Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Primer
  • Published:

Vitiligo

Nature Reviews Disease Primers volume 1, Article number: 15011 (2015) Cite this article

Subjects

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

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The hair follicle unit.
Figure 2: The melanocyte and its environment.
Figure 3: Treatment target in interferon signalling.
Figure 4: Typical presentation of vitiligo.
Figure 5: Differential diagnosis of vitiligo.
Figure 6: Management algorithm for the treatment of vitiligo.
Figure 7: Determinants of quality of life in vitiligo.
Figure 8: Vitiligo as a model for autoimmune and degenerative diseases.

Similar content being viewed by others

References

  1. Gauthier, Y. et al. in Vitiligo. Ch.1.1 (eds Picardo, M. & Taïeb, A. ) 3–10 (Springer, 2010).

    Book  Google Scholar 

  2. Nair, B. K. Vitiligo—a retrospect. Int. J. Dermatol. 17, 755–757 (1978).

    Article  CAS  PubMed  Google Scholar 

  3. Ezzedine, K. et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 25, E1–E13 (2012). This is the last consensus document on vitiligo classification and management from the International Vitiligo Conference.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ezzedine, K. et al. Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): a retrospective case series of 19 patients. J. Am. Acad. Dermatol. 65, 965–971 (2011).

    Article  PubMed  Google Scholar 

  5. Prignano, F., Betts, C. M. & Lotti, T. Vogt-Koyanagi-Harada disease and vitiligo: where does the illness begin? J. Electron. Microsc. 57, 25–31 (2008).

    Article  Google Scholar 

  6. Park, S., Albert, D. M. & Bolognia, J. L. Ocular manifestations of pigmentary disorders. Dermatol. Clin. 10, 609–622 (1992).

    Article  CAS  PubMed  Google Scholar 

  7. Anbar, T. S., El-Badry, M. M., McGrath, J. A. & Abdel-Azim, E. S. Most individuals with either segmental or nonsegmental vitiligo display evidence of bilateral cochlear dysfunction. Br. J. Dermatol. 172, 406–411 (2014).

    Article  PubMed  Google Scholar 

  8. Ozuer, M. Z., Sahiner, T., Aktan, S., Sanli, B. & Bayramoglu, I. Auditory evoked potentials in vitiligo patients. Scand. Audiol. 27, 255–258 (1998).

    Article  CAS  PubMed  Google Scholar 

  9. Angrisani, R. M., Azevedo, M. F., Preira, L. D., Lopes, C. & Garcia, M. V. A study of otoacoustic emissions and suppression effects in patients with vitiligo. Braz. J. Otorhinolaryngol. 75, 111–115 (2009).

    Article  PubMed  Google Scholar 

  10. Silverberg, N. B. Update on childhood vitiligo. Curr. Opin. Pediatr. 22, 445–452 (2010).

    Article  PubMed  Google Scholar 

  11. Hann, S. K. & Lee, H. J. Segmental vitiligo: clinical findings in 208 patients. J. Am. Acad. Dermatol. 35, 671–674 (1996).

    Article  CAS  PubMed  Google Scholar 

  12. Taïeb, A., Picardo, M. & VETF Members. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 20, 27–35 (2007).

    Article  PubMed  Google Scholar 

  13. van Geel, N. et al. New insights in segmental vitiligo: case report and review of theories. Br. J. Dermatol. 166, 240–246 (2012).

    Article  CAS  PubMed  Google Scholar 

  14. Howitz, J., Brodthagen, H., Schwartz, M. & Thomsen, K. Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark. Arch. Dermatol. 113, 47–52 (1977).

    Article  CAS  PubMed  Google Scholar 

  15. Boisseau-Garsaud, A. M. et al. Epidemiology of vitiligo in the French West Indies (Isle of Martinique). Int. J. Dermatol. 39, 18–20 (2000).

    Article  CAS  PubMed  Google Scholar 

  16. Behl, P. N. & Bhatia, R. K. 400 cases of vitiligo. A clinico-therapeutic analysis. Indian. J. Dermatol. 17, 51–56 (1972).

    CAS  PubMed  Google Scholar 

  17. Sehgal, V. N. & Srivastava, G. Vitiligo: compendium of clinico-epidemiological features. Indian J. Dermatol. Venereol. Leprol. 73, 149–156 (2007).

    Article  PubMed  Google Scholar 

  18. Wang, X. et al. Prevalence and clinical profile of vitiligo in China: a community-based study in six cities. Acta Derm. Venereol. 93, 62–65 (2013).

    Article  PubMed  Google Scholar 

  19. Singh, M., Singh, G., Kanwar, A. J. & Belhaj, M. S. Clinical pattern of vitiligo in Libya. Int. J. Dermatol. 24, 233–235 (1985).

    Article  CAS  PubMed  Google Scholar 

  20. Alikhan, A., Felsten, L. M., Daly, M. & Petronic-Rosic, V. Vitiligo: a comprehensive overview Part, I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J. Am. Acad. Dermatol. 65, 473–491 (2011).

    Article  PubMed  Google Scholar 

  21. Al-Refu, K. Vitiligo in children: a clinical-epidemiologic study in Jordan. Pediatr. Dermatol. 29, 114–115 (2012).

    Article  PubMed  Google Scholar 

  22. Krüger, C. & Schallreuter, K. U. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int. J. Dermatol. 51, 1206–1212 (2012).

    Article  PubMed  Google Scholar 

  23. Das, S. K., Majumder, P. P., Chakraborty, R., Majumdar, T. K. & Haldar, B. Studies on vitiligo. I. Epidemiological profile in Calcutta, India. Genet. Epidemiol. 2, 71–78 (1985).

    Article  CAS  PubMed  Google Scholar 

  24. Taieb, A. & Picardo, M. in Vitiligo. Ch.1.2.1 (eds Picardo, M. & Taïeb, A. ) 13–24tf (Springer, 2010).

    Book  Google Scholar 

  25. Ezzedine, K. et al. Pre- versus post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br. J. Dermatol. 167, 490–495 (2012).

