Expert Tips for Treating Vitiligo Shared at Elevate-Derm Conference

“Vitiligo is a very frustrating disorder, because it does not respond quickly. It does not respond for everyone. It does not respond in every area on a patient,” Diego Ruiz Dasilva, MD, told Dermatology Times after his session at the 2025 Elevate-Derm Fall Conference in Tampa, Florida.^1,2

Although vitiligo is challenging for clinicians and patients alike, the good news, he added is that there are effective therapies and a rapidly expanding therapeutic pipeline, added Dasilva, who is a general dermatologist in Virginia Beach, Virginia. The goal of his session was to review the “nuts and bolts of vitiligo, different comorbidities that you can see, the impact it has on patients, as well as treatment options that we have available now and things that are in the pipeline.”

Oral JAK Inhibitors Lead the Near-Term Pipeline

The most immediate developments in vitiligo center on systemic JAK inhibition, he reported. “I think the most immediate future is oral JAK inhibitors,” Dasilva said, adding that agents that are already familiar to dermatologists for other inflammatory diseases may soon enter the vitiligo space.

Currently, ruxolitinib 1.5% cream is FDA-approved for nonsegmental vitiligo in patients ages 12 years and older, and there are other agents in the pipeline, he said. Upadacitinib and rittlecitinib are currently in phase 3 trials, and both can be considered for off-label use. Povorcitinib and afamelanotide are also in phase 3 trials but are not commercially available.

Combination Therapy Remains Essential

Dasilva emphasized that no single treatment consistently delivers rapid or universal repigmentation.

For that reason, he encouraged clinicians to consider combining modalities. “Don’t be afraid of combination therapy,” he said. Light therapy, topical agents, including the approved topical JAK inhibitor (ruxolitinib), systemic immunomodulators, and supplements can help.

In addition, microneedling with or without topical steroids or fluorouracil (5-FU), melanocyte transplantation, and supplements (eg, polypodium leuctomos, alpha lipic acid, ginko biloba) can be considered.

The bottom line is setting clear expectations with patients, helping them to understand it could take some time to realize a difference. He emphasized the importance of “putting the whole package together for the patient and reassuring them that they have to be patient.”

When in Doubt, Biopsy

Dasilva also cautioned against overconfidence in a purely clinical diagnosis. “Don’t be afraid of doing a skin biopsy,” he said, especially in atypical or subtle cases. A biopsy at the border of pigmented and depigmented skin allows for melanocyte staining, which provides a straightforward confirmation. This approach helps avoid misdiagnosis of entities that can mimic vitiligo, including rare conditions such as hypopigmented mycosis fungoides.

The Takeaway Message

By combining evolving therapies with careful diagnostic evaluation, clinicians can offer increasingly effective and precise care for patients with vitiligo, Dasilva said.

Taken together, he said, “it’s an exciting time for vitiligo, knowing that the future is bright.”

References

1. Dasilva D. Vitiligo: A Practical Approach for APPs. Presented at the 2025 Elevate-Derm Fall Conference; November 12-16, 2025; Tampa, Florida.

2. Prajapati VH, Lui H, Miller-Monthrope Y, Ringuet J, Turchin I, Hong HC, Lynde C, Papp KA, Yeung J, Gooderham MJ. Canadian Consensus Guidelines for the Management of Vitiligo. Dermatol Ther (Heidelb). 2025 Jun;15(6):1351-1369. doi: 10.1007/s13555-025-01402-5. Epub 2025 Apr 20. PMID: 40253664; PMCID: PMC12092322.