Shared Decision-Making and the Vitiligo Treatment Landscape

Segment summary: In this episode titled "Shared Decision-Making and the Vitiligo Treatment Landscape," moderator Nada Elbuluk, MD, MSc, FAAD and panelist Susan Taylor, MD, FAAD discuss the importance of individualized, goal-directed decision-making in vitiligo treatment and provide an overview of available therapeutic options.

Dr. Taylor explains that she begins every treatment conversation by directly asking patients what their goal is. While most seek repigmentation, some with near-complete depigmentation are interested in discussing depigmentation therapy, and others prioritize learning about comorbidities and disease management. When repigmentation is the goal, she asks follow-up questions about which areas bother patients most and their readiness to begin treatment — acknowledging that some patients with widespread disease may only be concerned about specific locations such as the face or hands.

A key point raised by Dr. Taylor is that patients with active vitiligo must first understand the two-step treatment process: halting disease progression before attempting to restore pigmentation. This expectation-setting is essential to avoid disappointment and ensure patients stay engaged with their treatment plan.

The discussion then turns to the full treatment landscape. Pharmacologic options include topical and systemic corticosteroids, topical calcineurin inhibitors, and topical and systemic JAK inhibitors. Non-pharmacologic approaches include narrowband UVB phototherapy, excimer laser, and surgical procedures.

Dr. Taylor emphasizes that treatment selection is highly individualized and depends on the extent of disease (localized versus generalized), patient willingness to accept potential risks of systemic therapy, lifestyle factors such as ability to apply topical agents correctly or attend frequent phototherapy sessions, and the risk-benefit profile of each option.

Dr. Elbuluk reinforces that there is no single formula — the full clinical picture, including comorbidities, occupation, and patient preferences, must guide each decision.

In the next episode, "Setting Expectations: Treatment Timelines, Adherence, and Monitoring in Vitiligo," the panelists discuss realistic repigmentation timelines, adherence challenges, and practical strategies for keeping patients engaged throughout the treatment journey.

This video series is not sponsored, and has been produce independently by Dermatology Times.