Skip to main content
SpringerLink
Log in

Vitiligo: An Update on Pathophysiology and Treatment Options

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

The pathophysiology of vitiligo is becoming increasingly clarified. In non-segmental vitiligo, early factors include activation of innate immunity, inflammasome activation, oxidative stress, and loss of melanocyte adhesion. Nonetheless, the main mechanism leading to non-segmental vitiligo involves an immune-mediated destruction of melanocytes. Anti-melanocyte-specific cytotoxic T cells exert a central role in the final effector stage. Genetic research revealed a multi-genetic inheritance displaying an overlap with other autoimmune disorders. However, some melanocyte-specific genes were also affected. Segmental vitiligo carries a different pathogenesis with most evidence indicating a mosaic skin disorder. Current management includes topical corticosteroids and immunomodulators. Narrow-band ultraviolet B can be used in patients not responding to topical treatment or in patients with extensive disease. Pigment cell transplantation offers an alternative for the treatment of segmental vitiligo or stable non-segmental lesions. Recent findings have revealed new targets for treatment that could lead to more efficient therapies. Targeted immunotherapy may halt the active immune pathways, although combination therapy may still be required to induce satisfying repigmentation. A recently established core set of outcome measures, new measurement instruments, and biomarker research pave the way for future standardized clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview. Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011;65:473–91.

    Article  PubMed  Google Scholar 

  2. Prasad PVV, Bhatnagar VK. Medico-historical study of “Kilasa” (vitiligo/leucoderma) a common skin disorder. Bull Indian Inst Hist Med Hyderabad. 2003;33:113–27.

    CAS  PubMed  Google Scholar 

  3. Yazdani Abyaneh M-A, Griffith R, Falto-Aizpurua L, Nouri K. The dark history of white spots. JAMA Dermatol. 2014;150:936.

    Article  PubMed  Google Scholar 

  4. Salzes C, Abadie S, Seneschal J, Whitton M, Meurant J-M, Jouary T, et al. The Vitiligo Impact Patient Scale (VIPs): development and validation of a vitiligo burden assessment tool. J Invest Dermatol. 2016;136:52–8.

    Article  CAS  PubMed  Google Scholar 

  5. Lai Y, Yew YW, Kennedy C, Schwartz RA. Vitiligo and depression: a systematic review and meta-analysis of observational studies. Br J Dermatol. 2016. doi:10.1111/bjd.15199.

    Google Scholar 

  6. Taïeb A, Picardo M. Clinical practice: vitiligo. N Engl J Med. 2009;360:160–9.

    Article  PubMed  Google Scholar 

  7. Kim D-Y, Oh SH, Hann S-K. Classification of segmental vitiligo on the face: clues for prognosis. Br J Dermatol. 2011;164:1004–9.

    Article  PubMed  Google Scholar 

  8. van Geel N, Bosma S, Boone B, Speeckaert R. Classification of segmental vitiligo on the trunk. Br J Dermatol. 2014;170:322–7.

    Article  PubMed  Google Scholar 

  9. Ezzedine K, Gauthier Y, Léauté-Labrèze C, Marquez S, Bouchtnei S, Jouary T, et al. Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): a retrospective case series of 19 patients. J Am Acad Dermatol. 2011;65:965–71.

    Article  PubMed  Google Scholar 

  10. Lommerts JE, Schilder Y, de Rie MA, Wolkerstorfer A, Bekkenk MW. Focal vitiligo: long-term follow-up of 52 cases. J Eur Acad Dermatol Venereol. 2016;30:1550–4.

    Article  CAS  PubMed  Google Scholar 

  11. Lommerts JE, Teulings H-E, Ezzedine K, van Geel N, Hartmann A, Speeckaert R, et al. Melanoma-associated leukoderma and vitiligo cannot be differentiated based on blinded assessment by experts in the field. J Am Acad Dermatol. 2016;75:1198–204.

