WHAT IS VITILIGO?

Vitiligo (pronounced vit-il-EYE-go) is aprogressiveskin condition wheremelanocytes, the skin cells responsible for producing the pigment melanin, areno longer able toproduce the pigment. The exact mechanism ofdepigmentation is not understood but we do know that the body eventually attacks and destroys its own melanocytes [1]. This leavespatches of bright white skin of varying sizes overthe body, most commonly observed on the face, hands, and feet. Below, we’ll discuss the prevalence of vitiligo in the general population, different types of the disease, and how to manage and care for this unique condition. 

WHO DOES IT AFFECT? 

Vitiligo is amultifactorial polygenic disorder that affects about 1% of the U.S. population [2]. This means that a person’s risk for developing the disease is controlled both by genetics and by environmental stressors [3] and is more prevalent in non-white demographics, specifically those of Latin or Hispanic origin. Additionally, having a sibling with vitiligo increases your risk to 6% [4]. However, there are over 50 different genetic loci associated with one’s risk for developing vitiligo [5]. Despite these genetic associations, it often takes some sort of environmental or physical stress to the skin barrier to initiate the depigmentation process [6]. While there are different types of vitiligo, the onset usually occurs before the age of 30, sometimes during childhood. It’s also important to note that this conditionis more noticeable in those with darker skin tones (Fitzpatrick types III-V) although it can really occur in anyone.

SEGMENTAL VS. NON-SEGMENTAL 

The most common type of vitiligo involves anautoimmune response to melanocytesthat causes the body to destroy them. Unfortunately, the specific molecule(s) generating an immune response are unknown however, some hypothesize that they could be related to intermediates of melanin synthesis or melanocyte cell signaling [7].This autoimmunetype isoften callednon-segmental, bilateral, or generalizedvitiligo and occurs inadults, progressing or changingslowlythroughout life. The maindistinguishingcharacteristic of non-segmental vitiligo isthe presence of white patches on both sides of the body, often inmirror-like patterns. Non-segmental vitiligo is often accompanied by the development of other autoimmune disorders including [8]:

• Hypothyroidism
• Diabetes
• pernicious anemia
• Addison’s disease
• alopecia areata
• inflammatory bowel disease
  

On the other hand,segmental vitiligo often appears inchildren orteens in an isolated region and doesn’t change much throughout life. While an autoimmune component still exists, the risk of having additional autoimmune comorbidities is lower in this population. It is suspected that non-segmental vitiligo has a stronger genetic component and as a result, is less responsive to currently available therapies [9].

THERAPEUTIC OPTIONS

While there is no cure for vitiligo, there aretherapeutic options that can help repigment the affected areas, control spreading of depigmentation, or depigment the rest of the skin to match thealreadyaffected areas [10]. These includetopical corticosteroids or small moleculesthat perform either repigmentation or depigmentationfunctions,UVB light therapy to induce repigmentation,skin grafting from unaffected areasof the patient, andmicro-tattooing of the depigmented areas. Vitiligo has also been shown to affect the mental health of those diagnosed which may increase stress and further disease progression. While it is a unique condition that affects the physical appearance of the skin, it is not life threatening on its own and the disease course can be managed. As always, wearing sunscreen, using skin care products with cleaner, nourishing ingredients, and caring for your mental health can minimize disease progression and improve the overall quality of the skin barrier. 

Sources:

[1] Ahmed jan N, Masood S (2022) Vitiligo. InStatPearls StatPearls Publishing, Treasure Island (FL).

[2] Gandhi K, Ezzedine K, Anastassopoulos KP, Patel R, Sikirica V, Daniel SR, Napatalung L, Yamaguchi Y, Baik R, Pandya AG (2022) Prevalence of Vitiligo Among Adults in the United States.JAMA Dermatology 158, 43–50.

[3] Henning SW, Jaishankar D, Barse LW, Dellacecca ER, Lancki N, Webb K, Janusek L, Mathews HL, Price RN, Le Poole IC (2020) The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data.PLoS One 15, e0227909.

[4] Rashighi M, Harris JE (2017) Vitiligo pathogenesis and emerging treatments.Dermatol Clin 35, 257–265.

[5] Spritz R, Andersen G (2017) Genetics of Vitiligo.Dermatol Clin 35, 245–255.

[6] Nordlund JJ (2011) VITILIGO: A REVIEW OF SOME FACTS LESSER KNOWN ABOUT DEPIGMENTATION.Indian J Dermatol 56, 180–189.

[7] Frisoli ML, Essien K, Harris JE (2020) Vitiligo: Mechanisms of Pathogenesis and Treatment.Annu Rev Immunol 38, 621–648.

[8] Gill L, Zarbo A, Isedeh P, Jacobsen G, Lim HW, Hamzavi I (2016) Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study.Journal of the American Academy of Dermatology 74, 295–302.

[9] Sakhiya J, Sakhiya D, Virmani N, Gajjar T, Kaklotar J, Khambhati R, Daruwala F, Dudhatra N (2021) A Retrospective Study of 3,000 Indian Patients with Vitiligo Treated with Phototherapy or Topical Monotherapy.J Clin Aesthet Dermatol 14, 46–49.

[10] Cleveland Clinic, Vitiligo: Types, Symptoms, Causes, Treatment & Recovery.