Vitiligo is an acquired, chronic, benign skin disorder of unknown cause, characterized by the inability to produce melanin due to the progressive loss of functional melanocytes in the affected skin, resulting in cosmetic concerns for patients. Vitiligo may also affect mucous membranes (e.g., the lining of the mouth) and the eyes.
The exact mechanism by which melanocytes are destroyed or disappear from the affected areas of the skin has not been fully clarified. However, many theories have been proposed regarding the cause of this condition, with the most widely accepted being the classification of vitiligo—specifically the non-dermatomal form—as an autoimmune disease.
A condition is considered autoimmune when the immune system mistakenly identifies certain cells of the body as foreign and attacks them. The various theories developed do not exclude one another and often appear to coexist, contributing collectively to the onset of the disease.
The prevalence of the disease in the general population is between 0.5% and 2%. Both sexes can be affected by vitiligo. The age of onset varies, ranging from childhood to old age. Several studies show that 25% of cases occur during childhood, often affecting the child’s psychological well-being.
In the majority of cases, the patient’s history reports disease onset following emotional stress, skin trauma (Koebner phenomenon), or another illness. In a large percentage of cases, vitiligo also tends to be hereditary. A positive family history is present in 10% to 50% of patients. Finally, it may coexist with other conditions, such as autoimmune thyroiditis.
As simple as the diagnosis of the disease may be, its management is equally complex. For a patient with vitiligo, the following are recommended:
- General measures:
- Photoprotection is essential, and sun exposure must be avoided
- Avoid friction or trauma to the skin
- Avoid stress-inducing factors and provide psychological support to the patient when necessary
- Use of topical camouflage products (makeup) on exposed areas
2. Topical therapy, which includes:
- Topical corticosteroids
- Topical application of calcineurin inhibitors (tacrolimus – pimecrolimus), which can also be used on sensitive areas such as the eyelids and the face in general
- Topical creams containing piperine, placenta, etc.
3. Phototherapy: UVB-nb or PUVA can be used (with either topical or oral administration of psoralens). The first-line treatment is UVB-nb phototherapy.
4. Depigmentation of the remaining skin in patients with universal stable vitiligo who only have a few patches of normal skin.
5. Surgical treatment (various techniques of autologous transplantation).
6. Laser: The 308 nm excimer laser is used.
7. Follicular unit transplantation using the FUE method (this treatment is under investigation).
The disease clinically appears in the form of asymptomatic, depigmented (milk- or chalk-colored) macules and patches of varying size, with clearly defined borders separating them from healthy skin. They are selectively located around natural body orifices (around the mouth, eyes, navel, anus), in areas of increased friction (elbows, knees, armpits, inguinal folds, ankle joints), in areas with increased pigmentation (e.g., the nipple), and on the genital organs. White hair on the scalp is also common, occurring in approximately 10% to 60% of patients.
According to medical science, vitiligo is classified into the following categories based on its clinical presentation:
Localized: The depigmented areas appear in one or a few specific parts of the body. This category includes:
- Focal: One or more macules in a single area of the skin without dermatomal distribution
- Segmental (dermatomal): One or more macules on one side of the body, where the patches stop at the midline; most commonly appears in children
- Mucosal: Patches appear only on the mucous membranes
Generalized: This is the most common type of vitiligo (more than 90% of cases), where depigmented patches appear in multiple areas of the body and usually develop symmetrically on corresponding parts. This category includes:
- Common (vulgaris): Macules scattered across the body
- Acrofacial: Macules on the face and the distal extremities
Mixed: A combination of acrofacial or generalized vitiligo with segmental lesions
Universal: Depigmentation of the entire or nearly entire surface of the skin.
Vitiligo should be differentiated from pityriasis versicolor, progressive macular hypomelanosis of the trunk, post-inflammatory hypopigmentation, and chemical leukoderma (depigmentation of the skin caused by chemical substances and medications). Solitary lesions should be differentiated from achromic nevus, nevus anemicus, and lichen sclerosus et atrophicus.
Vitiligo is not a skin infection, nor is it a contagious disease. It cannot be transmitted through physical contact from a patient to a healthy individual.
Vitiligo usually progresses slowly once it appears. However, it may remain stable for a long period or, in some cases, suddenly worsen. In order to help prevent the spread of vitiligo as much as possible, patients must be particularly cautious about avoiding injuries, as trauma can lead to the appearance of new lesions.
Additionally, patients should consistently use sunscreen—both to protect the depigmented patches and to shield healthy skin from sunburn, which can also contribute to the development of new lesions (Koebner phenomenon).