Efficient history, targeted exam, selective labs and clear shared‑decision plans let dermatologists deliver meaningful vitiligo care in time‑pressed visits
In routine practice, non‑segmental vitiligo (NSV) visits can be both brief and impactful when structured: capture phototype, disease duration, extent and recent progression, use Wood’s lamp selectively (most useful in lighter skin tones) and dermatoscopy for inflammation or leukotrichia, and document a target lesion with reproducible photos for serial tracking. Estimate body surface area quickly with the palm‑print method, and consider the 5‑point Physician Global Assessment for standardized severity staging. Screen for associated autoimmunity with TSH, TPO antibodies and ANA, and check vitamin D given its role in pigmentation and mixed data in vitiligo.
First‑line topical options remain corticosteroids calcineurin inhibitors and vitamin D analogs; topical ruxolitinib 1.5% cream is now an FDA‑approved, effective option for patients greater than or equal to 12 years, particularly for facial repigmentation. Reserve systemic agents (oral steroids, immunosuppressants, oral JAK inhibitors) for rapidly progressive or extensive disease and use phototherapy – narrowband UVB or excimer laser – as a key adjunct when uniform repigmentation is the goal. Always address sun protection and explicitly assess psychosocial impact; a simple question about how often vitiligo bothers the patient guides need for mental‑health referral. Before the patient leaves, summarize the plan, set follow‑up timing, encourage at‑home photos and enlist staff to provide educational resources and support‑group information. Shared decision‑making and clear expectations about slow but measurable response improve adherence and patient satisfaction, and multidisciplinary care is valuable in complex or highly distressed patients.
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J Drugs Dermatol. 2025;24(12) doi:10.36849/JDD.9257
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