Vitiligo Treatment: How Phototherapy Works with Depigmentation - And Why They’re Not Combined

When you hear the words vitiligo and phototherapy together, it’s easy to assume they’re part of the same plan - like mixing two medicines to make one stronger solution. But that’s not how it works. In fact, phototherapy and depigmentation are opposites. One tries to bring color back. The other removes what’s left. They’re not combined. They’re chosen - based on how much of your skin has lost pigment.

What Vitiligo Really Is

Vitiligo isn’t just a skin condition. It’s an autoimmune disorder where your body’s immune system attacks melanocytes - the cells that make your skin color. This leads to white patches that can show up anywhere: face, hands, armpits, even inside your mouth. About 1 in 50 people worldwide have it, with higher rates in places like India. It doesn’t hurt. It doesn’t itch. But it can change how you see yourself.

Phototherapy: Bringing Color Back

If you have vitiligo covering less than 80% of your body, phototherapy is usually the first step. The goal? Repigmentation. You want your skin to regain its natural tone. The most common and effective method today is narrowband ultraviolet B (NB-UVB) light. It uses a specific wavelength - 311 to 313 nanometers - that targets the skin without burning it deeply.

You’ll typically go to a clinic two or three times a week. Each session lasts only a few minutes. The light doesn’t cure vitiligo, but it helps your body’s leftover melanocytes - especially those hiding in hair follicles - start making pigment again. Studies show that after six months, about 37% of people see at least half their patches repigment. After a year, that number jumps to over 56%. For some, especially on the face and neck, repigmentation can reach 70-80%.

But not all areas respond the same. Hands, feet, lips, and areas with no hair follicles barely react. That’s why people with vitiligo on their fingers often give up - they don’t see results, even after months of treatment.

How Phototherapy Works: More Than Just Light

Phototherapy isn’t just about shining UV light. It does two things at once. First, it calms down the immune attack on melanocytes. Second, it wakes up dormant pigment cells. That’s why it works better when paired with topical treatments like tacrolimus or pimecrolimus. These creams, applied right before light therapy, can boost repigmentation by 25-30%.

There are other light options too. PUVA uses a drug called psoralen with UVA light. It works, but it’s older and riskier - nausea is common, and long-term use raises skin cancer risk. Excimer lasers deliver targeted UVB to small patches. Great for spots on the face or elbows, but useless if you have patches all over your back.

Home Phototherapy: Convenience vs. Risk

Many people now use home phototherapy units. These are FDA-approved devices like the Philips TL-01. They cost between $2,500 and $5,000 upfront. But they save time - no driving to clinics, no waiting rooms. A 2020 study found home users stuck with treatment 35% more often than clinic-goers. That’s huge. Compliance is the biggest reason treatment fails.

But there’s a catch. Home users are 22% more likely to get burns. Why? Because dosing is tricky. Too much light, too soon, and your skin reddens, blisters, or peels. That’s why tracking sessions with apps is critical. UC Davis Health found that patients using smartphone trackers had 92% adherence. Those who didn’t? Half quit before six months.

Depigmentation: When You Choose to Go All White

Now, here’s where people get confused. If vitiligo covers more than 80% of your body, doctors may suggest depigmentation. Not as a last resort - as a deliberate choice. The idea? Remove the remaining pigment from your normal skin so everything matches. It’s not about fixing vitiligo. It’s about creating a uniform look.

The only approved treatment for this is monobenzone cream. It’s not a moisturizer. It’s a chemical that permanently destroys melanocytes. You apply it to pigmented areas - arms, legs, face - twice a day, every day, for months. It takes 6 to 12 months to see full results. Once done, your skin stays white forever. You’ll need to avoid sun exposure. Your skin becomes extremely sensitive. You’ll need sunscreen daily, even indoors.

This isn’t for everyone. It’s irreversible. And it’s only recommended when repigmentation isn’t possible or when the emotional toll of patchy skin outweighs the risks of depigmentation. Most patients choose it after years of failed treatments. It’s a psychological decision as much as a medical one.

Why You Don’t Mix Them

You can’t do phototherapy and depigmentation at the same time. They cancel each other out. Phototherapy tries to bring pigment back. Depigmentation tries to burn it away. If you try both, you’ll end up with uneven results - some patches darkening, others fading - and your skin could get damaged.

The American Academy of Dermatology says clearly: these are separate treatment paths. You pick one based on your disease extent. If you have 30% vitiligo? Go for NB-UVB. If you have 90%? Talk to your dermatologist about depigmentation.

Cost, Time, and Real-Life Barriers

Phototherapy is affordable compared to newer drugs. A full year of NB-UVB costs between $1,200 and $2,500. Topical ruxolitinib cream? Over $5,000 a year. But cost isn’t the only hurdle. Time is.

Two to three visits a week. For a year. That’s 100-150 sessions. Many people start strong. Then work gets busy. Kids need rides. Weather gets bad. Suddenly, you miss a week. Then two. Progress stalls. The JAMA Dermatology meta-analysis says you need at least six months to even know if it’s working. Most people give up before then.

Insurance doesn’t always cover everything. Even with coverage, out-of-pocket costs can hit $1,000 a year. And if your vitiligo is on your hands? You’re more likely to quit. Only 15-20% of people see improvement there - even after a full year.

New Hope: Combining Light With Drugs

The future isn’t about mixing light with depigmentation. It’s about combining light with drugs that help the light work better. The 2023 Ruxotmel trial showed that using ruxolitinib cream with NB-UVB led to 54% of patients achieving over 50% repigmentation in just 24 weeks - compared to 32% with light alone. That’s a big deal. It means fewer sessions. Faster results. Especially for stubborn areas.

New tech is helping too. The Vitilux AI device, cleared by the FDA in October 2023, uses your smartphone camera to measure your skin tone and adjust the light dose automatically. It cuts dosing errors by 37%. That means fewer burns. More confidence.

What to Do Next

If you have vitiligo and are considering treatment:

• Get a full-body assessment from a dermatologist who specializes in vitiligo.
• Ask what percentage of your skin is affected. That determines your path.
• If under 80%: Start with NB-UVB phototherapy. Ask about adding a topical cream.
• If over 80%: Discuss depigmentation - understand the permanence and lifestyle changes.
• If you’re tired of clinic visits: Ask about home phototherapy. Get trained properly.
• Track your progress. Use an app. Take photos monthly. Don’t rely on how you feel.

Support Is Out There

You’re not alone. The Vitiligo Support International forum has over 15,000 members. The AAD’s Vitiligo Navigator program gives you personalized calendars and tips. Reddit’s r/vitiligo community has real stories - from people who gave up, to those who found peace with depigmentation, to others who got their color back after two years.

The truth? Vitiligo doesn’t have one fix. But it does have options. And the right one depends on your skin, your life, and your goals.