    Article  PubMed  Google Scholar 

  12. Laureti S, Vecchi L, Santeusanio F, Falorni A. Is the prevalence of Addison’s disease underestimated? J Clin Endocrinol Metab. 1999;84:1762.

    CAS  PubMed  Google Scholar 

  13. Vrijman C, Kroon MW, Limpens J, Leeflang MMG, Luiten RM, van der Veen JPW, et al. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol. 2012;167:1224–35.

    Article  CAS  PubMed  Google Scholar 

  14. van Geel N, Speeckaert M, Brochez L, Lambert J, Speeckaert R. Clinical profile of generalized vitiligo patients with associated autoimmune/autoinflammatory diseases. J Eur Acad Dermatol Venereol. 2014;28:741–6.

    Article  PubMed  Google Scholar 

  15. Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res. 2003;16:208–14.

    Article  PubMed  Google Scholar 

  16. Shen C, Gao J, Sheng Y, Dou J, Zhou F, Zheng X, et al. Genetic susceptibility to vitiligo: GWAS approaches for identifying vitiligo susceptibility genes and loci. Front Genet. 2016;7:3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jin Y, Birlea SA, Fain PR, Gowan K, Riccardi SL, Holland PJ, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med. 2010;362:1686–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gough SC, Simmonds MJ. The HLA region and autoimmune disease: associations and mechanisms of action. Curr Genomics. 2007;8:453–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jin Y, Birlea SA, Fain PR, Ferrara TM, Ben S, Riccardi SL, et al. Genome-wide association analyses identify 13 new susceptibility loci for generalized vitiligo. Nat Genet. 2012;44:676–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Spritz RA. Six decades of vitiligo genetics: genome-wide studies provide insights into autoimmune pathogenesis. J Invest Dermatol. 2012;132:268–73.

    Article  CAS  PubMed  Google Scholar 

  21. Speeckaert R, van Geel N. Distribution patterns in generalized vitiligo. J Eur Acad Dermatol Venereol. 2014;28:755–62.

    Article  CAS  PubMed  Google Scholar 

  22. van Geel N, Speeckaert R, De Wolf J, Bracke S, Chevolet I, Brochez L, et al. Clinical significance of Koebner phenomenon in vitiligo. Br J Dermatol. 2012;167:1017–24.

    Article  PubMed  Google Scholar 

  23. Doss RW, El-Rifaie A-AA, Abdel-Wahab AM, Gohary YM, Rashed LA. Heat shock protein-70 expression in vitiligo and its relation to the disease activity. Indian J Dermatol. 2016;61:408–12.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mosenson JA, Flood K, Klarquist J, Eby JM, Koshoffer A, Boissy RE, et al. Preferential secretion of inducible HSP70 by vitiligo melanocytes under stress. Pigment Cell Melanoma Res. 2014;27:209–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bertolotti A, Boniface K, Vergier B, Mossalayi D, Taieb A, Ezzedine K, et al. Type I interferon signature in the initiation of the immune response in vitiligo. Pigment Cell Melanoma Res. 2014;27:398–407.

    Article  CAS  PubMed  Google Scholar 

  26. Speeckaert R, Voet S, Hoste E, van Geel N. S100B is a potential disease activity marker in non-segmental vitiligo. J Invest Dermatol. 2017. doi:10.1016/j.jid.2017.01.033.

    Google Scholar 

  27. Kim JY, Lee EJ, Seo J, Oh SH. Impact of HMGB1 on melanocytic survival and its involvement in the pathogenesis of vitiligo. Br J Dermatol. 2016. doi:10.1111/bjd.15151.

    Google Scholar 

  28. Gauthier Y, Cario Andre M, Taïeb A. A critical appraisal of vitiligo etiologic theories: is melanocyte loss a melanocytorrhagy? Pigment Cell Res. 2003;16:322–32.

