Does the treatment outcome for facial vitiligo vary depending on its location?

They are divided into centrofacial, generalized facial, and frontal line-limited types.

The most common type was centrofacial, accounting for 73% of all cases, and the type with the lowest treatment response was the frontal line-limited type.

The centrofacial and generalized facial types have relatively good treatment responses, but the frontal line-limited type tends to be more difficult to treat.

① Centrofacial vitiligo

This type shows white patches concentrated around the eyes, nose, and mouth, and is the most common, accounting for 73% of facial vitiligo.

The median age of onset was 35 years, the youngest among the three types, and the rate of vitiligo also appearing on other parts of the body besides the face was the highest at 68%. This means it often appears as part of a generalized form rather than being limited to the face.

The Koebner phenomenon has been suggested as a possible cause. This phenomenon involves lesions appearing in areas subjected to repeated friction or irritation, and it is interpreted in connection with the fact that the eye area, nose, and mouth are areas with frequent stimulation from washing or facial expressions.

The treatment response is relatively good. Repigmentation of 75% or more was confirmed in about 50% of cases.

② Generalized facial vitiligo

This type shows white patches over broad areas of the face such as the cheeks, temples, and forehead, accounting for 18% of all cases.

The median age of onset was 52 years, and the rate of vitiligo also appearing on other body parts was 31%, the lowest among the three types. There was a relatively stronger tendency for it to be limited to the face rather than involving other areas.

The treatment response was the most favorable among the three types, with 53% showing repigmentation of 75% or more.

③ Frontal line-limited vitiligo

This type is characterized by white patches concentrated around the frontal hairline where the forehead meets the hair.

It was the least common, accounting for 9% of all cases, but had the highest median age of onset at 57 years.

The treatment response was particularly poor. Only 11% of patients showed repigmentation of 75% or more, and more than half showed less than 25% repigmentation.

For this type, possible contributing factors include chemical irritation such as from hair dye, or age-related changes in melanocytes.

Yes. Identifying the type before starting treatment helps set realistic treatment goals.

For the centrofacial and generalized facial types, the treatment response is relatively good, so meaningful repigmentation can be expected through active treatment.

On the other hand, for the frontal line-limited type, even though it occurs on the face, the treatment response may be low, so it is important to set the treatment duration and goals realistically rather than expecting the same results as other types of facial vitiligo from the start.

In other words, for facial vitiligo, it is not enough to simply look at the size of the lesions; checking where and in what pattern they are distributed together allows for a more accurate explanation of the treatment course.

They were expanded into a classification of 12 types that includes generalized vitiligo.

This study was first presented at the 1st World Vitiligo Congress held in Rome, Italy in 2016. Subsequent follow-up studies led to the development of a classification system that encompasses not only the face but also the distribution patterns of vitiligo across the entire body.

Vitiligo is not a disease that appears in the same way in all patients. Therefore, rather than broadly saying "vitiligo on the face," it is necessary to check the location and pattern of the lesions. This is because once the type is identified, the treatment response and long-term course can be predicted in more detail.

The face is generally an area with a good treatment response. However, there are exceptional types like the frontal line-limited type that respond more slowly, so it is important to take this into account from the beginning when planning treatment.