Understanding of Pathomechanisms and Clinical Practice for Vitiligo

Abstract

Vitiligo is a disease caused by the acquired depletion of melanocytes and/or melanocyte precursor cells in response to genetic and environmental factors, resulting in depigmentation of the entire body. It is roughly divided into segmental and non-segmental vitiligo, and it has been found that abnormalities of melanocytes themselves and dysregulation of autoimmune responses to melanocytes are greatly involved in the pathology of non-segmental vitiligo. Segmental vitiligo pathology is largely unknown; however, it has been suggested that it may be caused by skin or melanocyte mosaicism. Treatments for vitiligo include topical therapy, ultraviolet therapy, and surgical transplantation, and it is extremely important to correctly understand the pathology to perform optimal treatment. In recent years, the development of vitiligo treatments using Janus kinase (JAK) inhibitors has progressed rapidly. We herein outline the latest pathology of vitiligo, from general vitiligo treatment to the progress of clinical trials using JAK inhibitors, along with what clinicians should consider in archiving precision medicine, including my own ideas thereon.

Keywords: Melanocytes; Pathology; Precision medicine; Vitiligo.

Fig. 1. Current understanding of vitiligo pathomechanisms. SNPs: single nucleotide polymorphisms, GSH: reduced glutathione, GSGG: oxidized disulfide, IL: interleukin, IFN-γ: interferon-gamma, ILC1: innate lymphoid cell 1, Keap 1: Kelch-like ECH associated protein 1, Nrf 2: NF-E2 related factor 2.