Vitiligo is signified by acquired white or hypopigmented macules or patches. Affected areas are generally well differentiated, and are spherical, oblong, or linear in shape. Borders can be convex [9]. Generally, the lesions grow centrifugally as the time passes at an erratic rate. Size of the lesions can differ from millimeters to centimeters. In the beginning, lesions appear very often on the hands, forearms, feet, and face. Perioral and periocular areas are most favorable sites.

Vitiligo lesions may be seen only in an area or many areas all over the body, but commonly it widely affects the entire body. In such cases, the macules are generally seen on both sides of the trunk, either evenly or unevenly aligned.

Vitiligo commonly affects the face, neck, and scalp. Mostly, it affects the areas that are subjected to recurrent trauma. Common involvements are bony prominences, extensor surface of forearm, ventral aspects of wrists, dorsal side of hands, and digital phalanges.

Mucous membranes are involved in cases of generalized vitiligo. It generally develops surrounding the body orifices like the lips, genitals, gingiva, areolas, and nipples.

Depigmented body hair (leukotrichia) can be seen in vitiliginous macules. Vitiligo affecting the scalp develops as a limited area of white or gray hair, but complete depigmentation of entire scalp hair may take place. Scalp is involved very frequently, followed by the eyebrows, axillary hair, and pubic hair.

• Pain

  This approach resulted in less pain during and after the procedure, no scarring or cobblestone formation at the recipient site, and was more feasible to perform on curved surfaces such as joints, lips, eyelids, ears, and face. [ncbi.nlm.nih.gov]

  The psychological impact was quite painful, and took some time to overcome. [bmj.com]

  Sunburn : A dermatologist can create a customized plan to help you avoid painful sunburns. The plan may include using sunscreen that right for you and wearing sun protective clothing when appropriate. [aad.org]

  […] chest or upper back pain, or shortness of breath or difficulty breathing. [opzelura.com]

• Falling

  And with that, opportunities started to fall into my lap and I thank God for all of them. Try loving yourself.” [people.com]

  Please note that studies investigating HSP70iQ435A-based treatment thus fall out of the remit of this project. All other Topic Editors declare no competing interests with regards to the Research Topic subject. [frontiersin.org]

  People with other autoimmune diseases, specifically Hashimoto's disease (which affects the thyroid gland) and alopecia (which makes hair fall out), are more likely to get vitiligo as well. [health.com]

  […] study: https://www.umassmed.edu/vitiligo/blog/blog-posts1/2017/06/topical-jak-inhibitor-shown-to-be-effective-for-facial-vitiligo/ The trial was started in the spring of 2017 and recruited 157 participants, completing enrollment for the study in the fall [umassmed.edu]

  I went to consult another doctor and he said that the high exposure to the UV light was the reason why I was falling sick. This was before 2012 and there wasn’t much awareness about vitiligo,” she says. [thenewsminute.com]

• Weight Loss

  Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor... read more (Graves disease) and hypothyroidism (Hashimoto thyroiditis Hashimoto Thyroiditis Hashimoto thyroiditis is chronic autoimmune inflammation of the thyroid [msdmanuals.com]

  loss, warm, red, or painful skin or sores on your body, diarrhea or stomach pain, burning when you urinate or urinating more often than usual, feeling very tired. have ever had any type of cancer, or are a current or past smoker have had a heart attack [opzelura.com]

  Systemic symptoms include fever/chills, weight loss, or malaise in 43% of patients. [emedicine.com]

  Indeed, Nlrp3 −/− mice suffered from increased sensitivity to body weight loss, rectal bleeding, diarrhea, and mortality, thus suggesting that Nlrp3 inflammasome signaling provides protection against DSS-induced colitis ( 53, 56, 91 ). [ncbi.nlm.nih.gov]

• Short Stature

  Additional features are seizures, diabetes mellitus, hearing loss, cardiac disease, short stature, endocrinopathies, neuropsychiatric dysfunctions and skin alterations including hypertrichosis, eczema, and vitiligo. [frontiersin.org]

• Hypertension

  Although elevated IOP is common in ocular hypertension as well as in glaucoma, there is no glaucomatous visual field loss in ocular hypertension. [mdedge.com]

  Millions of people have joined one of the company's 35 highly engaged communities focusing on the following conditions: Crohn's and colitis, multiple sclerosis, lupus, fibromyalgia, pulmonary hypertension, spondylitis, eczema, myeloma, hyperhidrosis, [prnewswire.com]

