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

Many people assume that if vitiligo causes white patches on the skin, then the goal is to remove all pigment to match those areas. But that’s not how it works. Phototherapy and depigmentation are two completely different strategies - one rebuilds color, the other removes it. They’re never used together. Mixing them would be like trying to fill a leaky bucket while also drilling holes in it.

What Vitiligo Really Is

Vitiligo isn’t just a cosmetic issue. It’s an autoimmune condition where the body’s own immune system attacks and destroys melanocytes - the cells that make skin pigment. About 0.25% to 2.5% of people worldwide have it, with higher rates in places like India. It can show up at any age, but often starts before 20. The patches appear where pigment is lost, usually on the face, hands, arms, feet, or around body openings. Some people get it in patches; others see it spread across large areas.

Phototherapy: The Gold Standard for Repigmentation

If you have vitiligo covering less than 80% of your body, the first-line treatment is almost always phototherapy. This isn’t tanning. It’s precise, controlled exposure to specific wavelengths of ultraviolet light that wake up dormant melanocytes hiding in your hair follicles.

The most common type is narrowband ultraviolet B (NB-UVB), which uses light at 311-313 nanometers. It’s safer than older methods, doesn’t require chemicals, and works for most body areas. You typically get treated 2-3 times a week. Each session lasts from seconds to a few minutes, depending on your skin type and how much light your skin can handle.

Studies show that after 6 months of consistent NB-UVB treatment, about 37% of people see at least half their pigment return. After a full year, that number jumps to over 56%. On the face and neck, results are even better - up to 80% of patients get strong repigmentation. But hands and feet? Those are tough. Even after a year, only 15-20% see noticeable color return. That’s why many people with vitiligo on their fingers give up - the progress is too slow.

Why Depigmentation Is a Separate Path

Depigmentation is not a treatment for early-stage vitiligo. It’s a last-resort option for people who have lost pigment on more than 80% of their body. If you’re mostly white already, and the remaining patches of normal skin are causing you distress, your dermatologist might suggest removing the last bits of color to make your skin look even.

This is done with a topical cream called monobenzone. It permanently destroys melanocytes in pigmented areas. It’s not reversible. You’ll need to use it daily for months. Your skin becomes permanently lighter, and you’ll need lifelong sun protection because your skin loses its natural defense against UV damage.

The key point: you don’t do phototherapy and depigmentation at the same time. One tries to bring color back. The other tries to take it away. They’re opposites.

Other Phototherapy Options

There are two other types of light therapy, but they’re used less often.

PUVA combines a plant-derived chemical called psoralen (taken orally or applied to the skin) with UVA light. It’s effective, but it comes with side effects - nausea in up to 30% of users, and a higher risk of skin cancer over time. Studies show PUVA carries a 13-fold increased risk of squamous cell carcinoma after more than 200 treatments. Because of this, most doctors now choose NB-UVB instead.

The excimer laser (308 nm) is great for small patches - say, less than 10% of your body. It targets only the white spots, sparing healthy skin. You might see results in as little as 8-12 weeks. But if you have vitiligo across your back, legs, and arms? This becomes impractical. You’d need hundreds of laser sessions. It’s like using a paintbrush to color a whole wall.

Home vs. Clinic Phototherapy

You don’t have to go to a clinic every time. Home phototherapy units are FDA-approved and widely used. A 2020 study found they work just as well as clinic treatments - 78% of home users got over 50% repigmentation compared to 82% in clinics. The big advantage? Compliance. People using home units missed fewer sessions because they didn’t have to drive to a center twice a week.

But there’s a catch. About 22% of home users had minor burns because they misjudged the dose. That’s why proper training matters. Some devices now come with smartphone apps that track your sessions and adjust light levels automatically. One such device, Vitilux AI, cleared by the FDA in October 2023, cuts dosing errors by 37% using image analysis.

Home units cost between $2,500 and $5,000. Medicare covers 80% of the cost for qualifying patients. Private insurance varies - 43% of insured patients still pay over $1,000 a year out of pocket.

Combining Phototherapy With Other Treatments

Phototherapy works better when paired with other therapies. Topical calcineurin inhibitors like tacrolimus or pimecrolimus boost repigmentation by 25-30%. These are often applied right before or after light sessions.

A newer option is ruxolitinib cream (Opzelura), an FDA-approved JAK inhibitor. A 2023 trial showed that combining it with NB-UVB led to 54% of patients achieving over 50% repigmentation in just 24 weeks - compared to 32% with phototherapy alone. This could mean shorter treatment times and better results on stubborn areas like hands and feet.

There’s also emerging research into afamelanotide implants - tiny rods placed under the skin that stimulate pigment production. Early trials are testing whether they can speed up phototherapy results.

What You Need to Know Before Starting

Phototherapy isn’t a quick fix. You need to commit for at least 6 months just to see if it’s working. Most people don’t see real results until month 4 or 5. That’s why so many quit early.

You’ll need to:

• Protect your eyes with special goggles during every session
• Shield genitals and other sensitive areas
• Avoid sun exposure on treatment days
• Track your sessions - apps help
• Expect some redness - it’s normal, but burning isn’t

Winter months can slow progress because your skin has less natural pigment to respond. Some patients notice slower repigmentation between November and February.

Who Shouldn’t Use Phototherapy

Phototherapy isn’t for everyone. Avoid it if you:

• Have a history of skin cancer
• Have lupus or other photosensitive conditions
• Are pregnant and not under close supervision
• Have a genetic condition like xeroderma pigmentosum

Children respond well to NB-UVB - it’s considered safe and is used in over 85% of pediatric cases. Pregnant women can also use it under supervision since it doesn’t enter the bloodstream.

The Real Challenge: Sticking With It

The biggest reason people fail at phototherapy isn’t lack of results - it’s lack of consistency. A Reddit survey from early 2023 found 68% of users missed at least a quarter of their scheduled sessions. The top reasons? Time and travel.

If you’re working full-time, have kids, or live far from a clinic, sticking to 2-3 weekly visits is hard. That’s why home units are changing the game. People who use them are 35% more likely to finish their treatment.

Support helps too. Organizations like Vitiligo Support International have over 15,000 members sharing tips, progress photos, and encouragement. The American Academy of Dermatology’s Vitiligo Navigator tool lets you build a personalized treatment calendar - something that keeps people on track.

What’s Next for Vitiligo Treatment

The future is personalization. Researchers are looking at genetic markers to predict who will respond best to phototherapy. New devices are being developed to adjust light doses based on real-time skin analysis. Combination therapies with JAK inhibitors are becoming standard in top clinics.

But the core hasn’t changed: for most people, NB-UVB phototherapy remains the most effective, safest, and most affordable way to restore pigment. It’s not magic. It’s science - and it works if you stick with it.