Editing Vitiligo

{{Short description|Skin condition where patches lose pigment}}
{{About||the album|Vitiligo (album){{!}}''Vitiligo'' (album)}}
{{Distinguish|Vertigo}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Use dmy dates|date=September 2021}}
{{Infobox medical condition (new)
| name = Vitiligo
| image = Vitiligo2.JPG
| caption = Non-segmental vitiligo of the hand
| field = [[Dermatology]] [[Immunology]]
| pronounce = {{IPAc-en|ˌ|v|ɪ|t|ᵻ|ˈ|l|aɪ|ɡ|oʊ}} {{respell|vi|ti|leye|goh}}
| symptoms = Patches of [[depigmentation|white skin]]<ref name=Andrew2020/>
| complications = 
| onset = Childhood, young adult<ref name=Andrew2020/>
| duration = Long term<ref name=Andrew2020/>
| causes = Unknown<ref name=Lancet2016/>
| risks = Family history, other [[autoimmune diseases]]<ref name=NIH2014>{{cite web|title=Questions and Answers about Vitiligo|url=http://www.niams.nih.gov/health_info/Vitiligo/default.asp|website=NIAMS|access-date=11 August 2016|date=June 2014|url-status=live|archive-url=https://web.archive.org/web/20160821083604/http://niams.nih.gov/health_info/Vitiligo/default.asp|archive-date=21 August 2016}}</ref>
| diagnosis = [[Tissue biopsy]]<ref name=NIH2014/>
| differential = 
| prevention = 
| treatment = [[Sunscreen]], [[makeup]], topical [[corticosteroid]]s, [[phototherapy]]<ref name=Lancet2016/><ref name=NIH2014/>
| medication = 
| prognosis = 
| frequency = 0.1-2.1%<ref>{{cite journal | last1 = Zhang | first1 = Y. | last2 = Cai | first2 = Y. | last3 = Shi | first3 = M. | last4 = Jiang | first4 = S. | last5 = Cui | first5 = S. | title = The Prevalence of Vitiligo: A Meta-Analysis | journal = PLOS ONE | volume = 11 | issue = 9 | pages = e0163806 | year = 2016 | doi = 10.1371/journal.pone.0163806 | doi-access = free | bibcode = 2016PLoSO..1163806Z }}</ref>
| deaths = 
}}
'''Vitiligo''' ({{IPAc-en|ˌ|v|ɪ|t|ɪ|ˈ|l|aɪ|ɡ|oʊ}}, {{respell|vi|ti|LEYE|goh}}) is a [[chronic condition|chronic]] [[autoimmune disorder]] that causes patches of skin to lose [[pigment]] or color.<ref name=Andrew2020>{{cite book | vauthors = James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I  |title=Andrews' Diseases of the Skin: Clinical Dermatology |date=2020 |publisher=Elsevier |location=Edinburgh|isbn=978-0-323-54753-6 |pages=871–874 |edition=13th |chapter-url=https://books.google.com/books?id=UEaEDwAAQBAJ&pg=PA871 |language=en |chapter=36. Disturbances of pigmentation}}</ref> The cause of vitiligo is unknown, but it may be related to immune system changes, genetic factors, stress, or sun exposure, and susceptibility to it may be affected by regional environmental risk factors, especially early in life.<ref name="Mayo">{{cite web|url=https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912|title=Vitiligo - Symptoms and causes|website=Mayo Clinic|access-date=2023-05-05}}</ref><ref name="NIAMS">{{cite web|url=https://www.niams.nih.gov/health-topics/vitiligo|title=Vitiligo Symptoms, Treatment & Causes|website=NIAMS|date=12 April 2017 |access-date=2023-05-05}}</ref><ref>{{Cite web |url=https://jamanetwork.com/journals/jamadermatology/fullarticle/1886697 |title=Regional Variation of and Association of US Birthplace With Vitiligo Extent |last1=Silverberg |first1=Jonathan | last2=Reja |first2=Misha |last3=Silverberg |first3=Nanette |date=December 2014 |work= |publisher=JAMA Network |accessdate=16 May 2025}}</ref> Treatment options include [[Topical medication|topical medications]], [[Light therapy|light therapy]], [[Surgery|surgery]] and [[Cosmetics|cosmetics]].<ref name="NIAMS"/> The condition can show up on any skin type as a light peachy color and can appear on any place on the body in all sizes. Vitiligo spots on the skin can also “change” as they lose and regain pigment over long periods, although they will stay in relatively the same areas.
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== Signs and symptoms ==