    Article  CAS  PubMed  Google Scholar 

  26. Nicolaidou, E. et al. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J. Am. Acad. Dermatol. 66, 954–958 (2012).

    Article  PubMed  Google Scholar 

  27. Halder, R. M. Childhood vitiligo. Clin. Dermatol. 15, 899–906 (1997).

    Article  CAS  PubMed  Google Scholar 

  28. Halder, R. M. et al. Childhood vitiligo. J. Am. Acad. Dermatol. 16, 948–954 (1987).

    Article  CAS  PubMed  Google Scholar 

  29. Hu, Z., Liu, J. B., Ma, S. S., Yang, S. & Zhang, X. J. Profile of childhood vitiligo in China: an analysis of 541 patients. Pediatr. Dermatol. 23, 114–116 (2006).

    Article  PubMed  Google Scholar 

  30. Le Poole, I. C., Das, P. K., van den Wijngaard, R. M., Bos, J. D. & Westerhof, W. Review of the etiopathomechanism of vitiligo: a convergence theory. Exp. Dermatol. 4, 145–153 (1993). This is the first convergent approach to understanding vitiligo pathogenesis.

    Article  Google Scholar 

  31. Schallreuter, K. U. et al. Vitiligo pathogenesis: autoimmune disease, genetic defect, excessive reactive oxygen species, calcium imbalance, or what else? Exp. Dermatol. 2, 139–140; discussion 139–160 (2008).

    Google Scholar 

  32. Dell'anna, M. L. & Picardo, M. A review and a new hypothesis for non-immunological pathogenetic mechanisms in vitiligo. Pigment Cell Res. 5, 406–411 (2006).

    Article  Google Scholar 

  33. Shin, S., Shin, Y., Lee, H. & Oh, S. H. Spreading of pre-existing segmental vitiligo after immunotherapy with house dust mite in a patient with atopic dermatitits. Clin. Exp. Dermatol.http://dx.doi.org/10.1111/ced.12443 (2014).

  34. Liu, L. et al. Promoter variant in the catalase gene is associated with vitiligo in Chinese people. J. Invest. Dermatol. 11, 2647–2653 (2010).

    Article  CAS  Google Scholar 

  35. Sravani, P. V. et al. Determination of oxidative stress in vitiligo by measuring superoxide dismutase and catalase levels in vitiliginous and non-vitiliginous skin. Indian J. Dermatol. Venereol. Leprol. 3, 268–2671 (2009).

    Google Scholar 

  36. Schallreuter, K. U., Wood, J. M. & Berger, J. Low catalase levels in the epidermis of patients with vitiligo. J. Invest. Dermatol. 97, 1081–1085 (1991).

    Article  CAS  PubMed  Google Scholar 

  37. Maresca, V. et al. Increased sensitivity to peroxidative agents as a possible pathogenic factor of melanocyte damage in vitiligo. J. Invest. Dermatol. 3, 310–313 (1997).

    Article  Google Scholar 

  38. Bulut, H. et al. Lack of association between catalase gene polymorphism (T/C exon 9) and susceptibility to vitiligo in a Turkish population. Genet. Mol. Res. 4, 4126–4132 (2011).

    Article  Google Scholar 

  39. Kostyuk, V. A. et al. Dysfunction of glutathione S-transferase leads to excess 4-hydroxy-2-nonenal and H(2)O(2) and impaired cytokine pattern in cultured keratinocytes and blood of vitiligo patients. Antioxid. Redox Signal. 5, 607–620 (2010).

    Article  CAS  Google Scholar 

  40. Vafaee, T., Rokos, H., Salem, M. M. & Schallreuter, K. U. In vivo and in vitro evidence for epidermal H2O2-mediated oxidative stress in piebaldism. Exp. Dermatol. 10, 883–887 (2010).

    Google Scholar 

  41. Ozturk, I. C. et al. Comparison of plasma malondialdehyde, glutathione, glutathione peroxidase, hydroxyproline and selenium levels in patients with vitiligo and healthy controls. Indian J. Dermatol. 53, 106–110 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dell'Anna, M. L. et al. Membrane lipid alterations as a possible basis for melanocyte degeneration in vitiligo. J. Invest. Dermatol. 5, 1226–1233 (2007).

    Article  CAS  Google Scholar 

  43. Jimbow, K., Chen, H., Park, J. S. & Thomas, P. D. Increased sensitivity of melanocytes to oxidative stress and abnormal expression of tyrosinase-related protein in vitiligo. Br. J. Dermatol. 1, 55–65 (2001).

    Article  Google Scholar 

  44. Boissy, R. E. & Manga, P. On the etiology of contact/occupational vitiligo. Pigment Cell Res. 3, 208–214 (2004).

    Article  Google Scholar 

  45. Hasse, S., Gibbons, N. C., Rokos, H., Marles, L. K. & Schallreuter, K. U. Perturbed 6-tetrahydrobiopterin recycling via decreased dihydropteridine reductase in vitiligo: more evidence for H2O2 stress. J. Invest. Dermatol. 2, 307–313 (2004).

    Article  Google Scholar 

  46. Schallreuter, K. U., Elwary, S. M., Gibbons, N. C., Rokos, H. & Wood, J. M. Activation/deactivation of acetylcholinesterase by H2O2: more evidence for oxidative stress in vitiligo. Biochem. Biophys. Res. Commun. 2, 502–508 (2004).

    Article  CAS  Google Scholar 

  47. Dell'Anna, M. L. et al. Membrane lipid defects are responsible for the generation of reactive oxygen species in peripheral blood mononuclear cells from vitiligo patients. J. Cell. Physiol. 1, 187–193 (2010).

    Google Scholar 

  48. Le Poole, I. C., van den Wijngaard, R. M., Westerhof, W. & Das, P. K. Tenascin is overexpressed in vitiligo lesional skin and inhibits melanocyte adhesion. Br. J. Dermatol. 2, 171–178 (1997).

