New discoveries in the pathogenesis and classification of vitiligo

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Abstract

Learning objectives

After completing this learning activity, participants should be able to categorize the different forms and presentations of vitiligo; recognize the key features that distinguish active vitiligo; and discuss the mechanisms that influence the initiation and progression of vitiligo.

Disclosures

Editors

Disclosures

The editors involved with this CME activity and all content validation/peer reviewers of the journal-based CME activity have reported no relevant financial relationships with commercial interest(s).

Authors

The authors involved with this journal-based CME activity other than Dr Harris have reported no relevant financial relationships with commercial interest(s). Dr Harris has served on advisory boards, as a consultant, or as principle investigator on research agreements with Pfizer, AbbVie, Genzyme/Sanofi, Concert Pharmaceuticals, Stiefel/GSK, Mitsubishi Tanabe Pharma, Novartis, Aclaris Therapeutics, The Expert Institute, Celgene, Biologics MD, and Dermira. Dr Harris' relevant relationship with Pfizer was resolved by nonconflicted reviewers and editors.

Planners

The planners involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). The editorial and education staff involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).

Planners

Vitiligo patients are often told that their vitiligo “isn't a big deal,” that there is “nothing that can be done for it,” and that they “should just learn to live with it” by their physicians. This is a disservice, because patients often arrive in a dermatologist's clinic discouraged after years of disease progression. Those with long-standing disease (>1-2 years) treated with narrowband ultraviolet B light therapy (NB-UVB) demonstrate lower efficacy compared to patients with recent onset vitiligo.1-3 Therefore, recognizing vitiligo as a treatable disease and initiating appropriate treatment early is a critical step in helping these patients both physically and psychologically. Despite this, many patients with even long-standing disease can respond to treatment, and so while patients should be encouraged to initiate treatment early in their disease, no one should be discouraged from attempting treatment. New discoveries in the past 5 years have improved our understanding of the disease. The purpose of this review is to empower dermatologists to approach the diagnosis, classification, and management of vitiligo patients in a way that will lead to improved outcomes.

Vitiligo is a common autoimmune disease that progressively destroys melanocytes in the skin, resulting in the appearance of patchy depigmentation. This disfiguring condition frequently affects the face and other visible areas of the body, which can be psychologically devastating. The onset of vitiligo often occurs in younger individuals and progresses for life, resulting in a heavy burden of disease and decreased quality of life. Presentation patterns of vitiligo vary, and recognition of these patterns provides both diagnostic and prognostic clues. Recent insights into disease pathogenesis offer a better understanding of the natural history of the disease, its associations, and potential for future treatments. The first article in this continuing medical education series outlines typical and atypical presentations of vitiligo, how they reflect disease activity, prognosis, and response to treatment. Finally, we discuss disease associations, risk factors, and our current understanding of disease pathogenesis.

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