The only sign of vitiligo is the presence of pale patchy areas of depigmented skin which tend to occur on the extremities.<ref name="niams">{{cite web |title=What Is Vitiligo? Fast Facts: An Easy-to-Read Series of Publications for the Public Additional |author=National Institute of Arthritis and Musculoskeletal and Skin Diseases |date=March 2007 |url=http://www.niams.nih.gov/Health_Info/Vitiligo/vitiligo_ff.asp#c |access-date=2010-07-18 |url-status=live |archive-url=https://web.archive.org/web/20100715210530/http://www.niams.nih.gov/Health_Info/Vitiligo/vitiligo_ff.asp#c |archive-date=15 July 2010 }}</ref><ref name="halder2">{{cite book |vauthors=Halder RM, Taliaferro S |chapter=72. Vitiligo |veditors=Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Lefell D |title=Fitzpatrick's dermatology in general medicine |edition=7th |location=New York |publisher=McGraw-Hill Professional |year=2007 |isbn=978-0-07-146690-5 |oclc=154751587}}</ref> Some people may experience itching before a new patch appears.<ref name=Whit2015>{{cite journal | vauthors = Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K | title = Interventions for vitiligo | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | pages = CD003263 | date = February 2015 | pmid = 25710794 | pmc = 10887429 | doi = 10.1002/14651858.CD003263.pub5 }}</ref> The patches are initially small, but often grow and change shape.<ref name="niams"/><ref name="halder">{{cite journal | vauthors = Halder RM, Chappell JL | title = Vitiligo update | journal = Seminars in Cutaneous Medicine and Surgery | volume = 28 | issue = 2 | pages = 86–92 | date = June 2009 | pmid = 19608058 | doi = 10.1016/j.sder.2009.04.008 | doi-broken-date = 1 November 2024 }}</ref> When skin [[lesion]]s occur, they are most prominent on the face, hands and wrists.<ref name="niams"/><ref name="halder2"/> The loss of skin pigmentation is particularly noticeable around body orifices, such as the mouth, eyes, [[nostril]]s, [[genitalia]] and [[Navel|umbilicus]].<ref name="niams"/><ref name="halder2"/> Some lesions have [[hyperpigmentation|increased skin pigment]] around the edges.<ref name="huggins">{{cite journal | vauthors = Huggins RH, Schwartz RA, Janniger C | title = Vitiligo | journal = Acta Dermatovenerologica Alpina, Pannonica, et Adriatica | volume = 14 | issue = 4 | pages = 137–42, 144–45 | date = December 2005 | pmid = 16435042 | url = http://www.mf.uni-lj.si/acta-apa/acta-apa-05-4/2.pdf | url-status = live | archive-url = https://web.archive.org/web/20061210104146/http://www.mf.uni-lj.si/acta-apa/acta-apa-05-4/2.pdf | archive-date = 10 December 2006 }}</ref> Those affected by vitiligo who are [[Stigmatization|stigmatized]] for their condition may experience depression and similar [[mood disorder]]s.<ref name="picardi">{{cite journal | vauthors = Picardi A, Pasquini P, Cattaruzza MS, Gaetano P, Melchi CF, Baliva G, Camaioni D, Tiago A, Abeni D, Biondi M | title = Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study | journal = Psychotherapy and Psychosomatics | volume = 72 | issue = 3 | pages = 150–158 | year = 2003 | pmid = 12707482 | doi = 10.1159/000069731 | s2cid = 22105282 }}</ref><!-- consider PMID 20616733 here -->
<gallery widths="220" heights="220">
File:Vitiligo03.jpg|Vitiligo on lighter skin
File:Vitiligo1.JPG|Non-segmental vitiligo on dark skin
File:Eyelid vitiligo 06.jpg|Non-segmental vitiligo of the eyelids
</gallery>

==Causes==
Although multiple hypotheses have been suggested as potential triggers that cause vitiligo, studies strongly imply that changes in the [[immune system]] are responsible for the condition.<ref name=Lancet2016>{{cite journal | vauthors = Ezzedine K, Eleftheriadou V, Whitton M, van Geel N | title = Vitiligo | journal = Lancet | volume = 386 | issue = 9988 | pages = 74–84 | date = July 2015 | pmid = 25596811 | doi = 10.1016/s0140-6736(14)60763-7 | s2cid = 208791128 }}</ref><ref>{{cite journal | vauthors = Ongenae K, Van Geel N, Naeyaert JM | title = Evidence for an autoimmune pathogenesis of vitiligo | journal = Pigment Cell Research | volume = 16 | issue = 2 | pages = 90–100 | date = April 2003 | pmid = 12622785 | doi = 10.1034/j.1600-0749.2003.00023.x | doi-access =  }}</ref> Vitiligo has been proposed to be a [[Multifactorial disease|multifactorial disease]] with genetic susceptibility and environmental factors both thought to play a role.<ref name=Lancet2016/> It is hypothesized that damaging environmental factors can disrupt [[Redox|redox]] reactions necessary for [[Protein folding|protein folding]], so skin cells may initiate the unfolded protein response which releases [[Cytokine|cytokines]], thus mounting an immune response.<ref name="Baldini 2017">{{cite journal | vauthors = Baldini E, Odorisio T, Sorrenti S, Catania A, Tartaglia F, Carbotta G, Pironi D, Rendina R, D'Armiento E, Persechino S, Ulisse S | title = Vitiligo and Autoimmune Thyroid Disorders | journal = Frontiers in Endocrinology | volume = 8 | issue = 290 | pages = 290 | date = 27 October 2017 | pmid = 29163360 | pmc = 5663726 | doi = 10.3389/fendo.2017.00290 | doi-access = free }}</ref><ref name="Chang 2021">{{cite journal | vauthors = Chang WL, Lee WR, Kuo YC, Huang YH | title = Vitiligo: An Autoimmune Skin Disease and its Immunomodulatory Therapeutic Intervention | journal = Frontiers in Cell and Developmental Biology | volume = 9 | issue = 797026 | pages = 797026 | date = 14 December 2021 | pmid = 34970551 | pmc = 8712646 | doi = 10.3389/fcell.2021.797026 | doi-access = free }}</ref>

The [[National Institutes of Health]] states that sometimes an event, like a [[sunburn]], emotional distress, or exposure to a chemical, can trigger or exacerbate the condition,<ref>{{cite web|title=Questions and Answers about Vitiligo|url=https://www.niams.nih.gov/health-topics/vitiligo#tab-causes|access-date=29 June 2024|date=30 October 2022|publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases|archive-date=8 August 2007|archive-url=https://web.archive.org/web/20070808050044/http://www.niams.nih.gov/hi/topics/vitiligo/vitiligo.htm#tab-causes|url-status=live}}</ref> Skin depigmentation in particular areas in vitiligo can also be triggered by mechanical trauma: this is an example of the [[Koebner phenomenon|Koebner phenomenom]].<ref name=":0">{{cite journal | vauthors = Zhang Y, Ding X, Wang F, Li M, Du J | title = Clinical significance of Koebner's phenomenon in vitiligo: a hospital-based epidemiological investigation from China | journal = Chinese Medical Journal | volume = 136 | issue = 4 | pages = 502–504 | date = February 2023 | pmid = 36580639 | pmc = 10106213 | doi = 10.1097/CM9.0000000000002431 }}</ref> Unlike in other skin diseases, this can be caused by daily activities, especially chronic friction on particular areas of the body.<ref name=":0" />

=== Immune ===
[[Melanin]] is the pigment that gives skin its color; it is produced by skin cells called [[melanocyte]]s.

