A promising advance in the treatment of non-segmental vitiligo

Vitiligo Society of South Africa (VSSA) | October 2026

For people living with vitiligo, treatment options have expanded considerably in recent years. One of the most exciting developments is the approval in Europe of upadacitinib, an oral medication that targets the immune processes responsible for the loss of skin pigmentation.

This is an important milestone because upadacitinib is the first oral Janus kinase (JAK) inhibitor approved in the European Union specifically for the treatment of non-segmental vitiligo.

Although this represents significant progress, it is important to understand what the treatment can achieve, who may benefit, and why careful medical supervision is essential.

What is vitiligo?

Vitiligo is a condition in which the skin loses its natural colour because pigment-producing cells, called melanocytes, are destroyed or damaged.

In most patients, the immune system mistakenly attacks these cells, resulting in white patches on the skin. Vitiligo may affect the face, hands, arms, legs, trunk and other areas.

The most common form is non-segmental vitiligo, in which patches may develop on both sides of the body.

Vitiligo is not contagious, and it is not caused by poor hygiene or anything a person has done wrong.

What is upadacitinib?

Upadacitinib, marketed internationally under the brand name Rinvoq, is a medication taken by mouth once daily.

It belongs to a group of medicines called JAK inhibitors. These medications interfere with certain chemical signals that drive inflammation and autoimmune activity.

Upadacitinib preferentially inhibits an enzyme called JAK1, which plays an important role in immune signalling.

The medication has already been used for several inflammatory conditions, including atopic dermatitis and certain forms of arthritis.

Its approval for vitiligo represents an important new application of this treatment.

How does upadacitinib work in vitiligo?

Research has shown that vitiligo involves an immune response in which specialised immune cells attack melanocytes.

One of the important chemical messengers involved is interferon-gamma, which activates an inflammatory pathway involving JAK1 and JAK2.

Upadacitinib helps interrupt this signalling pathway, reducing the immune activity responsible for attacking pigment-producing cells.

By reducing this attack, the treatment may create an opportunity for surviving melanocytes, particularly those within hair follicles, to produce pigment again.

In simple terms, upadacitinib helps calm the immune attack so that the skin has a better opportunity to regain its colour.

However, stopping the immune attack does not automatically guarantee repigmentation. The ability of the skin to recover pigment varies between patients and between different areas of the body.

What have clinical studies shown?

The most important evidence comes from two large international phase 3 clinical trials known as the Viti-Up studies, published in The Lancet in August 2026.

These studies investigated upadacitinib 15 mg once daily in adults and adolescents with non-segmental vitiligo.

The results showed that significantly more patients receiving upadacitinib achieved meaningful repigmentation compared with those receiving placebo.

At 48 weeks:

• Approximately 23–25% of patients receiving upadacitinib achieved at least 75% improvement in facial pigmentation scores, compared with approximately 6–7% receiving placebo.
• Approximately 19–21% achieved at least 50% improvement in total-body pigmentation scores, compared with approximately 6% receiving placebo.

These results are encouraging, but they also show that not every patient will respond sufficiently to treatment.

Importantly, the studies demonstrated that repigmentation takes time. Treatment may need to continue for many months before meaningful improvement becomes visible.

Can upadacitinib be combined with phototherapy?

Phototherapy, particularly narrowband ultraviolet B (NB-UVB) and 308-nm excimer light, is an established treatment for vitiligo.

While upadacitinib helps control the immune response, phototherapy stimulates processes involved in pigment recovery.

Small studies published in 2025 and 2026 have explored combining upadacitinib with NB-UVB or excimer light, with encouraging early results.

This combination is scientifically attractive because the treatments act through different but potentially complementary mechanisms.

However, these studies are relatively small. Combination treatment is not yet established as a standard approach, and further research is required to determine its effectiveness and safety.

Patients should not add phototherapy to upadacitinib treatment without discussing it with their dermatologist.

