Vitiligo: what are its clinical manifestations?

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

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

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

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

We distinguish two main types of vitiligo : segmental vitiligo and non-segmental vitiligo. Segmental vitiligo, the rarer form, appears in a single region of the body, often unilaterally, and tends to stabilise after a period of rapid progression. It typically begins in childhood or adolescence. Non-segmental vitiligo, on the other hand, is the more common form. It is characterised by a symmetrical progression of lesions, potentially affecting various parts of the body, sometimes extensively. The intensity and speed of depigmentation vary considerably between individuals, with alternating phases of exacerbation and stability.

If vitiligo does not cause any pain or pose any medical risk, it nevertheless represents a significant cosmetic impairment that can have a considerable psychological impact, particularly among young people.

Indeed, vitiligo can cause a significant emotional and social impact, ranging from loss of self-confidence to genuine isolation. The perception of others’ gaze, the difficulty in concealing the patches and the widespread lack of societal understanding of the condition all exacerbate this psychological burden. That is why a holistic approach, integrating dermatological care with psychological support, is often essential to help patients live more comfortably with the vitiligo.

Note: Not all skin depigmentation is indicative of vitiligo. Other dermatological conditions, such as pityriasis versicolor, or certain inflammatory reactions, can also result in lighter patches. Only a doctor can establish an accurate diagnosis of vitiligo after a comprehensive 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).