Variations in genes that are part of the immune system or part of melanocytes have both been associated with vitiligo.<ref name="Lancet2016" /> It is also thought to be caused by the immune system attacking and destroying the melanocytes of the skin.<ref>{{cite web|url = http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/causes/con-20032007|title = Vitiligo Causes | author = Mayo Clinic Staff |publisher = Mayoclinic|date = 15 May 2014|access-date = 22 April 2015|url-status=live|archive-url = https://web.archive.org/web/20150430065653/http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/causes/con-20032007|archive-date = 30 April 2015}}</ref> A genome wide association study found approximately 36 independent susceptibility [[locus (genetics)|loci]] for generalized vitiligo.<ref>{{cite journal | vauthors = Spritz RA | title = Modern vitiligo genetics sheds new light on an ancient disease | journal = The Journal of Dermatology | volume = 40 | issue = 5 | pages = 310–318 | date = May 2013 | pmid = 23668538 | pmc = 3783942 | doi = 10.1111/1346-8138.12147 }}</ref>

The TYR gene encodes the protein [[tyrosinase]], which is not a component of the immune system but is an enzyme of the melanocyte that catalyzes melanin biosynthesis, and a major [[autoantigen]] in generalized vitiligo.<ref name="Lancet2016" />

=== Autoimmune associations ===
Vitiligo is sometimes associated with [[autoimmune]] and [[inflammatory disease]]s such as [[Hashimoto's thyroiditis]], [[scleroderma]], [[rheumatoid arthritis]], [[type 1 diabetes mellitus]], [[psoriasis]], [[Addison's disease]], [[pernicious anemia]], [[alopecia areata]], [[systemic lupus erythematosus]], and [[celiac disease]].<ref name=Lancet2016/><ref name=VanDriesscheSilverberg2015>{{cite journal | vauthors = Van Driessche F, Silverberg N | title = Current Management of Pediatric Vitiligo | journal = Paediatric Drugs | volume = 17 | issue = 4 | pages = 303–313 | date = August 2015 | pmid = 26022363 | doi = 10.1007/s40272-015-0135-3 | type = Review | s2cid = 20038695 }}</ref>

Among the inflammatory products of [[NLRP1]] are [[caspase 1]] and [[caspase 7]], which activate the inflammatory [[cytokine]] [[Interleukin-1 beta|interleukin-1β]]. Interleukin-1β and [[interleukin-18]] are expressed at high levels in people with vitiligo.<ref name=LamkanfiVandeWalle2011>{{cite journal | vauthors = Lamkanfi M, Vande Walle L, Kanneganti TD | title = Deregulated inflammasome signaling in disease | journal = Immunological Reviews | volume = 243 | issue = 1 | pages = 163–173 | date = September 2011 | pmid = 21884175 | pmc = 3170132 | doi = 10.1111/j.1600-065X.2011.01042.x | type = Review }}</ref> In one of the mutations, the [[amino acid]] leucine in the NALP1 protein was replaced by [[histidine]] (Leu155&nbsp;→&nbsp;His). The original protein and sequence is highly [[Conserved sequence|conserved in evolution]], and is found in humans, [[Common chimpanzee|chimpanzees]], [[Rhesus macaque|rhesus monkeys]], and [[Galago|bush babies]]. [[Addison's disease]] (typically an autoimmune destruction of the [[adrenal gland]]s) may also be seen in individuals with vitiligo.<ref>{{cite journal | vauthors = Gregersen PK | title = Modern genetics, ancient defenses, and potential therapies | journal = The New England Journal of Medicine | volume = 356 | issue = 12 | pages = 1263–1266 | date = March 2007 | pmid = 17377166 | doi = 10.1056/NEJMe078017 }}</ref><ref name=NALP2>{{cite journal | vauthors = Jin Y, Mailloux CM, Gowan K, Riccardi SL, LaBerge G, Bennett DC, Fain PR, Spritz RA | title = NALP1 in vitiligo-associated multiple autoimmune disease | journal = The New England Journal of Medicine | volume = 356 | issue = 12 | pages = 1216–1225 | date = March 2007 | pmid = 17377159 | doi = 10.1056/NEJMoa061592 | url = http://openaccess.sgul.ac.uk/111251/1/nejmoa061592.pdf | access-date = 16 December 2019 | url-status = live | archive-url = https://web.archive.org/web/20200306115942/http://openaccess.sgul.ac.uk/111251/1/nejmoa061592.pdf | archive-date = 6 March 2020 }}</ref>

=== Oxidative stress ===
Numerous whole-exome sequencing studies have demonstrated that vitiligo is associated with polymorphisms in genes involved in the response to oxidative stress such as CAT, SOD1, SOD2, SOD3, NFE2L2, HMOX1, GST-M1 or GST-T1 supporting the association of elevated levels of reactive oxygen species in melanocytes with the induction of an auto-immune response.<ref>{{Cite journal | vauthors = Chiarella P |date=2019-10-22 |title=Vitiligo susceptibility at workplace and in daily life: the contribution of oxidative stress gene polymorphisms |journal=Biomedical Dermatology |volume=3 |issue=1 |pages=5 |doi=10.1186/s41702-019-0043-1 |doi-access=free |issn=2398-8460}}</ref><ref>{{cite journal | vauthors = Ezzedine K, Eleftheriadou V, Whitton M, van Geel N | title = Vitiligo | journal = Lancet | volume = 386 | issue = 9988 | pages = 74–84 | date = July 2015 | pmid = 25596811 | doi = 10.1016/S0140-6736(14)60763-7 }}</ref>

