Why does the same treatment work differently depending on where the patch is?
Pigment cells regrow mainly from a reservoir of melanocytes living in hair follicles, and how much of that reservoir survives varies by body site. A dermatology reference source I checked states plainly that treatment is most successful on the face and trunk. It states that hands, feet, and areas where the hair has already gone white respond poorly. Evidence
Why this matters
- Sources cited, not yet graded
The same reference source notes that an international taskforce does not treat the body as one surface. It scores extent on five body regions: head and neck, trunk, arms, legs, and hands and feet. Clinicians already treat region as a variable that matters.
Considerations
- Depends on you
A site-level pattern is not a promise for your own patch. New patches are documented as more likely to respond than long-standing ones. The reservoir explanation does not rule out a face patch responding poorly, or a hand patch responding well.
Questions for your dermatologist
Does where my ___ is change what you would expect from this treatment?
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What if more than one area needs treatment, or a patch is changing fast?
A systemic medicine such as Rinvoq (upadacitinib) is not body-area-specific. It changes immune signaling throughout the body rather than one patch. It comes up mainly when topical or light-based options are exhausted across several areas at once. Separately, some specialists discuss a short course of an oral corticosteroid for selected, fast-changing vitiligo. Its goal is different from a cream or light box: it tries to control active spread, not guarantee that color returns. Evidence Evidence
Why this matters
- Sources cited, not yet graded
The trials behind Rinvoq report facial and total-body results, not separate reliable estimates by hands, feet, genitals, or scalp. It is reviewed as a whole-body option, not chosen area by area. The consensus guidance I read on oral corticosteroids describes selected off-label use in unstable or rapidly progressing disease, distinct from the routine per-area choices above.
Considerations
- Depends on you
Neither path is a routine next step. The exact regimen, starting point, and whether the benefit justifies the risk belong in the treating clinician’s plan, not a general description.
Questions for your dermatologist
Would a whole-body medicine make sense given how many areas are affected?
Saving keeps this on your device and needs JavaScript, which is off in this browser.If this patch is changing quickly, would a short course of a steroid pill fit, and for how long?
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What about a permanent procedure, camouflage, or treating no area at all?
RECELL, a cell-grafting procedure, is FDA-approved for selected stable, localized disease. It was studied on head, neck, dorsal hands, dorsal feet, arms, legs, and trunk skin. Its own instructions name several sites, including lips and eyelids, where safety and effectiveness are not established. Camouflage is a separate, valid choice for any area, usable sometimes and not other times. It does not require you to have "accepted" vitiligo to use it. Treating no area right now is also a legitimate, deliberate choice, not a failure to act. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
The FDA approval record sets out exactly which sites RECELL’s pivotal study covered and which its own instructions exclude. The guideline I read recognizes camouflage and continuing supportive care as part of vitiligo care. Visible difference can affect daily life, independent of any biological change.
Considerations
- Depends on you
None of these three paths predicts what happens to an untreated or camouflaged patch over time. The choice can change by area, by season, or by how you feel about it.
Questions for your dermatologist
Is this stable patch, and this body area, one RECELL has actually been studied on?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Would you support me choosing not to treat this area for now?
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The evidence the table above draws on
Every "how it tends to do" figure in the table is measured differently - different trials, at different weeks, on different definitions of improvement. None of them can be stacked into a ranking against each other.
- BAD 2021 vitiligo guideline
- States plainly that treatment often does better on the face and trunk than on the hands and feet, without giving an exact per-region number.
- Opzelura trials, pooled body-region data
- Among people using the cream alone, a pooled look at body areas found 68.1% reached at least half improvement on the head and neck (excluding the face) at week 52. On the hands it was 38.2%, and on the feet 29.3%.
- HI-Light steroid-cream trial
- Found hands and feet did worse than other body areas but did not publish an exact per-region percentage in its main results.
- Pooled narrowband UVB review
- 172 people across 6 studies: 89.0% of hands-and-feet patches had less than a quarter of their color back after at least 6 months, with no untreated comparison group.
- RECELL FDA approval record
- Its pivotal study covered head, neck, dorsal hands, dorsal feet, arms, legs, and trunk. Its own instructions state safety and effectiveness are not established for lips, eyelids, palms, or soles.
Evidence behind this page
Sources
Each evidence badge opens the source and its limits. The full list stays available here.
- Journal of the European Academy of Dermatology and VenereologyGuideline · Regulatory / guideline, tier 1Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: The journal is the publisher. This label refers to extensive author relationships disclosed for the recommendation, not to the journal itself.
What this source supports
Supports an expert-consensus map of established, off-label and developing Vitiligo treatment categories and makes clear that research is continuing.
What it does not support
It is an international consensus with extensive author relationships, not independent comparative proof, current U.S. regulatory status for every option or a personal treatment sequence.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- DailyMed, U.S. National Library of MedicineRegulatory · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the defined US nonsegmental-vitiligo indication, limitations of use, boxed warnings, skin-cancer and ultraviolet precautions, and clinical-study labeling.
