Vitiligo:
treatment, sun protection & what really helps

1. What is vitiligo?

Vitiligo, sometimes described as white spot disease, is a chronic skin condition in which the skin loses its pigment cells. These melanocytes produce the pigment melanin, which gives skin and hair their colour and protects against UV radiation. Where they are missing, sharply defined, milky-white patches appear.^¹,²

According to current knowledge, the body's own immune system turns against the melanocytes — vitiligo is considered an autoimmune disease. It is not contagious, does not hurt and usually does no harm to the rest of the body. Even so, it is not a trivial matter: the patches often sit on the face or the hands, and that weighs on many people more heavily than outsiders would assume.

It is estimated that around 0.5 to 2 per cent of people worldwide are affected, women and men equally often. Vitiligo occurs in all skin types; on darker skin the contrast is greater. It often begins in childhood or young adulthood.^²

The course is hard to predict: some patches stay unchanged for years, while in other people new ones appear in flare-ups. A cure in the sense of “treated once, gone for good” does not exist so far. Treatment aims to stop the spread and bring colour back — both take patience.

2. Forms: segmental, non-segmental, active or stable

The classification helps decide which treatment is an option and how good the outlook is.^¹

Active or stable?

At least as important is whether the vitiligo is currently active. Signs of this: new or growing patches in recent months, blurred edges, small confetti-like pale spots and the Koebner phenomenon — new patches exactly where the skin has been rubbed, scratched or injured. Vitiligo is considered stable if nothing new appears over a longer period, usually taken to be one year.

3. Symptoms, associated conditions and emotional burden

• Milky-white, sharply defined patches — at first sometimes just paler rather than completely white.
• White hairs within the patches (leukotrichia) — an unfavourable sign for the outlook, because the hair roots otherwise serve as a reservoir for new pigment cells.
• A tendency to sunburn — the patches have no UV protection of their own.
• Occasional itching — mainly in active phases, usually mild.

Associated conditions: keeping an eye on the thyroid

People with vitiligo more often have other autoimmune diseases, above all of the thyroid, such as Hashimoto's thyroiditis. Less common are type 1 diabetes, alopecia areata (patchy hair loss) or anaemia caused by vitamin B12 deficiency (pernicious anaemia). The guideline therefore recommends testing thyroid levels.^¹

The underestimated burden

Many people affected report stares and questions — and that they avoid swimming pools, sport or dating. Depressive moods and anxiety are more common with vitiligo. This is not vanity but a real part of the condition, and a legitimate reason to seek treatment or psychological support. Many people also find it helpful to talk to others in a self-help group, for example through the Deutscher Vitiligo Bund (German vitiligo patient association).

4. Causes and triggers

At the centre is a misdirected immune response: immune cells (T cells) destroy the melanocytes. The messenger substance interferon-gamma drives this attack via the JAK-STAT signalling pathway — which is exactly where the new JAK inhibitors act.^¹

• Genetic predisposition: vitiligo runs in families; what is inherited is a tendency, not the condition itself.
• Sensitive pigment cells: in vitiligo, melanocytes apparently react more strongly to cellular stress and attract the immune system in the process.
• Mechanical irritation and sunburn: can trigger new patches in active vitiligo.
• Psychological stress: discussed as a trigger, not proven as a cause.
• Chemical substances: certain chemicals, for example phenols in rubber or skin-bleaching creams or the hair dye ingredient para-phenylenediamine, can cause vitiligo-like whitening of the skin (chemical leukoderma).

Poor diet, lack of hygiene or infection are not causes — and vitiligo is not a precursor of skin cancer.

5. Diagnosis at the dermatology practice

Vitiligo can usually be recognised at first glance. The examination is meant to rule out other causes, establish the form and activity, and provide a baseline against which any treatment has to be measured.^¹,²

• Medical history: Since when? Have new patches appeared? Are there autoimmune diseases in the family? Which medicines do you take, and what do you come into contact with at work?
• Wood's lamp: Under a UV-A lamp, vitiligo patches glow a chalky, bluish white — this makes patches on fair skin visible too, and a fungal infection can be told apart.
• Recording the extent: As a rule of thumb, the palm of one hand including the fingers corresponds to about one per cent of the body surface. Photos and scores make the course comparable.
• Blood tests: The thyroid value TSH and thyroid antibodies, plus further values depending on symptoms.
• Tissue sample: Only if the picture is unclear.

Photos of the patches from recent months show activity better than any memory. Tips for the consultation are in the guide Prepare for a doctor's appointment.

6. Treatment: goals, steps, expectations

Every treatment pursues two goals: stopping the spread and bringing colour back. Both succeed better today than they did a few years ago — but rarely completely and never quickly.^¹

• Repigmentation takes months. Colour usually returns in dots from the hair roots or grows in from the edge; first effects often show after three to six months.
• Location matters. The face and neck respond best; hands, feet and lips respond worst.
• Relapses are common. Patches can return once treatment is stopped.
• Not treating is legitimate. Especially with fair skin, some people deliberately choose sun protection and camouflage instead of months of treatment.

