Vitiligo: what are its clinical manifestations?

The vitiligo is an autoimmune depigmenting disease characterized by the progressive destruction of melanocytes, the cells responsible for producing melanin, the pigment that gives skin its color and protects it from UV radiation. This disorder results from a complex interaction between genetic and environmental factors (exposure to certain chemicals, UV rays, the Koebner phenomenon, oxidative stress, metabolic abnormalities, or emotional stress).

In predisposed individuals, abnormal melanocytes release danger signals (DAMPs) and inflammatory cytokines, first activating innate immunity and then adaptive immunity. CD8+ cytotoxic T lymphocytes then target the melanocytes, inducing their destruction through apoptosis, while other mechanisms, such as impaired cell adhesion, contribute to their loss. This process leads to the characteristic depigmented patches of vitiligo.

Vitiligo is characterized by the appearance of depigmented white patches on the skin.

These areas, often well-defined, appear more frequently on sun-exposed regions—such as the face, hands, arms, or legs—but can also affect the scalp, mucous membranes (mouth, genitalia), or even skin appendages, leading to depigmentation of hair and scalp hair (poliosis). Some individuals also report tingling or mild itching in the areas affected by vitiligo, especially during active progression of the condition.

We distinguish two main forms of vitiligo : segmental vitiligo and nonsegmental vitiligo. Segmental vitiligo, the less common form, manifests in a single body region, often unilaterally, and tends to stabilize after a rapid progression phase. It typically begins in childhood or adolescence. Nonsegmental vitiligo, on the other hand, is the most common form. It is characterized by a symmetrical progression of lesions, which can affect various parts of the body, sometimes extensively. The intensity and speed of depigmentation vary widely among individuals, with periods of exacerbation and stabilization.

If the vitiligo causes no pain or medical risk, it nonetheless represents a significant cosmetic concern that can have a major psychological impact, especially among young individuals.

Indeed, vitiligo can lead to a strong emotional and social impact, ranging from loss of self-confidence to genuine isolation. Others’ perceptions, the difficulty of concealing the patches, and society’s lack of awareness about the condition all reinforce this psychological burden. That is why a comprehensive approach, integrating dermatological care and psychological support, is often essential to help patients live better with vitiligo.

Note: Not all skin depigmentation is synonymous with vitiligo. Other dermatologic conditions, such as pityriasis versicolor, or certain inflammatory reactions, can also cause lighter areas. Only a physician can establish an accurate diagnosis of vitiligo after a thorough clinical examination, often using a Wood’s lamp.

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• PASSERON T. & al. Vitiligo : Une maladie bénigne à l’impact psychologique souvent considérable. INSERM (2023).