Vitiligo Follow-Up Case: Treatment Adjustment and Expectations — Village Dermatology Katy & Houston, Texas
By: Dr. Ashley Baldree
Vitiligo is a chronic autoimmune skin condition that can require patience, consistency, and individualized treatment plans. At Village Dermatology, serving patients in Katy, Texas and Houston, Texas, we regularly follow patients with vitiligo to monitor response and adjust therapy as needed.
This case highlights a 48-year-old female returning for follow-up after initiating topical treatment for vitiligo affecting the hands and wrists.
Chief Complaint
Follow-up evaluation for vitiligo, initially assessed on August 21, 2025.
History of Present Illness
The patient returned for reassessment of vitiligo after previously starting:
Opzelura® (ruxolitinib) cream twice daily
Controlled sun exposure for 10 minutes, three times weekly
She reported using Opzelura for approximately one month without noticeable improvement. She also expressed concern about the cost of the medication and preferred a treatment option that was more affordable and covered by insurance.
Clinical Examination
A focused dermatologic exam was performed, including:
Scalp and hair inspection
Face
Hands and wrists
The patient appeared well-nourished, alert, and in no acute distress.
A dermatoscope was utilized during examination.
Key Findings
Depigmented patches involving:
Right radial dorsal hand
Left ulnar dorsal hand
Right ventral wrist
Left ventral wrist
Evidence of confetti-like pigmentation, suggesting early repigmentation activity
Diagnosis
Vitiligo
Vitiligo is an autoimmune condition in which the immune system targets melanocytes, leading to depigmented or white patches of skin. Disease course and response to treatment vary among patients, and improvement often requires several months of consistent therapy.
Vitiligo can be associated with other autoimmune conditions, including:
Thyroid disease
Pernicious anemia
Diabetes
Treatment Plan Adjustment
After reviewing treatment expectations and cost concerns, the patient elected to transition to a steroid-sparing combination topical regimen.
New Treatment Regimen
Tacrolimus 0.1% ointment
Apply twice daily Monday through Friday
Clobetasol 0.05% cream
Apply twice daily on weekends only
Controlled sunlight exposure
10–15 minutes, 3 times per week, without burning
Updated clinical photographs were obtained for future comparison.
Patient Counseling
The patient received extensive counseling regarding:
Treatment Expectations
Vitiligo treatments often take months to show visible improvement
Combination therapy improves outcomes while minimizing steroid side effects
Skin Care & Phototherapy
Vitiligo may respond to:
Topical steroids
Topical calcineurin inhibitors
Natural sunlight or phototherapy
Use broad-spectrum SPF 30+ sunscreen on unaffected skin
Medication Safety
Prolonged steroid use may cause:
Skin thinning (atrophy)
Visible blood vessels (telangiectasias)
High-potency steroids should be avoided on the face, groin, and skin folds
The patient demonstrated understanding of proper medication use and potential side effects.
Follow-Up Plan
Follow-up visit in 3 months
Reassess response to therapy and degree of repigmentation
Adjust treatment plan as needed
Why Follow-Up Is Essential in Vitiligo
Vitiligo management requires ongoing monitoring to ensure:
Appropriate response to treatment
Early identification of repigmentation
Safe long-term medication use
At Village Dermatology in Katy and Houston, we provide personalized, evidence-based vitiligo care tailored to each patient’s needs, lifestyle, and treatment goals.
