title: Vitiligo.
abstract: Vitiligo is an acquired depigmenting disorder that affects 0.5% to 2% of the world population. Three different forms are classified according to the distribution of lesions; namely non-segmental, segmental and mixed vitiligo. Vitiligo is associated with polymorphisms in genes involved in the immune response and in melanogenesis. However, environmental factors are required for the development of manifest disease. In general, the diagnosis is clinical and no laboratory tests or biopsies are required. Metabolic alterations are central to current concepts in pathophysiology. They induce an increased generation of reactive oxygen species and susceptibility to mild exogenous stimuli in the epidermis. This produces a senescent phenotype of skin cells, leads to the release of innate immune molecules, which trigger autoimmunity, and ultimately causes dysfunction and death of melanocytes. Clinical management aims to halt depigmentation, and to either repigment or depigment the skin, depending on the extent of disease. New therapeutic approaches include stimulation of melanocyte differentiation and proliferation through α-melanocyte-stimulating hormone analogues and through epidermal stem cell engineering. Several questions remain unsolved, including the connection between melanocyte depletion and stem cell exhaustion, the underlying degenerative mechanisms and the biological mediators of cell death. Overall, vitiligo is an excellent model for studying degenerative and autoimmune processes and for testing novel approaches in regenerative medicine. For an illustrated summary of this Primer, visit: http://go.nature.com/vIhFSC.
authors.affiliation: Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Picardo
authors.affiliation: Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Dell'Anna
authors.affiliation: Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France.
authors.forename: Khaled
authors.initials: K
authors.lastname: Ezzedine
authors.affiliation: Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital Detroit, Michigan, USA.
authors.forename: Iltefat
authors.initials: I
authors.lastname: Hamzavi
authors.affiliation: Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Harris
authors.affiliation: Department of Dermatology, PGIMER, Chandigarh, India.
authors.forename: Davinder
authors.initials: D
authors.lastname: Parsad
authors.affiliation: Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Taieb
mesh_terms: D015551:Autoimmunity / Q000276:immunology; D016923:Cell Death / Q000276:immunology; D006801:Humans; D008544:Melanocytes / Q000276:immunology; D010858:Pigmentation / Q000276:immunology; D017382:Reactive Oxygen Species / Q000276:immunology; D044968:Regenerative Medicine / Q000639:trends; D012867:Skin / Q000276:immunology; D014820:Vitiligo / Q000276:immunology* / Q000628:therapy
chemical_list: D017382:Reactive Oxygen Species