Laser and Aesthetic Procedures in Patients with Vitiligo: Patient Selection, Safety, and Practical Clinical Recommendations

Background: Patients with vitiligo increasingly seek laser and aesthetic procedures. Current vitiligo guidelines primarily address medical interventions, with limited dedicated guidance on the safety of elective laser and cosmetic procedures. Objective: To evaluate the safety of laser and aesthetic procedures in patients with vitiligo and to propose practical risk-stratified clinical recommendations. Methods: This narrative review searched PubMed/MEDLINE and Embase from inception to July 30, 2026 for literature on vitiligo, disease activity and stability, Koebnerization, procedure-induced leukoderma, and laser and aesthetic procedures. Evidence from relevant original studies, case reports, case series, systematic reviews, and expert consensus documents was critically synthesised. Where direct procedure-specific evidence was unavailable, recommendations were informed by the extent of tissue trauma, epidermal disruption, thermal or chemical injury, inflammatory burden, mechanistic plausibility, and clinical judgement. Results: Procedure induced vitiligo appears to be uncommon but may occur even in clinically stable disease. Risk is likely influenced by current disease activity, previous Koebnerization, and type, intensity and depth of procedural trauma. A four-tier, mechanism-based framework, based on available evidence, expert opinion, and mechanistic reasoning rather than validated comparative studies, is proposed, ranging from minimal-risk procedures, such as botulinum toxin injections to high-trauma interventions such as ablative laser resurfacing. Conservative treatment parameters and avoidance of excessive tissue injury are recommended. Vitiligo-specific safety data remain limited for many aesthetic procedures. Conclusions: Vitiligo should not be considered an absolute contraindication to laser or aesthetic procedures. Individualised assessment of disease activity, stability, previous Koebnerization, treatment site, and procedural trauma risk may support safer patient selection. Prospective studies and consensus methodology are needed to validate procedure-specific risk estimates and establish standardised safety recommendations.