Thus, diseases presenting with altered mitochondrial function such as MELAS, Vogt-Koyanagi-Harada syndrome and Kabuki syndrome are associated with increased risk of vitiligo.<ref>{{cite journal | vauthors = Karvonen SL, Haapasaari KM, Kallioinen M, Oikarinen A, Hassinen IE, Majamaa K | title = Increased prevalence of vitiligo, but no evidence of premature ageing, in the skin of patients with bp 3243 mutation in mitochondrial DNA in the mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS) | journal = The British Journal of Dermatology | volume = 140 | issue = 4 | pages = 634–639 | date = April 1999 | pmid = 10233312 | doi = 10.1046/j.1365-2133.1999.02761.x | first6 = And }}</ref><ref>{{cite journal | vauthors = Liang L, Tan X, Zhou Q, Tian Y, Kijlstra A, Yang P | title = TLR3 and TLR4 But not TLR2 are Involved in Vogt-Koyanagi- Harada Disease by Triggering Proinflammatory Cytokines Production Through Promoting the Production of Mitochondrial Reactive Oxygen Species | journal = Current Molecular Medicine | volume = 15 | issue = 6 | pages = 529–542 | date = 2015-08-19 | pmid = 26238371 | doi = 10.2174/1566524015666150731095611 }}</ref><ref>{{cite journal | vauthors = Margot H, Boursier G, Duflos C, Sanchez E, Amiel J, Andrau JC, Arpin S, Brischoux-Boucher E, Boute O, Burglen L, Caille C, Capri Y, Collignon P, Conrad S, Cormier-Daire V, Delplancq G, Dieterich K, Dollfus H, Fradin M, Faivre L, Fernandes H, Francannet C, Gatinois V, Gerard M, Goldenberg A, Ghoumid J, Grotto S, Guerrot AM, Guichet A, Isidor B, Jacquemont ML, Julia S, Khau Van Kien P, Legendre M, Le Quan Sang KH, Leheup B, Lyonnet S, Magry V, Manouvrier S, Martin D, Morel G, Munnich A, Naudion S, Odent S, Perrin L, Petit F, Philip N, Rio M, Robbe J, Rossi M, Sarrazin E, Toutain A, Van Gils J, Vera G, Verloes A, Weber S, Whalen S, Sanlaville D, Lacombe D, Aladjidi N, Geneviève D | title = Immunopathological manifestations in Kabuki syndrome: a registry study of 177 individuals | journal = Genetics in Medicine | volume = 22 | issue = 1 | pages = 181–188 | date = January 2020 | pmid = 31363182 | doi = 10.1038/s41436-019-0623-x }}</ref>

In line with these observations, genetic alterations in mitochondrial DNA (mtDNA) of melanocytes associated with altered mitochondrial function lead to a release of mtDNA that can be detected in the skin of vitiligo patients.<ref name=":1">{{cite journal | vauthors = Sant'Anna-Silva AC, Botton T, Rossi A, Dobner J, Bzioueche H, Thach N, Blot L, Pagnotta S, Kleszczynski K, Steinbrink K, Mazure NM, Rocchi S, Krutmann J, Passeron T, Tulic MK | title = Vitiligo auto-immune response upon oxidative stress-related mitochondrial DNA release opens up new therapeutic strategies | journal = Clinical and Translational Medicine | volume = 14 | issue = 8 | pages = e1810 | date = August 2024 | pmid = 39113238 | pmc = 11306283 | doi = 10.1002/ctm2.1810 }}</ref><ref>{{cite journal | vauthors = Bzioueche H, Simonyté Sjödin K, West CE, Khemis A, Rocchi S, Passeron T, Tulic MK | title = Analysis of Matched Skin and Gut Microbiome of Patients with Vitiligo Reveals Deep Skin Dysbiosis: Link with Mitochondrial and Immune Changes | journal = The Journal of Investigative Dermatology | volume = 141 | issue = 9 | pages = 2280–2290 | date = September 2021 | pmid = 33771527 | doi = 10.1016/j.jid.2021.01.036 }}</ref> This mtDNA can be sensed by the cGAS-STING pathway resulting in pro-inflammatory cytokine and chemokines production promoting the recruitment of cytotoxic CD8+ T cells. The use of mitochondrial antioxidants, NRF2 inhibitors, and TBK1 inhibitors is emerging as potential therapeutic options to block this cascade of events.<ref name=":1" />

== Diagnosis ==
[[File:Vitiligo UV 1.jpg|thumb|UV photograph of a hand with vitiligo]]
[[File:Vitiligo UV 2.jpg|thumb|UV photograph of a foot with vitiligo]]
An [[ultraviolet light]] can be used in the early phase of this disease for identification and to determine the effectiveness of treatment.<ref>{{cite journal | vauthors = Wang YJ, Chang CC, Cheng KL | title = Wood's lamp for vitiligo disease stability and early recognition of initiative pigmentation after epidermal grafting | journal = International Wound Journal | volume = 14 | issue = 6 | pages = 1391–1394 | date = December 2017 | pmid = 28799192 | pmc = 7949874 | doi = 10.1111/iwj.12800 | s2cid = 205222684 }}</ref> Using a [[Wood's light]], skin will change colour ([[fluoresce]]) when it is affected by certain bacteria, fungi, and changes to pigmentation of the skin.<ref>{{cite journal | title = Woods Light (Woods Lamp) | journal = StatPearls | date = 2019 | pmid = 30725878 | publisher = StatPearls Publishing | vauthors = Al Aboud DM, Gossman W }}</ref>

=== Classification ===

Classification attempts to quantify vitiligo have been analyzed as being somewhat inconsistent,<ref>{{cite book|chapter=Introduction|title=Vitiligo| veditors = Picardo M, Taïeb A |date=2009 |publisher=Springer |location=Berlin|isbn=978-3-540-69360-4}}</ref> while recent consensus has agreed to a system of segmental vitiligo (SV) and non-segmental vitiligo (NSV). NSV is the most common type of vitiligo.<ref name=Lancet2016 />

