Promoting Pigmentation and Preventing Relapses Highlighted as Keys in Vitiligo Treatment

The way practitioners diagnose and manage vitiligo patients continues to advance with recent discoveries in the pathogenesis, risk factors, and features of the disease activity. At the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida, one discussion focused on patterns of depigmentation, as well as their differential diagnoses and implications for prognosis and treatment. The goal of the session was to “empower attendees to approach vitiligo in a way that will lead to improved outcomes for their patients.” 

Thierry Passeron, MD, PhD, spoke about medical therapy for vitiligo. He explained effective management involves not only controlling inflammation but also promoting pigmentation and preventing relapses. A central focus of treatment is assessing whether vitiligo is in an active phase. Once active, combination treatments, such as narrowband ultraviolet B therapy and systemic steroids, show promising results.

“Treating vitiligo is complicated because it’s not that easy,” Dr. Passeron said. “For example, yes, we remove the inflammation and patients is relieved, there is no lesion. In vitiligo you must have the pigmentation, which is targeting the immune complex, but after that you must enhance the differentiation and perforation of melanocyte stem cells to enhance and to recommend the patient. We know that about 40 to 50% of the [patient’s vitiligo] will relapse. You must try to prevent those relapses.”

Topical treatments like corticosteroids and tacrolimus can be helpful, especially when applied intermittently. It’s important to remind patients that results will take time, often six to 2 years, before seeing significant improvement.

Topical ruxolitinib is the first FDA-approved treatment for vitiligo. Clinical studies show that it works particularly well on the face, with approximately 50% of patients achieving 75% pigmentation after one year of use. When combined with phototherapy or narrowband UVB, results are even more impressive, especially on the body. Dr. Passeron noted that areas such as the hands, wrists, and fingers remain challenging to treat.

In more severe cases systemic treatments, such as Janus Kinase (JAK) inhibitors, have shown positive results. Dr. Passeron explains these treatments are currently in phase three trials and appear to offer improvements, particularly on the face and body. In combination with other treatments, such as narrowband UVB, JAK inhibitors may enhance the overall efficacy in achieving pigmentation. 

The future of vitiligo treatment looks promising, with multi-modal approaches likely to provide the best outcomes for patients.