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Vitiligo is a chronic autoimmune disorder characterized by skin depigmentation which imposes a significant impact on quality of lives.1, 2 The psychosocial burden of vitiligo has been extensively studied in individuals with lesions on exposed areas such as the face and hands, as their visibility can substantially affect appearance, social interactions and self-esteem.3-5 However, less attention has been given to those with non-exposed lesions. The psychosocial impact of vitiligo stems from the disease itself, not merely from its visibility. Therefore, this study aims to bridge this knowledge gap by investigating the quality of life, psychological well-being and specific concerns of patients with vitiligo exclusively on non-exposed sites. In this multicentre, prospective, cross-sectional study conducted at 15 hospitals in Korea, 283 patients with vitiligo affecting only non-exposed body areas were enrolled between March 2023 and September 2024. Non-exposed sites were defined as areas typically covered by clothing, excluding the face, neck, hands, arms and feet. The mean age was 47.8 years, with 65% female participants. Mean disease duration was 6.5 years and nonsegmental vitiligo comprised 87.3% of cases. Body surface area (BSA) involvement was <1% in 54% of patients and ≥10% in 4.3%. Patients completed questionnaires including the Dermatology Life Quality Index (DLQI), Psychosocial Well-being Index-Short Form (PWI-SF), Beck Anxiety Inventory (BAI),6 Beck Depression Inventory (BDI)7 and Vitiligo Impact Patient Scale-Short Form (VIPS-SF).8 The DLQI was rated on a five-point scale (no effect to extremely large effect), the PWI-SF assessed stress risk levels (healthy, potential and high risk) and the BAI and BDI classified anxiety and depression into four severity categories (minimal to severe), respectively. The overall quality of life questionnaires revealed that 47.7% reported moderate to severe quality of life impairment (DLQI ≥ 6), and 67.8% were at high-risk stress (PWI-SF ≥ 27). Moderate to severe anxiety (BAI ≥ 16) and depression (BDI ≥ 20) were accompanied in 23.7% and 19.8% of the patients, respectively. In the vitiligo-specific questionnaire, disease progression (Item 3), appearance-related anxiety (Item 4) and daily disease management (Item 12) emerged as primary concerns, with 34.6%, 19.4% and 21.2% of the patients responding ‘always’, respectively (Figure 1). Logistic regression analysis was used to estimate the association between clinical variables (sex, age, BSA, disease duration) and moderate to severe quality of life impairment (Table 1). Female patients showed significantly higher impairment in DLQI (odds ratio [OR] 2.17, p = 0.004), BAI (OR 2.50, p = 0.008) and BDI (OR 3.60, p = 0.001), compared to males. It is in line with previous results that females are more vulnerable to stigma and have difficulties coping with the disease.9, 10 Patients with 1–10% BSA were at significantly higher risk of stress compared to BSA <1% in PWI (OR 4.85, p = 0.041). This study showed that patients with non-exposed vitiligo also experienced significant quality of life impairment and substantial psychological distress, suggesting that the disease burden of vitiligo extends beyond visibility or noticeability.4 Almost half of the patients reported moderate effects on their quality of life despite having no vitiligo lesion on exposed areas such as face and hands. Moreover, 23.7% and 19.8% of the patients showed moderate-to-severe risk of anxiety and depression, respectively. Disease progression, appearance-related anxiety and daily management were key factors that adversely affected patients' quality of life, even in the absence of noticeable lesions. While this study has limitations including its cross-sectional design, potential selection bias and lack of a control group, our findings underscore the need for comprehensive therapeutic approaches and psychosocial support for all vitiligo patients, regardless of lesion visibility or location. This work was supported by the Korean Dermatology Foundation in 2022. None to be declared. This study was approved by the Institutional review board of St. Vincent's Hospital (VC23QIDI0022) and the Seoul National University Hospital (No. 2303-039-1409). The patients in this manuscript have given written informed consent to publication of their case details. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.