Two classifications matter clinically. One describes the pattern — segmental or non-segmental. The other describes the moment — active or stable. Between them they decide almost everything about your treatment.
These behave so differently that they are almost two conditions sharing one name.
Symmetrical — if it appears on one knee it tends to appear on the other. Comes and goes in waves over years, often starting on the hands, face, or around the eyes and mouth.
Confined to one side, often following a nerve territory, and usually starting in childhood or adolescence. It spreads quickly for six to twenty-four months, then typically stops for good.
Because it stabilises reliably and rarely returns, segmental disease is where grafting gives its most durable results. It also responds poorly to phototherapy — so recognising it early saves patients months of light treatment that was never going to work.
Every treatment decision hangs on this. Active disease must be quietened before anything is rebuilt; stable disease can be rebuilt, including surgically. Getting it wrong in either direction wastes months.
There is no blood test for stability. It is a clinical judgement made from the history, the appearance of the patch margins, and — most reliably — photographs taken at intervals and compared properly.
| Sign | What it means | What it changes |
|---|---|---|
| New patches in 6 months | The disease is producing fresh lesions | Stop the spread before repigmenting |
| Blurred, ill-defined edges | The patch is expanding outward | Surgery deferred |
| Trichrome appearance | A pale zone between normal and white skin | Marker of ongoing activity |
| Koebner phenomenon | New patches where skin was cut or scratched | A strong argument against grafting now |
| Confetti-like macules | Small scattered spots around a patch | Suggests rapid progression |
| White hairs in the patch | Follicular pigment reserve is depleted | Medical repigmentation less likely to work |
None of these is decisive alone. A Wood’s lamp examination and dated photographs together are how the judgement is actually made.
Grafting into disease that is still active does two things, both bad: the transplanted cells are attacked like the original ones, and the donor site can develop its own patch.
Twelve months without a new patch, without expansion at any margin, and without koebnerisation is the accepted threshold. It is not an arbitrary wait — it is the interval that separates a graft that takes from a graft that fails.
What graft surgery involvesOne new patch in month ten resets the count. This is frustrating and it is also the honest answer.
Dated images at fixed distance and lighting are worth more than anyone’s recollection of what the patch looked like last year.
If no new patch has appeared and no existing patch has grown for twelve months, and cuts or scratches have not turned white, it is likely stable. It is confirmed clinically with a Wood’s lamp and by comparing dated photographs — not by how it feels to you.
Non-segmental vitiligo on the face and trunk responds best to phototherapy. Segmental vitiligo responds poorly to light but does very well with surgery once it has burnt out.
Typically not. It spreads within its segment for six to twenty-four months and then usually stops permanently. That predictability is what makes it a good surgical candidate.
New vitiligo appearing exactly where the skin was injured — a cut, a scratch, a burn, a tight strap. It is a marker of active disease and an argument against operating until things settle.
Segmental disease does not usually become non-segmental. But a person can have both, and focal disease that has not declared itself may evolve into either — which is why the first classification is sometimes provisional.
Not a treatment plan sold on the spot. Message the clinic and bring your history.