with face and neck lesions. Fear of greeting others may be a factor as well, because personal interactions often start with a hand shake, which is important in making a good first impression. Indeed, 1 study 4 showed that a handshake preceding social interaction enhanced the positive impact of approach and diminished the negative impact of avoidance behavior on the evaluation of social interaction. Individuals with vitiligo of the hands may find that others avoid shaking their hand because of the contrast between normal and depigmented skin, contributing to a lower QOL.Although this study was performed in only 1 center, our results suggest that hand involvement with vitiligo is associated with a significant negative effect on quality of life. Unfortunately, hands are one of the most difficult areas to treat. Similar studies should be performed in other parts of the world. If confirmed, research should focus on hand involvement in patients with vitiligo as one of the most important sites for which effective treatments should be developed.