    Article  Google Scholar 

  49. Wagner, R. et al. Altered e-cadherin levels and distribution in melanocytes precedes clinical manifestations of vitiligo. J. Invest. Dermatol.http://dx.doi.org/10.1038/jid.2015.25 (2015).

  50. Gauthier, Y., Cario-Andrè, M., Lepreux, S., Pain, C. & Taieb, A. Melanocyte detachment after skin friction in non lesional skin of patients with generalized vitiligo. Br. J. Dermatol. 148, 95–101 (2003).

    Article  CAS  PubMed  Google Scholar 

  51. Rokos, H., Beazley, W. D. & Schallreuter, K. U. Oxidative stress in vitiligo: photo-oxidation of pterins produces H(2)O(2) and pterin-6-carboxylic acid. Biochem. Biophys. Res. Commun. 4, 805–811 (2002).

    Article  CAS  Google Scholar 

  52. Moore, J., Wood, J. M. & Schallreuter, K. U. Evidence for specific complex formation between alpha-melanocyte stimulating hormone and 6(R)-L-erythro-5,6,7,8-tetrahydrobiopterin using near infrared Fourier transform Raman spectroscopy. Biochemistry 46, 15317–15324 (1999).

    Article  CAS  Google Scholar 

  53. Schallreuter, K. U. et al. Epidermal H(2)O(2) accumulation alters tetrahydrobiopterin (6BH4) recycling in vitiligo: identification of a general mechanism in regulation of all 6BH4-dependent processes? J. Invest. Dermatol. 1, 167–174 (2001).

    Article  Google Scholar 

  54. Bellei, B. et al. Vitiligo: a possible model of degenerative diseases. PLoS ONE 3, e59782 (2013).

    Article  CAS  Google Scholar 

  55. Salem, M. M. A. E. L. et al. Enhanced DNA binding capacity on up-regulated epidermal wild-type p53 in vitiligo by H2O2-mediated oxidation: a possible repair mechanism for DNA damage. FASEB J. 23, 3790–3807 (2009).

    Article  CAS  PubMed  Google Scholar 

  56. Xavier, J. M., Morgado, A. L., Solá, S. & Rodrigues, C. M. Mitochondrial translocation of p53 modulates neuronal fate by preventing differentiation-induced mitochondrial stress. Antioxid. Redox Signal. 21, 1009–1024 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Paradisi, A. et al. Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo. J. Am. Acad. Dermatol. 71, 1110–1116 (2014).

    Article  PubMed  Google Scholar 

  58. Teulings, H. E. et al. Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners. Br. J. Dermatol. 168, 162–171 (2013).

    Article  CAS  PubMed  Google Scholar 

  59. Dell'Anna, M. L. et al. Alterations of mitochondria in peripheral blood mononuclear cells of vitiligo patients. Pigment Cell Res. 16, 553–559 (2003).

    Article  CAS  PubMed  Google Scholar 

  60. Dell'Anna, M. L. et al. Mitochondrial impairment in peripheral blood mononuclear cells during the active phase of vitiligo. J. Invest. Dermatol. 117, 908–913 (2001).

    Article  CAS  PubMed  Google Scholar 

  61. Nakagawa, T. & Guarente, L. SnapShot: sirtuins, NAD, and aging. Cell. Metab. 20, 192 (2014).

    Article  CAS  PubMed  Google Scholar 

  62. Imai, S. & Guarente, L. NAD+ and sirtuins in aging and disease. Trends Cell. Biol. 24, 464–471 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Shulyakova, N. et al. Over-expression of the Sirt3 sirtuin protects neuronally differentiated PC12 Cells from degeneration induced by oxidative stress and trophic withdrawal. Brain Res. 1587, 40–53 (2014).

    Article  CAS  PubMed  Google Scholar 

  64. Vega-Naredo, I., Cunha-Oliveira, T., Serafim, T. L., Sardao, V. A. & Oliveira, P. J. Analysis of pro-apoptotic protein trafficking to and from mitochondria. Methods Mol. Biol. 1241, 163–180 (2015).

    Article  CAS  PubMed  Google Scholar 

  65. Green, D. R., Galluzzi, L. & Kroemer, G. Cell biology. Metabolic control of cell death. Science 345, 1250256 (2014). This study supports the point of view that metabolic changes lead to cell impairment in vitiligo.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Martel, C., Wang, Z. & Brenner, C. VDAC phosphorylation, a lipid sensor influencing the cell fate. Mitochondrion 19, 69–77 (2014).

    Article  CAS  PubMed  Google Scholar 

  67. Basak, N. P., Roy, A. & Banerjee, S. Alteration of mitochondrial proteome due to activation of Notch1 signaling pathway. J. Biol. Chem. 11, 7320–7334 (2014).

    Article  CAS  Google Scholar 

  68. de Moura, M. B., Uppala, R., Zhang, Y., Van Houten, B. & Goetzman, E. S. Overexpression of mitochondrial sirtuins alters glycolysis and mitochondrial function in HEK293 cells. PLoS ONE 9, e106028 (2014).

    Article  PubMed  Google Scholar 

  69. Dai, S. H. et al. Sirt3 attenuates hydrogen peroxide-induced oxidative stress through the preservation of mitochondrial function in HT22 cells. Int. J. Mol. Med. 34, 1159–1168 (2014).

    Article  CAS  PubMed  Google Scholar 

  70. Wu, Y. T., Wu, S. B. & Wie, Y. H. Roles of sirtuins in the regulation of antioxidant defense and bioenergetic function of mitochondria under oxidative stress. Free Radic. Res. 48, 1070–1084 (2014). This study elegantly explores the mitochondria-nucleus network and intra- and extracellular links.

    Article  CAS  PubMed  Google Scholar 

  71. Giblin, W., Skinner, M. E. & Lombard, D. B. Sirtuins: guardians of mammalian healthspan. Trends Genet. 30, 271–286 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Prignano, F. et al. Ultrastructural and functional alterations of mitochondria in perilesional vitiligo skin. J. Dermatol. Sci. 54, 157–167 (2009).

