A woman in her 50s presented for evaluation and management of vitiligo, which had been widespread and progressive for approximately the past 1 year. Increasing involvement of the face and hands was causing the patient significant concern. She had used triamcinolone ointment, 0.1% (owing to the need for a large amount of topical medication in the setting of generalized involvement), and tacrolimus ointment, 0.1%, without effect. Treatment with narrowband UV-B phototherapy had recently been initiated; however, after 3 treatments, the patient continued to note progression of the vitiligo and therefore sought a second opinion regarding treatment. She was otherwise healthy and denied a family history of vitiligo or other autoimmune conditions. Complete review of systems was negative. Physical examination revealed innumerable white macules and patches involving the forehead (Figure 1A), trunk, and extremities (Figure 2A) involving approximately 10% of body surface area, which highlighted with Wood’s lamp.