The natural history and prognosis of vitiligo can be difficult to predict. Baseline patient characteristics including family history, the type and location of vitiligo and clinical markers of disease activity must be understood by the treating clinician in order to plan treatment and address patient expectations. The non-segmental subtype and acral involvement suggest a risk of future autoimmune thyroid disease. Dermoscopy findings and serum or lesional biochemical markers may also serve as predictors of disease activity. The extent of depigmentation, the involvement of the hair follicle unit and repigmentation patterns provides prognostic information on repigmentation. It is important for the practicing clinician to identify prognostic factors that can indicate progressive and active disease, as early treatment initiation in these patients will help prevent uncontrolled or irreversible disease activity.