AbstractBackgroundNarrowband ultraviolet B (NB‐UVB) phototherapy promotes stability and repigmentation in vitiligo. No studies have compared targeted NB‐UVB with whole‐body NB‐UVB in treatment of acral vitiligo.ObjectivesThis randomized split‐body study compared whole‐body NB‐UVB with targeted NB‐UVB in inducing stability and repigmentation in acral vitiligo.MethodsThirty‐two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees) were recruited. Patients received whole‐body NB‐UVB treatment, with one hand and one foot shielded until elbow and knee, followed by targeted NB‐UVB treatment on the shielded side. Patients were assessed at 4‐week intervals for 24 weeks using Vitiligo Disease Activity (VIDA) score, Vitiligo Skin Activity Score (VSAS), Vitiligo Area Scoring Index (determined through fingertip method, using the method to calculate facial‐VASI) and degree of repigmentation.ResultsAfter 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks. Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole‐body and targeted groups, respectively (p = .95). No improvement in F‐VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24‐week period.ConclusionOur study showed comparable repigmentation rates between whole‐body and targeted NB‐UVB groups. Limited effectiveness of phototherapy in repigmentation of hands and feet underscores an important therapeutic gap.