GUIDELINES IN DERMATOLOGY

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VITILIGO

Selen Taner Akbay1
Ümit Türsen2

1Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Dermatology, Hatay, Türkiye
2Mersin University, Faculty of Medicine, Department of Dermatology, Mersin, Türkiye

Taner Akbay S, Türsen Ü. Vitiligo. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.235-243.

ABSTRACT

Vitiligo is a skin disease caused by the progressive loss of melanocytes, which give color to the skin, and is characterized by whitening. The exact cause is unknown, and it occurs with a general prevalence of 0.5-2% regardless of gender and race. It typically starts during childhood or early adulthood. Vitiligo is a multifactorial and polygenic disease with a complex pathogenesis. Although the disease is not contagious or fatal, it can lead to increased psychological stress or decreased self-confidence, significantly affecting patients’ lives. The disease occurs when, for an unknown reason, the immune system attacks the melanocytes that produce melanin, the body’s natural pigment. This autoimmune condition can be triggered by events such as family history, stress, skin trauma, chemical exposure, and the use of certain medications. The diagnosis of vitiligo is made clinically by the appearance of depigmented macules and patches that are sharply demarcated from the normal skin. Wood’s light can be used to assist in diagnosis during examination, and sometimes a skin biopsy is performed to enhance diagnostic accuracy. Vitiligo is associated with other autoimmune diseases, such as thyroid disorders and diabetes, since it is itself an autoimmune condition. Therefore, patients need to be periodically screened for comorbidities. Because depigmented skin is more susceptible to ultraviolet (UV) damage, it is essential to instruct all patients to use sun protection methods. The treatment goals for vitiligo are to stop disease progression and restore skin pigmentation. For limited and localized disease, first-line treatment involves topical corticosteroids and calcineurin inhibitors that help reduce inflammation and suppress autoimmune activity. Vitamin D analogs can be used both topically and systemically to aid repigmentation. Among systemic treatments, phototherapy, considered one of the most effective methods, stimulates melanocyte functions and promotes repigmentation. In resistant or advanced cases, autologous skin grafts and melanocyte transfer procedures may be considered. In recent years, new treatment options have emerged for vitiligo patients who do not respond to conventional therapies. The use of Janus kinase (JAK) inhibitors and new-generation biological agents are promising developments for patients. These new immunomodulatory agents target immune pathways that lead to melanocyte destruction, offering effective and targeted treatment options. For patients with widespread vitiligo who do not respond to repigmentation treatments, depigmenting agents such as monobenzone can be used to create an even skin tone. Since vitiligo affects patients both physically and psychologically, its treatment requires a multidisciplinary approach, including pharmacological, surgical, and psychological support. As the pathophysiology of vitiligo is better understood, new treatments will continue to be developed.

Keywords: Vitiligo; Melanocytes; Hypopigmentation; Autoimmunity; Ultraviolet therapy; Janus Kinases

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