| Topical Immunomodulators | Tacrolimus 0.1%, pimecrolimus 1%, ruxolitinib 1.5% cream | Inhibit JAK/STAT (ruxolitinib) or calcineurin (TCIs) → reduce cytotoxic T-cell activity | Face, neck, intertriginous, thin skin; active disease |
| Topical Corticosteroids | Clobetasol, betamethasone, mometasone (potency by site) | Anti-inflammatory, suppress local immunity | Body (not face); pulse therapy to limit atrophy |
| Vitamin D Analogs | Calcipotriene 0.005% | Modulates keratinocyte/melanocyte differentiation; synergizes with UVB | Adjunct to steroids/phototherapy |
| Phototherapy | NB-UVB (311 nm) 2–3×/wk; home units available | Stimulates melanocyte stem cell migration, proliferation, melanogenesis; local immunosuppression | Generalized, active disease; gold standard |
| Targeted Phototherapy | Excimer laser/lamp (308 nm) | High-dose targeted UVB; faster repigmentation | Localized, stable vitiligo (<10% BSA) |
| Systemic | Oral mini-pulse dexamethasone/prednisone; JAK inhibitors (tofacitinib, upadacitinib – off-label) | Systemic immunomodulation for rapid stabilization | Rapidly progressive, extensive disease |
| Surgical | Suction blister, split-thickness, MKTP (melanocyte-keratinocyte transplant) | Transplants functional melanocytes to depigmented skin | Stable disease × 1 yr; segmental or focal |
| Depigmentation | Monobenzone 20% cream | Permanent chemical destruction of remaining melanocytes | >50% BSA, refractory, patient choice |
