Vitiligo: a Multifaceted Narrative


Figure 1: White patches of vitiligo

Vitiligo is a distressing disease whose effect lies beyond the depigmentation that it leaves. It is a multi-faceted issue that can cause psychological disorders and self-esteem degradation, thereby having a detrimental effect on the overall health of the patient. Vitiligo is a widespread and debilitating autoimmune disease that leaves many negative consequences [1]. Vitiligo is an assimilated dermatological disease where the epidermis layer of the skin starts to lose the melanocytes that produce skin pigmentation. Clinically, it visually manifests as well-demarcated white patches on the skin [2]. Distribution of the white patches varies from a case to another and depending on the distribution of these patches, vitiligo can be subdivided into three categories: Localized; Segmental; and Generalized [3].


When examining the different disorders that cause skin depigmentation, we find vitiligo at the top of the list. The age range at which vitiligo first manifests varies greatly, with the second and third decades of life being the most prominent time for its appearance. No ethnicity is affected more than other ethnicities, [4] and its prevalence is around 0.5 percent to 1 percent globally [5].


When debating the pathogenesis of vitiligo, the accurate etiology of vitiligo is undiscovered. It is habitually coupled with other autoimmune disorders, such as thyroid diseases. There are a variety of assumptions about its pathogenesis, with the following factors include: genetics; oxidative stress; environment; innate immunity; and adaptive immunity [6]. Studies examining vitiligo in the context of genes and inheritance using family and twin models demonstrated a complex narrative. Furthermore, it is postulated that genetic factors can impact at what age vitiligo manifests [7].


Treatment of vitiligo may utilize diverse tactics, including topical and systemic medications, phototherapy, laser therapy, and surgical therapy. The most preeminent topical treating agent is corticosteroid. Phototherapy, which works on re-pigmentation of the skin, is also a very important modality of treatment. Systemic medications include Tacrolimus and systemic corticosteroids [8]. Surgical treatment decisions are restricted to segmental or localized vitiligo, when it is constrained to a smaller area [9].


Prognosis of vitiligo depends on the extent of the skin affected and the age of onset. The younger the patient, the more skin that will be involved, and therefore a higher rate of progression. Conversely, some patients may experience skin re-pigmentation in depigmented areas [10]. Vitiligo is a chronic disorder, and its effect extends to the mental health of patients, particularly because of the societal stigma that accompanies it.




Keywords: Vitiligo; Depigmentation; Disease



References:


1. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N

Lancet. 2015 Jul 4; 386(9988):74-84.


2. Mazzei Weiss ME. Vitiligo: to biopsy or not to biopsy? Cutis. 2020 Apr;105(4):189-190.


3. de Baat C, Phoa KH, Zweers PGMA, Bolling MC, Rozema FR, Vissink A. [Medicaments and oral healthcare. Hyperpigmentation of oral soft tissues due to afamelanotide]. Ned Tijdschr Tandheelkd. 2020 Apr;127(4):237-243.


4. Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology. 2020;236(6):571-592.


5. Vitiligo: Medlineplus Genetics. (2020, August 18). Retrieved March 28, 2021, from https://medlineplus.gov/genetics/condition/vitiligo/#frequency


6. Rashighi M, Harris JE. Vitiligo Pathogenesis and Emerging Treatments. Dermatol Clin. 2017;35(2):257-265. doi:10.1016/j.det.2016.11.014.


7. Abdel-Malek ZA, Jordan C, Ho T, Upadhyay PR, Fleischer A, Hamzavi I. The enigma and challenges of vitiligo pathophysiology and treatment. Pigment Cell Melanoma Res. 2020 Nov;33(6):778-787.


8. Juntongjin P, Toncharoenphong N. Effectiveness of a combined 308-nm excimer lamp and topical mid-potent steroid treatment for facial vitiligo: a preliminary, randomized double-blinded controlled study. Lasers Med Sci. 2020 Dec;35(9):2023-2029.


9. Kim DS, Ju HJ, Lee HN, Choi IH, Eun SH, Kim J, Bae JM. Skin seeding technique with 0.5-mm micropunch grafting for vitiligo irrespective of the epidermal-dermal orientation: Animal and clinical studies. J Dermatol. 2020 Jul;47(7):749-754.


10. Wen Y, Wu X, Peng H, Li C, Jiang Y, Liang H, Zhong R, Liu J, He J, Liang W. Cancer risks in patients with vitiligo: a Mendelian randomization study. J Cancer Res Clin Oncol. 2020 Aug;146(8):1933-1940.

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