Vitiligo is a relatively common, acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. The prevalence of this disease varies from 0.1% to 2% in various global populations. Onset may occur at any age, but the incidence usually peaks in the second and third decades of life. Patterns of distribution of the disease include the generalized, acral or acrofacial, localized and segmental types. A generalized distribution is most common and is characterized by symmetrically distributed areas of depigmentation. Segmental vitiligo is the least common variety and occurs in a dermatomal or quasi-dermatomal distribution often affecting the trigeminal nerve; however, nerve function is not impaired. The course of the disease is unpredictable. Vitiliginous skin lesions can remain stable or slowly progress for years. In some instances, however, patients undergo rapid, complete depigmentation in one or two years.
The disease shows no racial, socioeconomic, or ethnic predilection. However, given the contrast between depigmented patches and normal skin, the disease is most disfiguring in darker racial-ethnic groups. Vitiligo is one of the most psychologically devastating skin diseases. The devastation of vitiligo is indeed influenced and exacerbated by societal perceptions of skin disfigurement and irregularities in skin color. Hence, the disease causes major emotional trauma in the lives of the afflicted. Patients with vitiligo experience low self-esteem, job discrimination, depression, and embarrassment during social and sexual relationships.
The precise cause of vitiligo is unknown. However, autoimmune, neural, biochemical, oxidative stress, autocytotoxic, viral, and melanocyte detachment mechanisms have been proposed to explain the pathogenesis of vitiligo. The autoimmune hypothesis remains the most well-supported by current data.
Vitiligo has been and remains a therapeutically challenging disease. Previously, therapeutic options have included administration of oral and topical psoralen photochemotherapy, topical steroids, and depigmentation therapies. During the past 8 years, there have been several new advances in the treatment of vitiligo. These new treatment options include narrowband UV-B phototherapy, targeted light therapy, topical immunomodulators, and calcipotriol in combination with UV light. Excellent results have been obtained with each of these modalities.