatures that differentiate stable, active, repigmenting and repigmented vitiligo, supporting its potential for noninvasive monitoring of disease course and therapeutic response.

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA treatment, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) remains unclear. This study evaluates the efficacy and safety of baricitinib in patients with severe AA and coexisting psoriasis and/or PsA. Materials and Methods: A retrospective case series of five patients (mean age 53.2 years) with severe AA (SALT > 80) or alopecia universalis (AU) and concomitant psoriasis (n = 2) and/or PsA (n = 3) was conducted in the Dermatology Unit of Policlinico of Tor Vergata, Catholic University of the Sacred Heart and La Sapienza University of Rome, Italy. Patients received baricitinib 4 mg/day and were assessed at weeks 4, 24, and 52 using SALT, PASI, and pVAS scores. Results: At week 52, one patient achieved complete AA remission, while two improved to SALT < 20 (mean SALT 83 to 8.75). Psoriasis remained stable (mean PASI 1.4 to 0.5). However, one PsA patient worsened (pVAS 9) and discontinued the treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but it may not be optimal for PsA. Further studies are needed to define its role in multiple immune diseases.

Background: Primary cicatricial alopecias (PCA) are rare inflammatory disorders that irreversibly destroy hair follicles, making early, accurate diagnosis crucial. Objective: The aim of this study is to describe line field confocal optical coherence tomography (LC‐OCT) features of major PCA subtypes and assess its potential role in diagnosis and disease monitoring. Methods: Twenty‐five patients with PCA (lichen planopilaris [LPP], frontal fibrosing alopecia [FFA], folliculitis decalvans [FD], discoid lupus erythematosus [DLE], dissecting cellulitis of the scalp [DCS]) underwent LC‐OCT imaging with vertical, horizontal, and 3D acquisitions of clinically and trichoscopically selected lesions. Images were independently evaluated to identify both shared and subtype‐specific patterns. Results: In active lesions of LPP/FFA ( n = 15), infundibular hyperkeratosis with hyper‐reflective keratinous sleeves was observed in 14/15 (93.3%), perifollicular bright inflammatory aggregates in 7/15 (46.6%), and dilated dermal vessels in 9/15 (60.0%). DLE ( n = 4) was characterized by periadnexal inflammation, basal vacuolar alteration, and a continuous hyper‐reflective junctional band in 4/4 (100%), dermal hyporeflective bands compatible with mucin in 2/4 (50.0%), and follicular plugs in 2/4 (50.0%). FD ( n = 4) demonstrated tufted follicles with markedly dilated infundibula in 3/4 (75.0%), pustule‐like hyporeflective cavities in 2/4 (50.0%), and periadnexal inflammatory infiltrates in 3/4 (75.0%). DCS ( n = 2) showed superficial abscess‐like lobulated hyporeflective cavities with perifollicular inflammatory clusters in 2/2 (100%) and follicular fusion with hair tufting in 1/2 (50.0%). In end‐stage cicatricial areas, LC‐OCT demonstrated follicular dropout with loss of sebaceous glands, dermal sclerosis forming a stellate pattern, and a flattened, hyper‐reflective dermal–epidermal junction in all 25/25 cases (100%). Conclusions: LC‐OCT identifies shared scarring signatures as well as distinct patterns among PCA subtypes, and it supports targeted biopsy site selection. Moreover, it provides a noninvasive tool for real‐time assessment of disease activity that is complementary to trichoscopy and histopathology.

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) re-mains unclear. This study evaluates the efficacy and safety of baricitinib in patients with severe AA and coexisting psoriasis and/or PsA. Materials and Methods: A retrospective case series of five patients (mean age 53.2 years) with severe AA (SALT >80) or alopecia universalis (AU) and concomitant psoriasis (n=2) and/or PsA (n=3) was conducted at the Dermatology Unit of Policlinico of Tor Vergata, Catholic University of the Sacred Heart and La Sapienza University of Rome, Italy. Patients received baricitinib 4 mg/day and were assessed at weeks 4, 24, and 52 using SALT, PASI, and pVAS scores. Results: At Week 52, one patient achieved complete AA remission, while two improved to SALT < 20 (mean SALT 83 to 8.75). Psoriasis remained stable (mean PASI 1.4 to 0.5). However, one PsA patient worsened (pVAS 9) and discontinued treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but may not be optimal for PsA. Further studies are needed to define its role in multi-immune diseases.

Topical agents that are currently available for the treatment of atopic dermatitis may represent a valid approach in the management of mild or mild–moderate cases, whereas they are often supplemented with systemic therapies for handling more complex or unresponsive cases. The most used compounds include topical corticosteroids and calcineurin inhibitors, although their use might be burdened by side effects, poor response, and low patient compliance. Consequently, new innovative drugs with higher efficacy and safety both in the short and long term need to be integrated into clinical practice. A deeper understanding of the complex pathogenesis of the disease has led to identifying new therapeutic targets and to the development of innovative therapeutics. This narrative review aims to collect data on selected promising topical drugs that are in an advanced stage of development.