Question 3. What causes vitiligo?

Key points

  • The cause of vitiligo is unknown.
  • There are different types of vitiligo.
  • The different types could have different origins and causes.
  • The most widespread forms of vitiligo seem to be related to an immune system disorder resulting in the production of antibodies against melanocytes. Stressful life events, infections, and the accumulation of toxic compounds in the body are under investigation.
  • Limited forms of vitiligo seem to be related to an alteration in skin nerves.
  • The autoimmune hypothesis is the best documented theory: it seems that the immune system reacts against the cells which produce melanin pigment.
  • The neurohumoral, cytotoxic, and oxidative stress theories have moderate evidence (All medical terms will be explained in the following pages.)
  • New theories focus on melanocytorrhagy – i.e. melanocytes being discharged by the skin – and on decreased melanocyte survival in the skin.

It remains unclear what causes damage to melanocytes and their subsequent total inactivation and/or disappearance in vitiligo skin. There are several theories; the most prominent are autoimmune, neurohumoral (related to abnormal detachment of melanocytes from the epidermal layers) and autocytotoxic. None are mutually exclusive, and it is likely that each of them partially contributes to the disease development.

The current opinion is that vitiligo represents a group of different disorders with a similar outcome: the appearance of white patches on the skin.

Convergence theory states that stress, accumulation of toxic compounds, infections, autoimmunity, genetic predisposition, altered cellular environment, and impaired melanocyte migration can all contribute to the vitiligo initiation process. Autoimmune mechanisms are likely to underlie generalized vitiligo, while a more localized phenomenon (i.e. the altered activities of sensitive nerves in the skin) may be responsible for segmental or focal vitiligo. At the site of physical trauma to the skin, vitiligo may develop; this is called a “Koebner phenomenon”.

Author: Prof. Torello Lotti, MD

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