We searched PubMed with the terms “vitiligo”, “autoimmunity”, and “leucoderma”. Our search covered articles published in English between Jan 1, 2000, and Jan 31, 2014. We identified additional reports that were judged the most relevant and recently published from the reference lists of selected articles. Some important older publications are cited either directly or indirectly through review articles.
SeminarVitiligo
Introduction
Vitiligo is an acquired chronic depigmenting disorder of the skin resulting from selective destruction of melanocytes. Celsus1 was the first to use the term vitiligo in his Latin medical classic De Medicina during the second century BCE.1, 2 The name is believed to derive from the Latin vitium, meaning defect or blemish,3 rather than vitellus, meaning calf.4 Typical vitiligo lesions can be defined as milky white, non-scaly macules with distinct margins. According to a recent international consensus conference,5 vitiligo can be classified into two major forms—namely, non-segmental vitiligo, also known as vitiligo, and segmental vitiligo. Non-segmental vitiligo, the commonest form of this unpredictable disease, is characterised by symmetrical and bilateral white patches. Different clinical subtypes have been described, including generalised, acrofacial, and universalis types, all with a bilateral distribution. Segmental vitiligo is less common than non-segmental vitiligo and usually has a unilateral distribution. Overall, progressive patchy loss of pigmentation from skin, overlying hair, and sometimes mucosa remains the basis of diagnosis of vitiligo.
Section snippets
Epidemiology
Vitiligo is the most common depigmenting disorder. The largest epidemiological study6 was done in 1977 on the island of Bornholm in Denmark, where vitiligo was reported to affect 0·38% of the population. The prevalence of vitiligo is often referred to as 0·5–1% of the world's population,5 although the exact prevalence is difficult to estimate, with rates as high as 8·8% in India.7 This high value could be due to the inclusion of cases with chemically induced depigmentation,8 or because these
Classification
Segmental vitiligo lesions are characterised by their unilateral and segmental or band-shaped distribution, (figure 1) early involvement of the follicular melanocyte reservoir, early age of onset, and rapid stabilisation,22 whereas non-segmental vitiligo lesions are typically bilaterally distributed in an acrofacial pattern, or scattered symmetrically over the entire body, evolving over time. Non-segmental vitiligo can initially have an acrofacial distribution, but can later progress to the
Pathophysiology
Histological examination and immunohistochemical studies with a large panel of antibodies generally show an absence of melanocytes in lesional skin, although sometimes an occasional melanocyte can be seen.28 However, the presence of a lymphocytic infiltrate has been described when biopsy specimens are taken from perilesional skin of actively spreading or inflammatory vitiligo (figure 3), in which there is a raised erythematous border. Various theories have been suggested for the cause of
Management
Before management is discussed with the patient, the extent of the disease should be assessed with natural and Wood's lamp examination. The Vitiligo European Task Force23 has developed an assessment form summarising the results of the personal and family history of the patient and clinical examination items. Skin phototype and disease duration, extent, and activity are important elements that will help to guide therapeutic management. Additionally, the patient's psychological profile and way of
Effects on people
So far, there is no cure for vitiligo. Current treatment results vary between individuals and are often unsatisfactory. Best results are generally reported for the face, whereas acral lesions respond poorly. Moreover, treatment is more efficient in recently developed lesions compared with older lesions, which argues for early therapeutic intervention.93 Patients with a fair complexion should be advised, after discussion, that no treatment can be offered because of an expected poor response and
Future directions
Whitton and colleagues80 pointed out that there is no consensus about the classification and definition of the disorder or about methods of assessment and outcome measures used in trials, and noted heterogeneity of interventions used to treat vitiligo.106, 107 These issues have been recognised by international experts worldwide as a priority for research. Efforts have been made to resolve these issues by the creation of consensus,5 identification and definition of priorities for research,108
Search strategy and selection criteria
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Exosomes: new players in cell–cell communication
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Skin-depigmenting agent monobenzone induces potent T-cell autoimmunity toward pigmented cells by tyrosinase haptenation and melanosome autophagy
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Increased sensitivity to peroxidative agents as a possible pathogenic factor of melanocyte damage in vitiligo
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In vitro growth characteristics of melanocytes obtained from adult normal and vitiligo subjects
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Detection of antibodies to melanocytes in vitiligo by specific immunoprecipitation
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Correlation between vitiligo antibodies and extent of depigmentation in vitiligo
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4-Tertiary butyl phenol exposure sensitizes human melanocytes to dendritic cell-mediated killing: relevance to vitiligo
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Low catalase levels in the epidermis of patients with vitiligo
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Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL)
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Randomized controlled study to evaluate the effectiveness of dexamethasone oral minipulse therapy versus oral minocycline in patients with active vitiligo vulgaris
Indian J Dermatol Venereol Leprol
Depigmentation therapy in vitiligo universalis with topical 4-methoxyphenol and the Q-switched ruby laser
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Psychological reaction to chronic skin disorders: a study of patients with vitiligo
Gen Hosp Psychiatry
Vitiligo—a retrospect
Int J Dermatol
Historical aspects
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The medico historical perspective of vitiligo (Switra)
Bull Indian Inst Hist Med Hyderabad
Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference
Pigment Cell Melanoma Res
Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark
Arch Dermatol
400 cases of vitiligo. A clinico-therapeutic analysis
Indian J Dermatol
Vitiligo: compendium of clinico-epidemiological features
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Epidemiology of vitiligo in the French West Indies (Isle of Martinique)
Int J Dermatol
Clinical pattern of vitiligo in Libya
Int J Dermatol
Studies on vitiligo. I. Epidemiological profile in Calcutta, India
Genet Epidemiol
Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo
Br J Dermatol
Profile of childhood vitiligo in China: an analysis of 541 patients
Pediatr Dermatol
Update on childhood vitiligo
Curr Opin Pediatr
Vitiligo in children: a clinical-epidemiologic study in Jordan
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A review of the worldwide prevalence of vitiligo in children/adolescents and adults
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Latent class analysis of a series of 717 patients with vitiligo allows the identification of two clinical subtypes
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Follicular vitiligo: a new form of vitiligo
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Review of the etiopathomechanism of vitiligo: a convergence theory
Exp Dermatol
Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms
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Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families
Pigment Cell Res
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