VITILIGO: WHAT’S OLD, WHAT’S NEW?

Abstract

Vitiligo is a chronic, inflammatory, autoimmune disorder resulting from a selective destruction of melanocytes and the appearance of depigmented skin patches. It affects all ethnic groups and genders equally, with a slight female predominance. It is estimated that approximately 0.5-2% of the global population suffer from vitiligo, making this dermatosis the most common pigmentation disorder. Vitiligo is a complex disease with complex etiology and pathogenesis. It is currently accepted that genetic predisposition and environmental factors lead to melanocyte oxidative stress, and activation of abnormal immune response, but the overall contribution of each of these processes remains insufficiently clear.

Historically, vitiligo was recognized in ancient times, with evidence found in ancient Egyptian, Greek, and Indian texts. Early interpretations associated this skin disease with divine punishment or contagion, leading to quarantines and stigmatization. Today, vitiligo is classified as an autoimmune disease, with autoimmune attack on melanocytes considered the primary factor leading to the appearance of depigmented macules. The skin and gut microbiome and neural hypothesis have recently gained attention as emerging factors in the pathogenesis of vitiligo.

The treatment of vitiligo remains a significant challenge. It includes local and systemic immunosuppressives, phototherapy, surgical techniques, as well as other therapeutic approaches, including traditional medicine, camouflage, depigmentation, and psychological interventions. However, vitiligo has a long treatment cycle, and all current treatments provide only short-term benefits, with relapse of the disease being common once treatments are discontinued. In recent years targeted therapies such as JAK inhibitors are actively being developed.