==== Non-segmental ====
In non-segmental vitiligo (NSV), there is usually some form of [[symmetry]] in the location of the patches of depigmentation. New patches also appear over time and can be generalized over large portions of the body or localized to a particular area. Extreme cases of vitiligo, to the extent that little pigmented skin remains, are referred to as ''vitiligo universalis''. NSV can come about at any age (unlike segmental vitiligo, which is far more prevalent in teenage years).<ref name="huggins"/>

Classes of non-segmental vitiligo include the following:

* Generalized vitiligo: the most common pattern, wide and randomly distributed areas of depigmentation<ref name="halder07">{{cite book | vauthors = Halder RM |chapter=Vitiligo | veditors = Fitzpatrick TB, Wolff K  |title=Fitzpatrick's Dermatology in General Medicine |edition=7th |location=New York |publisher=McGraw-Hill Professional |year=2007 |isbn=978-0-07-146690-5 }}</ref>
* Universal vitiligo: depigmentation encompasses most of the body<ref name="halder07"/>
* Focal vitiligo: one or a few scattered macules in one area, most common in children<ref name="halder07"/>
* Acrofacial vitiligo: fingers and periorificial areas<ref name="halder07"/>
* Mucosal vitiligo: depigmentation of only the mucous membranes<ref name="halder07"/>

==== Segmental ====

Segmental vitiligo (SV) differs in appearance, cause, and frequency of associated illnesses. Its treatment is different from that of NSV. It tends to affect areas of skin that are associated with [[dorsal root]]s from the [[spinal cord]] and is most often unilateral.<ref name=Lancet2016/><ref name=VanGeel2012/> It is much more stable/static in its course and its association with autoimmune diseases appears to be weaker than that of generalized vitiligo.<ref name=VanGeel2012>{{cite journal | vauthors = van Geel N, Mollet I, Brochez L, Dutré M, De Schepper S, Verhaeghe E, Lambert J, Speeckaert R | title = New insights in segmental vitiligo: case report and review of theories | journal = The British Journal of Dermatology | volume = 166 | issue = 2 | pages = 240–246 | date = February 2012 | pmid = 21936857 | doi = 10.1111/j.1365-2133.2011.10650.x | s2cid = 32746282 }}</ref> SV does not improve with topical therapies or UV light; however, surgical treatments such as cellular grafting can be effective.<ref name="huggins"/>

=== Differential diagnosis ===
Chemical leukoderma is a similar condition due to multiple exposures to chemicals.<ref name=Andrew2020/> Vitiligo however is a risk factor.<ref name=Andrew2020/> Triggers may include inflammatory skin conditions, burns, intralesional steroid injections, and abrasions.<ref name=Andrew2020/>

Other conditions with similar symptoms include the following:

* [[Albinism in humans|albinism]]
* [[halo nevus]]
* [[idiopathic guttate hypomelanosis]] (white sunspots)<ref name="halder07"/>
* [[piebaldism]]<ref name="halder07"/>
* [[pityriasis alba]]
* [[postinflammatory hypopigmentation]]
* [[primary adrenal insufficiency]]
* [[progressive macular hypomelanosis]]<ref name="halder07"/>
* [[tinea versicolor]]<ref name="halder07"/>
* [[tuberculoid leprosy]]

== Treatment ==
There is no cure for vitiligo but several treatment options are available.<ref name=Lancet2016/> The best evidence is for applied [[steroid]]s and [[ultraviolet light]] in combination with creams.<ref>{{cite journal | vauthors = Whitton ME, Ashcroft DM, González U | title = Therapeutic interventions for vitiligo | journal = Journal of the American Academy of Dermatology | volume = 59 | issue = 4 | pages = 713–717 | date = October 2008 | pmid = 18793940 | doi = 10.1016/j.jaad.2008.06.023 }}</ref> Due to the higher risks of skin cancer, the United Kingdom's [[National Health Service]] suggests phototherapy be used only if primary treatments are ineffective.<ref name="UK">{{cite web|url=http://www.nhs.uk/Conditions/Vitiligo/Pages/Treatment.aspx|title=Vitiligo -Treatment|last=Anon|work=Patient UK|publisher=NHS|access-date=2013-06-03|url-status=live|archive-url=https://web.archive.org/web/20130606020140/http://www.nhs.uk/Conditions/Vitiligo/Pages/Treatment.aspx|archive-date=6 June 2013}}</ref> Lesions located on the hands, feet, and joints are the most difficult to repigment; those on the face are easiest to return to the natural skin color as the skin is thinner.<ref name=Lancet2016/>

=== Immune mediators ===
Topical preparations of immune-suppressing medications including [[glucocorticoids]] (such as 0.05% clobetasol or 0.10% betamethasone) and [[calcineurin inhibitor]]s (such as [[tacrolimus]] or [[pimecrolimus]]) are considered to be first-line vitiligo treatments.<ref name=Lancet2016/>

In July 2022, [[ruxolitinib]] cream (sold under the brand name Opzelura) was approved for medical use in the United States for the treatment of vitiligo.<ref>{{cite web | title=Incyte Announces U.S. FDA Approval of Opzelura (ruxolitinib) Cream for the Treatment of Vitiligo | publisher=Incyte | via=Business Wire | date=19 July 2022 | url=https://www.businesswire.com/news/home/20220718005819/en/Incyte-Announces-U.S.-FDA-Approval-of-Opzelura%E2%84%A2-ruxolitinib-Cream-for-the-Treatment-of-Vitiligo | access-date=19 July 2022 | archive-date=19 July 2022 | archive-url=https://web.archive.org/web/20220719011431/http://www.businesswire.com/news/home/20220718005819/en/Incyte-Announces-U.S.-FDA-Approval-of-Opzelura%E2%84%A2-ruxolitinib-Cream-for-the-Treatment-of-Vitiligo/ | url-status=live }}</ref>

