Heal House Vitiligo Research 17 · Original Article
Is facial vitiligo all the same? How can it be classified into types?
Classification of facial vitiligo: A cluster analysis of 473 patients
Last reviewed
In short
Facial vitiligo was classified into three types based on the location of the lesions: centrofacial, generalized facial, and hairline-limited. The age of onset and treatment response differed by type.
Vitiligo on the face is the area that causes the most distress for patients. Fortunately, the face is generally known to respond well to treatment. However, treatment outcomes were not all the same. Which types of facial vitiligo respond well, and which may show less effect? This study began with that question.
Q1 How Was Facial Vitiligo Classified?
It was classified into three main types. The 'centrofacial type,' where lesions cluster in the center of the face around the eyes, nose, and mouth, was the most common at 72.9%. The 'generalized facial type,' which spreads across the entire face, accounted for 18.0%, and the 'hairline-limited type,' which appears along the hairline on the forehead, accounted for 9.1%. When the lesion locations of 473 patients were grouped by computer analysis, these distinctions emerged naturally. This classification was not arbitrarily assigned by me but was revealed by the actual data.
Three types of facial vitiligo and their proportions (473 patients)
| Type | Proportion | In simple terms |
|---|---|---|
| Centrofacial | 72.9% | Clusters in the center of the face (around the eyes, nose, and mouth) — most common |
| Whole Face | 18.0% | Spreads across the entire face |
| Frontal line-limited | 9.1% | Appears along the hairline on the forehead |
Q2 How Does Treatment Response Differ by Type?
Treatment response differed noticeably by type. The most common centrofacial type responded relatively well to treatment, as is generally the case with facial vitiligo. It could be seen as a form of generalized vitiligo that spreads to the body, appearing on the face. The generalized facial type often began at an older age and was less likely to appear on other parts of the body. In contrast, the hairline-limited type started later and tended not to respond well to conventional phototherapy. This means that even for the same facial vitiligo, if it is the hairline-limited type, phototherapy alone may not restore color as expected. Therefore, knowing the type helps in anticipating whether phototherapy will be effective for a particular patient or whether other methods should be used together, providing practical assistance in planning treatment.
Closing remarks
Rather than treating facial vitiligo as a single entity, this study was a first attempt to organize it into three types with different characteristics, based on where the lesions appear. Knowing the type makes it considerably easier to anticipate the course of the condition and to tailor treatment. Above all, being able to explain to patients a little more specifically, "This type tends to behave in this way," has been a great help in clinical practice.
