Personalized medicine in vitiligo: A guide for daily practice

Vitiligo is a chronic autoimmune depigmenting disorder with a complex clinical course and highly heterogeneous therapeutic response. Many disease-specific and patient-related factors determine the best personalized management in vitiligo. Despite recent advances, a one-size-fits-all approach remains insufficient, often leading to suboptimal outcomes and patient dissatisfaction. In this review, we outline a pragmatic framework for personalized vitiligo management based on clinical subtype, disease activity, extent, anatomical location, patient age, sex, skin phototype, comorbidities and psychosocial context. We discuss the clinical application of emerging data on clinical and dermoscopic activity signs, specific skin symptoms (e.g., halo naevi or poliosis), laboratory biomarkers and imaging modalities. Special populations such as children, the elderly, pregnant patients and autoimmune or psychiatric comorbidities are also considered. This guide can be used to achieve a comprehensive assessment for a personalized vitiligo practice.