Vitiligo – from Clinical Manifestations to Pathophysiological Mechanisms and Cell Death (original) (raw)

Concise review of recent studies in vitiligo

Qatar Medical Journal, 2013

Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's l& also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment ...

A Critical Appraisal of Vitiligo Etiologic Theories. Is Melanocyte Loss a Melanocytorrhagy?

Pigment Cell Research, 2003

Common generalized vitiligo is an acquired depigmenting disorder characterized by a chronic and progressive loss of melanocytes from the epidermis and follicular reservoir. However, the mechanism of melanocyte disappearance has never been clearly understood, and the intervention of cellular and humoral autoimmune phenomena as primary events remains unproven. In this review, is discussed the data supporting the major theories of vitiligo, namely melanocyte destruction (autoimmune, neural and impaired redox status) and melanocyte inhibition or defective adhesion. Based on recent morphologic findings in vivo supporting a chronic detachment and transepidermal loss of melanocytes in common generalized vitiligo, a new theory is suggested proposing melanocytorrhagy as the primary defect underlying melanocyte loss, integrating most of the possible triggering/precipitating/ enhancing effects of other known factors.

Vitiligo: A Possible Model of Degenerative Diseases

PLoS ONE, 2013

Vitiligo is characterized by the progressive disappearance of pigment cells from skin and hair follicle. Several in vitro and in vivo studies show evidence of an altered redox status, suggesting that loss of cellular redox equilibrium might be the pathogenic mechanism in vitiligo. However, despite the numerous data supporting a pathogenic role of oxidative stress, there is still no consensus explanation underlying the oxidative stress-driven disappear of melanocytes from the epidermis. In this study, in vitro characterization of melanocytes cultures from non-lesional vitiligo skin revealed at the cellular level aberrant function of signal transduction pathways common with neurodegenerative diseases including modification of lipid metabolism, hyperactivation of mitogen-activated protein kinase (MAPK) and cAMP response element-binding protein (CREB), constitutive p53-dependent stress signal transduction cascades, and enhanced sensibility to pro-apoptotic stimuli. Notably, these long-term effects of subcytotoxic oxidative stress are also biomarkers of pre-senescent cellular phenotype. Consistent with this, vitiligo cells showed a significant increase in p16 that did not correlate with the chronological age of the donor. Moreover, vitiligo melanocytes produced many biologically active proteins among the senescence-associated secretory phenotype (SAPS), such as interleukin-6 (IL-6), matrix metallo proteinase-3 (MMP3), cyclooxygenase-2 (Cox-2), insulin-like growth factor-binding protein-3 and 7 (IGFBP3, IGFBP7). Together, these data argue for a complicated pathophysiologic puzzle underlying melanocytes degeneration resembling, from the biological point of view, neurodegenerative diseases. Our results suggest new possible targets for intervention that in combination with current therapies could correct melanocytes intrinsic defects. Citation: Bellei B, Pitisci A, Ottaviani M, Ludovici M, Cota C, et al. (2013) Vitiligo: A Possible Model of Degenerative Diseases. PLoS ONE 8(3): e59782.

Vitiligo Etiology and Treatment

Journal of the Dermatology Nurses' Association, 2010

The disease pathway of the skin pigmentary disorder vitiligo involves hereditary factors, disease onset after overproduction of reactive oxygen species, and disease expansion through an adaptive, antigen-specific immune response to melanocytes. The current study was performed to obtain further knowledge of the disease process through patient questionnaires. Fifteen questions describing the condition of vitiligo were posted on the National Vitiligo Foundation and Vitiligo Support International Web sites and distributed by participating dermatologists to patients visiting their clinics. A total of 400 responses to the survey were collected and subjected to statistical analysis. The data support an overall increase in affected skin averaging 1% per year, with 50% of patients displaying a Koebner phenomenon, where new skin lesions appear at sites of trauma. Approximately 25% more women than men develop the disease. Patients recognize the importance of hereditary factors and the involvement of stress in precipitating the disease, yet only few note the contribution of an autoimmune response. Patients with relatives affected by vitiligo demonstrated an earlier age of onset. Autoimmune diseases found to be at least 25-fold more prevalent among respondents include Addison's disease, sarcoidosis, diabetes, and alopecia areata. Among a third of patients currently undergoing treatment, half note satisfactory efficacy, in particular for depigmentation treatment or topical immune modulation. The study has provided new insight into vitiligo disease parameters.

Vitiligo: symptoms, pathogenesis and treatment

International journal of immunopathology and pharmacology

Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.

Overview on vitiligo and its treatment

World Journal of Biology Pharmacy and Health Sciences, 2022

Vitiligo, is a skin disorder, in which the skin loses its pigment due to the loss of melanocytes. The exact cause is still under research but the disorder is linked to autoimmune disease, oxidative stress, genetics and environmental variables. The disease being progressive in nature often spreads all over the body. Globally, Vitiligo affects nearly about 0.5% to 1% of people. In 2012, the most recent and approved classification for Vitiligo was given at Vitiligo Global Issues Consensus Conference (VGICC). Understanding the biological mediators and molecular mechanisms that result in metabolic problems, melanocyte degradation, and autoimmunity is crucial in order to identify innovative therapy targets and drugs that may be able to stop the progression of the condition or even cure vitiligo. Treatment options range from oral antibiotics, topical immunosuppressants, melanocyte promoters, oral immunosuppressants, JAK kinase inhibitors, physical therapy, to surgical intervention. Systemic biological therapies that target cytokines have shown promising results in the treatment of diseases like vitiligo and psoriasis.

Vitiligo: Translational research and effective therapeutic strategies

Pigment Cell & Melanoma Research, 2021

Vitiligo is an acquired pigmentary disorder characterized by the loss of melanocytes leading to depigmented patches on the skin, mucosae, or both and often associated with leukotrichia. (Ezzedine et al., 2015) The disease significantly affects the quality of life in affected individuals, especially in darker skin types. (Elbuluk & Ezzedine, 2017) Vitiligo has been classified as segmental and nonsegmental vitiligo, and the two clinical forms behave differently. (Ezzedine, Lim, et al., 2012) Segmental vitiligo generally stabilizes after progressing for some time, while non-segmental vitiligo may have an unpredictable course often with quiescent and progressive phases. (Rodrigues et al., 2017). 2 | EPIDEMI OLOGY Vitiligo is the most common depigmenting disorder, and the worldwide prevalence ranges from 0.5% to 2% with great geographical variations. (Bergqvist & Ezzedine, 2020) In a large epidemiological survey from Denmark, the prevalence of vitiligo was found 0.38%, while in the Indian population, this was as high as 8.8%.

Vitiligo. Diagnostic and therapeutic recommendations of the Polish Dermatological Society

Dermatology Review, 2019

Vitiligo is an idiopathic chronic dermatosis manifested by depigmented patches of skin due to the loss of normal pigment-producing cells (melanocytes) and pigment (melanin). The disease develops more commonly in genetically predisposed individuals affected by various adverse external and internal factors inducing cellular stress in melanocytes. Cellular stress activates autoimmune and autoinflammatory mechanisms leading to melanocyte destruction. The disorder affects 0.5-4.0% of the world population, with no predilection for either sex. Manifestations can appear at any age, however in more than half of patients vitiligo starts before the age of 20 years. The course of the disease is varied-from stable cases with small isolated vitiligo patches to the rapid progression of lesions resulting in large areas of the skin being affected. There are multiple methods of treating vitiligo including pharmacological and surgical modalities, and phototherapy. Another essential aspect is patient education. Available treatment methods do not always yield the expected therapeutic effect. The Recommendations contain infor