What it does not support
It also supports the labeled dosing instruction: "Apply a thin layer of OPZELURA topically twice daily to affected areas of up to 10% body surface area." It further supports the labeled re-evaluation point: "If the patient does not find the repigmentation meaningful by 24 weeks, the patient should be re-evaluated by the healthcare provider." It also supports the vitiligo-trial adverse-reaction rates at 1% incidence or greater: application-site acne 6%, application-site itching 5%, a common-cold-type illness (nasopharyngitis) 4%, headache 4%, urinary tract infection 2%, application-site redness (erythema) 2%, and fever (pyrexia) 1%. It does not guarantee benefit, establish suitability beyond the labeled population, authorize adding phototherapy, or state which reaction should prompt a call to the prescriber beyond directing patients to the Medication Guide and their healthcare provider.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- U.S. Food and Drug AdministrationRegulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports FDA authorization of this device for repigmentation of stable depigmented vitiligo lesions in a defined adult population and trained professional setting.
What it does not support
It does not approve every grafting procedure, define stability for a reader or guarantee color match, durability or satisfaction.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Thomas KS, et al.)Randomized trial · Clinical research, tier 2Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a group-level benefit for the exact supervised topical-corticosteroid and home handheld-light combination studied in active limited vitiligo, alongside minority success, reactions and limited maintenance after treatment ended.
What it does not support
It does not create a general home plan, support other product-device combinations or predict an individual result. The topical-corticosteroid-alone arm used mometasone furoate 0.1% ointment, applied once daily on alternating weeks for up to 9 months. It supports 17% (20/119) reaching participant-reported treatment success at 9 months, and 3% (4/115) reaching the trial’s stricter blinded-assessed ≥75% repigmentation at 9 months. Skin thinning was reported in 2.5% (13/517) of participants across all trial groups, including one on placebo ointment. Over 40% of participants across all groups reported loss of treatment response by 21 months. It supports that participant-reported treatment success at 9 months was lower for patches on the hands and feet than on other body regions, without publishing an exact per-region percentage in its main results tables. The trial randomized 517 adults and children, aged over 5, with nonsegmental vitiligo covering about 10% or less of body surface area and at least one patch active in the prior 12 months, across 16 UK hospitals.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Harris JE, et al.)Randomized trial · Clinical research, tier 2Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: Incyte Corporation funded the study and states a role in its design, conduct, analysis and manuscript review.
What this source supports
Supports that facial repigmentation was often held for a further year. Among people who had reached near-complete facial repigmentation at Week 52, 38 of 55 randomized to continue ruxolitinib cream and 22 of 56 randomized to vehicle still held at least 75% facial improvement at Week 104.
What it does not support
It does not predict an individual result. Everyone in it had already responded, the rollover design set no sample size for a powered comparison between the two groups, and more people left the withdrawal group than the continuation group.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Journal of the European Academy of Dermatology and Venereology (Passeron T, et al.)Randomized trial · Clinical research, tier 2Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: Incyte Corporation funded the analysis, two of its employees are authors, and it reports the company’s own phase 3 programme.
What this source supports
Supports that repigmentation differed by body region in the pooled phase 3 data, and that hands and feet responded least. At Week 52, among people who applied ruxolitinib cream only, 68.1% reached at least 50% improvement on the head and neck excluding the face, 38.2% on the hands and 29.3% on the feet.
What it does not support
It is a regional breakdown of one company programme reported as a letter, not a trial designed to compare body areas or to compare this cream with anything else. It does not predict what any one area will do.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- JAMA Dermatology (Bae JM, et al.)Systematic review · Clinical research, tier 2Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the separate pooled repigmentation rates and participant counts the review reports for narrowband UVB and PUVA at 3, 6 and 12 months, and the narrowband UVB rates pooled by body region after at least 6 months. Each pooled figure rests on the subset of studies that reported that measure at that time, not on the full review. It also supports plainly labelled arithmetic complements of those reported rates.
What it does not support
The pooled arms are single-group, so they describe what happened to those groups, not what the light caused. The review planned an intention-to-treat count and kept people who stopped early where it could; otherwise it used the group described at the final assessment, so no pooled figure is guaranteed to cover every enrolled participant. It does not report how many people worsened during treatment, does not predict an individual course, and sets no device, schedule or dose.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- eClinicalMedicine (Passeron T, et al.)Randomized trial · Clinical research, tier 2Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: AbbVie funded the study, and multiple authors were AbbVie employees. The peer-reviewed design and results remain sponsor-linked evidence.
What this source supports
Supports the reported randomized phase 2 design, 185-adult study population, facial and total-body outcomes, continued improvement during follow-up, and reported adverse events.
What it does not support
It does not establish approval, comparative superiority, reliable outcomes for individual hands or feet, long-term safety, or an individual result.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- U.S. Food and Drug AdministrationRegulatory · Regulatory / guideline, tier 1Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: FDA hosts the approved instructions supplied by the device manufacturer. They control product use but are not independent comparative evidence.
What this source supports
Supports the trained-professional setting, donor-skin processing, ablative-laser surface preparation, contraindications, warnings, aftercare responsibilities, and body-site and population limitations in the approved US instructions.
