Vitiligo

Abstract

Vitiligo is a common pigment disorder of the skin resulting in destruction of melanocytes. Non-segmental vitiligo (NSV) is an autoimmune disorder. The etiopathogenesis of segmental vitiligo (SV) remains incompletely understood. Genetic predisposition and increased vulnerability of melanocytes towards stressors lead to a melanocyte-specific CD8⁺ T cell-driven immune response with a γ-interferon signature. Vitiligo may lead to significant impairment of life quality. Importantly, vitiligo can be associated with somatic and psychological disorders. Early recognition, correct classification, precise assessment of disease extent and activity, burden of disease and presence of comorbidities is crucial for a holistic therapeutic management. Shared decision making with the patient should define treatment goals including halting disease progression, induction of repigmentation, prevention of relapses, and in rare cases depigmentatation of residual normal skin. Topical treatments in addition to corticosteroids and calcineurin inhibitors now include the Janus kinase inhibitor ruxolitinib cream, as a first-line therapy officially approved for children from 12 years on and adults with NSV and facial involvement. Targeted phototherapies, in combination with topical corticosteroids or calcineurin inhibitors, are used for limited NSV or SV. For extensive NSV, whole-body UVB-NB phototherapy remains a cornerstone treatment and may be combined with oral corticosteroid mini-pulses in rapidly progressive cases. Among emerging therapeutic options for NSV, oral Janus kinase inhibitors are the most advanced in clinical development.

Keywords: Janus kinase inhibitors; comorbidity; phototherapy; shared decision makting; systemic therapy; topical therapy.