Introduction and Classification

Skin Anatomy

Melanin Production and Metabolism

Vitiligo Pathogenesis

Vitiligo diagnosis is primarily made by visual inspection of the skin. Observations of localized hypopigmented skin patches can often be made by the naked eye, although tools such as a Woods lamp can be useful for further inspection. A Woods lamp shines long wave ultraviolet light, and in the absence of other light, it makes patches and boarders of vitiligo lesions exceptionally clear. Blood tests are also a useful tool in vitiligo diagnosis, particularly in ruling out the possibility of other skin conditions causing depigmentation. Blood examination would test for the presence of antibodies and vitamin deficiencies which could cause skin abnormalities not associated with vitiligo diagnosis. It is worth noting that vitiligo is often underdiagnosed or misdiagnosed depending on people’s ethnicity or skin tone. People with darker skin may be hastily diagnosed with vitiligo despite the possibility of other skin depigmentation mechanisms. In contrast, people with lighter skin are often undiagnosed or do not seek medical attention when patches are found.

Vitiligo treatment has historically depended on the size of hypopigmented areas. If the areas are small, cosmetic coverup or topical immune suppressants may be applied. Topical immunosuppressants, such as the promising new drug Opzerula, act by altering the immune system in the skin only, opposed to the entire immune system. Such drugs can reduce or prevent the activity of T cells or cytokines, resulting in a reduction of inflammation and risk of melanocyte breakdown.

If the areas are large, systemic immune suppression, skin bleaching, or skin grafts may be used. Systemic immune suppressant drugs include corticosteroids such as Prednisone, Betamethasone, and Dexamethasone. Such drugs can reduce the activity of the entire immune system, resulting in the slowing or complete prevention of melanocyte destruction. However, if such drugs are used, close monitoring from a medical professional is necessary, as increased risk of dangerous infection and other complications become prevalent.

In all cases of vitiligo, it is crucial for patients to wear sunscreen, as depigmented skin lacking melanin is especially vulnerable to burns and UV radiation, which may result in skin cancer (Melanoma). Today, there is an increasing movement towards embracing the cosmetic effects of vitiligo and redefining conventional beauty standards. Because vitiligo does not inherently impose health risks, other than increased risk of UV damage, many individuals have opted out of therapeutic regimes.

Review Questions