VITILIGO: A COMPREHENSIVE REVIEW OF PATHOGENESIS, TYPES AND MANAGEMENT

Vitiligo is a chronic, multifactorial autoimmune disorder characterized by progressive loss of functional melanocytes, leading to depigmented macules and patches on the skin and mucosa. Affecting approximately 0.5–1% of the global population, vitiligo imposes significant psychosocial distress and remains a therapeutic challenge due to its complex and incompletely understood pathogenesis. Current evidence indicates that vitiligo arises from an intricate interplay of genetic predisposition, oxidative stress, immune dysregulation, and environmental triggers. Mitochondrial dysfunction, excessive oxidative stress, and impaired antioxidant defence initiate melanocyte damage, while autoreactive CD8⁺ T cells, altered CD4⁺/CD8⁺ ratios, and reduced regulatory T-cell (Treg) activity drive autoimmune destruction. Heat shock protein 70 (HSP70i) and proinflammatory cytokines such as IFN-γ and IL-17 amplify this immune cascade, culminating in melanocyte loss. Clinically, vitiligo presents in diverse forms—focal, segmental, acrofacial, generalized, universal, and mucosal—each with distinct distribution and prognostic implications. Diagnosis is primarily clinical but may be supported by laboratory and imaging modalities such as Wood’s lamp examination, digital photography, and point-counting techniques for disease assessment. Therapeutic approaches include topical corticosteroids, calcineurin inhibitors, vitamin D analogues, and phototherapy (NB-UVB, PUVA), with emerging options like Janus kinase (JAK) inhibitors, HSP70i gene therapy, and melanocyte-stimulating agents offering new hope. Despite recent advances, complete and sustained repigmentation remains elusive. Future directions emphasize the need for personalized, multimodal regimens targeting immune modulation, oxidative balance, and melanocyte regeneration. This comprehensive review explores the current understanding of vitiligo’s pathogenesis, classification, diagnostic strategies, and evolving management paradigms, highlighting promising innovations that may transform patient outcomes.