Vitiligo is a chronic skin condition that affects millions of people each year, approximately 1% of the global population. It is characterized by the loss of melanin, the brown-black pigment (Eumelanin) that is produced by melanocytes in the epidermis. As a result, patches of skin lose their pigmentation, creating a stark contrast between the pigmented and depigmented areas of skin. Vitiligo can be caused by a combination of genetic, environmental, and autoimmune factors.
The Different Types of Vitiligo
Vitiligo is commonly classified as depigmented patches of skin that can be found on the body, however, there are many different types of vitiligo that are classified based on the location, distribution, and pattern of the depigmented patches.
Nonsegmental/Generalized Vitiligo is the most common type of vitiligo, which accounts for roughly 80% of cases. It is characterized by the widespread distribution of depigmented patches on both sides of the body, including the face, trunk, and extremities. The depigmented patches in non-segmental vitiligo are usually well-defined and may have irregular borders. The patches may start small and gradually expand in size over time, or they may appear suddenly and progress rapidly. The affected skin may be more susceptible to sunburn and other forms of skin damage, as it lacks the protective pigment melanin. Nonsegmental vitiligo can occur at any age, but it typically begins in adolescence or early adulthood. It affects people of all skin types, but it is more noticeable in individuals with darker skin tones. While non-segmental vitiligo is not life-threatening, it can have a significant impact on a person’s quality of life, causing psychological distress and social stigma.
Segmental Vitiligo is a type of vitiligo that occurs in a localized area of the body, often on one side only. It typically begins in childhood or adolescence and tends to stabilize after a few years. Unlike non-segmental vitiligo, which is believed to be an autoimmune disorder, the exact cause of segmental vitiligo is not fully understood. The depigmented patches in segmental vitiligo are usually unilateral, meaning they occur on one side of the body only, and they tend to be well-defined and have a smooth border. The patches may be smaller and less numerous than those in non-segmental vitiligo, and they may occur in a specific pattern or shape, such as a band or a cluster. Segmental vitiligo is less common than non-segmental vitiligo, accounting for about 10% of cases. It is not typically associated with other autoimmune disorders or systemic symptoms, as is often the case with non-segmental vitiligo.
Mixed Vitiligo is a type of vitiligo that involves both segmental and non-segmental vitiligo patterns. This means that the depigmentation may occur on one side of the body in a segmental pattern, as well as in a non-segmental pattern on other areas of the body. The depigmented patches in mixed vitiligo may be localized or generalized and may occur on any part of the body, including the face, neck, arms, and legs. The patches may be well-defined or irregular in shape and may have a darker border. Hair in the affected areas may also lose its pigmentation and become white or gray.
Focal Vitiligo is a type of vitiligo that is characterized by one or a few small, isolated patches of depigmentation on the skin. These patches may occur anywhere on the body and are typically circular or oval in shape. The patches in focal vitiligo may start small and gradually expand in size, or they may remain stable and not spread. They may occur singly or in a few small clusters, and they may repigment on their own, although this is not always the case. Unlike non-segmental vitiligo, which often has irregular borders, the patches in focal vitiligo usually have well-defined borders. Focal vitiligo is less common than non-segmental vitiligo, accounting for about 5% of cases. It may occur at any age, but it is more common in childhood and adolescence. The exact cause of focal vitiligo is not fully understood, but it is believed to be related to an autoimmune response or a genetic predisposition to the condition.
Mucosal Vitiligo is a type of vitiligo that affects the mucous membranes of the body, such as those in the mouth, nose, and genitals. It is less common than other types of vitiligo and accounts for only a small percentage of cases. The depigmentation in mucosal vitiligo may be localized or generalized and may occur on one or both sides of the body. The affected areas may appear white or pink and may be surrounded by a darker border. Mucosal vitiligo may be associated with other types of vitiligo on the skin, or it may occur on its own.
Acrofacial Vitiligo is a type of vitiligo that primarily affects the extremities, such as the hands, feet, and face. It is more common in people with darker skin and may occur at any age. The depigmented patches in acrofacial vitiligo may occur symmetrically on both sides of the body, or they may be unilateral. They tend to be well-defined and may have irregular or scalloped borders. The patches may occur on the fingers, toes, and around the mouth, eyes, and nose. The hair in the affected areas may also lose its pigment and become white or gray.
Universal Vitiligo is a type of vitiligo that involves the widespread loss of pigment across the entire body, including the skin, hair, and mucous membranes. It is the most severe form of vitiligo and is relatively rare, accounting for only a small percentage of cases. The depigmentation in universal vitiligo may be progressive, with new areas of skin and hair becoming affected over time. The patches may occur symmetrically on both sides of the body or may be unilateral. The hair in the affected areas may become white or gray, and the mucous membranes may also be affected.
