Vitiligo in Focus: When to Treat, When to Reassure, and Why It Matters

At Dermatology Week APP Day 2025, Andrew Mastro, MS, PA-C, delivered a thoughtful, high-impact session titled “The Approaches to Vitiligo: Treat, Refer, or Reassure?” With a focus on personalized care, Mastro explored the clinical, emotional, and therapeutic complexities behind this common but often misunderstood autoimmune skin condition.

“When we see beyond the pigmentation, these patients will finally be seen,” he said.

Mastro opened by reviewing vitiligo’s pathogenesis, emphasizing the role of inflammatory T cells, cytokines like IL-15, and JAK-STAT signaling in disease progression. While the science is key, the heart of the talk centered on recognizing when and how to treat.

For patients with active or rapidly progressing disease, early intervention is critical. “Knowing when to hit the gas pedal makes all the difference,” he said. He encouraged providers to watch for signs like confetti depigmentation, trichrome patterns and inflammation—markers of ongoing activity.

When stable, some patients may opt for maintenance therapy or watchful reassurance, depending on their goals. But for Mastro, every visit must begin with shared decision-making, taking into account disease burden, lesion location, skin tone, and the patient’s readiness to pursue care.

“This is a journey. Meet them where they are.”

A standout moment came as Mastro addressed the psychosocial toll of vitiligo. With nearly half of patients misdiagnosed and many left untreated, stigma and discouragement are common. “They’ve spent 2-and-a-half years, on average, just trying to get a diagnosis,” he said. “And many were told nothing could be done.”

Treatment options discussed included topical ruxolitinib, now US Food and Drug Administration-approved for nonsegmental vitiligo in patients aged 12 years and older, narrowband UVB phototherapy, and, in select cases, oral mini-pulse steroids to halt aggressive spread. He also noted emerging strategies like IL-15 blockade and regenerative procedures that may offer hope in the future.

Above all, Mastro emphasized empathy and individualized care.

“This isn’t just about pigment loss; it’s about identity, confidence, and quality of life.”

Whether referring, reassuring, or treating, providers should know their options, and their patients’ stories. In a field with growing tools and widening access, the biggest difference may still come from how providers listen.

For more meeting coverage, visit the Dermatology Week APP Day newsroom.

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Reference

Mastro A. The approaches to vitiligo: treat, refer, or reassure? Presented at: Dermatology Week; October 22–25, 2025; Virtual.