Understanding the mechanism of disease of vitiligo and the impact on clinical management

Vitiligo is a depigmenting skin condition that affects 0.5% to 2.0% of the global population and can significantly affect quality of life. Although vitiligo may be dismissed as cosmetic or untreatable, pathogenesis is driven by immunologic mechanisms that can be blocked with treatment, leading to skin repigmentation. The disease typically begins with genetic or environmental factors that induce skin cell stress, which initiates a cascade of immune events resulting in the recruitment of T cells to the skin and the destruction of melanocytes. Various treatment options exist that can block this autoimmune attack and allow repigmentation to occur over time. However, given the complexity of vitiligo pathogenesis, many patients do not fully understand their disease, how repigmentation can be achieved, or why repigmentation is a slow process that requires long-term treatment. Furthermore, dermatology health care providers may find it difficult to explain the underlying disease mechanism of vitiligo or answer patient questions about treatment. Better education about vitiligo and repigmentation mechanisms is crucial for successful disease management. This review aims to summarize what is known about vitiligo pathogenesis and current treatment options so dermatology health care providers can help patients manage their vitiligo with realistic expectations. Supplemental materials include additional information that can be shared with patients.