Advertisement

Vitiligo pp 181-185 | Cite as

Defining the Disease: Editor’s Synthesis

  • Alain TaïebEmail author
  • Mauro Picardo
Chapter

Abstract

The initial clinical evaluation of a vitiligo patient is a step frequently neglected. Some new variants have been described only recently such as mixed and follicular vitiligo, and the frontiers of the disease challenge an unambiguous delineation of the disease (e.g. vitiligoid depigmentation after cancer immunotherapies, hypochromic vitiligo...). Major progresses have been made to understand heritability, but more epidemiological data are needed to address in particular environmental factors, natural history, and comorbidities to confirm on a large scale a protection against cancer. At this time point, available clinical data do not support a significant involvement of non-skin melanocytes in vitiligo/NSV.

Major initial determinants are probably situated directly in the skin and activated in a subset of patients by largely unknown stressors. Vitiligo/NSV can be considered as a marker of an auto-inflammatory/autoimmune diathesis, and microinflammation is central to its pathophysiology. The skewing of the immune system towards vitiligo seems of benefit to fight skin cancer and possibly internal cancer. If inflammation and autoimmunity are pivotal in all subset of vitiligo, other factors are involved predisposing to premature melanocyte ageing.

References

  1. 1.
    Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002;347:911–20.CrossRefGoogle Scholar
  2. 2.
    Schultz Larsen F. Atopic dermatitis: a genetic-epidemiologic study in a population-based twin sample. J Am Acad Dermatol. 1993;28:719–23.CrossRefGoogle Scholar
  3. 3.
    Bae JM, Chung KY, Yun SJ, Kim H, Park BC, Kim JS, Seo SH, Ahn HH, Lee DY, Kim YC, Park HJ, Kim M. Markedly reduced risk of internal malignancies in patients with Vitiligo: a nationwide population-based cohort study. J Clin Oncol. 2019;37(11):903–11.CrossRefGoogle Scholar
  4. 4.
    Taïeb A, Picardo M, Members VETF. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007;20:27–35.CrossRefGoogle Scholar
  5. 5.
    van Geel N, Bekkenk M, Lommerts JE, Ezzedine K, Harris J, Hamzavi I, Eleftheriadou V, Picardo M, Taieb A, Prinsen CAC, Wolkerstorfer A, Speeckaert R. The Vitiligo Extent Score (VES) and the VESplus are responsive instruments to assess global and regional treatment response in patients with vitiligo. J Am Acad Dermatol. 2018;79(2):369–71.  https://doi.org/10.1016/j.jaad.2017.12.070. Epub 2018.CrossRefGoogle Scholar
  6. 6.
    Boniface K, Jacquemin C, Darrigade A-S, Dessarthe B, Martins C, Boukhedouni N, Vernisse C, Grasseau A, Thiolat D, Rambert J, Lucchese F, Bertolotti A, Ezzedine K, Taieb A, Seneschal J. Vitiligo skin is imprinted with resident memory CD8 T cells expressing CXCR3. J Invest Dermatol. 2018;138(2):355–64.CrossRefGoogle Scholar
  7. 7.
    Schallreuter KU, Kothari S, Elwary S, et al. Molecular evidence that halo in Sutton’s naevus is not vitiligo. Arch Dermatol Res. 2003;295:223–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Service de DermatologieHôpital St André, CHU de BordeauxBordeauxFrance
  2. 2.Cutaneous Physiopathology and CIRM, San Gallicano Dermatological InstituteIRCCSRomeItaly

Personalised recommendations