Vitiligo Treatment: How Phototherapy Works and Why Depigmentation Isn't Combined With It

When you hear the words vitiligo and depigmentation together, it’s easy to assume they’re part of the same treatment plan. But that’s not how it works. In fact, combining depigmentation with phototherapy would be like trying to paint a wall white while also trying to restore its original color at the same time. They’re opposites. Understanding the difference isn’t just important-it’s critical to making the right choice for your skin.

What Vitiligo Really Is

Vitiligo isn’t just a cosmetic issue. It’s an autoimmune condition where the body’s own immune system attacks melanocytes, the cells that give your skin its color. This leads to white patches appearing anywhere on the body-face, hands, arms, legs, even inside the mouth. It affects about 1 in 50 people worldwide, with higher rates in places like India. The patches don’t hurt, don’t itch, but they can change how you see yourself. That’s why treatment isn’t just about skin-it’s about confidence.

Phototherapy: The Gold Standard for Repigmentation

Phototherapy isn’t a new idea. Doctors have been using light to treat vitiligo since the late 1990s. Today, the most common and effective form is narrowband ultraviolet B (NB-UVB), which uses a specific wavelength of light (311-313 nm) to trigger melanocytes to start producing pigment again. It’s not magic. It’s science.

Treatment usually happens two to three times a week, in a clinic or at home with a prescribed device. Each session lasts less than five minutes. The light doesn’t burn the skin-it gently stimulates the remaining melanocytes, especially those hiding in hair follicles. Over time, those tiny islands of color start to spread. Studies show that after six months, about 37% of people see at least half their patches repigment. By 12 months, that number jumps to over 56%. For some, the face and neck respond almost dramatically-up to 80% repigmentation in nine months.

But not all areas respond the same. Hands and feet? They’re stubborn. Even after a full year of treatment, only 15-20% of people see meaningful color return there. That’s why doctors don’t give up on them right away-they know it takes time. The key is consistency. Missing sessions slows progress. One study found that people who stuck with their schedule had 35% better results than those who skipped appointments.

Why Depigmentation Is a Separate Path

Depigmentation is not a treatment for early vitiligo. It’s not even for most people with vitiligo. It’s reserved for those with more than 80% of their body covered in white patches. When the pigment is almost gone everywhere, the goal changes. Instead of trying to bring color back, doctors help patients remove the last bits of remaining color. This creates a uniform, lighter skin tone.

The drug used is monobenzone, a strong topical agent applied daily to pigmented areas. It’s not gentle. It can cause redness, irritation, and permanent loss of pigment. It’s irreversible. And it takes months-sometimes over a year-to complete. You can’t use it alongside phototherapy. One tries to restore color. The other destroys it. They cancel each other out.

Doctors only recommend depigmentation after all other options have been tried and failed. It’s not a first choice. It’s a last resort for a small group of people who feel their remaining pigment makes their condition more noticeable.

Phototherapy vs. Other Treatments

Phototherapy doesn’t work alone. It’s often paired with topical creams. Calcineurin inhibitors like tacrolimus or pimecrolimus, applied right after light sessions, can boost repigmentation by 25-30%. These creams calm the immune system locally without affecting the whole body.

Newer options like ruxolitinib cream (a JAK inhibitor) are also showing promise. A 2023 study found that combining it with NB-UVB led to 54% of patients achieving over 50% repigmentation in just six months-much faster than phototherapy alone. That’s a big deal. It means less time under the lights, fewer visits, and better results.

Compared to pills or injections, phototherapy has fewer side effects. It doesn’t weaken your immune system. It doesn’t cause liver damage. It doesn’t require blood tests every month. And it’s cheaper. A year of NB-UVB costs $1,200-$2,500. Ruxolitinib cream? Over $5,000 a year. Insurance often covers phototherapy. It rarely covers the cream.

Home vs. Clinic Phototherapy

You don’t need to go to a clinic every time. Home phototherapy units are FDA-approved, widely available, and covered by Medicare for qualifying patients. The Philips TL-01 device costs between $2,500 and $5,000 upfront. But once you own it, there are no co-pays for sessions.

Studies show home users stick to their schedule better-82% complete over 80% of their treatments. Clinic users? Only about 60%. The reason? Travel time. Missed work. Childcare. For many, the clinic is just too far or too inconvenient.

But home use comes with risks. About 22% of home users report mild burns because they misjudge the dose. That’s why newer devices now include AI. The Vitilux AI device, approved in October 2023, uses your smartphone camera to analyze your skin tone and calculate the exact light dose. It cuts dosing errors by 37%. That’s a game-changer for safety.

What to Expect Over Time

There’s no quick fix. You need to plan for at least six months before you see real change. Most people don’t notice anything in the first month. That’s normal. The first signs are usually tiny dots of color returning around hair follicles in the white patches. That’s the melanocytes waking up.

After three months, you might start to see those dots connect. By six months, if you’re seeing 20-30% repigmentation, you’re on track. If not, your doctor may adjust your dose or add a topical cream. If you’re still seeing no change after 12 months, especially on your hands or feet, it’s time to talk about other options-or accept that some areas may not fully return.

Winter slows progress. Less natural sunlight means your skin is more sensitive. You might need slightly lower doses during colder months. Summer helps. More sun exposure can make your skin respond faster.

Real People, Real Results

One patient from UC Davis Health saw 70% of her facial patches repigment after nine months of twice-weekly NB-UVB. She said it was the first time in years she didn’t feel like she had to hide her face. Another man, with vitiligo on his hands, stopped treatment after eight months. He told his doctor, “I can’t keep doing this if nothing’s changing.” He wasn’t wrong. The hands are hard.

Reddit’s r/vitiligo community has over 15,000 members. The most common complaint? “I gave up because I didn’t see results fast enough.” The most common success story? “I kept going, and now I can wear short sleeves again.”

What’s Next in Vitiligo Treatment

The future is personalized. Researchers are testing afamelanotide implants-tiny rods placed under the skin that release a pigment-stimulating hormone. Early trials show they can speed up repigmentation when paired with NB-UVB.

Genetic testing might soon tell you if you’re likely to respond well to phototherapy. Some people have genes that make their melanocytes more responsive to light. Others don’t. That could mean skipping months of treatment if you’re not a candidate.

For now, phototherapy remains the most reliable, safest, and most affordable option for most people with vitiligo. It’s not perfect. It’s not fast. But it works-when you stick with it.