=== Phototherapy ===
Phototherapy is considered a second-line treatment for vitiligo.<ref name=Lancet2016/> Exposing the skin to light from UVB lamps is the most common treatment for vitiligo. The treatments can be done at home with a UVB lamp or in a clinic. The exposure time is managed so that the skin does not suffer overexposure. Treatment can take a few weeks if the spots are on the neck and face and if they existed not more than 3 years. If the spots are on the hands and legs and have been there for more than 3 years, it can take a few months. Phototherapy sessions are done 2–3 times a week. Spots on a large area of the body may require full-body treatment in a clinic or hospital. UVB broadband and narrowband lamps can be used,<ref>{{cite journal | vauthors = Scherschun L, Kim JJ, Lim HW | title = Narrow-band ultraviolet B is a useful and well-tolerated treatment for vitiligo | journal = Journal of the American Academy of Dermatology | volume = 44 | issue = 6 | pages = 999–1003 | date = June 2001 | pmid = 11369913 | doi = 10.1067/mjd.2001.114752 | s2cid = 17431219 }}</ref><ref>{{cite journal | vauthors = Don P, Iuga A, Dacko A, Hardick K | title = Treatment of vitiligo with broadband ultraviolet B and vitamins | journal = International Journal of Dermatology | volume = 45 | issue = 1 | pages = 63–65 | date = January 2006 | pmid = 16426381 | doi = 10.1111/j.1365-4632.2005.02447.x | s2cid = 454415 | doi-access = free }}</ref> but narrowband ultraviolet peaked around 311&nbsp;nm is the choice. It has been constitutively reported that a combination of UVB phototherapy with other topical treatments improves re-pigmentation. However, some people with vitiligo may not see any changes to skin or re-pigmentation occurring. A serious potential side effect involves the risk of developing skin cancer, the same risk as an overexposure to natural sunlight.{{citation needed|date=September 2019}}

Ultraviolet light ([[Ultraviolet A|UVA]]) treatments are normally carried out in a hospital clinic. [[Psoralen]] and ultraviolet A light ([[PUVA]]) treatment involves taking a drug that increases the skin's sensitivity to ultraviolet light and then exposing the skin to high doses of UVA light. Treatment is required twice a week for 6–12 months or longer. Because of the high doses of UVA and psoralen, PUVA may cause side effects such as sunburn-type reactions or skin freckling.<ref name="UK"/>

Narrowband ultraviolet B (NBUVB) phototherapy lacks the side effects caused by psoralens and is as effective as PUVA.<ref name=Lancet2016/> As with PUVA, treatment is carried out twice weekly in a clinic or every day at home, and there is no need to use psoralen.<ref name="UK"/> Longer treatment is often recommended, and at least 6 months may be required for effects to phototherapy.<ref name=Ba2017>{{cite journal | vauthors = Bae JM, Jung HM, Hong BY, Lee JH, Choi WJ, Lee JH, Kim GM | title = Phototherapy for Vitiligo: A Systematic Review and Meta-analysis | journal = JAMA Dermatology | volume = 153 | issue = 7 | pages = 666–674 | date = July 2017 | pmid = 28355423 | pmc = 5817459 | doi = 10.1001/jamadermatol.2017.0002 }}</ref> NBUVB phototherapy appears better than PUVA therapy with the most effective response on the face and neck.<ref name=Ba2017/>

With respect to improved repigmentation: topical calcineurin inhibitors plus phototherapy are better than phototherapy alone,<ref>{{cite journal | vauthors = Bae JM, Hong BY, Lee JH, Lee JH, Kim GM | title = The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs) | journal = Journal of the American Academy of Dermatology | volume = 74 | issue = 5 | pages = 907–915 | date = May 2016 | pmid = 26785803 | doi = 10.1016/j.jaad.2015.11.044 }}</ref> [[hydrocortisone]] plus laser light is better than laser light alone, [[ginkgo biloba]] is better than [[placebo]], and oral mini-pulse of [[prednisolone]] (OMP) plus NB-UVB is better than OMP alone.<ref name=Whit2015/>

=== Skin camouflage ===
In mild cases, vitiligo patches can be hidden with makeup or other [[cosmetic camouflage]] solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding [[sun tanning|tanning]] of unaffected skin.<ref name="halder07"/>

=== Depigmenting ===
In cases of extensive vitiligo the option to depigment the unaffected skin with topical drugs like [[monobenzone]], [[mequinol]], or [[hydroquinone]] may be considered to render the skin an even color. The removal of all the skin pigment with [[monobenzone]] is permanent and vigorous. Sun safety must be adhered to for life to avoid severe [[sunburn]] and [[melanomas]]. Depigmentation takes about a year to complete.<ref name="UK"/>

== History ==
Descriptions of a disease believed to be vitiligo date back to a passage in the medical text [[Ebers Papyrus]] {{circa|1500 BC}} in ancient [[Egypt]]. Also, the [[Hebrew language|Hebrew]] word "[[Tzaraath]]" from the [[Old Testament]] book of [[Leviticus]]<ref name=Taieb/> dating to 1280&nbsp;BC<ref name=Kurzweil11>{{cite book |title=The Torah For Dummies | vauthors = Kurzweil A |author-link=Arthur Kurzweil |year=2008 |publisher=For Dummies |isbn=978-0-470-28306-6 |page=11 |url=http://media.wiley.com/product_data/excerpt/59/04701734/0470173459.pdf |access-date=2010-08-19 |archive-date=22 June 2020 |archive-url=https://web.archive.org/web/20200622201855/https://media.wiley.com/product_data/excerpt/59/04701734/0470173459.pdf |url-status=live }}</ref> (or 1312&nbsp;BC<ref name=Timeline>{{cite web | url = http://www.aish.com/jl/h/48944541.html | title = History Crash Course #36: Timeline: From Abraham to Destruction of the Temple | archive-url = https://web.archive.org/web/20140720164107/http://www.aish.com/jl/h/48944541.html | archive-date=20 July 2014 | vauthors = Spiro K | work = Aish.com | access-date = 2010-08-19 }}</ref>) described a group of skin diseases associated with white spots, and a subsequent translation to Greek led to continued conflation of those with vitiligo with [[leprosy]] and spiritual uncleanliness.<ref name=Taieb/>