    Article  CAS  PubMed  Google Scholar 

  73. Bondanza, S. et al. Keratinocyte cultures from involved skin in vitiligo patients show an impaired in vitro behaviour. Pigment Cell Res. 20, 288–300 (2007).

    Article  CAS  PubMed  Google Scholar 

  74. Bastonini, E., Kovacs, D., Ottaviani, M., Dell'Anna, M. L. & Picardo, M. in XXII International Pigment Cell Conference (IPCC) http://www.ifpcs.org/ipcc2014/docs/IPCC%202014%20-%20Pigment%20Cell%20Melanoma%20Research%20Journal.pdf (2014).

  75. Zhang, C. F. et al. Suppression of autophagy dysregulates the antioxidant response and causes premature senescence of melanocytes. J. Invest. Dermatol.http://dx.doi.org/10.1038/jid.2014.439 (2014).

  76. Ainger, S. A. et al. DCT protects human melanocytic cells from UVR and ROS damage and increases cell viability. Exp. Dermatol. 23, 916–921 (2014).

    Article  CAS  PubMed  Google Scholar 

  77. Lee, A.-Y., Kim, N.-H., Choi, W.-I. & Youm, Y.-H. Less keratinocyte-derived factors related to more keratinocyte apoptosis in depigmented than normally pigmented suction-blistered epidermis may cause passive melanocyte death in vitiligo. J. Invest. Dermatol. 124, 976–983 (2005).

    Article  CAS  PubMed  Google Scholar 

  78. Choi, C. P., Kim, Y. I., Lee, J. W. & Lee, M. H. The effect of narrowband ultraviolet B on the expression of matrix metalloproteinase-1, transforming growth factor-beta1 and type I collagen in human skin fibroblasts. Clin. Exp. Dermatol. 32, 180–185 (2007).

    Article  CAS  PubMed  Google Scholar 

  79. Cario-André, M., Pain, C., Gauthier, Y., Casoli, V. & Taoeb, A. In vivo and in vitro evidence of dermal fibroblasts influence on human epidermal pigmentation. Pigment Cell Res. 19, 434–442 (2006).

    Article  PubMed  Google Scholar 

  80. Imokawa, G. Autocrine and paracrine regulation of melanocytes in human skin and in pigmentary disorders. Pigment Cell Res. 17, 96–100 (2004).

    Article  CAS  PubMed  Google Scholar 

  81. Shi, Y. et al. Premature graying as a consequence of compromised antioxidant activity in hair bulb melanocytes and their precursors. PLoS ONE 9, e93589 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Kim, J. et al. p53 induces skin aging by depleting Blimp1+ sebaceous gland cells. Cell Death Dis. 5, e1141 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Laddha, N. C. et al. Role of oxidative stress and autoimmunity in onset and progression of vitiligo. Exp. Dermatol. 5, 352–353 (2014).

    Article  CAS  Google Scholar 

  84. Mosenson, J. A. et al. Mutant HSP70 reverses autoimmune depigmentation in vitiligo. Sci. Transl. Med. 5, 174ra128 (2013).

    Article  CAS  Google Scholar 

  85. Richmond, J. M., Frisoli, M. L. & Harris, J. E. Innate immune mechanisms in vitiligo: danger from within. Curr. Opin. Immunol. 25, 676–682 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Alkhateeb, A., Fain, P. R., Thody, A., Bennett, D. C. Spritz, R. A. Epidemiology of vitiligo and associated aut oimmune diseases in Caucasian probands and their families. Pigment Cell Res. 16, 208–214 (2003). This study is a genomic analysis of families with generalized vitiligo, and it revealed mechanisms of genetic susceptibility to autoimmunity.

    Article  PubMed  Google Scholar 

  87. Yu, R. et al. Transcriptome analysis reveals markers of aberrantly activated innate immunity in vitiligo lesional and non-lesional skin. PLoS ONE 7, e51040 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. van den Boorn, J. G. et al. Skin-depigmenting agent monobenzone induces potent T-cell autoimmunity toward pigmented cells by tyrosinase haptenation and melanosome autophagy. J. Invest. Dermatol. 131, 1240–1251 (2011).

    Article  CAS  PubMed  Google Scholar 

  89. Kroll, T. M. et al. 4-Tertiary butyl phenol exposure sensitizes human melanocytes to dendritic cell-mediated killing: relevance to vitiligo. J. Invest. Dermatol. 124, 798–806 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Al-Shobaili, H. A. & Rasheed, Z. Mitochondrial DNA acquires immunogenicity on exposure to nitrosative stress in patients with vitiligo. Hum. Immunol. 10, 1053–1061 (2014).

    Article  CAS  Google Scholar 

  91. Passeron, T. & Ortonne, J. P. Activation of the unfolded protein response in vitiligo: the missing link? J. Invest. Dermatol. 11, 2502–2504 (2012).

    Article  CAS  Google Scholar 

  92. Toosi, S., Orlow, S. J. & Manga, P. Vitiligo-inducing phenols activate the unfolded protein response in melanocytes resulting in upregulation of IL6 and IL8. J. Invest. Dermatol. 11, 2601–2609 (2012). This study provides experimental evidence for the link between oxidative and autoimmune pathways, taking into account the different intracellular compartments and processes.

    Article  CAS  Google Scholar 

  93. Ogg, G. S., Rod Dunbar, P., Romero, P., Chen, J. L. & Cerundolo, V. High frequency of skin-homing melanocyte-specific cytotoxic T lymphocytes in autoimmune vitiligo. J. Exp. Med. 188, 1203–1208 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Wankowicz-Kalinska, A. et al. Immunopolarization of CD4+ and CD8+ T cells to Type-1-like is associated with melanocyte loss in human vitiligo. Lab. Invest. 83, 683–695 (2003).

    Article  CAS  PubMed  Google Scholar 

  95. Le Poole, I. C., van den Wijngaard, R. M., Westerhof, W. & Das, P. K. Presence of T cells and macrophages in inflammatory vitiligo skin parallels melanocyte disappearance. Am. J. Pathol. 148, 1219–1228 (1996).

