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Vitiligo
Vitiligo is medically benign and socially devastating in equal measure. The loss of skin pigmentation that defines vitiligo carries no physical pain, no systemic threat, and no infection risk. What it carries is visibility on the face, hands, and body in a society where skin colour is freighted with meaning. At Shree Hospitals, we treat vitiligo as the serious condition it is for the patient who lives with it, it affects how they present themselves, how they are perceived, and what they feel they can do.
Our vitiligo treatment in Mumbai is built around two goals: stopping the spread of melanocyte loss in skin in active disease, and restoring as much pigmentation as possible in stable disease. Both are achievable with the right approach and the right timing.
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Our Approach
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Our Approach in Managing Vitiligo
Shree Hospitals — Life-saving care
Vitiligo treatment strategy is determined almost entirely by one question: is the disease active or stable? Active vitiligo is spreading new patches are appearing, existing patches are enlarging. Stable vitiligo has not changed for at least 12 months. The treatment for each is entirely different, and applying the wrong treatment to the wrong phase wastes months of a patient's time and money. Our vitiligo specialist dermatologist team in Mumbai, India makes this determination at every visit before deciding on therapy.
- Classification & Activity Assessment.
- Non-segmental vitiligo (NSV) : the most common type; bilateral, often symmetrical; includes acrofacial, mucosal, generalised, and universal subtypes
- Segmental vitiligo (SV) : unilateral, dermatomal distribution; earlier stabilisation than NSV; excellent response to surgical therapy once stable
- Vitiligo Activity Score (VIDA) : assesses spread over 6 weeks, 3 months, 6 months, and 1 year; guides immunosuppression decisions
- Wood's lamp examination : highlights depigmentation in darker skin types where patches may not be immediately visible in normal light
- Associated autoimmune disease screening : thyroid function, ANA, fasting glucose vitiligo is associated with thyroid disease, type 1 diabetes, and Addison's disease
- Stopping Active Disease : Immunosuppressive Therapy
Active melanocyte loss in skin is immune-mediated — CD8+ T cells selectively destroy melanocytes. Suppressing this immune attack is the priority in active disease.
- Topical corticosteroids : first-line for localised active disease; medium to high potency; monitor for atrophy with regular follow-up
- Topical calcineurin inhibitors (Tacrolimus 0.1%) : particularly for facial vitiligo; steroid-sparing; no atrophy risk
- Oral mini-pulse corticosteroids dexamethasone 2.5mg on two consecutive days per week; used for rapidly progressive or generalised active vitiligo; limits systemic steroid burden while halting spread
- JAK inhibitors : topical Ruxolitinib (approved in some countries); oral Ruxolitinib (Opzelura); emerging as the most effective therapy for active and repigmenting vitiligo; targets the JAK-STAT pathway that drives melanocyte destruction
- Phototherapy for Vitiligo Repigmentation
Phototherapy for vitiligo is the cornerstone of repigmentation therapy in stable disease.
- Narrowband UVB (NB-UVB) — the gold standard; stimulates remaining melanocyte precursors (melanoblasts) in hair follicles to migrate and repopulate the depigmented skin; 2–3 sessions per week; 6–12 months for meaningful repigmentation
- Targeted phototherapy (308nm Excimer laser/lamp) ; for localised stable vitiligo; high-intensity UVB to small areas; faster response than whole-body NB-UVB; particularly effective for facial vitiligo
- PUVA phototherapy : less commonly used now given NB-UVB superiority and better safety profile; still used in selected resistant cases
- Repigmentation follows a follicular pattern initially perifollicular brown dots appearing within white patches are the first sign of response; a positive indicator that does not always look like progress initially
- Combined phototherapy + topical therapy NB-UVB combined with Tacrolimus or topical corticosteroids consistently produces better repigmentation than either alone
- Surgical Repigmentation — For Stable Segmental & Focal Vitiligo
Surgery is the most effective repigmentation option for truly stable versus active vitiligo defined as no new patches and no spread for at least 12 months (24 months preferred for surgical candidacy).
- Suction blister epidermal grafting epidermal blisters raised on donor normal skin and transferred to recipient depigmented site; excellent for small to medium stable patches
- Split-thickness skin grafting (STSG) thin skin graft harvested by dermatome and applied to recipient site; good for larger areas
- Punch grafting circular skin punches from normal to depigmented skin; simple; cosmetically variable results
- Follicular unit extraction (FUE) transplantation : transplanting melanocyte-containing hair follicle units to depigmented skin; excellent for stable segmental vitiligo; can treat any body site including acral areas
5.Camouflage, Psychological Support & Sun Protection
Biologic therapy for psoriasis has transformed outcomes for moderate to severe disease producing PASI 90 and PASI 100 (near-complete and complete clearance) in most patients.