Medical sources in the ancient world such as [[Hippocrates]] often did not differentiate between vitiligo and leprosy, often grouping these diseases together. The name "vitiligo" was first used by the Roman physician [[Aulus Cornelius Celsus]] in his classic medical text ''[[De Medicina]]''.<ref name=Taieb>{{cite book| vauthors = Gauthier Y, Benzekri L |chapter=Historical Aspects|title=Vitiligo| veditors = Picardo M, Taïeb A |date=2009|publisher=Springer|location=Berlin|isbn=978-3-540-69360-4|edition=Online-Ausg.}}</ref>

The term ''vitiligo'' is believed to be derived from "vitium", meaning "defect" or "blemish".<ref name="Taieb"/>

[[File:Winnie Harlow Cannes 2018.jpg|thumb|[[Winnie Harlow]]]]

==Society and culture==

The change in appearance caused by vitiligo can affect a person's emotional and psychological well-being and may create difficulty in becoming or remaining employed, particularly if vitiligo develops on visible areas of the body, such as the face, hands or arms. Participating in a vitiligo support group may improve social coping skills and emotional resilience.<ref>{{cite journal | vauthors = Chaturvedi SK, Singh G, Gupta N | title = Stigma experience in skin disorders: an Indian perspective | journal = Dermatologic Clinics | volume = 23 | issue = 4 | pages = 635–642 | date = October 2005 | pmid = 16112439 | doi = 10.1016/j.det.2005.05.007 }}</ref>

=== Notable people with vitiligo ===
Notable cases include American pop singer [[Michael Jackson]],<ref>{{cite web|title=Black and White: how Dangerous kicked off Michael Jackson's race paradox|url=https://www.theguardian.com/music/2018/mar/17/black-and-white-how-dangerous-kicked-off-michael-jacksons-race-paradox| vauthors = Vogel J |work=The Guardian|date=17 March 2018|access-date=14 September 2019|archive-date=17 March 2018|archive-url=https://web.archive.org/web/20180317162541/https://www.theguardian.com/music/2018/mar/17/black-and-white-how-dangerous-kicked-off-michael-jacksons-race-paradox|url-status=live}}</ref> Canadian fashion model [[Winnie Harlow]],<ref>{{cite web |title=Winnie Harlow: Canadian Model With Rare Skin Condition Lands 2 Major Campaigns |url=https://www.complex.com/style/2015/02/canadian-model-winnie-harlow-stars-major-fashion-campaigns |website=Complex |access-date=17 February 2020 |language=en |archive-date=23 October 2020 |archive-url=https://web.archive.org/web/20201023132021/https://www.complex.com/style/2015/02/canadian-model-winnie-harlow-stars-major-fashion-campaigns |url-status=live }}</ref> New Zealand singer-songwriter [[Kimbra]],<ref>{{Cite web | vauthors = Deahl D |date=2018-05-04 |title=Kimbra on the tech she carries everywhere |url=https://www.theverge.com/2018/5/4/17234638/whats-in-your-bag-kimbra-primal-heart |access-date=2022-11-23 |website=The Verge}}</ref> American actor [[David Dastmalchian]] and Argentine musician [[Charly García]]. Professional wrestler [[Bryan Danielson]]<ref>{{cite tweet|user=WWEDanielBryan|number=97214858474422272|title=@tarynlove77 It's vitiligo, not any artificial patch, which is an autoimmune disease you can look up on Wikipedia}}</ref> and French actor [[Michaël Youn]] are also affected,<ref>{{Cite web| vauthors = Prisma MP |title=Michaël Youn : l'étonnante maladie génétique dont il est atteint… au niveau du pénis - Voici|url=https://www.voici.fr/news-people/actu-people/michael-youn-letonnante-maladie-genetique-dont-il-est-atteint-au-niveau-du-penis-647550|access-date=2021-09-25|website=Voici.fr|date=11 June 2018 |language=fr|archive-date=25 September 2021|archive-url=https://web.archive.org/web/20210925235100/https://www.voici.fr/news-people/actu-people/michael-youn-letonnante-maladie-genetique-dont-il-est-atteint-au-niveau-du-penis-647550|url-status=live}}</ref> as is former French Prime Minister [[Édouard Philippe]],<ref>{{Cite web| vauthors = Match P |title=Dans les coulisses de la campagne d'Edouard Philippe au Havre|url=https://www.parismatch.com/Actu/Politique/Dans-les-coulisses-de-la-campagne-d-Edouard-Philippe-au-Havre-1689917|access-date=2021-09-25|website=parismatch.com|date=26 June 2020 |language=fr|archive-date=14 September 2021|archive-url=https://web.archive.org/web/20210914153948/https://www.parismatch.com/Actu/Politique/Dans-les-coulisses-de-la-campagne-d-Edouard-Philippe-au-Havre-1689917|url-status=live}}</ref> [[Miss Egypt|Miss Universe Egypt 2024]] Logina Salah,<ref>{{cite web |last1=Bi |first1=Huong |title=Người phụ nữ một con với làn da bạch biến sẽ đối đầu với Kỳ Duyên tại Miss Universe |url=https://www.saostar.vn/nguoi-mau-hoa-hau/nguoi-phu-nu-mot-con-voi-lan-da-bach-bien-se-doi-dau-voi-ky-duyen-202410061823347328.html |website=Saostar |access-date=7 October 2024 |language=Vietnamese |date=6 October 2024}}</ref> former [[Roman Catholic]] priest, [[Governor of Pampanga]] and TV host [[Eddie Panlilio]], and model and former [[Miss Colombia 2007]] [[Taliana Vargas]].<ref>{{Cite web|url=https://www.eltiempo.com/cultura/gente/taliana-vargas-muestra-marcas-de-vitiligo-en-su-piel-593184|title=Taliana Vargas muestra nuevas marcas de vitiligo en su piel|access-date=December 12, 2022|date=June 4, 2021|website=eltiempo.com}}</ref><ref>{{Cite web|url=https://www.infobae.com/america/colombia/2021/10/26/taliana-vargas-explico-como-va-el-tratamiento-para-su-problema-de-piel/|title=Taliana Vargas explicó cómo va el tratamiento para su problema de piel|access-date=December 12, 2022|date=October 26, 2022|website=infobae.com}}</ref>

