Case Report Vitiligo in 2025: An Evidence‑Based Narrative Update
by Abraham Perez Valencia*
Medical Laboratory Technician, Regional High Specialty Women's Hospital, Villahermosa, Tabasco, Mexico
*Corresponding author: Abraham Perez Valencia, Medical Laboratory Technician, Regional High Specialty Women's Hospital, Villahermosa, Tabasco, Mexico
Received Date: 04 September 2025
Accepted Date: 09 September 2025
Published Date: 11 September 2025
Citation: Valencia AP (2025) Vitiligo in 2025: An Evidence‑Based Narrative Update. Ann Case Report. 10: 2404. https://doi.org/10.29011/2574-7754.102404
Abstract
Background: Vitiligo is a chronic autoimmune depigmenting disorder. Advances in the IFN‑γ–CXCL10 axis and tissue‑resident memory T cells (TRM) have reshaped management.
Objective: Provide a 2025 update spanning epidemiology, pathophysiology, assessment, and therapy with a pragmatic algorithm. Methods: Narrative synthesis of recent guidelines and pivotal trials with clinical emphasis.
Results: Global prevalence approximates 0.3-0.5%. Standardized measures (VASI/F‑VASI, VIDA; VDAS/VDIS) enable monitoring and endpoints. NB‑UVB remains first‑line for extensive or progressive disease; ruxolitinib cream provides targeted benefit; surgery is effective in stable cases.
Conclusion: Combination of topical + NB‑UVB is foundational; JAK inhibition adds a novel option; surgery suits stable refractory cases.
Plain Language Summary
Vitiligo causes pale or white patches on the skin because the pigment‑making cells (melanocytes) are attacked by the immune system. Doctors now understand better how immune signals (like interferon‑gamma) and “memory” T cells keep the disease active. Treatment usually combines creams (steroids or tacrolimus) with narrowband UV‑B light. This light treatment is safe and effective and can be combined with creams.
A newer option is a JAK‑inhibitor cream (ruxolitinib 1.5%), approved for people 12 years and older with non‑segmental vitiligo. If the disease is stable for at least 6-12 months and other treatments are not enough, surgical techniques that transfer pigment cells can help, especially on the face and neck. Doctors track progress with scores like VASI and VIDA. Screening for thyroid problems is often considered. Most patients need steady treatment and patience; noticeable results commonly take several months (Tables 1, 2 and Figure 1).
|
Tool |
Description |
Clinical Use |
|
VASI (Vitiligo Area Scoring Index) |
Estimates BSA and depigmentation |
Extent/severity (0-100) |
|
F‑VASI |
Facial‑specific VASI |
Sensitive endpoint in trials |
|
VIDA |
Vitiligo Disease Activity (-1 to +4) |
Tracks disease activity over time |
|
VDAS/VDIS |
Dynamic scores for activity and improvement |
Research/monitoring |
|
QoL (DLQI, VitiQoL) |
Patient‑reported outcomes |
Impact on daily life |
Table 1: Assessment Tools in Vitiligo.
|
Therapy |
Indication |
Evidence/Notes |
Safety |
|
Topical corticosteroids |
Limited NSV, non‑facial |
8-12-week cycles, good efficacy |
Skin atrophy, striae |
|
Calcineurin inhibitors |
Face, neck, folds |
Useful alone or with NB‑UVB |
Burning, safe long‑term |
|
NB‑UVB phototherapy |
Extensive/progressive NSV |
Cornerstone, 2-3x/week |
Erythema, safe long‑term |
|
Excimer 308 nm |
Localized lesions |
Effective focal repigmentation |
Local erythema |
|
Ruxolitinib cream 1.5% |
NSV ≥12 y, face/neck |
Phase 3 trials: ~50% F‑VASI75 |
Local acne, pruritus |
|
Surgery (MKTP, grafts) |
Stable vitiligo ≥6-12m |
Effective esp. face/neck |
Scarring, variable success |
Table 2: Therapeutic Options in Vitiligo.
Figure 1: Practical Management Algorithm
Declarations
Funding: None.
Medical Writing/Editorial Assistance: None.
Authorship (CRediT): Conceptualization [ ]; Investigation [ ]; Writing – original draft [ ]; Writing – review & editing [ ]; Supervision [ ].
Data availability: Not applicable.
Compliance with Ethics Guidelines: Not applicable.
Competing Interests: The authors declare no competing interests.
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