Which step fits depends on the form, activity, extent and your own wishes — you make the decision together with your dermatology practice.

7. Creams and tablets in detail

Cortisone creams: effective, but with breaks

For limited involvement, the guideline recommends potent glucocorticoids (class III in the German classification) such as mometasone furoate — once a day for about three months, or intermittently: 15 days of treatment, 14 days off, over half a year.^¹ The breaks protect against thin, fragile skin, small visible blood vessels and stretch marks. On the face, eyelids and genital area, calcineurin inhibitors are therefore usually used instead.

Tacrolimus and pimecrolimus: the options for the face

They are actually approved for atopic dermatitis and do not thin the skin. They often sting during the first few days; alcohol can trigger a brief facial flush. After successful treatment, maintenance use on two days a week can reduce relapses.^¹ Because the use is off-label, it is worth clarifying in advance whether your health insurance will cover the cost.

Ruxolitinib cream: the first approved active substance

The cream containing the JAK inhibitor ruxolitinib has been approved in the EU since 2023 for non-segmental vitiligo with facial involvement from the age of 12 — applied thinly twice a day, to no more than ten per cent of the body surface.^³ According to the summary of product characteristics, satisfactory repigmentation often takes longer than six months, and not everyone responds well. Common side effects are acne-like spots, redness and itching at the application site. It should not be used during pregnancy or breastfeeding.

Upadacitinib: the first tablet for vitiligo

At the end of July 2026, the EU approved the JAK inhibitor upadacitinib — known from the treatment of rheumatic diseases, atopic dermatitis and inflammatory bowel disease — for non-segmental vitiligo from the age of 12, provided systemic treatment is an option.^⁴ In the approval studies, the effect was assessed after almost a year. A real step forward for extensive vitiligo — but not a remedy for a few small patches.

That is because, as a tablet, a JAK inhibitor acts throughout the whole body. The known risks of this drug class include serious infections, shingles, thromboses, serious cardiovascular events and certain cancers. The European Medicines Agency advises that JAK inhibitors should only be used in people aged 65 and over, in current or former long-term smokers and in people with an increased cardiovascular or cancer risk if there is no suitable alternative.^⁵

• Before starting: tests for tuberculosis and hepatitis, a blood count, liver values and blood lipids, vaccination status — live vaccines are off-limits during treatment.
• Contraception: upadacitinib must not be taken during pregnancy.
• Interactions: strong inhibitors of the metabolising enzyme CYP3A4, such as certain antifungals and antibiotics, as well as grapefruit, raise drug levels; rifampicin or St John's wort lower them. More in the guide Drug interactions.

Cortisone mini-pulse therapy, by contrast, is straightforward: because the tablets are only taken on two days a week, tapering off is usually not necessary. The dose, duration and end of treatment are nevertheless set by the treating practice.

8. Sun protection: protecting the patches

The white patches have no UV protection of their own. They burn more quickly, and in active vitiligo a sunburn can trigger new patches. On top of that, the healthy skin tans and the contrast becomes greater — consistent sun protection keeps it small.^²

• High sun protection factor: SPF 50 on the patches, reapplied after swimming.
• Protective clothing: a hat, UV clothing and shade at midday protect more reliably than any cream.
• No sunbeds: they are no substitute for light therapy and mainly tan the healthy skin.
• Check your medicines: some antibiotics, water tablets (diuretics) or painkillers make the skin more sensitive to light — particularly relevant during light therapy. Tell the practice what you are taking before every course of treatment; more under Medications and the sun.

Camouflage and self-tanners: waterproof cover creams make the patches almost invisible for a day; self-tanners colour the top layer of the skin and even out the contrast. Neither treats the vitiligo, but for many people both improve quality of life. Important: self-tanner does not protect against the sun.

9. What is not backed by evidence

Because treatment takes so long, the market for alternatives is large. A sober assessment:^¹

10. Everyday life with vitiligo

• Record the course — photos every two to three months, in the same light and from the same distance. That way you see progress that gets lost in the mirror.
• Dose creams correctly — one fingertip unit, a line of ointment from the tip of the finger to the first joint, is enough for about two palms.
• Take breaks seriously — with intermittent cortisone treatment, the break is part of the therapy.
• Avoid friction — with active vitiligo, watch out for tight belts, chafing bracelets and aggressive shaving.
• All products in one place — creams, tablets, thyroid medication and supplements belong in a single plan, see Create a medication plan.

Vitiligo calls for staying power. Set a realistic goal with your practice — for example stopping the spread and repigmenting the face — and only assess the treatment after a few months. If it has had no effect at all after six months, changing strategy is worthwhile rather than giving up.

Vitiligo treatment with staying power — with brite

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