Global Survey Finds Doctors May Stop Vitiligo Treatments Too Soon

A global survey of more than 1,200 healthcare professionals who routinely treat vitiligo has revealed a striking gap between how the chronic autoimmune skin disease should be managed and how it often is. The VALIANT survey assessed how the participating healthcare professionals diagnosed vitiligo, which treatments they prescribed, and how long they waited before judging whether a therapy was working.

Vitiligo is a chronic autoimmune disease in which the immune system destroys melanocytes, the pigment-producing cells of the skin, leading to progressive depigmentation in white patches. Although the condition is visibly apparent, patients commonly wait two to three years for an accurate diagnosis, and almost half report having been misdiagnosed at some point, according to earlier VALIANT findings cited by the authors. Because satisfactory repigmentation can take months to years, such delays can prolong the psychosocial burden of the disease and diminish quality of life.

Per the study's methods, eligible participants were doctors of medicine, nurse practitioners, or physician assistants practicing in dermatology, primary medicine, or internal medicine. To represent clinicians likely to be involved in vitiligo care, dermatology participants had to treat at least 10 patients with vitiligo in a typical three-month period, while those in primary or internal medicine had to treat at least five. Participants completed a 30-minute survey assessing how they diagnosed, managed, and treated vitiligo, including treatment objectives and decisions around treatment discontinuation. In countries where the internet was less accessible, face-to-face interviews were permitted. Data were summarized descriptively, and statistical comparisons were made using the chi-square test for categorical variables.

Of the 1,203 healthcare professionals who completed the survey, 91.4 percent were dermatologists and 8.6 percent were primary care physicians. A majority, 62.3 percent, self-identified as vitiligo specialists, including two-thirds of the dermatologists but only one-eighth of the primary care physicians. Notably, these self-described specialists reported rarely or never referring patients onward. Among the nonspecialists, 82.2 percent said they attempted to treat patients themselves before referring them to a vitiligo specialist, while only 17.8 percent referred immediately after suspecting or diagnosing the disease.

Diagnostic practice showed another potential weak point. Most respondents reported examining lesions, 74.1 percent, and the full body, 65.1 percent, very often or all the time. Yet fewer than half, 42.3 percent, used a Wood’s lamp to support the examination. The ultraviolet-based lamp causes vitiligo lesions to fluoresce blue-white, helping distinguish vitiligo from other depigmenting disorders and aiding detection of lesion activity and early repigmentation. Dermatologists used the device far more often than primary care physicians, 44.2 percent versus 22.1 percent, a difference that was statistically significant. The authors caution that the lamp’s incremental value varies by skin type, with potentially greater utility in fairer skin, where contrast between affected and unaffected skin may be less apparent to the naked eye.

Treatment goals differed by specialty. Repigmenting lesions was the most commonly cited top goal overall, chosen by 37.2 percent of respondents, followed by improving long-term clinical outcomes at 24.9 percent, reducing or stopping the spread of symptoms at 18.5 percent, and reducing psychological burden at 14.4 percent. Dermatologists were more likely than primary care physicians to prioritize repigmentation, 39.0 percent versus 17.3 percent, while primary care physicians more often cited reducing psychological burden, 27.9 percent versus 13.1 percent.

Topical therapies were the most frequently prescribed treatment type, used often or more by 91.4 percent of respondents, followed by light, laser, or phototherapy at 65.7 percent and oral medications at 53.8 percent. The timing of treatment decisions, however, diverged sharply from current guidance. Among clinicians who prescribed topical, light-based, or oral treatments at least sometimes, only 14.4 percent, 9.6 percent, and 4.4 percent, respectively, waited more than six months to determine whether a treatment was effective. In contrast, 45.5 percent, 49.8 percent, and 69.9 percent waited three months or less for the three treatment classes.

That impatience matters because repigmentation is biologically slow. Restoring skin color requires the development and migration of functional melanocytes into depigmented lesions, a gradual process that can take months to years. Current treatment guidelines recommend at least six months of initial treatment and twelve months or more of prolonged therapy. Yet in this survey, roughly five to seven out of ten clinicians decided on treatment efficacy within three months, and fewer than two in ten waited beyond six months. Long-term data from the TRuE-V studies of ruxolitinib cream in nonsegmental vitiligo, cited by the authors, showed repigmentation continuing to improve without plateau through two years of ongoing treatment.

Discontinuation behavior reinforced the pattern. More than half of respondents, 60.8 percent, reported advising patients to take a drug holiday from vitiligo treatment, and 80.8 percent said their patients had elected to take such breaks on their own. The most commonly cited reasons for these breaks were lack of treatment response, reported for 32.5 percent of drug holidays, and treatment being too time consuming, cited for 29.8 percent. The authors argue that persisting with a treatment plan for at least six months before discontinuing, or before accepting a perceived lack of effectiveness as final, is beneficial, and they emphasize the need for better education of both clinicians and patients about the long timeline of repigmentation.

The study has limitations the authors acknowledge directly. Online recruitment introduces selection bias, the survey lacked predefined hypotheses and statistical power calculations, and the analysis relied on clinicians accurately recalling their own diagnostic and management practices. The VALIANT study was not designed to compare primary care physicians with dermatologists, and meaningful statistical comparisons between the groups were not feasible given the small number of primary care respondents, which also limits how far the findings generalize to primary care. Because the survey was conducted in 2021, it predates both the 2023 update of the International Vitiligo Task Force treatment guidelines and the approval of ruxolitinib cream for vitiligo repigmentation. Nevertheless, the authors conclude that the observed deficiencies remain relevant: timely diagnosis and treatment, appropriate use of the Wood’s lamp with attention to patient skin type, rapid referral or consultation with a vitiligo specialist for clinicians with limited experience, and sustained, continuous treatment for at least six months are all essential to support optimal outcomes in this chronic autoimmune disease.

Subject of Research: A global survey of healthcare professionals on how vitiligo is diagnosed and treated

Article Title: Exploring How Healthcare Professionals Diagnose and Manage Vitiligo: Global VALIANT Study Findings and Recommendations

Article References: Ezzedine, K., Harris, J. E., Hamzavi, I. H., van Geel, N., Bibeau, K., Gao, J., Ren, H., & Grimes, P. (2026). Exploring How Healthcare Professionals Diagnose and Manage Vitiligo: Global VALIANT Study Findings and Recommendations. Dermatology and Therapy. https://doi.org/10.1007/s13555-026-01953-1

Image Credits: AI Generated

DOI: 10.1007/s13555-026-01953-1

Keywords: vitiligo, VALIANT study, dermatology, Wood's lamp, repigmentation, drug holidays, healthcare professionals, autoimmune disease, treatment guidelines, survey research, ruxolitinib cream, referral practices