Vitiligo Recap

Vitiligo affects 0.5–1% of the population and affects people of all races. It’s possible that it’s more widespread in India than elsewhere, with studies claiming that up to 8.8% of the population is affected. Pigment loss begins in 50 percent of sufferers before the age of 20, and in about 80 percent before the age of 30. Other family members have vitiligo in 20% of cases. Both men and women are affected in the same way.

Despite the fact that most people with vitiligo are in good general health, they are more likely to develop autoimmune diseases such as diabetes, thyroid disease (which affects 20% of patients with vitiligo over the age of 20), pernicious anemia (B12 deficiency), Addison disease (adrenal gland disease), systemic lupus erythematosus, rheumatoid arthritis, psoriasis, and (round patches of hair loss).

Patients with metastatic melanoma may develop a vitiligo-like leukoderma. Certain medicines used to treat metastatic melanoma, such as immune checkpoint inhibitors (pembrolizumab, nivolumab) and BRAF inhibitors (vemurafenib, dabrafenib), can cause it. Vitiligo is three times more common in haematology patients who have received allogeneic bone marrow and stem-cell transplants than it is in the general population.

How is Vitiligo Classified?

Vitiligo has clinical, genetic, pathobiological, epidemiological, and molecular characteristics that have been classified.

In 2007, the Vitiligo European Taskforce reached an agreement on vitiligo classification. They settled on four basic groups, each with its own set of subtypes.

Non-segmental Vitiligo

Non-segmental vitiligo is a type of vitiligo that is caused by an autoimmune loss of melanocytes. The development is influenced by both genetic and environmental factors. Predisposing genes for the development of non-segmental vitiligo have been discovered in recent genetic investigations. Dendritic cells, Th17 cells, and CD8+ cytotoxic T lymphocytes infiltrated the margins of vitiligo, and the number of regulatory T (Treg) cells in the afflicted skin was reduced, according to recent histopathological research.

The subtypes include:

• Focal: It’s being localized to a specific area or tissue
• Mucosal: Oral and genital mucosae are affected. In patients with acrofacial, common, or universal types, mucosal tissues may also be impacted.
• Acrofacial: It can affect the face, head, hands, and feet, with the perioral region and digit extremities being the most commonly affected areas.
• Generalised: Macules / patches are usually symmetrical and can affect any region of the tegument, especially the hands, fingers, face, and trauma-prone areas.
• Universal: is the most frequent variety in adulthood, affecting the biggest portion of the tegument (80-90 percent of the body surface). It is frequently preceded by the generalized or common form.

Segmental Vitiligo

Segmental vitiligo is an uncommon type of localized vitiligo that is distinguished by its dermatomal distribution. It is frequently unilateral and asymmetrical, seldom crossing the body’s midline. Depigmentation patches spread swiftly in the afflicted dermatomes and then stop spreading in this stage of the disease. It is thought that the vast majority of people with segmental vitiligo also have melanocytes in their hair follicles, resulting in leukotrichia.

The subtypes include:

• Focal: It tends to be present on one area or side of the body.
• Mucosal: Mucosal vitiligo is a type of vitiligo that affects the mucous membranes of the mouth, nose, inner ear, and genitals.
• Unisegmental, bi – or multisegmental:

Mixed Vitiligo

This variety is distinguished by a few scattered white spots on the trunk and scalp, and it is most common in people with dark complexion.  There is a mixture of segmental and non-segmental vitiligo in mixed vitiligo

Unclassified Vitiligo

Unclassified vitiligo is the time when vitiligo is first present on the skin.  Before diagnosis.

The subtypes include:

• Focal at onset: This is an unusual variety in which the macules are concentrated in a limited area and do not spread in a predictable pattern over the course of one to two years.
• Multifocal asymmetrical non-segmental: Having white spots or skin depigmentation in multiple areas of the skin.
• unifocal mucosal: It’s uncommon to have a mucosal subtype that affects only one part of the mucosa. Focuses around the mouth, nose, inner ear, and genitals.