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Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

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A Correction to this article was published on 06 August 2021

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Abstract

Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5–2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross- talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.

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Abbreviations

4-TAP:

4-Tert-amylphenol

4-TBC:

4-Tert-butylcatechol

4-TBP:

4-Tert-butylphenol

BSA:

Body surface area

CLA:

Cutaneous lymphocyte antigen

CXCR3B:

CXCR3 isoform B

DAMPs:

Damage-associated molecular patterns

DiHS:

Drug-induced hypersensitivity syndrome

Foxp3:

Forkhead box P3

GWAS:

Genome-wide association studies

HCV:

Hepatitis C virus

HMGB1:

High-mobility group protein B1

HSP:

Heat shock protein

IFN:

Interferon

IL:

Interleukin

ILCs:

Innate lymphoid cells

JAK:

Janus kinase

MHC:

Major histocompatibility complex

NB-UVB:

Narrowband UVB

NK:

Natural killer

NLRs:

Nucleotide oligomerization domain (NOD)-like receptors

Nrf2:

Nuclear factor E2-related factor 2

PPD:

Para-phenylenediamine

PRP:

Platelet-rich plasma

RAGE:

Receptor for advanced glycation end products

RCTs:

Randomized controlled trials

ROS:

Reactive oxygen species

SA-VASI:

Self-Assessed Vitiligo Area Scoring Index

SA-VES:

Self-Assessment Vitiligo Extent Score

Tregs:

Regulatory T cells

TRM cells:

Resident memory T cells

VASI:

Vitiligo area scoring index

VES:

Vitiligo extent score

VETF:

Vitiligo European task force

VIDA:

Vitiligo disease activity

VIPs:

Vitiligo impact patient scales

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Funding

The study has received funding from the National Natural Science Foundation of China (no. 81930087, no. 91742201, no. 81625020).

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  1. Yinghan Wang and Shuli Li contributed equally to this work.

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  1. Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 of West Changle Road, Xi’an, Shaanxi, 710032, China

    Yinghan Wang, Shuli Li & Chunying Li

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Chunying Li and Shuli Li had the idea for the article. Yinghan Wang and Shuli Li performed the literature search and data analysis. Yinghan Wang drafted the manuscript. Chunying Li and Shuli Li helped write the manuscript. All the authors critically revised the work.

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Wang, Y., Li, S. & Li, C. Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo. Clinic Rev Allerg Immunol 61, 299–323 (2021). https://doi.org/10.1007/s12016-021-08868-z

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