What it is
Vitiligo is the loss of the pigment cells in patches of skin, leaving well-defined white areas that may spread or may stay where they are for years. The first job of the appointment is the diagnosis, because several other conditions produce pale patches and are treated in completely different ways, and the second is deciding whether the disease is currently active or stable — that single judgment governs the entire plan. Options include topical treatment, targeted or whole-body light therapy, and, for patches that have been stable and resistant for a documented period, surgical pigment-cell techniques carried out in specialized centers.
What this page covers
- Vitiligo diagnosis, pattern classification and activity assessment
- Wood lamp examination and photographic documentation of borders over time
- Screening for associated autoimmune disease, particularly thyroid
- Separating vitiligo from pityriasis alba, tinea versicolor, post-inflammatory hypopigmentation and idiopathic guttate hypomelanosis
- Topical corticosteroids and calcineurin inhibitors, chosen by site and limited in duration on the face and eyelids
- Topical JAK inhibitor where local registration and access are confirmed
- Oral mini-pulse corticosteroid for documented actively spreading disease, with monitoring
- Narrowband UVB phototherapy and targeted 308 nm excimer, with cumulative dose tracking
- Surgical options — melanocyte transplantation, suction blister and punch grafting — for stable, resistant patches, by referral
- Depigmentation therapy in very extensive disease, after detailed counseling
- Medical camouflage, self-tanning agents and psychological support
- Micropigmentation for small, long-stable, resistant sites, discussed honestly and referred
Honestly
How much color returns depends on the site and on whether the disease is active or stable — the face and neck usually respond more readily than the hands, feet and skin over bone — and every option is a scheduled commitment over months rather than a course with an end date. Active vitiligo can be provoked by trauma to the skin, so needling, peels, laser hair removal and even friction at a patch need care, and depigmentation therapy is a decision that cannot be reversed.