Vitiligo Presentation in Different Patient Populations

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EP: 1.Vitiligo Presentation in Different Patient Populations

EP: 2.Importance of Early Diagnosis of Vitiligo

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Vitiligo is a complex autoimmune skin condition involving multiple pathophysiological factors that affect melanocytes, the pigment-producing cells in the skin. Edward Lain, M.D., MBA, explains that melanocyte damage can occur through genetic predisposition or oxidative stress from sun exposure, chemicals or skin injuries. The condition involves both innate and adaptive immune systems, with dendritic cells propagating immune reactions and circulating antibodies targeting melanocytes. Cytotoxic T cells act as “sniper rifles” to destroy these pigment-producing cells, creating the characteristic white patches of vitiligo.

A critical aspect of vitiligo pathogenesis involves resident memory T cells that remain dormant in affected areas even after initial melanocyte destruction. These immune cells can reactivate years later, causing previously stable white patches to suddenly worsen or expand. This mechanism explains why dermatologists often recommend continued treatment even after improvement to prevent recurrence. The unpredictable nature of these memory cells makes vitiligo particularly challenging to manage long-term.

Vitiligo presents in two main forms: segmental vitiligo, which rapidly affects one body segment (like an entire arm) then stops progressing, and nonsegmental vitiligo, which develops slower with scattered patches across the body. Nonsegmental vitiligo is more common and responds better to treatment, while segmental vitiligo proves more difficult to treat due to its rapid progression. Repigmentation occurs through two mechanisms: stem cells from hair follicles creating “islands” of pigment, or marginal repigmentation where healthy melanocytes migrate from patch borders. Treatment success depends largely on whether hair in affected areas retains pigment.