=== In popular culture ===
The Adult Swim animated sitcom ''[[The Boondocks (2005 TV series)|The Boondocks]]'' satirizes the idea of vitiligo in [[Uncle Ruckus]], one of the show's characters. Ruckus, who is black, frequently claims to be white, often stating that he has "Re-vitiligo, the opposite of what Michael Jackson had." He frequently uses this argument to maintain that he is actually white, leading him to commit delusional and racist antics in nearly every episode.<ref>{{Cite web | vauthors = Marsh K |date=2023-03-15 |title=Why I use 'The Boondocks' TV cartoon show to teach a course about race |url=http://theconversation.com/why-i-use-the-boondocks-tv-cartoon-show-to-teach-a-course-about-race-195060 |access-date=2024-01-08 |website=The Conversation |language=en-US}}</ref>

== Research ==
{{As of|2013|July}}, [[afamelanotide]] is in phase II and III clinical trials for vitiligo and other skin diseases.<ref>{{cite journal | vauthors = Fabrikant J, Touloei K, Brown SM | title = A review and update on melanocyte stimulating hormone therapy: afamelanotide | journal = Journal of Drugs in Dermatology | volume = 12 | issue = 7 | pages = 775–779 | date = July 2013 | pmid = 23884489 }}</ref>

A medication for rheumatoid arthritis, [[tofacitinib]], has been tested for the treatment of vitiligo.<ref>{{cite web|url=http://news.yale.edu/2015/06/24/vitiligo-patient-arthritis-drug-restores-skin-color|title=For vitiligo patient, arthritis drug restores skin color|url-status=live|archive-url=https://web.archive.org/web/20150722190939/http://news.yale.edu/2015/06/24/vitiligo-patient-arthritis-drug-restores-skin-color|archive-date=22 July 2015|date=24 June 2015}}</ref>

In October 1992, a scientific report was published of successfully transplanting [[melanocyte]]s to vitiligo-affected areas, effectively repigmenting the region.<ref>{{cite journal | vauthors = Olsson MJ, Juhlin L | title = Melanocyte transplantation in vitiligo | journal = Lancet | volume = 340 | issue = 8825 | pages = 981 | date = October 1992 | pmid = 1357390 | doi = 10.1016/0140-6736(92)92875-G | s2cid = 19599682 }}</ref> The procedure involved taking a thin layer of pigmented skin from the person's [[Gluteal muscles|gluteal]] region. Melanocytes were then separated out to a [[Cell (biology)|cellular]] suspension that was expanded in culture. The area to be treated was then denuded with a [[Dermabrasion|dermabrader]] and the melanocytes [[Skin grafting|graft]] applied. Between 70 and 85 percent of people with vitiligo experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from person to person.<ref>{{cite journal | vauthors = Olsson MJ, Juhlin L | title = Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension | journal = The British Journal of Dermatology | volume = 147 | issue = 5 | pages = 893–904 | date = November 2002 | pmid = 12410698 | doi = 10.1046/j.1365-2133.2002.04837.x | s2cid = 42396825 }}</ref>
{{Clear}}

Current research suggests that the Janus kinase/signal transducer and activator of the transcription pathway (JAK/STAT pathway) plays a crucial role in the loss of epidermal melanocytes. This pathway is activated by CXCR3+ CD8+ T cells, creating a positive feedback loop with interferon-gamma (IFN-γ) chemokines from keratinocytes, potentially contributing to vitiligo.<ref name=Qi21>{{cite journal | vauthors = Qi F, Liu F, Gao L | title = Janus Kinase Inhibitors in the Treatment of Vitiligo: A Review | journal = Frontiers in Immunology | volume = 12 | issue =  | pages = 790125 | date = 2021 | pmid = 34868078 | pmc = 8636851 | doi = 10.3389/fimmu.2021.790125 | doi-access = free }}</ref> JAK inhibitors like ruxolitinib show promise in targeting the IFN-γ-chemokine signaling axis implicated in vitiligo pathogenesis, and improving nonsegmental vitiligo.<ref name=Qi21/><ref>{{ClinicalTrialsGov|NCT04052425|Topical Ruxolitinib Evaluation in Vitiligo Study 1 (TRuE-V1)}}</ref><ref>{{ClinicalTrialsGov|NCT04057573|Topical Ruxolitinib Evaluation in Vitiligo Study 2 (TRuE-V2)}}</ref>

== References ==
{{Reflist}}

== External links ==
{{Commons category}}
* [http://niams.nih.gov/Health_Info/Vitiligo/default.asp Questions and Answers about Vitiligo]&nbsp;– US National Institute of Arthritis and Musculoskeletal and Skin Diseases

{{Medical condition classification and resources
| DiseasesDB      = 13965
| ICD10           = {{ICD10|L|80||l|80}}
| ICD9            = {{ICD9|709.01}}
| ICDO            = 
| OMIM            = 193200
| MedlinePlus     = 000831
| eMedicineSubj   = derm
| eMedicineTopic  = 453
| MeshID          = D014820
| SNOMED CT       = 56727007
}}
{{Diseases of the skin and appendages by morphology}}
{{Pigmentation disorders}}
{{Authority control}}

[[Category:Autoimmune diseases]]
[[Category:Disturbances of human pigmentation]]
[[Category:Genodermatoses]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Wikipedia medicine articles ready to translate]]