    Article  PubMed  Google Scholar 

  29. Wagner RY, Luciani F, Cario-André M, Rubod A, Petit V, Benzekri L, et al. Altered E-cadherin levels and distribution in melanocytes precede clinical manifestations of vitiligo. J Invest Dermatol. 2015;135:1810–9.

    Article  CAS  PubMed  Google Scholar 

  30. Jimbow K, Chen H, Park JS, Thomas PD. Increased sensitivity of melanocytes to oxidative stress and abnormal expression of tyrosinase-related protein in vitiligo. Br J Dermatol. 2001;144:55–65.

    Article  CAS  PubMed  Google Scholar 

  31. Marie J, Kovacs D, Pain C, Jouary T, Cota C, Vergier B, et al. Inflammasome activation and vitiligo/nonsegmental vitiligo progression. Br J Dermatol. 2014;170:816–23.

    Article  CAS  PubMed  Google Scholar 

  32. Levandowski CB, Mailloux CM, Ferrara TM, Gowan K, Ben S, Jin Y, et al. NLRP1 haplotypes associated with vitiligo and autoimmunity increase interleukin-1β processing via the NLRP1 inflammasome. Proc Natl Acad Sci USA. 2013;110:2952–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. van den Boorn JG, Konijnenberg D, Dellemijn TAM, van der Veen JPW, Bos JD, Melief CJM, et al. Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients. J Invest Dermatol. 2009;129:2220–32.

    Article  PubMed  Google Scholar 

  34. Maeda Y, Nishikawa H, Sugiyama D, Ha D, Hamaguchi M, Saito T, et al. Detection of self-reactive CD8+ T cells with an anergic phenotype in healthy individuals. Science. 2014;346:1536–40.

    Article  CAS  PubMed  Google Scholar 

  35. Dwivedi M, Laddha NC, Arora P, Marfatia YS, Begum R. Decreased regulatory T-cells and CD4(+) /CD8(+) ratio correlate with disease onset and progression in patients with generalized vitiligo. Pigment Cell Melanoma Res. 2013;26:586–91.

    Article  CAS  PubMed  Google Scholar 

  36. Elela MA, Hegazy RA, Fawzy MM, Rashed LA, Rasheed H. Interleukin 17, interleukin 22 and FoxP3 expression in tissue and serum of non-segmental vitiligo: a case-controlled study on eighty-four patients. Eur J Dermatol. 2013;23:350–5.

    PubMed  Google Scholar 

  37. Tembhre MK, Sharma VK, Sharma A, Chattopadhyay P, Gupta S. T helper and regulatory T cell cytokine profile in active, stable and narrow band ultraviolet B treated generalized vitiligo. Clin Chim Acta. 2013;424:27–32.

    Article  CAS  PubMed  Google Scholar 

  38. Vaccaro M, Cannavò SP, Imbesi S, Cristani M, Barbuzza O, Tigano V, et al. Increased serum levels of interleukin-23 circulating in patients with non-segmental generalized vitiligo. Int J Dermatol. 2015;54:672–4.

    Article  CAS  PubMed  Google Scholar 

  39. Vaccaro M, Cicero F, Mannucci C, Calapai G, Spatari G, Barbuzza O, et al. IL-33 circulating serum levels are increased in patients with non-segmental generalized vitiligo. Arch Dermatol Res. 2016;308:527–30.

    Article  CAS  PubMed  Google Scholar 

  40. Bhardwaj S, Rani S, Srivastava N, Kumar R, Parsad D. Increased systemic and epidermal levels of IL-17A and IL-1β promotes progression of non-segmental vitiligo. Cytokine. 2017;91:153–61.

    Article  CAS  PubMed  Google Scholar 

  41. Zhou L, Shi Y-L, Li K, Hamzavi I, Gao T-W, Huggins RH, et al. Increased circulating Th17 cells and elevated serum levels of TGF-beta and IL-21 are correlated with human non-segmental vitiligo development. Pigment Cell Melanoma Res. 2015;28:324–9.

