Phototherapy — treatment with ultraviolet light — has long been a treatment option for people living with vitiligo. Vitiligo is a chronic skin condition that causes depigmentation, or loss of skin color. With newer treatments like topical Janus kinase (JAK) inhibitors gaining attention in dermatology, some people wonder: Is UV therapy still worth it?

MyVitiligoTeam spoke with Dr. Amit Pandya, director of the Pigmentary Disorders Clinic at the Palo Alto Medical Foundation and chair of the medical advisory board of the Global Vitiligo Foundation, to help us understand how UV light therapy fits into current vitiligo treatment.

Why Use Ultraviolet Light?

Narrowband UVB (NB-UVB) is the most common form of phototherapy, according to Dr. Pandya. This form of UVB therapy uses a specific wavelength of ultraviolet light — between 311 and 313 nanometers — to stimulate melanocytes (pigment-producing cells) and calm the immune system’s attack on them.

“If you don’t give some type of light, such as NB-UVB phototherapy or even sunlight, to the treated area, you are not going to get significantly good results.”

— Dr. Amit Pandya

Some people living with vitiligo see skin color return solely from medications, such as topical corticosteroids or calcineurin inhibitors like tacrolimus or pimecrolimus. However, Dr. Pandya emphasized that combining NB-UVB with these medications can lead to more meaningful repigmentation.

“If you don’t give some type of light, such as NB-UVB phototherapy or even sunlight, to the treated area, you aren’t going to get significantly good results,” he explained. “Most of the areas that improve are exposed to light, especially the face.”

He noted that UV exposure in everyday life through exposure to the sun — such as while walking or driving — may explain why facial areas respond best to treatment.

Two Pillars of Vitiligo Treatment

Dr. Pandya described vitiligo therapy as a “two pillars” approach: “One pillar is to remove the T cells that are attacking the skin, causing the vitiligo lesions to appear, and the other pillar is to stimulate the missing cells, the melanocytes, to repopulate the skin.”

Treatments like topical and oral steroids, topical and oral JAK inhibitors, and topical calcineurin inhibitors can reduce the immune attacks that lead to depigmentation. However, that’s not enough to get pigment to come back.

“The only treatments we have that will address the second pillar of treatment are phototherapy, afamelanotide, bimatoprost, latanoprost, skin grafting, and cellular grafting,” he said.

Of these, phototherapy is by far the most common.

Dr. Pandya added that afamelanotide may soon offer a new way to boost melanin production by mimicking a naturally produced substance called melanocyte stimulating hormone. The drug is currently approved by the U.S. Food and Drug Administration (FDA) for treating a rare genetic disorder called erythropoietic protoporphyria, but now it’s in clinical trials for treating vitiligo. If the trials are successful, it may be approved for use in vitiligo in the near future.

When To Consider Phototherapy

NB-UVB treatment used to be reserved for people with widespread or nonsegmental vitiligo, or for those who didn’t respond to topical therapies. That’s changed, Dr. Pandya said.

“In the old days … you wouldn’t offer it to someone unless they don’t respond to topical therapy,” he explained. “Now, that’s changed for several reasons. First of all, it’s been shown that even patients with small areas of involvement can have a very significant effect on their quality of life and want the most effective treatment available.”

This is especially true for people with vitiligo spots on the face.

“The average improvement of the vitiligo lesions will be about 25 percent in three months, 50 percent in six months, and 75 percent in nine months.”

— Dr. Amit Pandya

Furthermore, all therapies seem to work better when combined with exposure to light, such as phototherapy. Dr. Pandya added that some people can see improvements with incidental UVB light exposure from sunlight, but for more consistent results, medically supervised UVB phototherapy is recommended.

Shared decision-making with a dermatologist is key in choosing the right type of phototherapy. It’s a collaborative approach where you and your doctor weigh treatment options together based on your goals, values, and medical needs.

Is Phototherapy Safe for Children?

