The Proposed Categorization of Vitiligo Lesions on the Hands

Vitiligo is a common depigmentation disorder characterized by patchy white macules. It has been reported that vitiligo lesions, particularly in exposed areas, such as the face and hands, cause severe psychological distress. Although the classification and outcome of facial vitiligo have been proposed, clinical analyses featuring hand vitiligo are very limited, irrespective of its severe psychological impact. In this study, we investigated hand lesions in nonsegmental vitiligo patients and found that the distribution of hand vitiligo was symmetric, whereas the dominant hand was more frequently affected. Moreover, our clustering analysis newly classified hand vitiligo lesions into four distinct subtypes (n = 140): focal/scattered (46.4%), distal digit (31.4%), universal (12.9%), and proximal digit (9.2%) and their clinical characteristics. The focal/scattered type is the most common subtype and exhibits a distinctive prevalence in pediatric cases. The distal digit type was suggested to be associated with smoking or the Koebner phenomenon. The universal type is a distinct subtype, with onset in older age and a poor response to treatment. The proximal digit type is the rarest subtype, with onset at a young age. In conclusion, these findings deepen our understanding of the heterogeneity of hand vitiligo and support the development of personalized treatment strategies.