  However, the manufacturing company generally recommends use of photoprotection while being treated with topical tacrolimus.18 Oral tacrolimus has limited use in skin disorders because of its potentially severe adverse effects, including infections, hypertension [jamanetwork.com]

  For example, ACTH, prednisone and other steroids are known to cause issues with immunosuppression, hypertension, glucose, gastric issues, agitation and irritability. [rarediseases.org]

  Matias, Vanessa Rocha Ribeiro, Celio Junior Da Costa Fernandes, Jose Carlos Peracoli, Jose Ricardo Rodrigues and Leandro De Oliveira, Hydrogen peroxide-mediated oxidative stress induces inflammasome activation in term human placental explants, Pregnancy Hypertension [doi.org]

• Skin Disease

  Prevalence of skin diseases among adolescents 12–16 years of age. Acta Derm Venereol. 1980; 60 ( 5 ):415–23. [ PubMed ] [ Google Scholar ] 12. Weismann K, Krakauer R, Wanscher B. Prevalence of skin diseases in old age. [ncbi.nlm.nih.gov]

  National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Vitiligo/default.asp. Accessed Dec. 20, 2013. FDA sheds light on sunscreens. U.S. [web.archive.org]

  This skin disease causes your skin to lose its color, or pigment. It affects patients of all races and ethnicities. [olanskydermatology.com]

  There is no cure, but there are ways to minimize the appearance of skin discoloration. Popular musical figure Michael Jackson was famously known for suffering from this skin disease. [innerbody.com]

  NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases Vitiligo (American Academy of Dermatology) Vitiligo (American Osteopathic College of Dermatology) Vitiligo (National Institute of Arthritis and Musculoskeletal and Skin Diseases [medlineplus.gov]

• Alopecia

  The other autoimmune disorders associated with vitiligo in our study were alopecia areata, diabetes mellitus, and Rheumatoid arthritis. [omicsonline.org]

  We report the case of a 17-year-old boy who presented to our clinic with trauma-induced skin blistering, alopecia, deafness, dental caries, nail dystrophy and vitiliginous areas. [ncbi.nlm.nih.gov]

  It may be more common in people who suffer from autoimmune diseases such as: hyperthyroidism alopecia areata adrenocortical insufficiency pernicious anemia However, the vast majority of affected people do not have any other autoimmune disorder. [news-medical.net]

  It is also under investigation as a treatment for alopecia areata, Ritlecitinib, also known provisionally as PF-06651600, is a JAK3 and tyrosine kinase inhibitor. [managedhealthcareexecutive.com]

• Blister

  The skin blisters had been appearing since birth, and healed without scarring. The vitiliginous areas were unrelated to the sites of the blisters. [ncbi.nlm.nih.gov]

  Pandya is in the process of acquiring the equipment for a second grafting procedure, called a blister graft. This technique uses the top layer of a blister created on normal skin and grafts it onto the target area. [sutterhealth.org]

  Blister grafting involves producing a blister on normal skin using suction. The top of the blister is then removed and placed on an area where pigment has been lost. There is a lower risk of scarring. [medicalnewstoday.com]

• Dermatitis

  Due to their ability to selectively modulate immune function, targeted JAK inhibitors are promising candidates for some skin diseases such as psoriasis and atopic dermatitis. [ncbi.nlm.nih.gov]

  Related Journals of Natural Vitiligo Treatment Journal of Vitiligo & Dermatomyositis, Journal of Cosmetology & Trichology, Journal of Dermatitis, Journal of Melanoma and Skin Diseases, Indian Journal of Research in Homoeopathy, Pigment International, [imedpub.com]

  Most of the adverse effects experienced to date when treating atopic dermatitis relate to skin irritation, burning sensation and pruritus, and folliculitis. [jamanetwork.com]

  Shiitake mushroom dermatitis Other/ ungrouped Acanthosis nigricans Freckle Familial progressive hyperpigmentation Pallister–Killian syndrome Periorbital hyperpigmentation Photoleukomelanodermatitis of Kobori Postinflammatory hyperpigmentation Transient [en.wikipedia.org]

• Piebaldism

  In vitiligo and piebaldism the lack of melanin in the epidermis is due to the fact that melanocytes are missing. [ncbi.nlm.nih.gov]

  Schwartz, Piebaldism: an update, International Journal of Dermatology, 43, 10, (716-719), (2004). [doi.org]

