Indications Ruxolitinib cream is indicated for:

Atopic Dermatitis: Short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and pediatric patients 12 years and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.
Vitiligo: Topical treatment of non-segmental vitiligo in adults and pediatric patients 12 years and older.

Pharmacology Ruxolitinib is a Janus kinase (JAK) inhibitor that blocks JAK1 and JAK2, interfering with cytokine and growth factor signaling pathways important for hematopoiesis and immune function. It is metabolized primarily by CYP3A4 and to a lesser extent by CYP2C9. Plasma protein binding is ~97%. Half-life after topical use is ~3 hours. Excretion occurs mainly via urine (74%) and feces (22%).

Dosage & Administration

Maximum use: ≤60 g per week or ≤100 g per 2 weeks. For topical use only.
Atopic Dermatitis: Apply thin layer twice daily to affected areas (≤20% body surface). Stop when symptoms resolve; reassess if no improvement within 8 weeks.
Vitiligo: Apply thin layer twice daily to affected areas (≤10% body surface). Treatment may continue beyond 24 weeks; reassess if no meaningful repigmentation occurs.
Children <12 years: Safety and efficacy not established.

Drug Interactions Avoid concomitant use with strong CYP3A4 inhibitors (↑ systemic exposure, ↑ adverse reactions). CYP3A4 inducers may reduce systemic exposure.

Contraindications Contraindicated in patients with known hypersensitivity to Ruxolitinib or its components.

Side Effects

Atopic Dermatitis: Nasopharyngitis, diarrhea, bronchitis, ear infection, eosinophilia, urticaria, folliculitis, tonsillitis, rhinorrhea.
Vitiligo: Application site acne, pruritus, erythema, headache, urinary tract infection, nasopharyngitis, pyrexia.

Pregnancy & Lactation Avoid breastfeeding during treatment and for ~4 weeks after the last dose due to risk of serious adverse effects (infections, cytopenias).

Precautions & Warnings

Serious infections: Avoid in active infections; monitor closely.
Mortality risk: Higher all-cause mortality observed in RA patients ≥50 years with CV risk factors compared to TNF blockers.
Skin cancers: Basal cell and squamous cell carcinoma reported; periodic skin exams advised.
Cardiovascular events: Increased risk in current/past smokers.
Thrombosis: Discontinue if thromboembolic events occur.
Cytopenias: Thrombocytopenia, anemia, neutropenia possible; monitor CBC as clinically indicated.