24 Weeks On Opzelura – A Vitiligo Treatment Update (With Pictures!)

If you have wondered how the vitiligo treatment Opzelura works, here are answers, images, and results to get you started. This is my personal journey, but I’m pretty impressed!

**All information, photos, observations, and opinions given in this post are based on my own personal experience as a patient using Opzelura. For any medical inquiries, please contact a medical professional**

I have had vitiligo since I was 19 years old. I have discussed it previously in terms of getting diagnosed and the emotional effects that this specific disorder has on one’s mental health, but I’ve never discussed treatment before. That’s because there wasn’t one available. But in February 2022, I started treatment for vitiligo so that we could see what happened together. So here’s how things went. 

What Is Vitiligo?

The NIH defines vitiligo as “a chronic (long-lasting) autoimmune disorder that causes patches of skin to lose pigment or color. This happens when melanocytes – skin cells that make pigment – are attacked and destroyed, causing the skin to turn a milky-white color.”

What this means in layman’s terms is that the body itself decides that the pigment in someone’s skin needs to be attacked and removed. It does this because it thinks that it is helping (much like your body fighting the flu), but it has gotten its wires crossed and it is attacking healthy tissue. This leaves the vitiligo patient with white spots in various regions of the body and – until recently – when the pigment was gone, it was gone. 

Before July 2022, there was virtually nothing available to treat vitiligo. As a vitiligo patient, I’d had light therapy and bleaching creams mentioned to me, which could respectively (and only possibly) slow the progression of vitiligo or lighten all of your skin color to match the melanin-free spots. And as a patient, I can tell you, I was not sold and never tried either. 

What Is Opzelura? 

In July 2022, the options for vitiligo treatment changed. Opzelura is the first FDA-approved prescription treatment for vitiligo repigmentation. It is a topical cream that the patient applies to the affected area(s) twice per day. 

According to their website, Opzelura:

• Is proven to help significantly restore some pigment over time in some patients.
• Is a steroid-free topical cream that you can apply yourself.
• Is proven to help restore pigment on the face and body (up to 10% body surface area).
• Can even be applied to sensitive areas like around the eyes, mouth, and genitals.

How Does Opzelura Work?

Because vitiligo is an autoimmune disease, the signals that get sent to the body – either globally or in specific areas – are that the body’s melanin should be removed so that the body can be healthy. 

Opzelura is thought to “inhibit JAK-STAT signaling, a key driver of depigmentation in vitiligo.” This essentially means that the areas in which the treatment cream is spread are able to send messages to the body (or stop autoimmune messages) saying that this specific surface is open for normal pigmentable business again.

Where Can I Get Opzelura?

Opzelura is a prescription, so you are required to see a doctor to get approval. This would most often be done through a dermatologist, but you may be able to discuss this prescription with your primary care physician as well. 

Speaking from my personal experience, this prescription was not covered by my health insurance. I was able to find a semi-local pharmacy (through a suggestion from my doctor’s office) that charged me a flat fee and mailed it to my home. This scenario could change at any time, so check with your insurance and local pharmacy if you plan to try this medication. 

How I Decided To Try Opzelura

Because I have had vitiligo since I was 19 and mine is the bilateral type (meaning that it appears on both sides of my body in the same spots – the top of my feet in the same spot, both hands in similar spots, inner thighs in the same spot, etc.), it is something I am used to seeing on my body. 

In the beginning, it progressed quickly. The first spot was on my breast, the second (within weeks) was on my right ring finger, and it continued heavily for years. Somewhere around the age of 35, it slowed down significantly. My spots do continue to grow and I do get new ones, but as one doctor described it to me, vitiligo tends to burn itself out. And if not altogether, it usually slows down. 

Now being 47, I have wondered if I wanted to do any treatment at this stage of my life. I have some spots on my face that make me especially self-conscious, particularly around my eyes and my lips, though. Because I am Caucasian, you cannot see them in winter unless you are really looking, but when the sun comes out, they are obvious. And that bothers me. 

So I decided to start using Opzelura on my elbows. My left elbow (which is the one I will primarily focus on – we’ll discuss the other one later) has the largest vitiligo patch on my entire body. It is approximately 3 inches long and 2 inches wide. (In the image above, you may see a darker area in that spot, but that is only a shadow from my bone curvature below.)