Who may benefit from upadacitinib?

The European approval covers adults and adolescents aged 12 years and older with non-segmental vitiligo who are considered suitable candidates for systemic treatment.

It may be particularly relevant for people with extensive or progressive disease, or those for whom existing treatments have been insufficient or impractical.

However, not every patient with vitiligo requires an oral medication.

Patients with limited patches may respond well to topical treatments, while phototherapy remains an important option for more widespread disease.

The decision to use systemic treatment must consider the extent and activity of vitiligo, its effect on quality of life, previous treatments and the patient’s general health.

Is upadacitinib safe?

Upadacitinib is a powerful immune-modulating medication and must be prescribed and monitored by an appropriately experienced doctor.

Potential adverse effects include acne, respiratory infections, shingles, changes in blood cell counts, increased liver enzymes and changes in cholesterol levels.

More serious risks associated with JAK inhibitors include serious infections, blood clots, cardiovascular events and certain malignancies.

These risks are not the same for every patient. Age, smoking history, cardiovascular health, previous illnesses and other medications may influence whether treatment is appropriate.

Before starting treatment, doctors generally assess infection risks, including tuberculosis and viral hepatitis, and arrange relevant blood tests. Continued monitoring is required during treatment.

Upadacitinib must not be used during pregnancy.

Patients should never obtain or start upadacitinib without medical supervision.

Is upadacitinib available for vitiligo in South Africa?

The European Commission approved upadacitinib for non-segmental vitiligo in July 2026.

However, European approval does not automatically extend to South Africa.

The South African Health Products Regulatory Authority (SAHPRA) independently regulates the registration and approved indications of medicines in South Africa.

Patients should therefore not assume that upadacitinib is locally registered or reimbursed for vitiligo. Its local regulatory status, availability and funding should be confirmed with their treating dermatologist.

Does this mean vitiligo can now be cured?

No. Upadacitinib is an important advance, but it is not a cure for vitiligo.

It may help restore pigmentation in some patients and may reduce the immune activity responsible for pigment loss.

However, responses vary, and long-term questions remain, including how well pigmentation is maintained after stopping treatment and whether continued treatment is necessary.

The development of oral JAK inhibitors represents a promising step towards more effective and individualised treatment.

A message from the Vitiligo Society of South Africa

The VSSA welcomes advances that improve the treatment options available to people living with vitiligo.

The approval of upadacitinib in Europe represents another important milestone in understanding and treating this condition.

We encourage patients to discuss new treatment developments with their dermatologists, while recognising that established treatments, including topical medication and phototherapy, continue to play an important role.

There is increasing reason for optimism. Vitiligo research is progressing, and new treatments are offering patients more options than ever before.

Scientific references

1. Passeron T, et al. Efficacy and safety of upadacitinib in adults and adolescents for treatment of non-segmental vitiligo (Viti-Up): results of two phase 3 randomised controlled studies. The Lancet. 2026;408:636–648. doi:10.1016/S0140-6736(26)00896-2.
2. Passeron T, et al. Once-daily upadacitinib versus placebo in adults with extensive non-segmental vitiligo: a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-ranging study. EClinicalMedicine. 2024;73:102655. doi:10.1016/j.eclinm.2024.102655.
3. Zhang W, et al. Short-term efficacy and safety of upadacitinib combined with 308 excimer light versus upadacitinib alone and 308 excimer light alone in patients with progressing facial vitiligo. Archives of Dermatological Research. 2025;317:252.
4. Yue Z, et al. Treatment of refractory progressive vitiligo with oral upadacitinib and narrow-band ultraviolet-B: a case series. Journal of the European Academy of Dermatology and Venereology. 2025;39–e856.
5. European Medicines Agency. Rinvoq (upadacitinib): European product information and regulatory updates.

Disclaimer: This article is intended for educational purposes and does not replace individual medical advice. Treatment decisions should always be made in consultation with a qualified healthcare professional.