Advances in Vitiligo: Pathophysiology, Psychosocial Impact and Emerging Therapy

Authors

  • Sameh Hanna, MD Medical Director, Dermatology on Bloor

Abstract

Vitiligo is a chronic autoimmune skin disorder that affects approximately 0.5–2% of the world’s population. It is characterized by the loss of pigment-producing melanocytes, resulting in depigmented patches on the skin. Vitiligo occurs equally in all genders and across the skin colour spectrum. Although vitiligo can start at any age, 50% of affected individuals experience the onset of the condition before the age of 20. Recent developments in vitiligo research have advanced the understanding of its pathophysiology, epidemiology, and psychosocial impact on patients. While traditional treatment options have been of limited benefit, several emerging therapies are in development and may soon be available to Canadian patients with vitiligo. 

Author Biography

Sameh Hanna, MD, Medical Director, Dermatology on Bloor

Dr. Hanna grew up in Toronto but completed his medical and dermatology specialty training in the U.S. He practiced there for almost a decade before returning home to Toronto to establish his dermatology practice. Dr. Hanna has been practicing medical, aesthetic and investigational dermatology for over 20 years. He is the Medical Director of Dermatology on Bloor, a large single-specialty dermatology practice in downtown Toronto. He is adjunct clinical faculty in the Division of Dermatology, Department of Medicine at the University of Toronto where he serves as co-lead for Undergraduate Medical Education. He is past-president of the Toronto Dermatological Society, serves on the OMA section of Dermatology Board and has been secretary of the Canadian Dermatology Association and a has sat on numerous committees in his role at the CDA. 

References

Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology. 2020;236(6):571-592. doi:10.1159/000506103

Whitton ME, Ashcroft DM, Barrett CW, Gonzalez U. Interventions for vitiligo. Cochrane Database Syst Rev. 2006;1:CD003263. doi:10.1002/14651858

Faraj S, Kemp EH, Gawkrodger DJ. Patho-immunological mechanisms of vitiligo: the role of the innate and adaptive immunities and environmental stress factors. Clin Exp Immunol. 2022;207(1):27-43. doi:10.1093/cei/uxab002

Marchioro HZ, Silva de Castro CC, Fava VM, Sakiyama PH, Dellatorre G, Miot HA. Update on the pathogenesis of vitiligo. An Bras Dermatol. 2022;97(4):478-490. doi: 10.1016/j.abd.2021.09.008

Kaushik H, Kumar V, Parsad D. Mitochondria–melanocyte cellular interactions: an emerging mechanism of vitiligo pathogenesis. J Eur Acad Dermatol Venereol. 2023;37(11):2196-2207. doi: 10.1111/jdv.19019

Ongenae K, Beelaert L, van Geel N, Naeyaert JM. Psychosocial effects of vitiligo. J Eur Acad Dermatol Venereol. 2006;20(1):1-8. doi: 10.1111/j.1468- 3083.2005.01369.x 1

Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, et al. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol. 2021;22(6):757-774. doi:10.1007/s40257-021-00631-6

Patel KR, Singam V, Rastogi S, Lee HH, Silverberg NB, Silverberg JI. Association of vitiligo with hospitalization for mental health disorders in US adults. J Eur Acad Dermatol Venereol. 2019;33(1):191-197. doi:10.1111/jdv.15255

Padmakar S, Murti K, Pandey K, Kumari S, Kumar R, Ali Siddiqui N, et al. Suicidal ideation associated with vitiligo - a systematic review of prevalence and assessment. Clinical Epidemiology and Global Health. 2022;17:101140. doi:10.1016/j.cegh.2022.101140

Vallerand IA, Lewinson RT, Parsons LM, Hardin J, Haber RM, Lowerison MW, et al. Vitiligo and major depressive disorder: a bidirectional population-based cohort study. J Am Acad Dermatol. 2019;80(5):1371-1379. doi:10.1016/j. jaad.2018.11.047

Shourick J, Ahmed M, Seneschal J, Passeron T, Andreux N, Qureshi A, et al. Development of a shared decision-making tool in vitiligo: an international study [published correction appears in Br J Dermatol. 2022 Jan;186(1):200]. Br J Dermatol. 2021;185(4):787-796. doi:10.1111/bjd.20137

Speeckaert R, Taïeb A, Ezzedine K, Lim HW, Pandya AG, Passeron T, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm. J Eur Acad Derm Venereol. 37(11), 2173-2184. doi: 10.1111/jdv.19451

Seneschal J, Speeckaert R, Taïeb A, Wolkerstorfer A, Passeron T, Pandya AG, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force—Part 2: specific treatment recommendations. J Eur Acad Derm Venereol. 37(11), 2185-2195. doi: 10.1111/ jdv.19450

Eleftheriadou V, Atkar R, Batchelor J, McDonald B, Novakovic L, Patel JV, et al. British Association of Dermatologists guidelines for the management of people with vitiligo 2021. Br J Dermatol.186(1):18-29. doi: 10.1111/bjd.20596

Moghadam PM, Rasouli SR, Gheybi F, Karimi E, Sahebkar AH. A comprehensive review on present and future of pharmacotherapy of vitiligo disease and potential therapeutic strategies. Phytomedicine Plus. 2023;3(2):100437. https://doi.org/10.1016/j. phyplu.2023.100437

Wolkerstorfer A. Efficacy of prolonged ruxolitinib cream treatment for vitiligo among patients with limited or no initial response at 6 months. Oral Presentation, Late Breaking News EADV Congress, Oct 13, 2023, Berlin, Germany

Ezzedine K. Efficacy and safety of povorcitinib for extensive vitiligo: 52-week results from a double-blinded, placebocontrolled, dose-ranging phase 2b study. Oral Presentation, Late Breaking News EADV Congress, Oct 13, 2023, Berlin, Germany

Su X, Luo R, Ruan S, et al. Efficacy and tolerability of oral upadacitinib monotherapy in patients with recalcitrant vitiligo. J Am Acad Dermatol. 2023;89(6):1257-1259. doi:10.1016/j.jaad.2023.07.1016

Ezzedine K, Peeva E, Yamaguchi Y, Cox LA, Banerjee A, Han G, et al. Efficacy and safety of oral ritlecitinib for the treatment of active nonsegmental vitiligo: a randomized phase 2b clinical trial [published correction appears in J Am Acad Dermatol. 2023 Sep;89(3):639]. J Am Acad Dermatol. 2023;88(2):395-403. doi:10.1016/j.jaad.2022.11.005

Seneschal J. Efficacy and safety of the combination of oral baricitinib and NB-UVB for the treatment of active vitiligo: results from a randomized, double-blind, phase 2 proof of concept study. Oral Presentation, Late Breaking News EADV Congress, Oct 13, 2023, Berlin, Germany

Feng Y, Lu Y. Advances in vitiligo: update on therapeutic targets. Front Immunol. 2022;13:986918. doi:10.3389/ fimmu.2022.986918

Published

2024-03-26

How to Cite

1.
Hanna S. Advances in Vitiligo: Pathophysiology, Psychosocial Impact and Emerging Therapy. Can Dermatol Today [Internet]. 2024 Mar. 26 [cited 2024 Apr. 27];5(1):4–9. Available from: https://canadiandermatologytoday.com/article/view/5-1-Hanna

Issue

Section

Articles