This handout is for vitiligo (autoimmune depigmentation, dermatology lens). Your care team identified this based on: acquired well-demarcated chalk/milky-white depigmented (not merely hypopigmented) macules/patches, often acral/periorificial, symmetric — vitiligo entry (bad 2021 pmid 34160061).
Other reasons your team may use this plan: wood-lamp bright chalk/blue-white accentuation with sharp margins (true depigmentation) vs poor accentuation in hypopigmentation — the pivotal bedside discriminator (bad 2021 pmid 34160061); unilateral, segmental/blaschkoid depigmentation, often early childhood onset, early-stabilising → segmental subtype + earlier surgical-candidacy entry (bad 2021 pmid 34160061); confetti macules, trichrome lesions, koebner phenomenon, leukotrichia, rapidly enlarging patches → active/progressive disease — arrest-progression entry (bad 2021 pmid 34160061).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| photoprotection_broad_spectrum_sunscreen_and_sun_avoidance | — | — | — | BAD 2021 (PMID 34160061) — depigmented skin has no melanin photoprotection (burns readily, ↑ actinic damage); broad-spectrum high-SPF sunscreen + behavioural sun protection also reduces lesion–skin contrast and Koebnerising sunburn. |
| cosmetic_camouflage_and_psychological_support | — | — | — | Eleftheriadou et al BJD 2024 (PMID 39018020) + BAD 2021 (PMID 34160061) — vitiligo increases depression/anxiety/sleep-disturbance and time off work (amplified by high contrast in skin of colour); camouflage + structured psychological support + mood screening are core management, independent of pharmacotherapy response. |
| maintenance_topical_after_repigmentation_to_prevent_relapse | — | — | — | BAD 2021 (PMID 34160061) — relapse at previously repigmented sites is common after stopping; intermittent maintenance topical (e.g. calcineurin inhibitor 1–2×/wk) to repigmented sites reduces relapse. |
Plan: Vitiligo — extent/activity/site-stratified ladder + photoprotection & psychological support (BAD 2021 / VGICC; FDA-approved topical ruxolitinib)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: counsel the often progressive/relapsing course + realistic site-dependent repigmentation expectations (face/neck best; acral, bony-prominence, and leukotrichic lesions poor; segmental more stable but less topical-responsive), maintenance topical 1–2×/wk after repigmentation to prevent relapse, lifelong autoimmune (thyroid #1, T1DM, AA, pernicious anaemia, Addison) + mental-health surveillance, photoprotection (depigmented skin burns, no melanin photoprotection) + camouflage + peer-support signposting, irreversibility counselling before any monobenzone depigmentation, and step-up/step-down + surgical-candidacy (stable ≥6–12 mo) criteria. Dermatology continuity; re-evaluate diagnosis (biopsy) if the course is atypical or treatment-resistant (hypopigmented MF/CTCL).
Guideline: British Association of Dermatologists guidelines for the management of people with vitiligo 2021 (Eleftheriadou et al, Br J Dermatol; PMID 34160061, DOI 10.1111/bjd.20596 — subtype/activity assessment, NB-UVB + topical CNI/corticosteroid first-line, 308-nm excimer for localised, oral mini-pulse to arrest active disease, surgery for documented-stable disease, monobenzone depigmentation for extensive recalcitrant universal disease, autoimmune-comorbidity + psychological screening, against chronic continuous systemic steroids) anchored by pivotal evidence: TRuE-V1/TRuE-V2 phase-3 topical ruxolitinib cream (Rosmarin et al, NEJM 2022; PMID 36260792, DOI 10.1056/NEJMoa2118828 — FDA-approved repigmentation) + pooled subgroup @52 wk (PMID 40156697, DOI 10.1007/s13555-025-01381-7) + F-/T-VASI psychometrics (PMID 39078582, DOI 10.1007/s13555-024-01223-y); INFO/VGICG repigmentation-outcome consensus (Eleftheriadou et al, Br J Dermatol 2018; PMID 30030843, DOI 10.1111/bjd.17013); UK lifetime-risk + psychosocial/ethnicity impact (Eleftheriadou et al, Br J Dermatol 2024; PMID 39018020, DOI 10.1093/bjd/ljae282); NB-UVB systematic review (Xiao et al, J Dermatolog Treat 2014; PMID 25102894, DOI 10.3109/09546634.2014.952610); oral-minipulse vs methotrexate unstable-vitiligo RCT (Singh et al, Dermatology 2015; PMID 26278124, DOI 10.1159/000433424); melanocyte–keratinocyte transplant outcomes (Ramos et al, An Bras Dermatol 2017; PMID 29186240, DOI 10.1590/abd1806-4841.20175700) + 6-yr relapse-factor follow-up (Altalhab et al, JEADV 2019; PMID 30793805, DOI 10.1111/jdv.15411)