New international criteria defining vitiligo severity and relapse highlight the need to integrate clinical measures with patient-reported psychosocial impact in both assessment and treatment decisions.

Published as a consensus statement in the journal JAMA Dermatology, the authors addressed longstanding gaps in vitiligo assessment, moving beyond reliance on body surface area (BSA) alone to capture the disease’s full clinical and psychosocial burden.

This need was further underscored by the absence of a standardised definition of vitiligo relapse, particularly as new treatments emerge, such as the recently approved topical Janus kinase inhibitor, ruxolitinib – the first repigmentation therapy for vitiligo available on the NHS.

Consensus process

The international multidisciplinary panel used a mixed-methods approach combining a literature review, qualitative research, two Delphi survey rounds and a final consensus meeting to define mild, moderate and severe vitiligo and relapse.

Secondary aims included identifying clinically meaningful domains and improving consistency across trials, regulatory frameworks and routine care.

In total, 91 participants from 21 countries registered, with 85 completing the first Delphi round and 81 the second (95% response rate in both rounds). The group represented five continents and included dermatologists, researchers, nurses, psychologists, journal editors and people with lived experience of vitiligo.

The qualitative phase involved 30 people who participated in online interviews or focus groups, using a semi-structured guide to explore how vitiligo affected daily life, emotional wellbeing, social interactions and identity.

Discussions covered both physical features, such as the extent and visibility of depigmentation, and psychosocial impact, including stigma, self-image and quality of life.

The interviews continued until data saturation was achieved and were then transcribed verbatim and analysed thematically, identifying 17 domains of patient-perceived severity. Participants also highlighted difficulty in defining relapse, underscoring the lack of consistent terminology.

A multidimensional severity framework for vitiligo

The final consensus meeting included 44 participants, including 16 patient representatives. Findings confirmed that while BSA remains a starting point, it does not capture overall disease burden.

A two-step classification was proposed using BSA thresholds (<3% mild, 3% to <10% moderate, ≥10% severe), followed by refinement using additional clinical and psychosocial criteria.

A total of 12 criteria were identified to upgrade severity. Major factors included disease activity; involvement of visible areas such as the face, hands or genitals; psychological distress; stigmatisation; lack of self-acceptance; and overall burden.

Minor factors included darker skin tone – as the condition can be more noticeable in people with richly pigmented skin – younger age and its impact on education or employment.

Rapidly progressive vitiligo was classified as severe regardless of BSA. The panel also emphasised the need to combine clinical judgement with patient-reported outcomes rather than relying solely on scoring tools.

Relapse was defined as loss of pigmentation in previously repigmented lesions -whether spontaneous or treatment-induced – with a suggested timeframe of around three months after treatment cessation. No consensus was reached on the extent of pigment loss required in relapse.

Implications for vitiligo assessment

The panel recommended considering systemic therapy for moderate-to-severe disease, particularly in rapidly progressive cases, with decisions guided by both clinical extent and psychosocial impact.

Some limitations were apparent, including an under-representation of caregivers of children with vitiligo, lower participation at the final consensus meeting (54%), and potential language barriers for non-native English speakers.

Despite this, the framework provides a globally informed, patient-inclusive approach that aims to better align clinical assessment with lived experience.

The authors suggested that adoption of the framework could improve decision-making, strengthen trial design and support more equitable access to emerging therapies.

Future research should validate the criteria in practice, refine psychosocial measurement tools and support implementation across healthcare systems, they added.

Reference
Eleftheriadou V et al. Definition of severity and relapse for vitiligo: an international consensus statement. JAMA Dermatol 2026;March 25:doi:10.1001/jamadermatol.2026.0294.