- Medical camouflage : micropigmentation (tattooing) for stable lip vitiligo; cosmetic camouflage creams with trained application technique
- Sunscreen : critical for depigmented skin which has no melanin UV protection; sunburn in vitiligo patches worsens disease and causes pain
- Psychological support : depression and social anxiety are disproportionately prevalent in vitiligo; psychological co-management is part of comprehensive care, not an afterthought
- Support group referral : peer support significantly improves quality of life in vitiligo patients
6. Emerging Therapy
- Oral Ruxolitinib JAK1/2 inhibitor; ongoing phase III trials in non-segmental vitiligo showing significant repigmentation; expected to transform medical management of vitiligo in coming years
- Afamelanotide (NeoMelan implant) melanocyte-stimulating hormone analogue; accelerates repigmentation when combined with NB-UVB; available at selected centres
Happy Patients & Their Case Stories
A young woman with rapidly spreading non-segmental vitiligo — six new patches in four months. VIDA score indicated active disease. She was started on oral mini-pulse dexamethasone and topical Tacrolimus. After 3 months, no new patches had appeared. Disease was considered controlled. NB-UVB phototherapy was then initiated twice weekly. At 9 months of phototherapy, perifollicular repigmentation was visible in all facial patches and 60% repigmentation was achieved at 14 months. She continues phototherapy maintenance.
Mrs. Priya S.
Had unilateral segmental vitiligo on the right forearm and hand — stable for 2 years. Phototherapy had produced minimal response. Vitiligo repigmentation through suction blister epidermal grafting was performed for the forearm patch under local anaesthesia. At 3 months, 85% repigmentation was achieved with excellent colour match. The hand was treated subsequently. He is now completing a second grafting session for residual areas.
Mr. Arun M.
How to Identify Vitiligo ?
Vitiligo has a characteristic appearance that is usually identifiable on clinical examination but Wood's lamp assessment adds precision in darker skin tones.
Features that distinguish vitiligo from other depigmenting conditions:
- Chalk-white or milk-white depigmented patches : complete loss of pigmentation with well-defined borders
- No scaling, thickening, or surface change within the white patch the skin texture is normal
- Symmetric distribution in non-segmental vitiligo matching patches on both sides of the body
- Unilateral, band-like distribution in segmental vitiligo typically on the face, limbs, or trunk in a dermatomal pattern
- Leukotrichia white hairs within a vitiligo patch; indicates melanocyte loss in skin extending to hair follicles; associated with poorer repigmentation response
- Trichrome vitiligo an intermediate pale zone between the white patch and normal skin; indicates active spread
- Onset typically in the second or third decade though any age from infancy to late adulthood is possible
The most important clinical question is whether vitiligo is currently spreading or stable. This determines whether immunosuppression to halt progression or phototherapy for vitiligo repigmentation is the priority. Seek vitiligo treatment in Mumbai at a centre offering both medical and surgical repigmentation options because the best outcome in stable disease is often surgical, and no amount of phototherapy will replace the speed and completeness of a well-executed epidermal graft in the right patient.
Important FAQs: Vitiligo
Is vitiligo an autoimmune disease?
Yes ,vitiligo is classified as an autoimmune condition where the immune system selectively destroys melanocytes. It is associated with other autoimmune conditions including thyroid disease and type 1 diabetes.
Can vitiligo spread to cover the entire body?
Universal vitiligo — complete depigmentation occurs in a minority of patients. Most patients have localised or generalised disease that remains partial. Active disease requires early immunosuppressive intervention to limit spread.
Does phototherapy work for all types of vitiligo?
NB-UVB works best for non-segmental vitiligo on the face, trunk, and proximal limbs. Response is poor for acral sites (hands, feet, fingertips) and lips. Segmental vitiligo responds better to surgical grafting than phototherapy.
How long does phototherapy take to show results in vitiligo?
Perifollicular repigmentation spots typically appear after 3–4 months of regular NB-UVB. Meaningful cosmetic improvement takes 9–12 months. Treatment is continued for up to 2 years in responding patients.
Is surgical treatment for vitiligo permanent?
Surgical repigmentation in truly stable vitiligo produces durable results grafted melanocytes establish and maintain pigmentation. However, if underlying disease activity resumes, new patches can appear elsewhere.
Can stress trigger vitiligo?
Psychological stress is a recognised trigger for both onset and flare of vitiligo . it activates the HPA axis and inflammatory pathways that accelerate melanocyte destruction. Stress management is part of a comprehensive vitiligo care plan.
Treatments for Vitiligo at Shree Hospitals
Treatments for Vitiligo at Shree Hospitals.Comprehensive vitiligo repigmentation and management in Mumbai from immunosuppression for active disease to surgical grafting for stable patches.
Treatments for Vitiligo Specialists in Mumbai
Dr. Snehal Thank
Pioneer Pediatric Physiotherapist & Neuro-Developmental
Dr. Yogesh Kalyanpad
Dermatology, Cosmetology and Hair Transplant
Every doctor and specialist at Shree Hospitals is board-certified and brings an average of 15 or more years of clinical experience in their area of subspecialty.
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