From pathogenesis to clinical practice: advances in vitiligo treatment

Vitiligo is a common acquired depigmenting skin disorder characterized by melanocyte dysfunction or loss. It affects 0.5%–2.0% of the global population and imposes a substantial psychological burden. The pathogenesis involves genetic predisposition, oxidative stress, and immune dysregulation; distinct mechanisms underlie its progressive and stable phases. This review provides a systematic overview of recent advances in vitiligo treatment, from pathogenesis to clinical management, and emphasizes the importance of stage-specific therapy. During the active phase, management focuses on suppression of immune-mediated inflammation to halt disease progression. Key therapies include topical corticosteroids, calcineurin inhibitors, and Janus kinase inhibitors, all of which have demonstrated increasing efficacy. In the stable phase, the therapeutic objective shifts to repigmentation. Narrowband ultraviolet B phototherapy remains the cornerstone of treatment and is often combined with adjunctive therapies to enhance outcomes. Emerging research targeting tissue-resident memory T cells and the interleukin-15 pathway, along with strategies to restore the cutaneous microenvironment, offers promising approaches to prevent disease relapse. This review aims to inform clinicians of recent therapeutic advances and support optimal disease management, ultimately improving quality of life for individuals with vitiligo.