One-Third of Patients With Vitiligo Go Untreated After Diagnosis

Nearly one-third of patients diagnosed with vitiligo go untreated after their diagnosis, and those who did receive care cycle through multiple short-lived treatment regimens, according to a large retrospective cohort study published in JAMA Dermatology.¹

The findings underscore a persistent gap between what is clinically available and what patients are actually receiving in practice. There is only 1 FDA-approved therapy² for repigmentation for adolescents and adults, with off-label use of other treatments being subject to adverse events, restricted treatment duration, and other barriers.

“To develop novel therapies, a comprehensive understanding of current treatment patterns is essential,” the authors explained.

Current Vitiligo Treatment Patterns

Researchers analyzed deidentified claims and electronic health record (EHR) data from more than 24,900 patients diagnosed with vitiligo between January 1, 2018, and August 31, 2023, using the linked Komodo Healthcare Map and OMNY Health Foundation databases.

Patients were stratified into cohorts based on age and vitiligo percentage of body surface area (BSA) at the date of their diagnosis. Across BSA involvement groups (≤ 10%, > 10%, or no BSA assessment), between 27% and 32% of patients received no vitiligo treatment at all during the follow-up period. Among patients who did receive treatment, topical corticosteroids (TCS), oral corticosteroids (OCS), and topical calcineurin inhibitors (TCI) or phosphodiesterase-4 inhibitors (PDE4i) were the most commonly prescribed therapies.

Treatment duration was notably short. Median therapy duration for first- and second-line treatments ranged from just 1.8 (95% CI, 1.6-2.1) months to 4.1 (95% CI, 3.7-4.4) months, depending on treatment type. However, at least 2 to 3 months of continued treatment is typically necessary to determine whether a given therapy is working for an individual patient.³

Among patients with 10% or less BSA involvement, the most common treatment was TCI/PDE4i (44%), followed by topical Janus kinase (JAK) inhibitors and OCS, both at 26%. Among patients with greater than 10% BSA involvement, 33% received TCI/PDE4i, 33% received OCS, and 21% received JAK inhibitors.

Treatment Varied Significantly by Age

Treatment patterns diverged across age groups. Children and adolescents were far more likely to receive topical therapies as their first-line treatment: 90% of children and 81% of adolescents, compared with 61% of adults. Conversely, OCS were prescribed to 17% of adults as a first-line agent vs just 2.4% of children and 7.6% of adolescents.

“Children and adolescents were more likely to receive topical treatments than adults, consistent with evidence supporting their use in pediatric patients,” the authors noted.

Across all age groups, there was high variability in treatment sequencing, with no clear standardized approach emerging from the data. Among the roughly 18,200 patients who initiated a first line of therapy (LOT), 64% went on to a second LOT, 43% to a third, 29% to a fourth, and 20% to a fifth. TCS was the most common first LOT at 39%, followed by OCS and TCI/PDE4i at 16% each. From the first to the second LOT, TCS monotherapy and TCI/PDE4i use declined while systemic corticosteroid use increased.

The Main Insurance and Access Barriers to Vitiligo Care

The cohort was predominantly commercially insured (56.8%), with 30.4% covered by Medicare and 11.4% by Medicaid. Nearly half of patients (46.4%) were diagnosed by a dermatologist, while more than one-fifth were diagnosed by a physician assistant, reflecting the broad range of care settings where vitiligo is identified and managed. Insurance approval remains a significant barrier for many patients seeking newer vitiligo therapies.⁴

The new data, which mainly captured commercially insured patients seeking dermatologic care, may not fully reflect the treatment landscape for Medicaid beneficiaries or those without consistent insurance access, the authors acknowledged. The study also could not capture compounded medications, therapies purchased out-of-pocket, or those obtained with manufacturer discounts, meaning treatment rates may be somewhat undercounted.

What Is the Psychosocial Burden of Vitiligo?

The data arrive at a moment of evolving therapeutic options for vitiligo, a disease that carries a substantial psychosocial burden. In the study cohort, 12.3% of patients had a diagnosis of anxiety and 9.1% had depression, and the psychiatric comorbidities were more prevalent in adults than in younger patients. Particular attention should be paid to patients with darker skin tones who are affected by vitiligo, noted Susan Taylor, MD, the Bernett Johnson Endowed Professor of Dermatology at the University of Pennsylvania and founder of the Skin of Color Society, during an interview.

“Since there is a greater psychosocial burden of vitiligo for these patients, a discussion of and screening for anxiety and depression should be done,” she explained.

The face was the most frequently affected body location, documented in 32.9% of patients with a reported vitiligo site. Facial lesions are among the most psychosocially impactful and are specifically noted in guidelines as preferring TCI over TCS to avoid steroid-related adverse effects on sensitive skin.

The authors suggested the short therapy durations and high variability in treatment sequences reflect a combination of factors: limited long-term options for vitiligo, tolerability concerns and insufficient efficacy with available therapies, and inconsistent prescribing patterns across providers.

“Poor adherence to dermatologic treatments may further explain short treatment durations and multiple LOTs,” the authors wrote.

References

1. Adiri R, Gauthier G, Kurosky SK, et al. Clinical characteristics and treatment patterns in patients with vitiligo. JAMA Dermatol. Published online May 6, 2026. doi:10.1001/jamadermatol.2026.0971
2. Gavidia M. FDA approves ruxolitinib cream as first repigmentation therapy for vitiligo. AJMC®. July 19, 2022. Accessed May 19, 2026. https://www.ajmc.com/view/fda-approves-ruxolitinib-cream-as-first-repigmentation-therapy-for-vitiligo
3. Disease burden and management of vitiligo. AJMC. January 10, 2023. Accessed May 19, 2026. https://www.ajmc.com/view/disease-burden-and-management-of-vitiligo
4. Vitiligo treatment and JAK inhibitors: AAD president Susan Taylor, MD. AJMC. April 2, 2026. https://www.ajmc.com/view/vitiligo-treatment-and-jak-inhibitors-aad-president-susan-taylor-md