Vitiligo is a long-term skin condition that causes patches of skin to lose their natural color. This change happens when the cells responsible for skin pigmentation, known as melanocytes, are attacked or destroyed. While the exact reason why this occurs is still under study, researchers believe several factors may increase the risk or trigger the onset of vitiligo.
Although there is no known cure for the condition, understanding its potential causes may help improve available treatments and delay progression.
What Is Vitiligo?
Vitiligo is a chronic disorder characterized by depigmented patches of skin caused by the loss of melanocytes. These patches can develop anywhere on the body, including the skin, hair, inside the mouth or nose, and even the eyes. According to global estimates, around 0.5% to 2% of the population lives with vitiligo.
The condition is not contagious and doesn't cause physical pain, but it can impact emotional health and self-confidence.
Immune System Dysfunction
autoimmune response against melanocytes
Vitiligo is widely considered an autoimmune condition, where the immune system mistakenly identifies melanocytes as harmful invaders and attacks them. Over time, this immune attack leads to inflammation and the destruction of pigment-producing cells.
association with other autoimmune disorders
People with vitiligo often have other autoimmune conditions such as Hashimoto’s thyroiditis, type 1 diabetes, rheumatoid arthritis, or psoriasis. In fact, research shows that 19% to 30% of vitiligo patients in North America also experience another autoimmune disorder.
Genetic Factors
inherited risk but low predictability
While genetics can influence the likelihood of developing vitiligo, having a family history doesn’t guarantee you’ll get the condition. About 20% of people with vitiligo have a first-degree relative who also has it.
However, even identical twins only both develop vitiligo 23% of the time, which means genetics alone don’t determine the onset of the disease.
Physical Trauma
skin injuries or environmental exposure
Physical trauma such as cuts, sunburns, or exposure to certain industrial chemicals may trigger vitiligo, especially in genetically predisposed individuals. In some cases, vitiligo patches appear exactly in the area where the skin was damaged.
Koebner phenomenon
This is a known effect where new lesions appear in areas of trauma. Though the precise cause is not clear, it's observed frequently in autoimmune skin conditions like vitiligo and psoriasis.
Emotional Stress
psychological impact as a trigger
Psychological stress has been identified as a potential contributing factor to the onset or worsening of vitiligo. Events like the death of a loved one, job loss, or financial problems may trigger inflammatory responses that exacerbate autoimmune activity.
adult-onset more stress-related
Studies suggest that individuals who develop vitiligo later in life may be more likely to report stressful life events before the onset of symptoms.
Oxidative Stress
imbalance between antioxidants and free radicals
Oxidative stress results from an imbalance between free radicals and antioxidants in the body. When free radicals build up, they may damage melanocytes, especially when combined with other risk factors.
external triggers of oxidative stress
Exposure to ultraviolet rays, air pollution, and certain chemicals can increase oxidative stress. Over time, the toxic effects can impair melanocyte function or destroy them altogether.
Current Treatment Approaches
Although there's no cure for vitiligo, treatment options aim to stop or slow the loss of pigment and help repigment affected areas.
UV light therapy
Ultraviolet (UV) light therapy is a common treatment that helps stimulate melanocyte activity and reduce inflammation.
immunosuppressive medications
Topical corticosteroids and other medications that suppress immune activity are used to prevent further melanocyte destruction.
FDA-approved treatments
In 2022, the FDA approved a medication called Opzelura (ruxolitinib) for treating non-segmental vitiligo in individuals aged 12 and older. It is the first approved drug that promotes repigmentation of the skin.
A Quick Review
Vitiligo is a chronic skin disorder marked by the loss of pigment-producing cells, resulting in white patches on various parts of the body. Although the exact cause remains unclear, autoimmune activity, genetics, skin trauma, emotional stress, and oxidative imbalance are believed to contribute to its development.
Managing vitiligo involves a combination of treatments such as light therapy, immunosuppressants, and lifestyle adjustments. While there's no permanent cure, ongoing research and newer therapies offer promising ways to manage symptoms and restore pigment.