    Article  CAS  PubMed  Google Scholar 

  42. Rashighi M, Agarwal P, Richmond JM, Harris TH, Dresser K, Su M-W, et al. CXCL10 is critical for the progression and maintenance of depigmentation in a mouse model of vitiligo. Sci Transl Med. 2014;6:223ra23.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Rezk AF, Kemp DM, El-Domyati M, El-Din WH, Lee JB, Uitto J, et al. Misbalanced CXCL12 and CCL5 chemotactic signals in vitiligo onset and progression. J Invest Dermatol. 2017;137:1126–34.

    Article  CAS  PubMed  Google Scholar 

  44. Speeckaert R, Ongenae K, van Geel N. Alterations of CXCL12 in serum of vitiligo patients. J Invest Dermatol. 2017. doi:10.1016/j.jid.2017.02.012.

    Google Scholar 

  45. Li S, Zhu G, Yang Y, Jian Z, Guo S, Dai W, et al. Oxidative stress drives CD8(+)T cells skin trafficking in vitiligo via CXCL16 upregulation by activating the unfolded protein response in keratinocytes. J Allergy Clin Immunol. 2016. doi:10.1016/j.jaci.2016.10.013.

    Google Scholar 

  46. Harning R, Cui J, Bystryn JC. Relation between the incidence and level of pigment cell antibodies and disease activity in vitiligo. J Invest Dermatol. 1991;97:1078–80.

    Article  CAS  PubMed  Google Scholar 

  47. Kroon MW, Kemp EH, Wind BS, Krebbers G, Bos JD, Gawkrodger DJ, et al. Melanocyte antigen-specific antibodies cannot be used as markers for recent disease activity in patients with vitiligo. J Eur Acad Dermatol Venereol. 2013;27:1172–5.

    Article  CAS  PubMed  Google Scholar 

  48. Ruiz-Argüelles A, García-Carrasco M, Jimenez-Brito G, Sánchez-Sosa S, Pérez-Romano B, Garcés-Eisele J, et al. Treatment of vitiligo with a chimeric monoclonal antibody to CD20: a pilot study. Clin Exp Immunol. 2013;174:229–36.

    PubMed  PubMed Central  Google Scholar 

  49. Regazzetti C, Joly F, Marty C, Rivier M, Mehul B, Reiniche P, et al. Transcriptional analysis of vitiligo skin reveals the alteration of WNT pathway: a promising target for repigmenting vitiligo patients. J Invest Dermatol. 2015;135:3105–14.

    Article  CAS  PubMed  Google Scholar 

  50. Yamada T, Hasegawa S, Inoue Y, Date Y, Yamamoto N, Mizutani H, et al. Wnt/β-catenin and kit signaling sequentially regulate melanocyte stem cell differentiation in UVB-induced epidermal pigmentation. J Invest Dermatol. 2013;133:2753–62.

    Article  CAS  PubMed  Google Scholar 

  51. Tu C, Zhao D, Lin X. Levels of neuropeptide-Y in the plasma and skin tissue fluids of patients with vitiligo. J Dermatol Sci. 2001;27:178–82.

    Article  CAS  PubMed  Google Scholar 

  52. van Geel N, Speeckaert R, Melsens E, Toelle SP, Speeckaert M, De Schepper S, et al. The distribution pattern of segmental vitiligo: clues for somatic mosaicism. Br J Dermatol. 2013;168:56–64.

    Article  PubMed  Google Scholar 

  53. van Geel NAC, Mollet IG, De Schepper S, Tjin EPM, Vermaelen K, Clark RA, et al. First histopathological and immunophenotypic analysis of early dynamic events in a patient with segmental vitiligo associated with halo nevi. Pigment Cell Melanoma Res. 2010;23:375–84.