    CAS  PubMed  PubMed Central  Google Scholar 

  96. van den Wijngaard, R. et al. Local immune response in skin of generalized vitiligo patients. Destruction of melanocytes is associated with the prominent presence of CLA+ T cells at the perilesional site. Lab. Invest. 80, 1299–1309 (2000).

    Article  CAS  PubMed  Google Scholar 

  97. van den Boorn, J. G. et al. Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients. J. Invest. Dermatol. 129, 2220–2232 (2009).

    Article  CAS  PubMed  Google Scholar 

  98. Harris, J. E. et al. A mouse model of vitiligo with focused epidermal depigmentation requires IFN-gamma for autoreactive CD8(+) T-cell accumulation in the skin. J. Invest. Dermatol. 132, 1869–1876 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Rashighi, M. et al. CXCL10 is critical for the progression and maintenance of depigmentation in a mouse model of vitiligo. Sci. Transl. Med. 6, 223ra223 (2014).

    Article  CAS  Google Scholar 

  100. Bertolotti, A. et al. Type I interferon signature in the initiation of the immune response in vitiligo. Pigment Cell. Mel. Res. 27, 398–407 (2014).

    Article  CAS  Google Scholar 

  101. Bassiouny, D. A. & Shaker, O. Role of interleukin-17 in the pathogenesis of vitiligo. Clin. Exp. Dermatol. 36, 292–297 (2011).

    Article  CAS  PubMed  Google Scholar 

  102. Wang, C. Q. et al. TH17 cells and activated dendritic cells are increased in vitiligo lesions. PLoS ONE 6, e18907 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Elela, M. A., Hegazy, R. A., Fawzy, M. M., Rashed, L. A. & Rasheed, H. Interleukin 17, Interleukin 22 and FoxP3 expression in tissue and serum of non-segmental vitiligo: a case- controlled study on eighty-four patients. Eur. J. Dermatol. 23, 350–355 (2013).

    PubMed  Google Scholar 

  104. Chatterjee, S. et al. A quantitative increase in regulatory T cells controls development of vitiligo. J. Invest. Dermatol. 134, 1285–1294 (2014).

    Article  CAS  PubMed  Google Scholar 

  105. Gregg, R. K., Nichols, L., Chen, Y., Lu, B. & Engelhard, V. H. Mechanisms of spatial and temporal development of autoimmune vitiligo in tyrosinase-specific TCR transgenic mice. J. Immunol. 184, 1909–1917 (2010).

    Article  CAS  PubMed  Google Scholar 

  106. Dwivedi, M., Laddha, N. C., Arora, P., Marfatia, Y. S. & Begum, R. Decreased regulatory T-cells and CD4+/CD8+ ratio correlate with disease onset and progression in patients with generalized vitiligo. Pigment Cell Melanoma Res. 26, 586–591 (2013).

    Article  CAS  PubMed  Google Scholar 

  107. Klarquist, J. et al. Reduced skin homing by functional TReg in vitiligo. Pigment Cell Melanoma Res. 23, 276–286 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Lili, Y. et al. Global activation of CD8+ cytotoxic T lymphocytes correlates with an impairment in regulatory T cells in patients with generalized vitiligo. PLoS ONE 7, e37513 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Tembhre, M. K., Parihar, A. S., Sharma, V. K., Chattopadhyay, P. & Gupta, S. Alteration in regulatory T cells in active generalized vitiligo and their clinical correlation. Br. J. Dermatol. 172, 940–950 (2014).

    Article  CAS  Google Scholar 

  110. Tu, C. X., Jin, W. W., Lin, M., Wang, Z. H. & Man, M. Q. Levels of TGF-beta(1) in serum and culture supernatants of CD4(+)CD25(+) T cells from patients with non-segmental vitiligo. Arch. Dermatol. Res. 303, 685–689 (2011).

    Article  CAS  PubMed  Google Scholar 

  111. Zhou, L. et al. Systemic analyses of immunophenotypes of peripheral T cells in non-segmental vitiligo: implication of defective natural killer T cells. Pigment Cell Melanoma Res. 25, 602–611 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  112. Maeda, Y. et al. Detection of self-reactive CD8+T cells with an anergic phenotype in healthy individuals. Science 346, 1536–1540 (2014).

    Article  CAS  PubMed  Google Scholar 

  113. Yang, F., Sarangarajan, R., Le Poole, I. C., Medrano, F. & Boissy, R. E. The cytotoxicity and apoptosis induced by 4-tertiary butylphenol in human melanocytes are independent of tyrosinase activity. J. Invest. Dermatol. 114, 157–164 (2000).

    Article  CAS  PubMed  Google Scholar 

  114. Wang, Q. et al. Stress-induced RNASET2 overexpression mediates melanocyte apoptosis via the TRAF2 pathway in vitro. Cell Death Dis. 5, e1022 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Becatti, M. et al. SIRT1 regulates MAPK pathways in vitiligo skin: insight into the molecular pathways of cell survival. J. Cell. Mol. Med. 18, 514–529 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Mosenson, J. A. et al. Preferential secretion of inducible HSP70 by vitiligo melanocytes under stress. Pigment Cell Melanoma Res. 27, 209–220 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Wu, J., Zhou, M., Wan, Y. & Xu, A. CD8+ T cells from vitiligo perilesional margins induce autologous melanocyte apoptosis. Mol. Med. Rep. 7, 237–241 (2013).

    Article  CAS  PubMed  Google Scholar 

  118. Kumar, R. & Parsad, D. Melanocythorragy and apoptosis in vitiligo: connecting jigsaw pieces. Indian J. Dermatol. Venereol. Leprol. 78, 19–23 (2012).

    Article  PubMed  Google Scholar 

  119. Taieb, A. & Ezzedine, K. Vitligo: the white armour? Pigment Cell Melanoma Res. 26, 286–299 (2013).

    Article  Google Scholar 

  120. Spritz, R. A. Modern vitiligo genetics sheds new light on an ancient disease. J. Dermatol. 40, 310–318 (2013).

    Article  CAS  PubMed  Google Scholar 

  121. Chen, J. X. et al. Genetic polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR) and risk of vitiligo in Han Chinese populations: a genotype-phenotype correlation study. Br. J. Dermatol. 170, 1092–1099 (2014).

