Vitiligo

Diagnose typical vitiligo clinically when sharply demarcated, milky-white, non-scaly macules or patches are present. Examine all skin in natural light and with a Wood lamp before selecting therapy: lesions fluoresce blue-white, contrast is enhanced, and occult areas may become apparent. Record skin phototype, duration, body distribution, mucosal and hair involvement, and whether lesions are expanding; these features guide treatment selection and provide a baseline for response. fda+1fda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDAScienceDirectVitiligo

Classify bilateral or symmetric patches as nonsegmental vitiligo unless another diagnosis explains the pattern. Classify a predominantly unilateral distribution as segmental vitiligo. This distinction matters because ruxolitinib cream efficacy and safety were established in nonsegmental vitiligo, and NB-UVB has less supporting evidence for segmental or unclassifiable disease. fda+2fda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDAScienceDirectVitiligoPubMedSecond Guidelines for the Diagnosis and Treatment of Vitiligo in Japan (2025) - PMC

Use dermoscopy when clinical morphology or disease activity is uncertain, particularly when distinguishing vitiligo from other acquired hypopigmentary or depigmenting disorders. If the diagnosis remains uncertain after examination, biopsy a representative active edge rather than a fully depigmented center; vitiligo histology shows absent or near-absent epidermal melanocytes, while early lesions may show interface dermatitis with CD8-positive lymphocytes and lymphocytic infiltrates at the advancing border. fdafda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDA

For suspected nonsegmental vitiligo, obtain thyroid function tests and antithyroid antibodies to identify patients at increased risk for autoimmune thyroid disease. Vitiligo is associated with Hashimoto thyroiditis and Graves disease, and thyroid testing is recommended in adults and children with vitiligo. fda+1fda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDAnice org uk[PDF] National Institute for Health and Care Excellence - NICE

Do not order broad autoimmune antibody panels solely because vitiligo is present. Add testing for another autoimmune condition only when symptoms, examination, family history, or initial testing creates a specific diagnostic suspicion. An abnormal thyroid result should trigger management according to the thyroid disorder rather than alter vitiligo treatment automatically. nice org uknice org uk[PDF] National Institute for Health and Care Excellence - NICE

At each treatment review, reassess disease activity and quality-of-life effect rather than relying only on pigment change. Higher vitiligo activity and severity scores have been associated with greater quality-of-life impairment in patients with thyroid dysfunction, supporting closer follow-up when active disease and thyroid autoimmunity coexist. Wolters KluwerWolters KluwerThyroid Dysfunction in Vitiligo Patients:... : Journal of Datta Meghe Institute of Medical Sciences University

Topical corticosteroids are a first-line option for focal, segmental, and localized vitiligo. Use a time-limited course because prolonged exposure can cause skin thinning; reassess clinical response and local toxicity rather than continuing indefinitely. Older consensus practice used moderately potent to potent corticosteroids for facial disease and potent to very potent agents for body lesions, but long-term topical corticosteroid treatment is not advocated because of adverse effects. PubMed+1PubMedVitiligo in adults and children - PMCaadVitiligo: Diagnosis and treatment - American Academy of Dermatology

Prefer tacrolimus ointment or pimecrolimus cream when lesions involve the face, neck, or body folds, where avoiding corticosteroid atrophy is a priority. Topical calcineurin inhibitors can be used longer than topical corticosteroids and are especially useful for head and neck lesions; counsel that transient application-site burning, itch, or irritation can occur. In a meta-analysis, burning occurred in 9.8%, pruritus in 7.4%, and erythema in 2.4% of patients treated with topical calcineurin inhibitor monotherapy. cks nice org uk+2cks nice org ukScenario: Management of vitiligo - CKS - NICEaadVitiligo: Diagnosis and treatment - American Academy of DermatologyPubMedTreatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo: A Systematic Review and Meta-analysis - PMC

Ruxolitinib 1.5% cream is a disease-directed topical option only for nonsegmental vitiligo, the population in which efficacy and safety were established. Confirm subtype before prescribing and reassess treatment response with standardized photography and Wood lamp examination; do not extrapolate the pivotal-population finding to segmental vitiligo as if equivalent evidence existed. fdafda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDA

For nonsegmental vitiligo involving 10% to 40% body surface area, systemic NB-UVB is recommended as first-line therapy in adults and children older than 10 years. NB-UVB has largely replaced PUVA for lesions affecting at least 10% of skin surface area because it has no systemic toxicity and has favorable safety in children and adults. Expect perifollicular repigmentation after approximately 15 to 20 sessions; continue therapy when pigmentation is progressing, with courses extending beyond 9 to 12 months and, in selected responders, up to 24 months followed by gradual dose reduction. PubMedPubMedSecond Guidelines for the Diagnosis and Treatment of Vitiligo in Japan (2025) - PMC

Choose targeted UVB or excimer laser/light for circumscribed lesions when whole-body NB-UVB is disproportionate to disease extent. Once-weekly targeted UVB may be as effective as twice-weekly therapy for lesions of the face, neck, torso, limbs, and scalp, but initial repigmentation may occur more slowly with the less frequent schedule. Wolters KluwerWolters KluwerPhototherapy in vitiligo : Pigment International

For highly progressive vitiligo, refer promptly to dermatology for systemic disease-stabilizing treatment rather than escalating topical therapy alone. A described regimen is methylprednisolone 16 mg or dexamethasone 5 mg on two consecutive days weekly for 3 to 6 months, combined with NB-UVB two to three times weekly for 6 months. This approach is reported to block relapse in more than 80% of cases, but systemic corticosteroid exposure requires individualized risk assessment and pediatric review after 3 months in growing children. PubMedPubMedVitiligo: Current Therapies and Future Treatments

Do not equate stabilization with durable remission. After treatment cessation, approximately 40% of patients have some pigment loss within one year. For patients who repigment, plan maintenance topical therapy several times weekly when appropriate and continue objective surveillance for recurrent activity. aadaadVitiligo: Diagnosis and treatment - American Academy of Dermatology

Consider surgical repigmentation procedures for stable vitiligo that remains cosmetically significant despite medical treatment, particularly segmental disease or focal stable lesions. Available approaches include tissue grafting and cellular grafting techniques; a systematic review and meta-analysis evaluated treatment response across surgical modalities, supporting surgery as a distinct management pathway rather than an extension of topical therapy. JAMAJAMASurgical Interventions for Patients With Vitiligo: A Systematic Review ...

Before surgical referral, reconfirm lesion stability with serial clinical and Wood lamp photographs and exclude active expansion. Persistent inflammatory activity, new lesions, or trauma-associated spread should redirect management toward disease stabilization, typically phototherapy with or without systemic therapy for highly progressive disease, rather than grafting into an active disease field. fda+2fda[PDF] NDA 215309/S‐001 Opzelura (ruxolitinib) cream, 1.5% - FDAWolters KluwerThyroid Dysfunction in Vitiligo Patients:... : Journal of Datta Meghe Institute of Medical Sciences UniversityPubMedVitiligo: Current Therapies and Future Treatments

Use dermoscopy and Wood lamp examination as adjuncts when monitoring postoperative repigmentation. Evaluate both pigment gain and recurrence at lesion edges; repeat grafting decisions should be based on durable stability and objective repigmentation rather than a single follow-up appearance. ScienceDirectScienceDirectAnalysis of dermoscopic characteristics in vitiligo lesions treated ...