As antioxidants remain a controversial tool for vitiligo therapy worldwide, experts advise sticking with evidence-based options, which include several supported by clinical studies: combined vitamin C, vitamin E, and alpha-lipoic acid (ALA); Ginkgo biloba; and Polypodium leucotomos.

Perhaps joining this list, they told Medscape Dermatology, is a specially formulated superoxide dismutase (SOD) that was found to improve the efficacy of phototherapy in a recently published study of patients with vitiligo.

Antioxidants Alone?

In people with vitiligo, melanocytes are more prone to oxidative stress and damage from reactive oxygen species, said Giovanni Leone, MD, a dermatologist at the Photodermatology and Vitiligo Treatment Center of Israelite Hospital in Rome, Italy. “So apart from combining antioxidants with phototherapy,” he noted, “at least in our clinic, we believe strongly that antioxidants are harmless and can help to stabilize the disease.” 

Accordingly, when treating active vitiligo, “even if patients can’t or don’t want to undergo phototherapy, we usually prescribe oral supplementation with antioxidants,” he told Medscape Medical News.

For the reasons stated above, Amit Pandya, MD, agreed that patients with vitiligo should be on antioxidants, which, he pointed out, are generally inexpensive and harmless. Pandya is director of the Pigmentary Disorders Clinic and associate medical director of phototherapy at the Palo Alto Medical Foundation in Sunnyvale, California.

“If we look at all the data over the years,” Pandya told Medscape Medical News, “it seems the oxidative stress pathway is deregulated in patients with vitiligo. This epidermal oxidative stress could contribute to the onset of inflammation that leads to melanocyte damage in vitiligo. But it is not clear if this is unique in vitiligo compared to other inflammatory skin diseases.” 

He added that although it makes sense to consider antioxidants for people with vitiligo, clinical trials with antioxidants in such patients are very limited, and a systematic review published in 2018 did not find enough evidence to support treatment recommendations.

“While we wait for more studies,” Pandya said, “I ask my patients to take easily available antioxidants, including vitamins C and E, ALA, and Ginkgo biloba.” He added that patients with actively worsening disease presumably have more oxidative stress in their skin, and antioxidants might be particularly indicated in this group.

Small randomized controlled studies support use of combined vitamin C, vitamin E, and ALA, as well as extracts of G biloba and P leucotomos, noted Pandya and Nanette Silverberg, MD, MPH, clinical professor of dermatology and pediatrics at the Icahn School of Medicine at Mount Sinai in New York City. Additional dietary antioxidants that proved protective against vitiligo in a genetic association study included coffee, red wine, and standard tea.

However, Silverberg told Medscape Medical News that although vitamins fit patients’ desire for natural skincare products, she avoids antioxidant monotherapy for vitiligo because the data support using antioxidants in combination with other therapies such as phototherapy.

In a review of 38 studies involving the treatment of vitiligo with a 308-nm excimer light, published in January 2026, adding topical antioxidants yielded a relative risk of 43.00 for achieving 50% repigmentation vs excimer light alone. Additionally, in a 2021 review of four studies, adding antioxidant supplements to phototherapy produced significantly better efficacy than phototherapy alone.

Along with oxidative damage, Silverberg said, widespread disease creates systemic inflammation, which requires multiple anti-inflammatory approaches that can include adjunctive antioxidants. Over the years, she added, companies have introduced various topical and oral antioxidant vitamin combinations to address such issues, with modest success.

Regarding additional oral supplements for vitiligo, Silverberg usually recommends multivitamins and extra vitamin D to stimulate production of SOD and glutathione, an antioxidant enzyme shown to be lacking in people with vitiligo.

Gliadin-Protected SOD (GP-SOD)

In a study published online in June in Photodermatology, Photoimmunology & Photomedicine, Leone and colleagues randomly assigned 40 patients with nonsegmental vitiligo involving less than 5% of their body surface area to twice-weekly targeted ultraviolet B (UVB) phototherapy using a 308-nm excimer lamp, with or without oral GP-SOD.

At 6 months, both patient cohorts achieved significant Vitiligo Area Scoring Index reductions — a mean of 1.65 points for the GP-SOD group and 1.14 points for UVB alone (P < .0001 for all analyses). “Our study has demonstrated the usefulness” of adding antioxidant treatment to phototherapy, Leone told Medscape Medical News.

Binding SOD with a soluble gliadin polymer protects the active ingredient during transit through the gastrointestinal tract, the study authors wrote. The only contraindication for GP-SOD is celiac disease because the polymer formulation contains gluten.

