Lewitt Shares Strategies for Treating Vitiligo in Difficult Areas

In a recent conversation with Dermatology Times at the 2025 Fall Clinical Dermatology Conference, G. Michael Lewitt, MD, partner at Illinois Dermatology Institute and clinical investigator with Denova Research, discussed practical and evolving treatment approaches for vitiligo, particularly in areas where topical therapies are difficult to apply or maintain. Lewitt outlined current challenges, FDA-approved options, and emerging strategies for improving patient outcomes.

Vitiligo management remains complex, especially in regions prone to frequent moisture or friction such as the perioral area, hands, and other high-use anatomic sites. According to Lewitt, nighttime application of topical agents may offer a practical advantage by reducing inadvertent removal of medication from routine activities such as eating, brushing teeth, or handwashing. He also described using barrier products, such as zinc oxide, to protect areas where medication should not migrate. While not formally studied, this approach aims to minimize unwanted spread of topical therapy.

Currently, there are 2 FDA-approved treatments for vitiligo: topical ruxolitinib and 308-nm excimer laser therapy. Lewitt emphasized that targeted phototherapy can be especially useful in regions where topical therapy is less practical, provided proper eye protection is used when treating near the face. In many cases, he finds that combination therapy offers superior benefit compared with single-modality treatment.

Before the approval of ruxolitinib, treatment options were limited to topical corticosteroids, calcineurin inhibitors, and phototherapy, all of which had inconsistent results for many patients. Participation in clinical trials, including those investigating topical and systemic JAK inhibitors, has expanded therapeutic possibilities and enhanced understanding of vitiligo pathophysiology. Ongoing trials are evaluating systemic JAK inhibitors down to age 12 and topical agents down to age 2.

Lewitt highlighted the importance of early intervention, noting parallels with other autoimmune dermatologic conditions such as alopecia areata. More recent disease onset may respond more readily, although individuals with long-standing vitiligo can still experience improvement. Anatomic variation also influences treatment response; for example, facial areas often repigment more quickly, while acral sites remain challenging. Hair follicle density may contribute to these differences.

Finally, Lewitt stressed the value of maintaining patient engagement, especially when progress feels slow. Reinforcing incremental improvements, such as reduced lesion size, can help patients stay encouraged and adhere to therapy, which is critical for long-term success.

As new therapies continue to emerge, personalized, combination-based, and patient-centered approaches remain central to optimizing vitiligo care.