Dr. Pandya stated that narrowband UVB can be used safely for children living with vitiligo: “I would say that any child, even 1 year of age or older, could be treated with phototherapy at home using a handheld unit while they’re sleeping.”

For in-office treatment, children typically need to be old enough to cooperate with instructions and stand alone in a booth while wearing protective goggles. For younger kids, home-based light therapy using small devices can target lesions while minimizing stress.

In-Office vs. At-Home Treatment

Most people receive NB-UVB treatment three times per week. “The average improvement of the vitiligo lesions over the whole body will be about 25 percent in three months, 50 percent in six months, and 75 percent in nine months,” Dr. Pandya said. “You can treat for a year, two years, three years. There’s no upper limit to the number of treatments or the amount of light you can receive.”

The incidence of skin cancer is negligible, even in people who have received hundreds of treatments.

It’s important to note that the percentages stated above are averages, and different parts of the body will have different response rates. Areas with hair follicles — like the face, trunk, upper arms, and legs — respond better than areas like wrists, hands, ankles, or feet.

UVB therapy can be performed in a dermatology clinic in a full-body light booth or a hand/foot light booth. It can also be administered at home with handheld devices or full-body panels. Another form of in-office phototherapy, excimer laser treatment, is helpful for people with small areas of involvement and offers good results when used twice weekly.

In-office phototherapy for vitiligo is usually covered by medical insurance companies. Unfortunately, many insurance plans still classify home phototherapy as experimental, even though it can be a cost-effective treatment with similar efficacy and safety as in-office treatment.

Dr. Pandya prescribes home units frequently, and the Global Vitiligo Foundation provides a four-page guide to help healthcare providers educate their patients on safe and effective use. He noted that companies producing home devices also manufacture in-office equipment, using the same bulbs and safety standards.

What Are the Side Effects of Phototherapy?

Common side effects of UVB treatment include:

• Mild itching
• Dry skin
• Mild sunburnlike reactions

Rarely, overexposure can cause skin discoloration or blistering. Dr. Pandya stressed the importance of working with a trained nurse who can monitor your reactions and adjust doses as needed for your skin tone. When given properly, phototherapy can be very safe, with few side effects.

Some people are concerned about the risk of skin cancer, but Dr. Pandya said the evidence is reassuring. “Multiple studies have been done since the early ’90s showing that skin cancer risk isn’t increased in patients who get phototherapy who have vitiligo,” he explained.

In fact, some studies suggest vitiligo may be associated with a lower risk of melanoma, possibly due to autoimmunity against melanocytes seen in people with vitiligo.

Don’t forget: Sunscreen is still important when you’re outdoors, even if you’re receiving UVB therapy in a controlled setting. Too much sun exposure can cause irritation on vitiligo-affected areas — including pinkness, redness, or other discoloration, depending on your skin tone. When this happens, your doctor may need to pause or slow your phototherapy, whether it's done in the office or at home.

The Bottom Line

Dr. Pandya believes NB-UVB phototherapy remains essential in treating vitiligo, particularly when paired with topical therapies and other new options being studied in clinical trials.

“You need phototherapy for significant improvement when you’re using a JAK inhibitor,” he said. “Phototherapy is the mainstay for that second pillar of treatment, which is bringing the melanocytes back to the white spots.”

Whether you’re considering in-office NB-UVB treatment, exploring excimer laser therapy for small areas, or seeking guidance on at-home UVB light therapy, talking to a dermatologist experienced in treating vitiligo can help you find an approach that suits your needs, skin type, and lifestyle. It may take many months of phototherapy to notice an improvement in skin repigmentation. If you and your doctor agree on a course of treatment and take images at each visit to monitor progress, you’ll often see a positive result.

Talk With Others Who Understand

On MyVitiligoTeam, the social network for people with vitiligo and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with vitiligo.

Have you tried phototherapy for vitiligo? Has it helped? What should others know? Share your story in a comment below, or start a conversation by posting on your Activities page.