    Article  CAS  PubMed  Google Scholar 

  122. Ren, Y. et al. Genetic variation of promoter sequence modulates XBP1 expression and genetic risk for vitiligo. PLoS Genet. 5, e1000523 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  123. Wood, J. M., Gibbons, N. C., Chavan, B. & Schallreuter, K. U. Computer simulation of heterogeneous single nucleotide polymorphisms in the catalase gene indicates structural changes in the enzyme active site, NADPH-binding and tetramerization domains: a genetic predisposition for an altered catalase in patients with vitiligo? Exp. Dermatol. 4, 366–371 (2008).

    Article  Google Scholar 

  124. Naveh, H. P., Rao, U. N. & Butterfield, L. H. Melanoma-associated leukoderma — immunology in black and white? Pigment Cell Melanoma Res. 26, 796–804 (2013).

    Article  CAS  PubMed  Google Scholar 

  125. Circosta, P. et al. T cell receptor (TCR) gene transfer with lentiviral vectors allows efficient redirection of tumor specificity in naive and memory T cells without prior stimulation of endogenous TCR. Hum. Gene Ther. 20, 1576–1588 (2009).

    Article  CAS  PubMed  Google Scholar 

  126. Spritz, R. A. The genetics of generalized vitiligo: autoimmune pathways and an inverse relationship with malignant melanoma. Genome Med. 2, 78 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Marie, J. et al. Inflammasome activation and vitiligo/nonsegmental vitiligo progression. Br. J. Dermatol. 170, 816–823 (2014).

    Article  CAS  PubMed  Google Scholar 

  128. Dammak, I. et al. Antioxidant enzymes and lipid peroxidation at the tissue level in patients with stable and active vitiligo. Int. J. Dermatol. 5, 476–480 (2009).

    Article  Google Scholar 

  129. Scioli, M. G. et al. Antioxidant treatment prevents serum deprivation- and TNF-α-induced endothelial dysfunction through the inhibition of NADPH oxidase 4 and the restoration of β-oxidation. J. Vasc. Res. 51, 327–337 (2014).

    Article  CAS  PubMed  Google Scholar 

  130. Hedstrand, H. et al. The transcription factors SOX9 and SOX10 are vitiligo autoantigens in autoimmune polyendocrine syndrome type I. J. Biol. Chem. 276, 35390–35395 (2001).

    Article  CAS  PubMed  Google Scholar 

  131. Das, S. K. et al. Studies on vitiligo. II. Familial aggregation and genetics. Genet. Epidemiol. 2, 255–262 (1985).

    Article  CAS  PubMed  Google Scholar 

  132. Spritz, R. A. in Vitiligo. Ch.2.2.1 (eds Picardo, M. & Taïeb, A. ) 155–163 (Springer, 2010).

    Book  Google Scholar 

  133. Gauthier, Y. & Benzekri, L. in Vitiligo. Ch.2.2.2.1 (eds Picardo, M. & Taïeb, A. ) 167–173 (Springer, 2010).

    Google Scholar 

  134. van Geel, N. et al. Clinical significance of Koebner phenomenon in vitiligo. Br. J. Dermatol. 167, 1017–1024 (2012).

    Article  CAS  PubMed  Google Scholar 

  135. Stinco, G., Buligan, C., Grimaldi, F., Valent, F. & Patrone, P. Serological screening for autoimmune polyendocrine sindrome in patients with vitiligo. J. Eur. Acad. Dermatol. Venereol. 26, 1041–1042 (2012).

    Article  CAS  PubMed  Google Scholar 

  136. Laberge, G. et al. Early disease onset and increased risk of other autoimmune diseases in familial generalized vitiligo. Pigment Cell Res. 18, 300–305 (2005).

    Article  PubMed  Google Scholar 

  137. Tuelings, H.-E. et al. The antibody response against MART-1 differs in patients with melanoma-associated leucoderma and vitiligo. Pigment Cell Melanoma Res. 27, 1086–1096 (2014).

    Article  CAS  Google Scholar 

  138. Oiso, N., Fukai, K., Kawada, A. & Suzuki, T. Piebaldism. J. Dermatol. 40, 330–335 (2013).

    Article  CAS  PubMed  Google Scholar 

  139. Hann, S. K., Gauthier, Y. & Benzekri, L. in Vitiligo. Ch.1.3.2 (eds Picardo, M. & Taïeb, A. ) 41–49 (Springer, 2010).

    Book  Google Scholar 

  140. Gey, A. et al. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. Br. J. Dermatol. 168, 756–761 (2013).

    Article  CAS  PubMed  Google Scholar 

  141. Cunningham, E. T. Jr, Rathinam, S. R., Tugal-Tutkun, I., Muccioli, C. & Zierhut, M. Vogt-Koyanagi-Harada disease. Ocul. Immunol. Inflamm. 22, 249–252 (2014).

    Article  PubMed  Google Scholar 

  142. Taieb, A. et al. Vitiligo European Task Force (VETF); EuropeanAcademy of Dermatology and Venereology (EADV); Union Europe´enne des MédecinsSpécialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br. J. Dermatol. 168, 5–19 (2013).

    Article  CAS  PubMed  Google Scholar 

  143. Boissy, R. in Vitiligo. Ch.2.2.2.2 (eds Picardo, M. & Taïeb, A. ) 175–180 (Springer, 2010).

    Google Scholar 

  144. Diallo, A. et al. Development and validation of the K-VSCOR for scoring Koebner's phenomenon in vitiligo/non-segmental vitiligo. Pigment Cell Melanoma Res. 26, 402–407 (2013).

    Article  PubMed  Google Scholar 

  145. Gawkrodger, D. J. et al. Guideline for the diagnosis and management of vitiligo. Br. J. Dermatol. 159, 1051–1076 (2008).

