From the Guidelines
Vitiligo is a chronic autoimmune skin condition characterized by the loss of skin color in patches due to the destruction of melanocytes, resulting in white or depigmented patches on various parts of the body. This condition is often symmetrical, affecting areas such as the fingers, wrists, axillae, and groins, as well as body orifices like the mouth, eyes, and genitalia 1. The destruction of melanocytes can also lead to white hair and depigmentation of mucosal areas, such as the mouth.
Key Characteristics
- The condition is often associated with autoimmune thyroid disease or other autoimmune diseases, with a family history of autoimmune disease present in 32% of patients 1.
- The skin type of the patient should be noted as part of the initial assessment, with definitions provided in Table 4 1.
- Vitiligo can cause significant psychological distress due to its visible nature, although it is not physically harmful or contagious.
Clinical Presentation
- The commonest sites affected are the fingers and wrists, the axillae and groins, and the body orifices such as the mouth, eyes, and genitalia 1.
- A 'trichrome' appearance of a white centre with an intermediate, pale area around it may be found as the pigment cells are destroyed 1.
- Inflammation is occasionally seen at the advancing edge of a vitiligo macule, and vitiligo skin typically has no surface change and usually no redness 1.
From the Research
Definition and Characteristics of Vitiligo
- Vitiligo is a chronic autoimmune depigmenting skin disorder characterized by patches of the skin losing functional melanocytes 2.
- It is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair 3.
- Vitiligo results from loss of normal melanin pigments in the skin, producing white patches 4.
Pathogenesis and Immune Response
- Multiple combinatorial factors are involved in disease development, among which immune T cells play a prominent role 2.
- The immune cells implicated in melanocyte destruction through adaptive immunity include CD8+ cytotoxic T cells and regulatory T cells 2.
- Aberrantly activated skin-resident memory T cells also play a role in melanocyte destruction 2.
Treatment Options and Therapies
- Topical corticosteroids, calcineurin inhibitors, phototherapy, and photochemotherapy represent the first-line therapeutic options for vitiligo 3.
- Vitamin D analogues, targeted phototherapy, oral corticosteroids, and surgery should be used as second-line therapies 3.
- Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments 3.
- Janus kinase (JAK) inhibitors have been reported to have therapeutic significance in vitiligo 2.
- Mesenchymal stem cells (MSCs) regulate cytokine secretion and the balance of T-cell subsets, making them a promising cell-based treatment option for autoimmune diseases like vitiligo 2.