Repigmentation along the edges of patches as melanocytes from healthy skin migrate into depigmented areas

Vitiligo management is anchored in 3 primary treatment goals^1,2

Talk to your patients about these treatment goals.^1-3

A first step

Stopping the immune attack

A visible milestone

Repigmentation

An ongoing commitment

Maintaining repigmentation

These treatment goals can apply to both nonsegmental and segmental vitiligo.

Vitiligo is unpredictable and disease activity can fluctuate over time.

Stopping the immune attack means:

The immune system's attack on melanocytes has been interrupted
Vitiligo-related inflammation has been reduced

Delaying the stop of the immune attack:

Could risk further melanocyte destruction
Could contribute to new patches
Could risk future depigmentation in hard-to-treat areas

Help your patients understand why stopping the immune attack is an important first step in treatment.

Repigmentation may take months to occur and can look different for every patient.

Speed, appearance, and level of repigmentation will vary
Some areas may be less challenging to repigment than others
Melanocyte stem cells may proliferate, migrate, and differentiate through the process called repigmentation

Greater repigmentation potential: Areas with a higher density of hair follicles, like the face, likely to have melanocyte reservoirs

Less repigmentation potential: Areas with less follicular density like hands and feet

The presence of leukotrichia—white or hypopigmented hairs in a group of follicles—is associated with poor response for repigmentation within that specific patch. It can indicate that hair follicle melanocyte reservoirs, which aid in repigmentation, are depleted.

Once the immune attack on melanocytes has been stopped, repigmentation takes time because it relies on melanocyte repopulation into depigmented patches before they can begin producing melanin:

Activation and proliferation: Melanocyte stem cells, often concentrated around hair follicles, are activated to proliferate and migrate to depigmented patches
Migration: Melanocytes can migrate from nearby pigmented skin to the depigmented patches and begin producing melanin

Counsel your patients that they may see earliest repigmentation in patterns that may overlap:

Perifollicular: Small dots of repigmentation around hair follicles as melanocyte stem cell reservoirs are activated (most common)

Marginal: Repigmentation along the edges of patches as melanocytes from nearby pigmented skin migrate into depigmented areas

Melanocyte repopulation is a slow process. Repigmentation can take months to occur.

Measuring Repigmentation

T-VASI and F-VASI are considered to be reliable and validated tools for assessing vitiligo and are most common in determining the efficacy of treatment. Recent studies have confirmed their reliability in clinical trials and their ability to reflect meaningful changes for patients.

Repigmentation is associated with a decrease in the VASI score over time.

F-VASI=Facial Vitiligo Area Scoring Index; T-VASI=Total Vitiligo Area Scoring Index.

LOOK DEEPER THAN PIGMENT:

Conversation topics to consider for your next patient visit

Ensure your patients understand the importance of these 3 primary treatment goals:

For many patients with vitiligo, repigmentation is a key treatment goal.
Repigmentation takes months.⁸ Encourage them with consistent follow-ups, and talk through progress that you see.
Take pictures in the same lighting at every visit so you can help them track treatment progress and monitor their disease for any progression.
You can work together to develop a treatment plan accordingly.

Keep these topics for future use—download a PDF or email them to yourself or your vitiligo patients.

Download

Find resources here that can help guide conversations with your patients.

