From Mechanisms to Clinical Practice: Advances in Vitiligo Treatment Across Western Medicine and Traditional Chinese Medicine.

OBJECTIVE: To review recent advances in the pathogenic mechanisms and treatment of vitiligo and to evaluate the evidence supporting Western medicine, traditional Chinese medicine, and integrative treatment strategies. METHODS: This narrative review was based on a structured literature search of PubMed, China National Knowledge Infrastructure, and Wanfang databases, primarily covering the period from January 2015 to March 2026. The search terms included "vitiligo", "pathogenesis", "treatment", "JAK inhibitors", and "traditional Chinese medicine". Articles published in English and Chinese were considered. Eligible publications included clinical trials, systematic reviews, meta-analyses, observational studies, and representative mechanistic studies relevant to the pathogenesis or treatment of vitiligo. Duplicate publications, articles not directly related to vitiligo, and studies with insufficient methodological reporting were excluded. RESULTS: Current evidence indicates that immune dysregulation and oxidative stress are central and interacting mechanisms in the initiation, progression, and recurrence of vitiligo. These mechanistic advances have supported the development of targeted and combination therapies, although the strength of evidence varies considerably among different interventions. Artificial intelligence-assisted phototherapy may improve lesion identification and irradiation planning, but current clinical evidence remains limited. JAK inhibitors, particularly topical ruxolitinib, represent an important mechanism-based therapeutic advance in non-segmental vitiligo. Surgical transplantation may provide effective repigmentation options for selected patients with stable vitiligo, although outcomes vary according to disease stability, lesion site, and surgical technique. Traditional Chinese medicine and integrative therapies may provide adjunctive clinical benefit, but the available evidence is limited by study heterogeneity and variable methodological quality. CONCLUSION: Future research should prioritize difficult-to-treat acral and mucosal lesions, relapse prevention, maintenance therapy, predictive biomarkers, and the long-term efficacy and safety of targeted and combination treatments.