What it does not support
The instructions do not select a patient, center, lesion, laser, aftercare plan, or predict response, color match, recovery, or coverage.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Eleftheriadou V, et al.)Guideline · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the clinical history and assessment domains, evaluation of associated autoimmune conditions, its recommendation for thyroid function and antithyroid antibody screening, current classification context, treatment-option map, psychosocial assessment, medical photography and the limits of pediatric evidence. Its classification table defines mucosal vitiligo as the oral or genital mucosae. One mucosal site alone is filed as undetermined or unclassified. Its differential diagnosis table lists genital or extragenital lichen sclerosus among the conditions that can be mistaken for vitiligo. That table also lists eczema, psoriasis, lichen planus, pityriasis alba and piebaldism. It calls autoimmunity a contributor to the pathogenesis of vitiligo. It reports an earlier review finding a possible negative impact on intimacy and sexual functioning. It tells clinicians to discuss the psychosocial impact of living with the condition. R28 offers a skin camouflage visit to people who want one. R10 to R14 name potent or very potent topical steroids as the first choice, with a topical calcineurin-inhibitor cream as an option for the face. These are different creams with different proof behind them. R20 names narrowband UVB as the first light option. It says the skin often does better on the face and trunk than on hands and feet. It says there is not enough proof to use any one current pill alone for vitiligo that is not changing. R25 and Table 2 keep cell grafting for vitiligo that is not changing and did not respond to other care. They also say a doctor cannot always tell if the vitiligo has truly stopped changing.
What it does not support
It was designed for UK care and reviewed literature through May 2019; it does not establish a universal testing plan, prescribe an individual plan, or establish current US labeling or coverage. Its differential diagnosis table is a list, not a method a reader can apply to their own skin. It does not say how to tell any two of those conditions apart. It gives no figure for how often vitiligo affects genital skin.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- National Institute of Arthritis and Musculoskeletal and Skin DiseasesPatient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a patient-facing description of clinician diagnosis using history and examination, possible use of a Wood lamp and selected tests, broad treatment categories, variable response and whole-person support.
What it does not support
It is educational context, not primary efficacy evidence, an online diagnostic method or a universal testing checklist.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- DermNet (Dr Bushra Alsayaydeh, Dermatologist, Amman, Jordan)Patient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a dermatology reference account of vitiligo. It supports that loss of hair color is called leukotrichia or poliosis. It supports that this may affect the scalp, eyebrows, eyelashes and body hair in 10 to 60 per cent of patients. It supports that it does not correlate with disease activity. It supports that it could be a predictor of poorer response to therapy, because the melanocyte reservoir in hair follicles is destroyed. It supports that treatment is most successful on the face and trunk. It supports that hands, feet, and areas with white hair respond poorly. It supports that new patches are more likely to respond to medical therapy than long-standing ones. It supports that the hair follicle is the main source of pigment restoration. It supports that another potential reservoir can be at the borders of the white patches. It supports that poor prognostic indicators include longstanding disease, leukotrichia, mucosal involvement and the Koebner phenomenon. It supports that segmental vitiligo often has an irregular border with leukotrichia. It supports that leukotrichia and halo naevi are listed as predictors of transformation into the mixed variant. It supports that the Vitiligo European Task Force assesses five sites: head and neck, trunk, arms, legs, and hands and feet. It supports that its grading runs from 0 for normal pigmentation to 4 for complete hair whitening. It supports that its clinical assessment form records sex, age, duration of disease and age of onset. It supports that premature hair greying has been described but that the association is still uncertain.
What it does not support
It is a dermatology reference page, not a trial and not a measurement of any one person. Its 10 to 60 per cent figure is a span, stated on the page without a study behind that span. Its wording on response to therapy is that hair whitening could be a predictor, which is weaker than a finding. Nothing on it predicts whether one patch or one hair will repigment, how much color returns, or how long that takes. It sets no treatment, no dose, no schedule and no product. It does not diagnose white hair on a reader as vitiligo. Its author line is dated August 2022 and the page records a last review of 11 July 2023, so parts of it are older than the date registered here.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- National Health Service (UK)Patient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a UK national health service account of vitiligo written for patients. It supports that the areas most commonly affected include the mouth and eyes, fingers and wrists, armpits, groin, genitals and the inside of the mouth. It supports that vitiligo is not caused by an infection and that you cannot catch it from someone else who has it. It supports that vitiligo does not cause discomfort to the skin, such as dryness, but that the patches may occasionally be itchy. It supports that a GP can diagnose vitiligo after examining the affected skin. It supports that the lack of melanin can turn the hair in an affected area white or grey.
What it does not support
It is a patient-information page, not a study, and it reports no numbers for any body site. It does not establish how common genital involvement is, and it cannot tell a reader that a patch they can see is vitiligo. It is written for UK care, so its diagnosis and referral route are UK ones. Its own footer records a last review of 22 March 2023 and a next review due 22 March 2026, so at the date it was verified here the page was five months past the date the NHS set for reviewing it.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.