If vitiligo is spreading, does the treatment method change?

Yes. The face generally responds well to treatment, but the hands and feet are more difficult to treat.

After ultraviolet therapy, repigmentation often starts from melanocytes remaining in hair follicles.

The face has a relatively abundant reservoir of these melanocytes, leading to good treatment response, whereas the hands and feet have few or no hair follicles, so treatment response may be lower.

However, lesions that have newly appeared within the last 2–3 months, even on the hands or feet, may respond to treatment. Because melanocytes may not have been completely lost yet, it is important to start treatment early.

If vitiligo is sufficiently stable, surgical treatment may be considered.

In areas that do not respond well to ultraviolet therapy or excimer laser, such as the lips or fingertips, surgical treatments like micro-punch grafting may be an alternative.

However, surgery is generally considered after confirming that vitiligo has been stable for at least one year. This is because if surgery is performed while vitiligo is still spreading, depigmentation may recur at the graft site.

Conversely, if most of the body is depigmented and repigmentation treatment is not realistically feasible, depigmentation therapy to remove pigment from remaining normal skin and even out the overall skin tone may be considered.

The most important thing is to first distinguish whether the vitiligo is currently 'spreading' or 'stable'.

Vitiligo treatment does not apply the same method to all patients.

If it is the active phase, treatment to suppress progression is a priority; if it is the stable phase, ultraviolet therapy or excimer laser is used to induce pigment restoration. For stable lesions that do not respond sufficiently to existing treatments, surgical treatment may be considered.

Also, treatment response may vary depending on the location of the lesions, such as the face versus the hands and feet.

Ultimately, it is more important to determine 'what treatment my vitiligo needs now' rather than 'which treatment to choose'.

Especially if vitiligo is newly appearing or rapidly expanding, rather than giving up early thinking it is difficult to treat, it is better to evaluate the condition early and start appropriate treatment.