Explore resources

References

Hlača N, Žagar T, Kaštelan M, Brajac I, Prpić-Massari L. Current concepts of vitiligo immunopathogenesis. Biomedicines. 2022;10(7):1639. doi:10.3390/biomedicines10071639
Abdel-Malek ZA, Jordan C, Ho T, Upadhyay PR, Fleischer A, Hamzavi I. The enigma and challenges of vitiligo pathophysiology and treatment. Pigment Cell Melanoma Res. 2020;33(6):778-787. doi:10.1111/pcmr.12878
Birlea SA, Goldstein NB, Norris DA. Repigmentation through melanocyte regeneration in vitiligo. Dermatol Clin. 2017;35(2):205-218. doi:10.1016/j.det.2016.11.015
Rosmarin D, Soliman AM, Marwaha S, et al. Disease course, treatment patterns and goals among patients with non-segmental vitiligo across Europe and the United States. Dermatol Ther (Heidelb). 2024;14(7):1945-1957. doi:10.1007/s13555-024-01212-1
Delbaere L, Duponselle J, Herbelet S, Speeckaert R, van Geel N. Predictive value of disease activity signs in vitiligo: an observational study. Exp Dermatol. 2024;33(9):e15167. doi:10.1111/exd.15167
van Geel N, Speeckaert R, Taïeb A, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol. 2023;37(11):2173-2184. doi:10.1111/jdv.19451
Das K, Sarkar R, Sinha S. Recent advances in management of vitiligo. Indian J Dermatol. 2025;70(4):201-207. doi:10.4103/ijd.ijd_158_25
Seneschal J, Bae JM, Ezzedine K, et al. Vitiligo. Nat Rev Dis Primers. 2025;11(1):85. doi:10.1038/s41572-025-00670-x
Speeckaert R, van Caelenberg E, Belpaire A, Speeckaert MM, van Geel N. Vitiligo: from pathogenesis to treatment. J Clin Med. 2024;13(7):5225. doi:10.3390/jcm13175225
Xu X, Zhang C, Jiang M, Xiang LF. Impact of treatment delays on vitiligo during the COVID-19 pandemic: a retrospective study. Dermatol Ther. 2021;34(4):e15014. doi:10.1111/dth.15014
Chang W-L, Lee W-R, Kuo Y-C, Huang Y-H. Vitiligo: an autoimmune skin disease and its immunomodulatory therapeutic intervention. Front Cell Dev Biol. 2021;9:797026. doi:10.3389/fcell.2021.797026.
Falabella R. Vitiligo and the melanocyte reservoir. Indian J Dermatol. 2009;54(4):313-318. doi:10.4103/0019-5154.57604
Kitchen H, Wyrwich KW, Carmichael C, et al. Meaningful changes in what matters to individuals with vitiligo: content validity and meaningful change thresholds of the Vitiligo Area Scoring Index (VASI). Dermatol Ther (Heidelb). 2022;12(7):1623-1637. doi:10.1007/s13555-022-00752-8
Bae JM, Zubair R, Ju HJ, et al. Development and validation of the fingertip unit for assessing Facial Vitiligo Area Scoring Index. J Am Acad Dermatol. 2022;86(2):387-393. doi:10.1016/j.jaad.2021.06.880
Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158(1):43-50. doi:10.1001/jamadermatol.2021.4724

Vitiligo management is anchored in 3 primary treatment goals^1,2

Talk to your patients about these treatment goals.^1-3

Vitiligo is unpredictable and disease activity can fluctuate over time.

Help your patients understand why stopping the immune attack is an important first step in treatment.

Repigmentation may take months to occur and can look different for every patient.

Melanocyte repopulation is a slow process. Repigmentation can take months to occur.

Continuing therapy may be necessary to maintain repigmentation. Recurrence is possible if discontinued.

Vitiligo is a chronic, unpredictable, and progressive disease. Set expectations with your patients about maintaining repigmentation.

Vitiligo management is anchored in 3 primary treatment goals1,2

Talk to your patients about these treatment goals.1-3

Vitiligo is unpredictable and disease activity can fluctuate over time.

Help your patients understand why stopping the immune attack is an important first step in treatment.

Repigmentation may take months to occur and can look different for every patient.

Melanocyte repopulation is a slow process. Repigmentation can take months to occur.

Continuing therapy may be necessary to maintain repigmentation. Recurrence is possible if discontinued.

Vitiligo is a chronic, unpredictable, and progressive disease. Set expectations with your patients about maintaining repigmentation.

Vitiligo management is anchored in 3 primary treatment goals^1,2

Talk to your patients about these treatment goals.^1-3