An estimated 1 in 100 people in the UK live with vitiligo, a long-term condition characterised by light patches of skin that have lost their pigmentation. Although not generally painful, its appearance can cause distress and emotional impact, especially when it affects visible areas such as the face, neck, or hands.
Until now, treatment options have generally addressed the symptoms rather than the root cause of the disease, such as using camouflage creams to reduce the visibility of patches and topical corticosteroids to try to restore pigment in early or active patches. However, long-term use of topical steroid creams can thin and damage the skin, and must therefore be used with caution. Light therapy is also offered, but it requires repeated hospital visits and does not always produce lasting results. Other treatments have been used but results can be slow and relapses are common.
A new topical medicine, ruxolitinib cream (brand name Opzelura), will now be recommended for use on the NHS in England for certain people with vitiligo, marking the first time the NHS has approved a medicine specifically designed to restore skin pigment and support repigmentation. The treatment stems from a focus in recent years on therapies that target the underlying autoimmune process, rather than treating the symptoms.
Vitiligo is a long-term autoimmune disease, in which the immune system attacks melanocytes, the cells that produce melanin, the pigment that gives skin its colour. The result is pale or white patches of skin, that can appear anywhere on the body, but are common on the face, hands, neck, and skin creases. It can also affect hair, causing it to turn white in affected areas.
The new cream works by interrupting the specific immune pathway that drives the loss of pigment in the first place, allowing the melanocytes to recover and start producing melanin again. Ruxolitinib will be offered to nearly 100,000 people aged 12 and over who have a form of the condition characterised by white patches typically appearing symmetrically on both sides of the face and body (non-segmental vitiligo). The treatment is particularly intended for patients whose vitiligo affects visible areas such as the face, where the condition can have the greatest psychological and social impact. The medicine is available as a 1.5% topical cream and is typically prescribed for areas affecting up to around 10% of the body surface.
In clinical trials, a substantial proportion of patients achieved at least 75% improvement in facial pigmentation, as measured by the Facial Vitiligo Area Scoring Index (F-VASI), with the best results seen on the face and hands. Treatment is long term and re-pigmentation is gradual, often noticeable after several months, with improvements seen over a 1-to-2-year period. Better outcomes in these areas are thought to be linked to the higher concentration of hair follicles, which contain melanocyte stem cells that help restore pigment.
The treatment is applied twice daily to affected areas of the skin, with results usually checked after about six months, and will be offered where standard steroid creams have not worked or are not suitable, following a deal struck by the NHS. According to the NHS, the cream may cause mild side effects in some patients, most commonly redness or irritation at the application site, as well as acne at the application site or common cold symptoms (nasopharyngitis).
The NHS recommendation follows a detailed review and appraisal by the National Institute for Health and Care Excellence (NICE). In earlier guidance published in August 2025, NICE did not recommend ruxolitinib for routine NHS funding because of uncertainties surrounding its long-term effectiveness and cost-effectiveness. However, following updated clinical evidence and commercial discussions with the manufacturer, NICE has now issued final guidance recommending the treatment for eligible patients. Once the guidance is formally published, NHS England will be required to fund the treatment within a statutory timeframe, enabling patients to access it through specialist dermatology services.
Helen Knight, Director of Medicines Evaluation at NICE, said: “Vitiligo that affects the face can be a devastating disease and have a profound impact on a person’s quality of life. This will be the first licensed treatment for the condition to be made available in the NHS, and having an effective drug will be welcomed by the thousands of people living with this condition.”
Sarah Sakeena Marshall Consultant, Writer, Editor, Climate Change, National Securit