    Article  CAS  PubMed  Google Scholar 

  146. Vrijman, C. et al. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br. J. Dermatol. 167, 1224–1235 (2012).

    Article  CAS  PubMed  Google Scholar 

  147. Whitton, M. E., Ashcroft, D. M., Barrett, C. W. & Gonzalez, U. Interventions for vitiligo. Cochrane Database Syst. Rev.http://dx.doi.org/10.1002/CD003263.pub3 (2006).

  148. Whitton, M. E. et al. Interventions for vitiligo. Cochrane Database Syst. Rev.http://dx.doi.org/10.1002/14651858.CD003263.pub4 (2010).

  149. Whitton, M. E. et al. Interventions for vitiligo. Cochrane Database Syst. Rev.http://dx.doi.org/10.1002/14651858 (2015). A complete analysis of the current therapeutic approaches.

  150. Taieb, A. et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br. J. Dermatol. 168, 5–19 (2013).

    Article  CAS  PubMed  Google Scholar 

  151. Sapam, R., Agrawal, S., Phil, M. & Dhali, T. K. Systemic PUVA versus narrowband UVB in the treatment of vitiligo: a randomized controlled study. Int. J. Dermatol. 51, 1107–1115 (2012).

    Article  PubMed  Google Scholar 

  152. Lim, H. W. et al. Afamelanotide and narrowband UV-B phototherapy for the treatment of vitiligo: A randomized multicenter trial. JAMA Dermatol. 151, 42–50 (2015).

    Article  PubMed  Google Scholar 

  153. Dong, D. et al. The effects of NB-UVB on the hair follicle-derived neural crest stem cells differentiating into melanocyte lineage in vitro. J. Dermatol. Sci. 66, 20–28 (2012).

    Article  CAS  PubMed  Google Scholar 

  154. Eleftheriadou, V., Thomas, K. S., Whitton, M. E., Batchelor, J. M. & Ravenscroft, J. C. Which outcomes should we measure in vitiligo? Results of a systematic review and a survey among patients and clinicians on outcomes in vitiligo trials. Br. J. Dermatol. 167, 804–814 (2012).

    Article  CAS  PubMed  Google Scholar 

  155. Kim, S. R., Han, K. D. & Kim, C. Y. Repigmentation of vitiligo using the follicular unit extraction technique. Dermatol. Surg. 40, 1425–1427 (2014).

    Article  CAS  PubMed  Google Scholar 

  156. Mapar, M. A., Safarpour, M., Mapar, M. & Haghighizadeh, M. H. A comparative study of the mini-punch grafting and hair follicle transplantation in the treatment of refractory and stable vitiligo. J. Am. Acad. Dermatol. 70, 743–747 (2014).

    Article  PubMed  Google Scholar 

  157. Singh, C., Parsad, D., Kanwar, A. J., Dogra, S. & Kumar, R. Comparison between autologous noncultured extracted hair follicle outer root sheath cell suspension and autologous noncultured epidermal cell suspension in the treatment of stable vitiligo: a randomized study. Br. J. Dermatol. 169, 287–293 (2013).

    Article  CAS  PubMed  Google Scholar 

  158. Mulekar, S. V. & Isedeh, P. Surgical interventions for vitiligo: an evidence-based review. Br. J. Dermatol. 169, 57–66 (2013).

    Article  PubMed  Google Scholar 

  159. Kumar, A., Mohanty, S., Sahni, K., Kumar, R., Gupta, S. Extracted hair follicle outer root sheath cell suspension for pigment cell restoration in vitiligo. J. Cutan. Aesthet. Surg. 6, 121–125 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  160. Sharquie, K. E., Noaimi, A. A. & Al-Mudaris, H. A. Melanocytes transplantation in patients with vitiligo using needling micrografting technique. J. Drugs Dermatol. 12, e74–e78 (2013).

    PubMed  Google Scholar 

  161. Kovacs, D. et al. Vitiligo: characterization of melanocytes in repigmented skin after punch grafting. J. Eur. Acad. Dermatol. Venereol. 29, 581–590 (2015).

    Article  CAS  PubMed  Google Scholar 

  162. Wakao, S., Akashi, H., Kushida, Y. & Dezawa, M. Muse cells, newly found non-tumorigenic pluripotent stem cells, reside in human mesenchymal tissues. Pathol. Int. 64, 1–9 (2014).

    Article  CAS  PubMed  Google Scholar 

  163. Zhou, M. N. et al. Dermal mesenchymal stem cells (DMSCs) inhibit skin-homing CD8+ T cell activity, a determining factor of vitiligo patients’ autologous melanocytes transplantation efficiency. PLoS ONE 8, e60254 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  164. Simerman, A. A., Perone, J. J., Gimeno, M. L., Dumesic, D. A. & Chazenbalk, G. D. A mystery unraveled: nontumorigenic pluripotent stem cells in human adult tissues. Expert Opin. Biol. Ther. 14, 917–929 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  165. Shenefelt, P. D. & Shenefelt, D. A. Spiritual and religious aspects of skin and skin disorders. Psychol. Res. Behav. Manag. 7, 201–212 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  166. Silverberg, J. I. & Silverberg, N. B. Association between vitiligo extent and distribution and quality-of-life impairment. JAMA Dermatol. 149, 159–164 (2013). In this paper the often-underestimated aspect of quality of life is studied and considered in relation to epidemiologic data.

    Article  PubMed  Google Scholar 

  167. Porter, J. R., Beuf, A. H., Nordlund, J. J. & Lerner, A. B. Personal responses to vitiligo. Arch. Dermatol. 114, 1348–1385 (1978).

    Article  Google Scholar 

  168. Mattoo, S. K., Handa, S., Kaur, I., Gupta, N. & Malhotra, R. Psychiatric morbidity in vitiligo: prevalence and correlates in India. J. Eur. Acad. Dermatol. Venereol. 16, 573–578 (2002).

    Article  CAS  PubMed  Google Scholar 

  169. Wong, S. M. & Baba, R. Quality of life among Malaysian patients with vitiligo. Int. J. Dermatol. 51, 158–161 (2012).