    Article  PubMed  Google Scholar 

  54. Attili VR, Attili SK. Segmental and generalized vitiligo: both forms demonstrate inflammatory histopathological features and clinical mosaicism. Indian J Dermatol. 2013;58:433–8.

    Article  PubMed  PubMed Central  Google Scholar 

  55. van Geel N, Mollet I, Brochez L, Dutré M, De Schepper S, Verhaeghe E, et al. New insights in segmental vitiligo: case report and review of theories. Br J Dermatol. 2012;166:240–6.

    Article  PubMed  Google Scholar 

  56. Whitton M, Pinart M, Batchelor JM, Leonardi-Bee J, Gonzalez U, Jiyad Z, et al. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol. 2016;174:962–9.

    Article  CAS  PubMed  Google Scholar 

  57. Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051–76.

    Article  CAS  PubMed  Google Scholar 

  58. Taieb A, Alomar A, Böhm M, Dell’anna ML, De Pase A, Eleftheriadou V, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168:5–19.

    Article  CAS  PubMed  Google Scholar 

  59. Silverberg NB, Lin P, Travis L, Farley-Li J, Mancini AJ, Wagner AM, et al. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004;51:760–6.

    Article  PubMed  Google Scholar 

  60. van Geel N, Desmedt V, De Schepper S, Boone B, Lapeere H, Speeckaert R. Cessation of spread as a treatment objective in vitiligo: perception from the patients’ point of view. Br J Dermatol. 2016;174:922–4.

    Article  PubMed  Google Scholar 

  61. Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo: meta-analysis of the literature. Arch Dermatol. 1998;134:1532–40.

    CAS  PubMed  Google Scholar 

  62. Jung H, Oh E-S. FK506 positively regulates the migratory potential of melanocyte-derived cells by enhancing syndecan-2 expression. Pigment Cell Melanoma Res. 2016;29:434–43.

    Article  CAS  PubMed  Google Scholar 

  63. Jung H, Chung H, Chang SE, Kang D-H, Oh E-S. FK506 regulates pigmentation by maturing the melanosome and facilitating their transfer to keratinocytes. Pigment Cell Melanoma Res. 2016;29:199–209.

    Article  CAS  PubMed  Google Scholar 

  64. Ho N, Pope E, Weinstein M, Greenberg S, Webster C, Krafchik BR. A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0·1% vs. clobetasol propionate 0·05% in childhood vitiligo. Br J Dermatol. 2011;165:626–32.

  65. Radakovic S, Breier-Maly J, Konschitzky R, Kittler H, Sator P, Hoenigsmann H, et al. Response of vitiligo to once- vs. twice-daily topical tacrolimus: a controlled prospective, randomized, observer-blinded trial. J Eur Acad Dermatol Venereol. 2009;23:951–3.

    Article  CAS  PubMed  Google Scholar 

  66. Lotti T, Buggiani G, Troiano M, Assad GB, Delescluse J, De Giorgi V, et al. Targeted and combination treatments for vitiligo: comparative evaluation of different current modalities in 458 subjects. Dermatol Ther. 2008;21(Suppl. 1):S20–6.

    Article  PubMed  Google Scholar 

  67. van Geel N, Speeckaert R, Mollet I, De Schepper S, De Wolf J, Tjin EPM, et al. In vivo vitiligo induction and therapy model: double-blind, randomized clinical trial. Pigment Cell Melanoma Res. 2012;25:57–65.

    Article  PubMed  Google Scholar 

  68. Schallreuter KU, Krüger C, Würfel BA, Panske A, Wood JM. From basic research to the bedside: efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo. Int J Dermatol. 2008;47:743–53.

    Article  PubMed  Google Scholar 

  69. Leone G, Paro Vidolin A. Effect of an antioxydant cream versus placebo in patients with vitiligo in association with excimer laser: a pilot randomized, investigator-blinded, and half-side comparison trial. G Ital Dermatol Venereol. 2015;150:461–6.

