Vitiligo Treatment: How Phototherapy Works and Why It’s Combined with Topical Therapies

When you have vitiligo, the white patches on your skin aren’t just a cosmetic issue-they can change how you see yourself. Many people assume the goal is to make those patches disappear overnight. But the reality is more complex. Phototherapy is one of the most effective ways to bring back color, but it doesn’t work alone. And it’s not the same as depigmentation, which is a completely different strategy for advanced cases.

What Phototherapy Actually Does

Phototherapy doesn’t mask vitiligo. It doesn’t cover it up with makeup or dye. It works from the inside out. The treatment uses controlled doses of ultraviolet light to wake up the dormant melanocytes-those are the pigment-producing cells-that still live in your hair follicles, even in the whitest patches. These cells aren’t gone; they’re just inactive. The light triggers them to multiply and move up to the skin’s surface, slowly restoring color.

The most common type is narrowband ultraviolet B (NB-UVB), which uses a precise 311-313 nm wavelength. It’s safer than older methods and doesn’t require swallowing pills. You stand in a light booth for seconds to minutes, two to three times a week. Sessions start short-sometimes just 30 seconds-and increase gradually based on your skin type and how your skin reacts. It’s not a one-size-fits-all process. A fair-skinned person might start at 200 mJ/cm², while someone with darker skin might begin at 700 mJ/cm². The goal isn’t to burn you; it’s to get just enough redness (erythema) to signal the cells are responding.

Why You Can’t Combine Phototherapy With Depigmentation

There’s a big misunderstanding here. Some people think you can do both-lighten the dark areas and darken the white ones at the same time. That’s not how it works. Depigmentation is a last-resort treatment for people who have lost more than 80% of their skin pigment. Instead of trying to restore color, doctors use a strong topical cream called monobenzone to permanently fade the remaining pigmented skin. The result? A uniform, pale appearance. It’s irreversible. You’re not treating vitiligo-you’re accepting it.

Phototherapy and depigmentation are opposites. One tries to bring color back. The other removes what’s left. Doing both together makes no medical sense. The American Academy of Dermatology’s 2023 guidelines clearly state these are separate pathways, chosen based on how much skin is affected. If you have patches on your face and arms, phototherapy is your best bet. If you’ve lost pigment over nearly your whole body, depigmentation might be discussed-but only after years of trying other options.

How Effective Is Phototherapy Really?

Success isn’t guaranteed, but the numbers are promising. A major 2017 study in JAMA Dermatology followed over 1,200 patients and found that after six months of NB-UVB, about 37% saw at least half their pigment return. By 12 months, that jumped to 57%. About one in three got 75% or more repigmentation. But location matters a lot. The face and neck respond best-up to 80% of patients see strong results. The hands and feet? Only 15-20% improve, even after a full year. That’s why many people get frustrated and quit. They see their face changing but their fingers stay white.

You need patience. The JAMA study made it clear: you can’t judge phototherapy after three months. You need at least six. Most doctors recommend sticking with it for a full year before deciding if it’s working. And even then, some areas may never fully repigment. That’s normal.

Home vs. Clinic: Which One Works Better?

You don’t have to go to a clinic every time. Home phototherapy units are now FDA-approved and widely used. The Philips TL-01 model costs between $2,500 and $5,000 upfront, but Medicare covers 80% for qualifying patients. A 2020 study found home users were 35% more likely to stick with treatment than those going to clinics. Why? No commute. No waiting. No taking time off work.

But there’s a catch. Home users had 22% more burns. Why? Incorrect dosing. If you don’t follow the schedule, increase the time too fast, or skip the eye protection, you risk irritation. That’s why the best home users use apps to log each session. UC Davis Health found that 92% of patients who tracked their treatments with a phone app stayed on schedule. The worst mistakes? Skipping sessions because you’re tired, or pushing the light too close to your skin because you want faster results.

