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AT-A-GLANCE
Vitiligo is a common autoimmune disease of the skin that causes depigmentation through T-cell–mediated destruction of melanocytes.
Pathogenesis is multifactorial, including genetic predisposition, autoimmunity, and environmental factors.
Vitiligo can cause significant social stigma, with serious implications for mental health.
Correlates with increased risk of other autoimmune diseases, but decreased risk of skin cancer.
Clinical signs of lesional activity include confetti, trichrome, and inflammatory lesions, as well as koebnerization.
Reversible with treatment, but only in areas with normally pigmented hair.
Effective treatments include topical and oral immunosuppressants, phototherapy, and chemical depigmenting agents.
Emerging treatments include targeted immunotherapy and melanocyte-stimulating hormones.
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DEFINITION AND HISTORY
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Vitiligo, an acquired skin disease of progressive melanocyte loss, is clinically characterized by well-defined milky-white macules that may also include white hairs, or poliosis. The term vitiligo initially appears in the first century, although clinical features consistent with vitiligo were described in ancient medical texts during the second millennium before Christ.1-3 Historically, vitiligo has been confused with leprosy, an infectious disease of the skin that results in ill-defined hypopigmentation. Some texts sought to differentiate the 2 diseases, while others conflated them. As early as 1500 BC, the Ebers Papyrus listed 2 diseases that affected skin color—one associated with “swellings,” which may have been leprosy, and another that exclusively affected the color, which was likely vitiligo. In the book of “Leviticus” in the Bible, also dated between 1500 and 1400 BC, a number of skin diseases could make one “unclean” and required examination by the priest to determine whether isolation was warranted. Skin swelling, lightening, poliosis, and evolution of lesions over time were assessed to make this determination. This protocol may have been designed to distinguish vitiligo from leprosy or other skin diseases. In India, vitiligo was described in the Atharva Veda (1400 BC) and the Buddhist Vinay Pitak (224 to 544 BC) under the term “Kilas,” a Sanskrit word “derived from kil,” meaning white.3-5 Hippocrates (460 to 355 BC) did not discriminate between vitiligo and leprosy. In fact, he included lichenoid eruptions, leprosy, psoriasis, and vitiligo under the same category. Still, today, in geographic areas with high incidence of leprosy, the 2 diseases are often confused.
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There have been very few studies conducted in the general population that aim to determine the prevalence of vitiligo. This is a difficult task, because unlike other diseases that cause significant morbidity and mortality, affected patients may not present to a medical facility to be counted. Thus, most estimates of prevalence are based on prospective surveys, retrospective observational studies, and prospective studies in selected populations, which may underestimate or overestimate the prevalence, depending on the approach. The largest epidemiologic study was performed in 1977 in Denmark, on the island of Bornholm, with a calculated prevalence of 0.38%.6 A study in ...