    CAS  PubMed  Google Scholar 

  70. Anbar TS, Westerhof W, Abdel-Rahman AT, El- Khayyat MA. Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites. Photodermatol Photoimmunol Photomed. 2006;22:157–63.

    Article  CAS  PubMed  Google Scholar 

  71. Njoo MD, Bos JD, Westerhof W. Treatment of generalized vitiligo in children with narrow-band (TL-01) UVB radiation therapy. J Am Acad Dermatol. 2000;42:245–53.

    Article  CAS  PubMed  Google Scholar 

  72. Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274–8.

    Article  PubMed  Google Scholar 

  73. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891–6.

    Article  CAS  PubMed  Google Scholar 

  74. Caron-Schreinemachers A-LDB, Kingswijk MM, Bos JD, Westerhof W. UVB 311 nm tolerance of vitiligo skin increases with skin photo type. Acta Derm Venereol. 2005;85:24–6.

  75. Cavalié M, Ezzedine K, Fontas E, Montaudié H, Castela E, Bahadoran P, et al. Maintenance therapy of adult vitiligo with 0.1% tacrolimus ointment: a randomized, double blind, placebo-controlled study. J Invest Dermatol. 2015;135:970–4.

    Article  PubMed  Google Scholar 

  76. Bhatnagar A, Kanwar A, Parsad D, De D. Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study. J Eur Acad Dermatol Venereol. 2007;21:638–42.

    Article  CAS  PubMed  Google Scholar 

  77. Lopes C, Trevisani VFM, Melnik T. Efficacy and safety of 308-nm monochromatic excimer lamp versus other phototherapy devices for vitiligo: a systematic review with meta-analysis. Am J Clin Dermatol. 2016;17:23–32.

    Article  PubMed  Google Scholar 

  78. Lindelöf B, Sigurgeirsson B, Tegner E, Larkö O, Johannesson A, Berne B, et al. PUVA and cancer: a large-scale epidemiological study. Lancet. 1991;338:91–3.

    Article  PubMed  Google Scholar 

  79. Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001;44:814–7.

    Article  CAS  PubMed  Google Scholar 

  80. Lee J, Chu H, Lee H, Kim M, Kim DS, Oh SH. A retrospective study of methylprednisolone mini-pulse therapy combined with narrow-band UVB in non-segmental vitiligo. Dermatology (Basel). 2016;232:224–9.

    Article  CAS  Google Scholar 

  81. Colucci R, Dragoni F, Conti R, Pisaneschi L, Lazzeri L, Moretti S. Evaluation of an oral supplement containing Phyllanthus emblica fruit extracts, vitamin E, and carotenoids in vitiligo treatment. Dermatol Ther. 2015;28:17–21.

    Article  PubMed  Google Scholar 

  82. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W. Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2007;21:942–50.

    Article  CAS  PubMed  Google Scholar 

  83. van Geel N, Wallaeys E, Goh BK, De Mil M, Lambert J. Long-term results of noncultured epidermal cellular grafting in vitiligo, halo naevi, piebaldism and naevus depigmentosus. Br J Dermatol. 2010;163:1186–93.

    Article  PubMed  Google Scholar 

  84. Goldstein NB, Koster MI, Hoaglin LG, Wright MJ, Robinson SE, Robinson WA, et al. Isolating RNA from precursor and mature melanocytes from human vitiligo and normal skin using laser capture microdissection. Exp Dermatol. 2016;25:805–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Speeckaert R, Speeckaert MM, van Geel N. Why treatments do(n’t) work in vitiligo: an autoinflammatory perspective. Autoimmun Rev. 2015;14:332–40.

    Article  CAS  PubMed  Google Scholar 

  86. Nordal EJ, Guleng GE, Rönnevig JR. Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study. J Eur Acad Dermatol Venereol. 2011;25:1440–3.

    Article  CAS  PubMed  Google Scholar 

  87. Ormerod AD. Topical tacrolimus and pimecrolimus and the risk of cancer: how much cause for concern? Br J Dermatol. 2005;153:701–5.

