For clinicians, staying up to date on advancements and updates in vitiligo is crucial for providing the best care to patients. With recent research and new data on prevalence, pathogenesis, and treatment options, there is compelling information emerging to advance vitiligo research. 

Updates on prevalence 

New data collected on the prevalence of vitiligo reveal that between 0.76% and 1.11% of adults in the United States have vitiligo (diagnosed and undiagnosed). Approximately 40% of adults with vitiligo may be undiagnosed; among this population, there was a higher proportion who were non-White or of Hispanic, Latino, or Spanish origin and demonstrated unilateral presentation.¹ 

Insights on pathogenesis 

The pathogenesis of vitiligo is most clearly summarized in the convergence theory which combines the genetics, autoimmunity, oxidative stress, and neurological system dysfunction mechanisms whereby each decreases overall melanocyte survival.^{2, 3} In addition, environmental factors, psychological stress, comorbidities, and other common susceptibilities are also challenging to integrate into its pathogenesis. Recent articles explore and summarize the role of oxidative stress, HMGB1, chemokines,^{3, 4, 5} immunopathogenesis,⁵ and genetics^{6, 7} in vitiligo. Lipopolysaccharide may reduce melanocyte synthesis by regulating autophagy,⁸ and unstable vitiligo may be associated with autoimmune thyroiditis due to elevated thyroglobulin antibodies levels despite normal thyroid stimulating hormone and free thyroxine.⁹ 

An overview of therapeutic options 

Narrow-band ultraviolet B (NB-UVB) phototherapy is currently the primary therapeutic choice for generalized vitiligo, and psoralen and ultraviolet A phototherapy are considered for spreading vitiligo.¹⁰ 

The effectiveness of various surgical methods has also been studied. Data from a recent systematic review and meta-analysis found that the technique that resulted in the highest repigmentation degree of >90% among the largest number of treated patients was thin skin grafting, followed by suction blister grafting, cultured epidermal cell suspension, noncultured epidermal cell suspension, punch grafting, and noncultured follicular cell suspension.¹¹ The matching of the surgical method to the patient, type of vitiligo, and lesion location was deemed most important.¹² 

Various Janus kinase (JAK) inhibitors have shown potential in the management of vitiligo. Rapid skin pigmentation resulted from male patients with vitiligo consuming oral ruxolitinib, and patients treated with topical ruxolitinib demonstrated substantial repigmentation after 52 weeks of treatment. The safety and efficacy of tofacitinib and baricitinib and each inhibitor’s combination with phototherapy in vitiligo treatment are currently being investigated.¹³ 

Topical corticosteroids may be most effective on recent and facial lesions and in combination with NB-UVB phototherapy. An immunomodulator such as topical tacrolimus increases the proliferation of melanocytes and does not come with the adverse effects associated with corticosteroids.¹⁴ 

Finally, afamelanotide–a synthetic analog of the key melanogenesis molecule α-MSH– stimulates melanogenesis–promotes the transfer of eumelanin into melanosomes and acts on the altered inflammatory microenvironment of vitiligo lesions. Afamelanotide is administered as a subcutaneous, biodegradable, controlled-release implant. Combination therapy of afamelanotide and NB-UVB phototherapy has been shown to induce repigmentation with few, well-tolerated side effects.² 

To provide the best care for patients with vitiligo, it is important for clinicians to note these recent publications’ updates on vitiligo prevalence, pathogenesis, and treatments.

References

1. Gandhi K, Ezzedine K, Anastassopoulos KP, et al. Prevalence of vitiligo among adults in the United States. JAMA Dermatol. 2022;158(1):43-50. doi:10.1001/jamadermatol.2021.4724 
2. Diotallevi F, Gioacchini H, De Simoni E, et al. Vitiligo, from pathogenesis to therapeutic advances: state of the art. Int J Mol Sci. 2023;24(5):4910. 2023;24(5):4910. doi:10.3390/ijms24054910 
3. Marchioro HZ, Silva de Castro CC, Fava VM, Sakiyama PH, Dellatorre G, Miot HA. Update on the pathogenesis of vitiligo. ^{An Bras Dermatol}. 2022;97(4):478-490. doi:10.1016/j.abd.2021.09.008 
4. Wei G, Pan Y, Wang J, Xiong X, He Y, Xu J. Role of HMGB1 in vitiligo: current perceptions and future perspectives. Clin Cosmet Investig Dermatol. 2022;15:2177-2186. doi:10.2147/CCID.S381432 
5. Hlača N, Žagar T, Kaštelan M, Brajac I, Prpić-Massari L. Current concepts of vitiligo immunopathogenesis. Biomedicines. 2022;10(7):1639. doi:10.3390/biomedicines10071639 
6. Spritz RA, Santorico SA. The genetic basis of vitiligo. J Invest Dermatol. 2021;141(2):265-273. doi:10.1016/j.jid.2020.06.004 
7. Jin Y, Andersen G, Yorgov D, et al. Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants. Nat Genet. 2016;48(11):1418-1424. doi:10.1038/ng.3680 
8. Sun L, Sun J, Huo X, et al. Lipopolysaccharide reduces melanin synthesis in vitiligo melanocytes by regulating autophagy. Exp Dermatol. 2022;31(10):1579-1585. doi:10.1111/exd.14629 
9. Moore AY, Cepica T, Maberry S. Amelioration of unstable vitiligo and normalization of thryroglobulin antibodies with oral tofacitinib. JAAD Case Rep. 2022;23:64-66. Published 2022 Mar 10. doi:10.1016/j.jdcr.2022.02.025 
10. Nimkar P, Wanjari A. Vitiligo and the role of newer therapeutic modalities. Cureus. 2022;14(11):e31022. doi:10.7759/cureus.31022 
11. Ju HJ, Bae JM, Lee RW, et al. Surgical interventions for patients with vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2021;157(3):307-316. doi:10.1001/jamadermatol.2020.5756 
12. Frączek A, Kasprowicz-Furmańczyk M, Placek W, Owczarczyk-Saczonek A. Surgical treatment of vitiligo. Int J Environ Res Public Health. 2022;19(8):4812. doi:10.3390/ijerph19084812 
13. Qi F, Liu F, Gao L. Janus kinase inhibitors in the treatment of vitiligo: a review. Front Immunol. 2021;12:790125. doi:10.3389/fimmu.2021.790125 
14. Vinardell MP, Maddaleno AS, Mitjans M. Melanogenesis and hypopigmentation: the case of vitiligo. Indian J Dermatol. 2022;67(5):524-530. doi:10.4103/ijd.ijd_1067_21