Introduction
Melanocyte damage and destruction is the underlying pathological event
in vitiligo, a skin disease characterised by depigmented patches.
Vitiligo has a worldwide prevalence of about one percent, and can be
classified into non-segmental, segmental, mixed and
unclassifiable/undetermined vitiligo [1, 2]. Differentiating
subtypes may be important as they might have different aetiologies.
Segmental vitiligo often maps to a blaschkoid or dermatomal distribution
[3]. Vitiligo can affect any gender, race or geographic region with
no significant difference [4].
Although non-life threatening, vitiligo can have a serious psychological
impact on sufferers [5]. Vitiligo patients commonly experience
feelings of stress, fear of spreading vitiliginous lesions,
embarrassment, negative self-image or self-consciousness [6].
Moreover, patients with vitiligo often experience depression, anxiety
and discrimination and stigmatisation from others resulting in low
self-esteem and social isolation [7].
In some countries such as India, vitiligo is still confused with leprosy
and patients are subjected to antagonism, insult and social stigma
[8]. Vitiligo can also have a major negative impact on the marital
status and sexuality of patients [9-11]. Furthermore, previous
reports have demonstrated that vitiligo patients with decreased quality
of life at treatment initiation face a lower response rate to a given
therapy [12]. Therefore, the development of specific psychological
intervention and quality of life measures may affect positively the
outcome of vitiligo treatment and enhance the patient’s self-esteem and
confidence [13].
A variety of factors may trigger vitiligo, including emotional stress,
physical trauma and chemical exposure to imbalances in endogenous neural
factors, metabolites, cytokines or hormones, which can stimulate
autoimmune responses, in individuals with the appropriate genetic
susceptibilities that ultimately target melanocytes [2]. The
melanocytes in vitiligo are highly vulnerable to damage and apoptosis
under the action of triggering factors [14]. The treatment of
vitiligo, including topical steroids, calcitonin-inhibitors,
phototherapies, and surgical procedure, in the past has frequently
failed to achieve satisfactory repigmentation, but recently, the Jak-1
inhibitors have shown promise [15].