Vitiligo: causes and treatment options

Vitiligo is a condition in which the skin loses its pigment cells, melanocytes, leaving white patches. In the most common form, the immune system destroys these cells. Treatment aims to stop the disease spreading, bring colour back to the patches (repigmentation) and prevent relapse. Which treatment fits depends on the type of vitiligo, how active it is and where the patches are.

What causes vitiligo?

Non-segmental vitiligo, the common form that can appear on both sides of the body, is an autoimmune disorder. A combination of genetic predisposition and melanocytes that are more vulnerable to stress triggers an immune response in which a type of T cell (CD8+) destroys them, driven by a signalling molecule called interferon gamma. Segmental vitiligo affects one area on one side of the body; its cause is less well understood. Vitiligo is not contagious.

Which treatments are used?

Creams and ointments

Topical corticosteroids and calcineurin inhibitors calm the immune attack in the skin. Ruxolitinib cream, a JAK inhibitor, is the first treatment approved in several countries specifically for non-segmental vitiligo, for people aged 12 and over. In two phase III trials, significantly more people using it regained colour on the face and body than with a placebo cream, with results holding to two years.

Phototherapy

Narrowband UVB phototherapy stimulates pigment cells to return. Whole-body NB-UVB remains a cornerstone for extensive vitiligo, and targeted light treats smaller areas. A 2024 review notes that combining phototherapy with JAK inhibitors gives strong results, suggesting that calming the immune system works best with light to stimulate the melanocytes.

Laser and microneedling

For patches that resist treatment, such as on the hands and feet, fractional CO2 laser or microneedling can be added to phototherapy. A randomised trial co-authored by Professor Nilforoushzadeh found these add-ons increased repigmentation in resistant areas.

Surgery and cell transplantation

For stable vitiligo that has not responded to medical treatment, pigment cells can be moved from normal skin. Melanocyte-keratinocyte transplantation (MKTP) spreads a suspension of the patient's own cells over the white patch.

Treatments for rapidly spreading vitiligo

When vitiligo is spreading quickly, short courses of oral corticosteroids ("mini-pulses") may be combined with phototherapy to stop it. Oral JAK inhibitors are the most advanced new treatments in development.

How is the right plan chosen?

A 2025 review in the Journal of the German Society of Dermatology stresses an accurate diagnosis first: the type of vitiligo, how far it extends, whether it is active and any related conditions, since vitiligo can be associated with other autoimmune and psychological conditions. Goals are then agreed with the patient. Repigmentation is slow: it often takes months, and results differ by body site, with the face responding best and the hands and feet least.