Vitiligo Repigmentation Treatment Options
Topical corticosteroids are a common treatment option for vitiligo, particularly for mild cases of the condition. These medications work by reducing inflammation in the skin, which can help to slow or halt the progression of depigmentation and promote repigmentation in affected areas. The exact mechanism of action is not fully understood, but it is believed that corticosteroids work by suppressing the immune system’s inflammatory response. When applied topically to the skin, corticosteroids are absorbed into the skin and work to reduce inflammation and immune cell activity in the affected areas. Over time, this can help to promote the growth of new melanocytes, which are the cells responsible for producing skin pigmentation. As new melanocytes are produced, the affected areas of skin may gradually repigment, leading to an improvement in the appearance of the skin.
Calcineurin Inhibitors are topical medications that are used to treat vitiligo by reducing inflammation and promoting repigmentation in affected areas of skin. These medications work by inhibiting the activity of calcineurin, a protein that plays a key role in the immune system’s response to inflammation. When applied topically to the skin, calcineurin inhibitors are absorbed into the skin and work to reduce inflammation and immune cell activity in the affected areas. This can help to slow or halt the progression of depigmentation and promote repigmentation by promoting the growth of new melanocytes, which are the cells responsible for producing skin pigmentation. Over time, the affected areas of skin may gradually repigment, leading to an improvement in the appearance of the skin.
Opzelura (ruxolitinib cream) is a prescription medication that is used to treat vitiligo in adults. It is a Janus kinase (JAK) inhibitor, which means it works by blocking the activity of certain enzymes that play a role in the immune response. Opzelura is applied topically to the affected areas of skin twice daily. It is absorbed into the skin and works by inhibiting the activity of JAK1 and JAK2 enzymes, which are involved in the immune response and the signaling pathways that control the growth and activity of melanocytes. By blocking these enzymes, Opzelura helps to reduce inflammation and promote the growth of new melanocytes, which can lead to repigmentation of the affected areas of skin. Opzelura has been shown to be particularly effective for treating non-segmental vitiligo, which is the most common form of the condition.
Clinical studies have shown that treatment with Opzelura can lead to significant improvements in repigmentation compared to placebo. The medication is generally well-tolerated, although some patients may experience side effects such as itching, burning, or redness at the application site. Opzelura is a relatively new treatment option for vitiligo, and more research is needed to fully understand its effectiveness and long-term safety profile. Patients considering treatment with Opzelura should work closely with their healthcare provider to determine if the medication is right for them and to monitor for any potential side effects or complications.
Phototherapy, also known as light therapy, is a treatment for vitiligo that uses ultraviolet (UV) light to promote repigmentation in affected areas of skin. Phototherapy is often used in combination with other treatments, such as topical medications or oral medications, to enhance their effectiveness.
There are several different types of phototherapy that may be used to treat vitiligo, including:
- Narrowband UVB therapy: This type of phototherapy uses a specific wavelength of UVB light that is thought to be most effective for treating vitiligo. The treatment involves exposing the affected areas of skin to UVB light for a short period of time, usually several times per week.
- Excimer laser therapy: This is a type of targeted phototherapy that uses a laser to deliver high-intensity UVB light to specific areas of skin. The treatment is typically performed in a dermatologist’s office and involves exposing the affected areas of skin to the laser for a short period of time, usually several times per week.
- PUVA therapy: This type of phototherapy involves exposing the affected areas of skin to UVA light after the application of a photosensitizing medication called psoralen. The psoralen is applied topically or taken orally before the treatment to make the skin more sensitive to UVA light. PUVA therapy is typically used for more widespread cases of vitiligo.
During phototherapy, the UV light works by stimulating the production of melanocytes, the cells responsible for producing skin pigmentation. Over time, the affected areas of skin may gradually repigment, leading to an improvement in the appearance of the skin. While phototherapy can be an effective treatment for vitiligo, it does carry some risks. UV light exposure can increase the risk of skin cancer and other skin damage, particularly with long-term use. Patients undergoing phototherapy should be closely monitored by a healthcare provider and should take steps to protect their skin from excessive sun exposure.
Sources
https://www.umassmed.edu/vitiligo/blog/blog-posts1/2020/05/patterns-of-vitiligo/
https://nyulangone.org/conditions/vitiligo/treatments/phototherapy-laser-treatment-for-vitiligo
https://www.umassmed.edu/vitiligo/vitiligo-treatment/
