Treatment of Vitiligo When Phototherapy Did Not Work
Phototherapy is the standard first-line approach for widespread vitiligo, aiming to halt disease activity and restore pigmentation. When a patient does not achieve these goals despite an adequate course of treatment, a structured next-line protocol applies.
Previous Line — Insufficient Response
Phototherapy (narrowband UVB or excimer) was the prior treatment. The goals were halting disease activity and achieving repigmentation of vitiligo lesions. Patients who remain non-responders after 30–48 sessions meet the threshold for escalation.
Next-Line Treatment — Partial Overview
This protocol involves systemic immunomodulating agents for progressive vitiligo. Newer systemic agents that act on specific immune pathways may also be considered, depending on regulatory availability in the treating country.
Agent selection, sequencing, and monitoring details are in the full protocol below.
References
DOI: 10.1111/jdv.19450
- Methotrexate, cyclosporine, azathioprine and minocycline can be used in patients with progressive vitiligo, although strong evidence for efficiency and safety is lacking.
- Systemic JAK inhibitors are promising, and their use can be considered when available and approved by regulatory agencies.
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