Combining Phototherapy With Creams

Here’s where things get smarter. Phototherapy doesn’t have to be done alone. When paired with topical treatments, results improve dramatically. The two most common partners are calcineurin inhibitors (like tacrolimus or pimecrolimus) and ruxolitinib cream.

Calcineurin inhibitors calm the immune system right where it’s attacking melanocytes. Studies show they boost repigmentation by 25-30% when used alongside NB-UVB. You apply them daily to the patches, then do your light session later. No interaction. No extra side effects. Just better outcomes.

Ruxolitinib, approved by the FDA in 2022, is newer but powerful. The 2023 Ruxotmel trial showed that when used with phototherapy, 54% of patients achieved over 50% repigmentation in just 24 weeks. That’s faster than phototherapy alone. It’s especially helpful for people who’ve struggled with slow progress. The catch? It’s expensive-over $5,000 a year without insurance.

What’s New in 2026?

The field is moving fast. In October 2023, the FDA cleared the first AI-assisted phototherapy device: Vitilux AI. It uses your smartphone to take a picture of your patches and calculates your exact light dose-cutting dosing errors by 37%. No more guesswork. No more burns from misjudging exposure.

Another breakthrough? Afamelanotide implants. These tiny rods, placed under the skin, release a pigment-boosting hormone over two months. The VITCURE-2 trial, launching in early 2024, is testing if they can speed up phototherapy results. Early lab data suggests patients might need fewer sessions overall.

Even more exciting? Researchers are now looking at genetic markers to predict who will respond best to NB-UVB. Some people have a natural advantage. If you carry certain gene variants, your melanocytes might react faster. Personalized treatment plans based on your DNA could be here within five years.

Real People, Real Results

One patient from Melbourne, 34, started NB-UVB after her vitiligo spread to her neck and chest. She used a home unit and applied tacrolimus every night. After nine months, she had 70% repigmentation on her neck. “I stopped hiding my collarbones,” she said. “I wore tank tops again.”

Another, a 12-year-old boy with patches on his hands, tried phototherapy for a year. His fingers barely changed. His parents considered quitting-until they added ruxolitinib. At 14 months, he had visible color returning on his knuckles. “It wasn’t perfect,” his mom said, “but it was enough to stop the bullying at school.”

But not everyone wins. A woman in Sydney gave up after 10 months. Her feet stayed white. She said, “I didn’t realize how little progress I’d make there. I thought the light would fix everything. It didn’t.”

What to Expect If You Start

If you’re considering phototherapy, here’s what you’re signing up for:

• 2-3 clinic or home sessions per week, every week
• At least 6 months before you see real change
• Eye protection and genital shielding during every session
• Gradual increases in light exposure-no jumping ahead
• Topical creams applied daily, unless your doctor says otherwise
• Tracking your progress with photos or an app

It’s not a quick fix. But for most people with moderate vitiligo, it’s the most reliable path to regaining color. The biggest risk isn’t the light-it’s giving up too soon.

When to Walk Away

There’s a point where continuing phototherapy stops making sense. If you’ve done 18 months of consistent treatment and your patches haven’t changed at all-especially on your face or torso-it’s time to talk about alternatives. Maybe it’s a different cream. Maybe it’s camouflage makeup. Maybe it’s accepting the pattern as part of you.

Dr. John Harris from UMass Medical School puts it bluntly: “Beyond 18 months, if nothing’s happening, you’re not gaining more color-you’re just spending more time and money.”

You don’t have to fight a losing battle. There’s dignity in knowing when to stop.

Support Is Out There

You’re not alone. The American Academy of Dermatology’s ‘Vitiligo Navigator’ tool helps you build a personalized treatment calendar. Vitiligo Support International has over 15,000 members sharing tips, photos, and encouragement. Reddit’s r/vitiligo community is full of people who’ve been where you are.

And remember: phototherapy isn’t the only option. But for most people, it’s the most proven. It’s not magic. But it’s science-and science, done right, can bring back more than pigment. It can bring back confidence.