  Is piebaldism the same as vitiligo? No. Both conditions cause white or light patches of skin or hair. Piebaldism occurs when a portion of your skin doesn’t have melanocytes, which are cells that produce pigment (melanin). [my.clevelandclinic.org]

  ISBN 1-4160-2999-0. v t e Pigmentation disorders/Dyschromia (L80–L81, 709.0) Hypo-/ leucism Loss of melanocytes Vitiligo Quadrichrome vitiligo Vitiligo ponctué Syndromic Alezzandrini syndrome Vogt–Koyanagi–Harada syndrome Melanocyte development Piebaldism [en.wikipedia.org]

• Burning Sensation

  In the case group, 10 patients have burning sensation on their skin areas (p value = .002). Also, redness of the treated areas was observed in 6 patients (p value = .028). Both side effects were temporary. [ncbi.nlm.nih.gov]

  In the Farajzadeh 2009 study a mild burning sensation during microdermabrasion was reported in 18 participants. [doi.org]

  Most of the adverse effects experienced to date when treating atopic dermatitis relate to skin irritation, burning sensation and pruritus, and folliculitis. [jamanetwork.com]

Diagnosis of vitiligo usually is made with the help of clinical findings, but sometimes biopsy is beneficial in individualization of vitiligo from various hypopigmentary disorders.

Vitiligo is sometimes seen along with various autoimmune diseases like thyroid disease, diabetes mellitus, pernicious anemia, Addison disease, and alopecia areata. Individuals should have knowledge about manifestations of these diseases. In case the disease is manifested than necessary tests should be done [10]. Vitiligo lesions are analyzed with the help of a Wood lamp.

No drug can stop the process of vitiligo, but some drugs when used individually, or along with light therapy, may be helpful in improving the skin's appearance.

• Local application: A topical corticosteroid may help repigment the skin, especially when used in the beginning of the disease. For several months there might be no change in skin color. Topical calcipotriene which is a form of vitamin D may be used along with corticosteroids or ultraviolet light. Ointments comprising of tacrolimus or pimecrolimus (calcineurin inhibitors) can be beneficial for people with tiny areas of depigmentation, particularly on the face and neck.
• Combined medication and light therapy: In this treatment a drug called psoralen is combined with light therapy (photochemotherapy) to regain color on the light patches. Once psoralen is taken by mouth or applied on the affected skin, than the person is exposed to ultraviolet A (UVA) or UVB light. The drug affects your skin in such a way that the skin becomes more sensitive to the light, and it turns pink. As the skin starts healing, normal skin color starts appearing.
• Light therapy: In this therapy narrow band UVB light is used. Maximum results are seen on the face, trunk and limbs
• Laser therapy: In this treatment an excimer laser is used to bring back the color in areas of light skin. It makes use of a particular wavelength of UVB light. This laser can be used on small areas only, and is generally used along with a drug applied on the skin.
• Removing the remaining color (depigmentation): This therapy is considered if the vitiligo is widespread and other treatments have failed. A medication containing monobenzone is applied on normal areas of skin. Because of this, the normal skin gradually lightens and blends with discolored skin.
• Surgery is the last option for those in whom light therapy and drugs do not have any effect. Various procedures like skin grafting, blister grafting or tattooing are used to cover the patches.

Generally, limited vitiligo involving the face and trunk in children of recent onset is very receptive to treatment. Wide-spread disease in adults and disease affecting the hands and feet is resistant to therapy.

The cause of vitiligo is not known, but studies suggest that it may develop due to viral infections, oxidative stress and autoimmune, genetic or neural causes [1].

The incidence worldwide is less than 1% [2]. Around 30% of the cases are seen within a group of members in a family. Appearance of the vitiligo is independent of the age, although the onset is usually observed in persons aged 10-30 years. In most of the cases, the person suffers from vitiligo at early age in life.

Vitiligo can be caused by both genetic and non-genetic factors. Even though the actual cause remains unknown, commonly considered factors are that there are no functional melanocytes left in the affected skin and there is damage of histochemically identified melanocytes, leading to their destruction. Theories regarding destruction of melanocytes include the following:

Autoimmune destruction of melanocytes

The autoimmune theory [3] suggests changes in humoral and cellular immunity in the devastation of melanocytes of vitiligo. The most assuring data of an autoimmune involvement is the existence of circulating antibodies in persons suffering from vitiligo [4]. Substantial data points towards link between cellular immunity and vitiligo.

