Personalized Approaches to Facial Vitiligo: A Comprehensive Review From Clinical Phenotypes to Novel Therapeutic Strategies.

Facial vitiligo affects a substantial proportion of patients with vitiligo and is associated with significant psychosocial burden due to its visibility. Facial vitiligo is primarily classified into nonsegmental and segmental subtypes, each with distinct distribution patterns and prognostic features. Nonsegmental vitiligo is further divided into 3 morphological patterns-centrofacial, panfacial, and hairline-each with unique clinical characteristics and treatment responses. The pathogenesis is multifactorial, involving genetic susceptibility, oxidative stress, and autoimmune destruction of melanocytes. Diagnosis is primarily clinical, supported by Wood lamp examination, dermoscopy, and advanced imaging techniques. First-line treatment includes topical calcineurin inhibitors and ruxolitinib, often combined with phototherapy to maximize repigmentation. The 308-nm excimer laser offers targeted delivery of ultraviolet (UV) radiation, minimizing photodamage to uninvolved skin. For progressive disease, systemic corticosteroids are commonly used for stabilization, with methotrexate, cyclosporine, or azathioprine as alternatives. Surgical interventions, particularly micropunch grafting, are effective options for stable, treatment-refractory cases. Emerging therapies, including oral Janus kinase inhibitors and biologics targeting tissue-resident memory T cells, are under investigation with encouraging preliminary results. Lifestyle modifications, including avoidance of mechanical friction, UV protection, and antioxidant-rich dietary patterns, may serve as supportive adjuncts to medical therapy. Recognizing the clinical heterogeneity of facial vitiligo, this review highlights the necessity of individualized treatment strategies based on clinical phenotypes to optimize therapeutic outcomes and improve quality of life.