Acral Vitiligo: A Comprehensive Review of Clinical Features, Pathogenesis, and Novel Therapeutic Advances.

Acral vitiligo, a distinct subtype predominantly affecting the distal extremities (hands and feet), presents significant clinical challenges due to its treatment resistance and profound psychosocial impact. This narrative review systematically synthesizes current knowledge on the epidemiology, unique clinical presentations, and the specific pathophysiological mechanisms underlying this recalcitrant variant. We critically appraise recent advances in diagnosis and treatment, integrating findings from clinical studies, experimental researches, and case reports. The central aim is to provide a nuanced, evidence-based understanding of acral vitiligo to guide clinical management. We critically evaluate contemporary treatment modalities, including the emerging roles of Janus kinase (JAK) inhibitors and biologic agents, while also addressing the crucial dimension of psychosocial burden. Finally, we delineate key knowledge gaps-particularly the lack of acral‑specific outcome measures and head‑to‑head comparative trials-and propose future research directions to improve outcomes for patients with this therapeutically orphaned subtype.