US Vitiligo Study Finds Short Treatment Duration, Variable Care Patterns

Key Clinical Summary

• A US cohort study of 24 949 patients with vitiligo found that approximately one-third received no vitiligo treatment during follow-up, regardless of documented body surface area (BSA) involvement.
• Topical and oral corticosteroids and topical calcineurin inhibitors/phosphodiesterase-4 inhibitors were the most commonly used therapies, with substantial variability in treatment sequences.
• Median treatment duration ranged from 1.8 to 4.1 months depending on therapy type and line of treatment, highlighting relatively short treatment persistence.

Vitiligo treatment patterns in US dermatology practices were characterized by short therapy duration, variable treatment sequences, and a substantial proportion of patients receiving no treatment after diagnosis, according to a retrospective cohort study of 24 949 patients. The study used linked electronic health record (EHR) and claims data to examine real-world management by disease extent and age.

Nearly One-Third of Patients Received No Treatment

Researchers analyzed deidentified data from the Komodo Healthcare Map and OMNY Health Foundation databases, including patients diagnosed with vitiligo between January 1, 2018, and August 31, 2023. Patients were categorized by age and percentage of BSA involvement at diagnosis.

Among 24 949 patients, 21 996 (88.2%) were adults aged 18 years or older and 14 057 (56.3%) were female. Only 1329 patients (5.3%) had a BSA assessment at index; 963 had BSA involvement of 10% or less and 366 had involvement greater than 10%.

Among 16 674 patients with a documented location of vitiligo, the face was the most commonly affected area, reported in 5482 patients (32.9%).

Across BSA groups, approximately 27% to 32% of patients received no vitiligo treatment during follow-up. Topical and oral corticosteroids and topical calcineurin inhibitors/phosphodiesterase-4 inhibitors were the most frequently used therapies.

Topical therapies were prescribed more frequently to children and adolescents than adults, whereas systemic therapies were more commonly prescribed to adults. Researchers also observed substantial variability in treatment sequences.

Treatment Courses Were Relatively Short

Topical corticosteroids and topical calcineurin inhibitors/phosphodiesterase-4 inhibitors were most commonly used as first-line treatments, while systemic corticosteroids appeared more frequently in later lines of therapy.

Treatment duration was relatively short. Depending on treatment type, median duration for first- and second-line therapy ranged from 1.8 months (95% CI, 1.6-2.1) to 4.1 months (95% CI, 3.7-4.4).

The researchers noted that short treatment duration, multiple lines of therapy, and heterogeneous treatment sequences may reflect several factors, including limited long-term treatment options, tolerability concerns, insufficient efficacy, and variation in prescribing practices. Poor adherence to dermatologic treatments may also contribute.

Patients with greater BSA involvement were less likely to receive topical treatments. The authors noted that applying topical medications over widespread areas can be challenging, potentially making these treatments less feasible for patients with extensive disease.

Authors Highlight Gaps in Real-World Vitiligo Management

The investigators emphasized that vitiligo can substantially affect psychosocial well-being and that effective treatment options remain important. During the study period, commonly used approaches included several off-label therapies, while ruxolitinib cream was the only US Food and Drug Administration–approved treatment for repigmentation in patients aged 12 years and older with nonsegmental vitiligo.

Interpretation of the findings was limited by infrequent documentation of disease extent. Nearly all patients lacked BSA data, and the dataset primarily represented commercially insured patients receiving dermatologic care. Reasons for treatment decisions or changes were also unavailable.

Overall, the study found that a substantial proportion of US patients with vitiligo received no treatment after diagnosis and that treatment courses were relatively short. The findings provide real-world insight into treatment patterns and potential unmet needs in vitiligo management.

Reference

Adiri R, Gauthier G, Kurosky SK, et al. Clinical characteristics and treatment patterns in patients with vitiligo. JAMA Dermatol. 2026;162(7):720-725. doi:10.1001/jamadermatol.2026.0971