I figured, if this vitiligo treatment worked, excellent, I’d try using it elsewhere (maybe on my face) and if it didn’t or the results made things worse, I was comfortable sacrificing my elbows to the cause. And here we are. 

Note – In all of the images, you can gauge changes and similarities by starting at the little red mole (cherry angioma) I have just above my elbow if needed.

My Month-To-Month Results On Opzelura

The Opzelura medication instructions state that at 24 weeks the patient should evaluate their progress. At that point, the patient should speak with their healthcare provider to determine if more treatment is needed. 

I did a full 24 weeks of using the cream on my elbows twice per day, every single day, and tracked that here. 

Left Elbow Opzelura Changes During Month #1

The first month was between February and March. As you can see from the photo comparison, not much changed in those first weeks, except for one tiny thing. 

There is a teeny tiny spot of melanin that had not been there in February. I actually thought it might be dirt because I couldn’t remember the last time I’d seen any pigment in that area, so that was promising!

Left Elbow Opzelura Changes During Month #2 

Betwee March and April of 2023, I wasn’t sure much had changed. That tiny spot was still there and had maybe grown a bit. There were some tiny dots around it, but I wasn’t sure if those were just my complexion (I have a pink undertone) or something more. So I kept watching and waiting. 

Left Elbow Opzelura Changes During Month #3 

During the third month, I was sure I was starting to see changes. 

Not only were there lots of little pigmented spots around my elbow now, but all of the edges around the spot began to get less defined. If I had drawn a straight line around the large white vitiligo spot as it was in February, it wouldn’t be the same any longer. Some of those white edges had developed new pigment. 

Left Elbow Opzelura Changes During Month #4 

At this point, many changes were evident and it was exciting that the pigment wasn’t going away. 

You can see that from the top of the vitiligo spot to the area underneath, the edges were definitely filling in with pigment. There was additional lacing of pigment beginning to connect the spots inside and lots of new spots of melanin. 

Left Elbow Opzelura Changes During Month #5 

At this point, you can see the changes happening more easily. 

Particularly in the upper area of the vitiligo spot, you can see that many tiny pigmented spots are appearing as well as beginning to connect with other darker spots. 

Left Elbow Opzelura Changes During Month #6 

The last month of my 24 weeks had the most clear progress. 

You can see in the images above that the lower area of the vitiligo spot has begun to fill in with more pigment spots and the upper area has so many pigment spots that you almost don’t know that it all used to be white and lack any melanin! I was incredibly impressed with the results. 

Remember, there is no cure for vitiligo and there has never been an effective treatment before. The fact that this much pigment returned was virtually unheard of before this medication. 

But It Continues!! 

What Happens If I Stop Using Opzelura?

After the 24 weeks, I got lazy. Life happened and I basically forgot to use the cream for the weekend. After the weekend was over, I reached for the tube of cream, but got to thinking… what would happen if I stopped using it? Would the pigment stay or would it go? Would there be any other changes to my skin?

Here are the answers to those questions (based on my own personal experience). 

Does Opzelura Keep Working If I Stop Applying It?

The answer to this question is maybe. There is very little data that I could find regarding this question, so I looked forward to conducting my own experiment. 

According to the limited research available, you may need to use Opzelura on and off indefinitely to maintain repigmentation. Since vitiligo isn’t curable, the body will likely continue to fight anything it feels isn’t healthy, which may include any repigmented areas. 

My personal experience was a mixed bag. 

As you can see, without having applied Opzelura for two months, the upper area of my large vitiligo spot continued to darken into more of a large pigmented spot, but the little flecks of pigment in the lower area seemed to disappear. 

Right Elbow Opzelura Changes

My right elbow has significantly more pigment than my left elbow. It is the only part of my body that is not similar in form as far as my vitiligo spots go, so I was curious what would happen. Here are images across all of the months. 

As you can see, there is virtually no change to the lower left spot, but there are changes to the upper right spot. 

While the upper right spot begins as kind of egg-shaped with a bit of pigment through the middle, by October, the pigment has grown across the width and filled in quite a bit. Again, I only used Opzelura from February through August 2023, so the improvement between August and October was without direct treatment. 

My goal with all of this is to help answer some questions for you, myself, and the future. If you have any specific questions about my experience with vitiligo and/or Opzelura treatment, please ask! I am an open book.