The 308-nm excimer lamp provides equivalent efficacy to 308-nm excimer lasers used stateside, Leone said, except that excimer lamps cost two to three times less in Europe. Besides sparing healthy skin surrounding vitiligo lesions, he added, targeted phototherapy is faster and more powerful than conventional phototherapy. In his experience, vitiligo treatment with the excimer lamp alone initiates repigmentation at a median of 2-3 months and adding antioxidants typically shortens the interval to 1.5 months, he added.

According to Pandya, the intense, collimated beam of excimer lasers used in the US provides faster treatment than excimer lamps. With excimer laser treatment, he said, a dose of 1000 mJ/cm² can be delivered in just 1 second vs 20 seconds with excimer lamps.

With 20 years having passed since publication of randomized controlled antioxidant studies in vitiligo, Pandya said, the new study will “put antioxidants back on the map and cause dermatologists, and maybe even patients, to start paying attention again.” He was not involved with Leone’s study but was asked to comment on the results.

The GP-SOD study moreover addresses concerns Pandya had with prior research from some of the same authors, which showed that GP-SOD significantly improved results and reduced risks of conventional full-body phototherapy. Perhaps because the earlier study focused on patients with nonsegmental vitiligo lasting more than 20 years, he explained, 6 months’ combination therapy produced only 19.85% repigmentation, which Pandya said is not very impressive. With phototherapy alone, he added, average full-body repigmentation rates after 6 months’ treatment are nearly 50%.

Silverberg applauds the new GP-SOD study’s combination of medical therapy with a natural extract to enhance response. “This demonstrates the whole concept of vitiligo — we need to concentrate on doing many things to address the multiple mechanisms of disease.” She also was not involved with the study.

Instead of offering snake oil, said Silverberg, “GP-SOD demonstrates a definable benefit.” Nevertheless, she added, the product’s capabilities in vitiligo must be better defined through future studies.

As for pediatric vitiligo, “we don’t necessarily talk about antioxidants in kids because it’s controversial,” Silverberg explained. “We don’t know the safety. And having a product that’s well-studied will be very important, particularly for younger patients with vitiligo.” 

Vitiligo Treatment Patterns

Antioxidants’ advantages aside, Pandya told Medscape Medical News that he doubts that most patients in the US with vitiligo are offered antioxidants. Typical US community dermatologists might suggest phototherapy for patients who fail topical therapies, he explained. “But most dermatologists don’t have full-body phototherapy facilities in their offices. Patients generally have difficulty finding and getting coverage for phototherapy,” so treatment discussions generally stop there.

Some community dermatologists will recommend oral steroid minipulses for rapidly progressing or segmental vitiligo, Pandya added, “and in the near future, we will have oral JAK inhibitors for patients with active and/or extensive disease.”

According to a database study of nearly 25,000 American patients with vitiligo published in May, the most common treatments prescribed during follow-up were topical corticosteroids, topical calcineurin inhibitors (TCIs), phosphodiesterase-4 inhibitors, and oral corticosteroids. Only about 6%-12% of patients received phototherapy and 27%-32% of patients received no treatment post-diagnosis.

In an earlier survey of US and European dermatologists, the most commonly reported treatments were TCIs (40%) and phototherapy (30%).

Apart from the laser-vs-lamp discussion, vitiligo treatment differs little between the US and Europe, according to Leone, Pandya, and Silverberg. Although US and international treatment guidelines are very similar, Leone said, the lack of insurance coverage creates barriers to phototherapy in Europe as well.

JAK Inhibitors and Phototherapy

The first topical treatment specifically approved for vitiligo, topical ruxolitinib, earned FDA approval (for nonsegmental vitiligo in people ≥ 12 years) in 2022 and European Medicines Agency approval in 2023. Upon European approval, Leone said, he and his colleagues worried that phototherapy would be pushed aside or abandoned. “But that’s absolutely not the case,” Leone said, noting that recent publications including a study in which Pandya was the lead author have shown that combining ruxolitinib cream with phototherapy yields better, faster results.

JAK inhibitors are unlikely to replace antioxidants in vitiligo because JAK inhibitors do not do what antioxidants do, Pandya said. Although it is too soon to say whether combining phototherapy with oral JAK inhibitors will show efficacy like that of phototherapy and antioxidants, Leone added, he expects such findings to be confirmed within a few years.

Leone reported having been a clinical investigator and advisor for Incyte, a clinical investigator for Isocell and Pfizer, and an advisor for ISDIN. Pandya reported having been a consultant for Incyte, Pfizer, AbbVie, Clinuvel, Lilly, Sun Pharma, and Takeda and reported owning shares in Tara Medical. Silverberg reported having been a consultant and investigator for Incyte, Pfizer, and AbbVie.

John Jesitus is a Denver-based freelance medical writer and editor.