Intrinsic defect of melanocytes

Vitiligo melanocytes might have an intrinsic defect causing death of melanocyte. These melanocytes exhibit different abnormalities like unusual, harsh endoplasmic reticulum and inadequate synthesis and transformation of melanocytes.

Disruption in oxidant-antioxidant mechanism in vitiligo

Studies suggest that piling up of free radicals lethal to melanocytes results in their devastation. Current investigations are deployed to figure out the action of oxidative stress by calculating the levels of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in the affected as well as the unaffected skin of patients suffering from vitiligo and in the skin of totally unaffected control persons. It was proved that oxidative stress is raised in vitiligo, as determined by increased levels of SOD and decreased levels of CAT in the skin of people suffering from vitiligo [5].

Neural theory

Case reports portray that patients suffering from an injury to nerve along with having vitiligo, are also suffering from hypopigmentation or depigmentation in those denervated regions. In addition, segmental vitiligo regularly develops in a dermatomal pattern, which indicates that some chemical mediators are liberated from nerve endings affecting the melanin production. Additionally, sweating and vasoconstriction are raised in depigmented patches of vitiligo, suggesting high adrenergic activity. Ultimately, increased excretion of homovanillic acid and vanillylmandelic acid in urine has been recorded in patients suffering from vitiligo. This can be a basic or trivial episode [6].

Genetics of vitiligo

Vitiligo is characterized by partial penetrance, many sensitive areas, and genetic heterogeneity [7]. Vitiligo caused due to inheritance can be due to involvement of genes related to the biosynthesis of melanin, reaction to oxidative stress, and control of autoimmunity [8].

There is no way to prevent vitiligo, but using sunscreens with a minimum sun protection factor (SPF) of 15 to protect the skin from the sun is always a healthy decision.

Vitiligo is a condition that causes depigmentation of segments of the skin. It develops due to death or malfunctioning of melanocytes, the cells that are in charge for skin pigmentation. This condition is often associated with disorders of autoimmune origin and thyroid abnormalities.

Vitiligo is a condition that causes depigmentation of segments of the skin. Being a genetic disorder there is no way of preventing this disease; it is advised to start the treatment as early as possible. As the disease is associated with various other autoimmune diseases, care must be taken to diagnose and treat them too. Emotional support is another important part of vitiligo therapy as the skin changes caused by vitiligo can affect people emotionally and socially.

Even in today’s world due to unawareness people feel that vitiligo can also spread due to close contact but that is not true, vitiligo is not a communicable disease. It does not cause any disability and the patient is fit for any type of work. Now due to progress in cosmetic industry there are many local applications that are available to hide small areas of vitiligo on the exposed area. The creams camouflages with the skin such that no one can make out the difference.

1. Halder RM, Chappell JL. Vitiligo update. Semin Cutan Med Surg. 2009 Jun;28(2):86-92.
2. Nath SK, Majumder PP, Nordlund JJ. Genetic epidemiology of vitiligo: multilocus recessivity cross-validated. Am J Hum Genet. 1994 Nov;55(5):981-90.
3. Le Poole IC, Luiten RM. Autoimmune etiology of generalized vitiligo. Curr Dir Autoimmun. 2008;10:227-43.
4. Toussaint S, Kamino H. Noninfectous papular and squamous diseases. In: Elder D, Elenitas R, Jaworsky D, Johnson B Jr. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincot-Raven; 1997:154-5.
5. Sravani PV, Babu NK, Gopal KV, Rao GR, Rao AR, Moorthy B. Determination of oxidative stress in vitiligo by measuring superoxide dismutase and catalase levels in vitiliginous and non-vitiliginous skin. Indian J Dermatol Venereol Leprol. 2009 May-Jun;75(3):268-71.
6. Kovacs SO. Vitiligo. J Am Acad Dermatol. 1998 May;38(5 Pt 1):647-66; quiz 667-8.
7. Spritz RA. The genetics of generalized vitiligo. Curr Dir Autoimmun. 2008;10:244-57.
8. Halder R, Taliaferro S. Vitiligo. In: Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Lefell D, eds.Fitzpatrick's Dermatology in General Medicine. Vol 1. 7th ed. New York, NY: McGraw-Hill; 2008:72.
9. Ortonne J. Vitiligo and other disorders of Hypopigmentation. In: Bolognia J, Jorizzo J, Rapini R, eds.Dermatology. Vol 1. 2nd. Spain: Elsevier; 2008:65.
10. Matz H, Tur E. Vitiligo. Curr Probl Dermatol. 2007;35:78-102.