Vitiligo: Highlights on Pathogenesis, Clinical Presentation and Treatment

Abstract

Vitiligo is a common acquired skin depigmentation that affects people of all races, but is significantly more disfiguring in black individuals. The exact cause of vitiligo is unknown. It is believed that an autoimmune process targeting melanocytes mediates its pathogenesis. In accordance with this hypothesis, histopathological examinations of vitiliginous skin have revealed the absence of melanocytes. Multiple autoantibodies against melanocyte antigens, including various enzymes and other substances, have been detected in the sera of some vitiligo patients. Twenty to thirty percent of patients were reported to have a family history of the disease, suggesting that genetic factors play a role. Despite this, a substantial proportion of vitiligo sufferers have neither a family history of vitiligo nor a history of other autoimmune diseases. As a result, numerous alternative hypotheses have been proposed to explain the underlying causes of this disorder, such as a weak defence against the toxic effects of free radicals and exposure to industrial pollutants. The most frequently prescribed treatments for vitiligo are systemic and topical phototherapy, immunomodulators such as corticosteroids, calcineurin inhibitors, and vitamin D analogues, as well as cosmetics that can camouflage the condition and improve quality of life. Other forms of treatment include surgical grafting and depigmenting procedures.