  88. AlGhamdi KM, Kumar A. Depigmentation therapies for normal skin in vitiligo universalis. J Eur Acad Dermatol Venereol. 2011;25:749–57.

    Article  CAS  PubMed  Google Scholar 

  89. Hossain C, Porto DA, Hamzavi I, Lim HW. Camouflaging agents for vitiligo patients. J Drugs Dermatol. 2016;15:384–7.

    CAS  PubMed  Google Scholar 

  90. Eleftheriadou V, Thomas K, van Geel N, Hamzavi I, Lim H, Suzuki T, et al. Developing core outcome set for vitiligo clinical trials: international e-Delphi consensus. Pigment Cell Melanoma Res. 2015;28:363–9.

    Article  PubMed  Google Scholar 

  91. van Geel N, Lommerts J, Bekkenk M, Wolkerstorfer A, Prinsen CAC, Eleftheriadou V, et al. Development and validation of the Vitiligo Extent Score (VES): an international collaborative initiative. J Invest Dermatol. 2016;136:978–84.

    Article  PubMed  Google Scholar 

  92. Strassner JP, Harris JE. Understanding mechanisms of autoimmunity through translational research in vitiligo. Curr Opin Immunol. 2016;43:81–8.

    Article  CAS  PubMed  Google Scholar 

  93. Craiglow BG, King BA. Tofacitinib citrate for the treatment of vitiligo: a pathogenesis-directed therapy. JAMA Dermatol. 2015;151:1110–2.

    Article  PubMed  Google Scholar 

  94. Harris JE, Rashighi M, Nguyen N, Jabbari A, Ulerio G, Clynes R, et al. Rapid skin repigmentation on oral ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J Am Acad Dermatol. 2016;74:370–1.

    Article  PubMed  Google Scholar 

  95. Rothstein B, Joshipura D, Saraiya A, Abdat R, Ashkar H, Turkowski Y, et al. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib. J Am Acad Dermatol. 2017;76(6):1054–60.e1.

  96. Ezzedine K, Whitton M, Pinart M. Interventions for vitiligo. JAMA. 2016;316:1708–9.

    Article  PubMed  Google Scholar 

  97. Korobko IV, Lomonosov KM. A pilot comparative study of topical latanoprost and tacrolimus in combination with narrow-band ultraviolet B phototherapy and microneedling for the treatment of nonsegmental vitiligo. Dermatol Ther. 2016;29:437–41.

    Article  PubMed  Google Scholar 

  98. Lim HW, Grimes PE, Agbai O, Hamzavi I, Henderson M, Haddican M, et al. Afamelanotide and narrowband UV-B phototherapy for the treatment of vitiligo: a randomized multicenter trial. JAMA Dermatol. 2015;151:42–50.

    Article  PubMed  Google Scholar 

  99. Passeron T. Indications and limitations of afamelanotide for treating vitiligo. JAMA Dermatol. 2015;151:349–50.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Reinhart Speeckaert & Nanja van Geel

Authors
  1. Reinhart Speeckaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nanja van Geel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reinhart Speeckaert.

Ethics declarations

Funding

This research was supported by a postdoctoral research grant to Reinhart Speeckaert from the Ghent University Special Research Fund (BOF; Grant No. 01P12914) and a research grant to Nanja van Geel from the Scientific Research Foundation-Flanders (FWO Senior Clinical Investigator; Grant No. FWO11/FKM/001).

Conflict of interest

Reinhart Speeckaert and Nanja van Geel have no conflicts of interest directly relevant to the contents of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Speeckaert, R., van Geel, N. Vitiligo: An Update on Pathophysiology and Treatment Options. Am J Clin Dermatol 18, 733–744 (2017). https://doi.org/10.1007/s40257-017-0298-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-017-0298-5

Search

Navigation