Topical therapy is often used for limited disease.

Topical corticosteroids

Topical steroids are used to suppress immune signaling in the skin that contributes to melanocyte loss and impaired repigmentation. Early changes may be seen in 6–12 weeks, with continued improvement over several months, especially on the face. Common side effects include skin thinning, stretch marks, visible small blood vessels, and acne-like breakouts with prolonged or frequent use, which is why potency and duration are typically adjusted by a dermatologist.

Topical calcineurin inhibitors (tacrolimus, pimecrolimus)

Calcineurin inhibitors reduce T-cell–driven inflammation without the skin-thinning risks of long-term steroid use, which makes them especially useful for the face, eyelids, and skin folds. These medications are widely used for vitiligo (often as first-line for limited areas) and may also be paired with phototherapy to enhance response. Repigmentation often becomes noticeable in 8–16 weeks, with continued gains over 6 months or longer. Common side effects include temporary burning or stinging at application; tacrolimus and pimecrolimus also carry an FDA boxed warning about a possible cancer risk, so treatment decisions should be individualized.

Ruxolitinib cream 1.5%

Ruxolitinib cream is FDA-approved for topical treatment of nonsegmental vitiligo in adults and adolescents ages 12 years and older. It works by inhibiting JAK1/JAK2 signaling, which can reduce immune pathways involved in melanocyte injury and allow repigmentation to develop over time. Repigmentation is typically gradual, with response commonly assessed over months rather than weeks. Common side effects reported for vitiligo use include acne at the application site, application-site itching or redness, headache, and upper respiratory infections such as nasopharyngitis; the prescribing information also includes class warnings related to serious infections, blood clots, and other risks that are considered during medical selection and follow-up.

Phototherapy is a cornerstone for more extensive vitiligo or for areas that do not respond well to topical therapy alone. Peak Skin Center often discusses light therapy as a longer-term strategy, since consistent treatments are typically required.

Narrowband UVB phototherapy

Narrowband UVB (NB-UVB) is thought to help by modulating local immune activity and stimulating melanocyte activity and migration from hair follicles into depigmented skin. Many patients begin noticing early repigmentation in 8–12 weeks, with stronger responses commonly developing over 6–12 months depending on consistency and body location. Common side effects include temporary redness, dryness, and itching; careful dosing helps reduce burn risk.

Excimer laser or excimer light (308 nm)

Excimer therapy delivers targeted UVB to smaller areas, which can be useful for localized patches while sparing unaffected skin. The 308 nm wavelength is a form of NB-UVB used in conditions such as vitiligo, with treatment typically requiring multiple sessions. Early changes are often assessed after 6–12 weeks of treatment. Common side effects include transient redness, warmth, blistering if over-treated, and temporary hyperpigmentation around treated areas.

PUVA (psoralen plus UVA)

PUVA combines a light-sensitizing medication (psoralen) with UVA exposure and may be considered in selected cases, particularly when NB-UVB is not appropriate or available. Repigmentation typically takes months and requires regular sessions. Side effects can include nausea (from psoralen), sunburn-like reactions, and eye sensitivity—protective eyewear and careful supervision are important with this modality.

Systemic therapy may be considered when vitiligo is rapidly progressive, widespread, or highly inflammatory, often as a stabilizing strategy.

Short courses of oral corticosteroids (selected cases)

Oral steroids can reduce immune “flare” activity and may help slow new patch development in rapidly spreading vitiligo. The goal is usually stabilization within weeks, while repigmentation still takes months and often relies on topical therapy and/or phototherapy. Common side effects include insomnia, mood changes, elevated blood pressure or blood sugar, increased appetite, and rebound flaring after discontinuation, which limits long-term use.

When vitiligo has been stable (not spreading) and does not respond to medical therapy, surgical approaches may be considered for selected candidates.

Grafting and cellular transplantation

Techniques such as suction blister grafting or melanocyte-keratinocyte cellular transplantation aim to move pigment cells from normally pigmented skin to vitiligo patches to restore color. A systematic review supports that surgical intervention can be effective and generally safe for refractory stable vitiligo when patient selection is appropriate. Results are typically assessed over several months as transplanted pigment matures; side effects can include color mismatch, scarring, cobblestoning texture changes, and recurrence if disease becomes active again.