There is an important difference between wanting to change how you look and seeking treatment for a disease. Changing your hair color is a choice. Getting a tattoo is a choice. Living with vitiligo is not.
Vitiligo is a chronic autoimmune disease that occurs when the immune system attacks and destroys melanocytes, the cells that produce skin pigment. The resulting white patches may be its most visible manifestation, but visibility should not be confused with vanity.
The National Institutes of Health (NIH) describes vitiligo as a chronic autoimmune disorder, and the American Academy of Dermatology calls it a medical condition. That distinction matters because the persistent characterization of vitiligo as “cosmetic” consequently determines when and whether patients can obtain treatment.
A cosmetic service is intended primarily to alter appearance. Vitiligo treatment addresses an underlying disease process. We would never characterize treatment for another autoimmune disease as cosmetic, simply because some of its symptoms are visible. Vitiligo deserves the same clinical seriousness.
The burden of the disease can also extend beyond changes in pigmentation. People living with vitiligo report anxiety, depression, stigma, social isolation and disruption to their sense of identity. Some avoid social situations or feel compelled to conceal their condition. Vitiligo can also involve physical symptoms such as skin sensitivity and itching and is associated with other autoimmune conditions.
These challenges can be particularly difficult when the disease is immediately visible to everyone a person encounters. People with vitiligo can face stigma and discrimination, especially in the workplace. They should not have to demonstrate that their experiences are sufficiently painful before their disease is taken seriously.
For Black communities, this is also a question of health equity. We know what happens when a disease is misunderstood, overlooked, or fails to receive the attention its patients deserve. For decades, advocates have fought to secure greater recognition, research and investment for sickle cell disease, which disproportionately affects Black Americans. The conditions are different, but the lesson is relevant: misconceptions about a disease should never become barriers to appropriate care.
Our federal health agencies already provide a strong foundation for getting this right. The Centers for Medicare & Medicaid Services (CMS) have explicitly stated that treatments indicated for vitiligo are not considered cosmetic under Medicare Part D plans. The Department of Veterans Affairs likewise recognizes vitiligo as a medical rather than cosmetic condition, and federal employee health plans provide coverage for vitiligo treatments.
Yet Medicaid patients often encounter a very different standard. New York is one of only eight states that have policies restricting access to vitiligo therapy, affecting thousands of Medicaid beneficiaries. That puts New York in the same company as Alabama and South Dakota. Most states cover vitiligo treatment, and six states have removed previous “cosmetic” classifications since 2024.
It’s time for New York State to catch up.
CMS should provide state Medicaid directors the same fundamental clarification it has already provided in Medicare: treatments indicated for vitiligo should not be categorically excluded as cosmetic. Doing so would help ensure that an autoimmune disease is not treated the same as elective efforts to change one’s appearance.
How we classify a disease shapes policy. Policy shapes access to care. Calling vitiligo “cosmetic” is not merely inaccurate terminology –– it can become the rationale for denying people the treatment they need.
Vitiligo is an autoimmune disease. Our healthcare policies should treat it like one.
Jordan J.G. Wright is the assemblyman for New York’s 70th District in Harlem.
