Vitiligo

Vitiligo is a chronic skin disorder characterized by the loss of melanocytes (cells responsible for skin pigmentation), resulting in benign but highly impactful but psychosocial effects. Clinically, it is characterized by sharply demarcated, milky-white macules. Disease It typically shows symmetrical distribution and can occur anywhere on the body.

World Vitiligo affects approximately 1–2% of the global population and is considered a complex disease thought to arise from the interaction of autoimmune and environmental factors. Although the exact cause remains unknown, together autoimmune mechanisms are believed to play a central role. The disease can occur in any age group but most commonly begins between the ages of 10 and 30.

• Global prevalence: 1–2%
• Most common age of onset: 10–30 years
• Gender difference: Occurs equally in men and women
• Ethnic variation: Can occur in all racial groups but may be more noticeable in individuals with darker skin

Although the exact cause of vitiligo is unknown, it is believed to involve multiple factors including autoimmunity, genetic susceptibility, oxidative stress stress, and environmental triggers.

• Destruction of melanocytes due to an autoimmune response directed against them
• Targeting of melanocytes by autoantibodies and cytotoxic T cells
• Frequent association of vitiligo with other autoimmune diseases (Hashimoto’s thyroiditis, type 1 diabetes, Addison’s disease)

• The prevalence of vitiligo among first-degree relatives of affected individuals is approximately 30%
• Associated with genes including TYR, PTPN22, NLRP1, and HLA

• Release of neurotoxic substances from nerve endings leading to melanocyte damage
• Neural mechanisms are thought to play a significant role in dermatomal vitiligo

• Melanocytes undergoing apoptosis due to excessive oxidative stress
• Markedly elevated levels of hydrogen peroxide (H₂O₂) found in vitiligo patients

• Factors such as sunburn, trauma (Koebner phenomenon), and chemical exposure may trigger the disease

Vitiligo is typically asymptomatic and painless but can significantly important affect patients’ psychosocial well-being.

• The most common form
• Shows symmetrical distribution
• Commonly affected areas include the face, dorsal hands, axillae, knees, elbows, and genital region

• Usually unilateral and follows a dermatomal distribution
• More common in childhood
• Less associated with autoimmune diseases

• Characterized by a few small, localized white macules
• Has potential to progress to generalized disease

• Characterized by lesions localized to the hands, feet, and face
• May be resistant to treatment and show poor response

• Depigmentation affects more than 80% of the body
• Rare and the most severe form

Vitiligo can be easily diagnosed clinically, but additional investigations may be required in some cases for differential diagnosis.

• Wood’s Lamp Examination:
• • Blue-white fluorescence is typical of vitiligo
• Dermatoscopy:
• • Inflammatory changes at the periphery and loss of melanocytes can be detected
• Biopsy (Rarely):
• • Loss of epidermal melanocytes and lymphocytic infiltration may be observed

• Pityriasis Alba: Mild hypopigmented patches, often associated with atopic dermatitis
• Tinea Versicolor: Fungal infection, shows yellow-green fluorescence under Wood’s lamp
• Drug-Induced Hypopigmentation: May develop due to corticosteroids or chemical agents
• Albinism: Characterized by congenital absence of melanin production

In treating vitiligo, the extent of disease, affected areas, and patient age should be considered.

• Corticosteroids (e.g., Betamethasone, Clobetasol)
• • Used for mild to moderate cases
• Calcineurin Inhibitors (e.g., Tacrolimus, Pimecrolimus)
• • Preferred for facial and sensitive areas

• Narrowband UVB (NB-UVB, 311 nm)
• • One of the most effective treatment modalities
  • Administered two to three times per week
• PUVA (Psoralen + UVA)
• • Used in widespread vitiligo but less favored due to side effects

• Oral Corticosteroids (Methylprednisolone, Dexamethasone)
• • Used in rapidly progressing cases
• JAK Inhibitors (Tofacitinib, Ruxolitinib)
• • Offer promising potential among newer therapies

• Melanocyte Transplantation
• • Performed in stable vitiligo cases
• Skin Grafting
• • May be effective for small areas

• Makeup and Dermatological Camouflage Products
• Use of Sunscreen
• Psychological Support (Depression and anxiety risk is high in vitiligo patients)