    Article  PubMed  Google Scholar 

  170. Krüger, C. & Schallreuter, K. U. Cumulative life course impairment in vitiligo. Curr. Probl. Dermatol. 44, 102–117 (2013).

    Article  PubMed  Google Scholar 

  171. Teovska Mitrevska, N., Eleftheriadou, V. & Guarneri, F. Quality of Life in vitiligo patients. Dermatol. Ther. 25 (Suppl. 1), S28–S31 (2012).

    Article  PubMed  Google Scholar 

  172. Parsad, D., Dogra, S. & Kanwar, A. J. Quality of life in patients with vitiligo. Health Qual. Life Outcomes 1, 58 (2013).

    Article  Google Scholar 

  173. Ingordo, V. et al. Dermatology Life Quality Index score in vitiligo patients: a pilot study among young Italian males. G. Ital. Dermatol. Venereol. 147, 83–90 (2012).

    CAS  PubMed  Google Scholar 

  174. Noh, S., Kim, M., Park, C. O., Hann, S.-K. & Oh, S. H. Comparison of the psychological impacts of asymptomatic and symptomatic cutaneous diseases: vitiligo and atopic dermatitis. Ann. Dermatol. 25, 454–461 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  175. Lilly, E. et al. Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL). J. Am. Acad. Dermatol. 69, e11–e18 (2013).

    Article  PubMed  Google Scholar 

  176. Senol, A., Yucelten, A. D. & Ay, P. Development of a quality of life scalefor vitiligo. Dermatology 226, 185–190 (2013).

    Article  PubMed  Google Scholar 

  177. Gupta, V. Sreenivas, V., Mehta, M., Khaitan, B. K. & Ramam, M. Measurement properties of the Vitiligo Impact Scale-22 (VIS-22), a vitiligo-specific quality-of-life instrument. Br. J. Dermatol. 171, 1084–1090 (2014). This is a comparative advantage–disadvantage analysis of the different instruments currently available to measure the impact of vitiligo on quality of life.

    Article  CAS  PubMed  Google Scholar 

  178. Shah, R., Hunt, J., Webb, T. L. & Thompson, A. R. Starting to develop self-help for social anxiety associated with vitiligo: using clinical significance to measure the potential effectiveness of enhanced psychological self-help. Br. J. Derm. 171, 332–337 (2014).

    Article  CAS  Google Scholar 

  179. Alghamdi, K. M., Khurrum, H., Taieb, A. & Ezzedine, K. Treatment of generalized vitiligo with anti-TNF-a agents. J. Drugs Dermatol. 11, 534–539 (2012).

    CAS  PubMed  Google Scholar 

  180. Tsuda, K. et al. Calcineurin inhibitors suppress cytokine production from memory T cells and differentiation of naïve T cells into cytokine-producing mature T cells. PLoS ONE 7, e31465 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  181. Yaar, M. & Park, H. Y. Melanocytes: a window into the nervous system. J. Invest. Dermatol. 132, 835–845 (2012). This review considers the similarity between melanocytes and neurons to provide a valuable model for studies of diseases that involve the nervous system and of innovative therapies.

    Article  CAS  PubMed  Google Scholar 

  182. Jian, Z. et al. Impaired activation of the Nrf2-ARE signaling pathway undermines H2O2-induced oxidative stress response: a possible mechanism for melanocyte degeneration in vitiligo. J. Invest. Dermatol. 8, 2221–2230 (2014).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Introduction (M.P.); Epidemiology (K.E., I.H., D.P.); Mechanisms/pathophysiology (M.L.D., M.P., J.E.H.); Diagnosis, screening and prevention (K.E., I.H., D.P., A.T.); Management (K.E., A.T.); Quality of life (I.H., D.P., M.P.); Outlook (M.P.); overview of Primer (M.P.).

Author information

Authors and Affiliations

  1. Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, Rome, 00144, Italy

    Mauro Picardo & Maria L. Dell'Anna

  2. Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France

    Khaled Ezzedine & Alain Taieb

  3. Department of Dermatology, Multicultural Dermatology Center, Henry Ford Hospital Detroit, Michigan, USA

    Iltefat Hamzavi

  4. Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, USA

    John E. Harris

  5. Department of Dermatology, PGIMER, Chandigarh, India

    Davinder Parsad

Authors
  1. Mauro Picardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria L. Dell'Anna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khaled Ezzedine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iltefat Hamzavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John E. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Davinder Parsad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alain Taieb
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Introduction (M.P.); Epidemiology (K.E., I.H., D.P.); Mechanisms/pathophysiology (M.L.D., M.P., J.E.H.); Diagnosis, screening and prevention (K.E., I.H., D.P., A.T.); Management (K.E., A.T.); Quality of life (I.H., D.P., M.P.); Outlook (M.P.); overview of Primer (M.P.).

Corresponding author

Correspondence to Mauro Picardo.

Ethics declarations

Competing interests

M.P. received research grants from Giuliani, Cantabria, Stealth Peptides, Fidia, and he was speaker for Pierre Fabre. J.E.H. received research grants from AbbVie, Sanofi/Genzyme, Combe, Gliknik; he was consultant for Pfizer and Biomedical System; he was a speaker for Alkem Pharmauceticals. I.H. was an investigator for Clinuvel, Estee Lauder, and Ferndale Laboratories and he received equipment from Canfield. A.T. received research grants from Galderma and Astellas. M.L.D. and D.P. declare no competing interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Picardo, M., Dell'Anna, M., Ezzedine, K. et al. Vitiligo. Nat Rev Dis Primers 1, 15011 (2015). https://doi.org/10.1038/nrdp.2015.11

Download citation

  • Published:

  • DOI: https://doi.org/10.1038/nrdp.2015.11

This article is cited by

Search

Advanced search

Quick links

Nature Briefing: Translational Research

Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology, drug discovery and pharma.

Get what matters in translational research, free to your inbox weekly. Sign up for Nature Briefing: Translational Research