Beyond vitiligo guidelines: combined stratified/personalized approaches for the vitiligo patient

Abstract

'Vitiligo' is a word that bears endless possibilities and no promises. Each vitiligo patient has a different story that demands a different therapeutic approach. Even though great efforts have been made to evaluate, study, compare and document the different therapeutic modalities available for vitiligo, clearly handling their modes of actions as well as their side effects and establishing clear stratified guidelines, numerous dilemmas are frequently met on practical grounds. 'Stabilize', 'repigment', 'depigment' or 'camouflage'? 'for whom and how do we achieve the best results' ? 'Separately or in combination ? -questions that need to be answered and decisions need to be taken in the appropriate timing and altered when the necessity arises. In the current viewpoint, we have utilized the available knowledge and exploited years of experience in an attempt to go beyond the guidelines to set the rationale for an optimal and personalized therapy, within the framework of a stratified approach.

The early repigmentation pattern of vitiligo is related to the source of melanocytes and by the choice of therapy: a retrospective cohort study

“…The precise pathogenesis of the skin depigmentation in vitiligo remains obscure. Clinical studies have identified three distinct patterns of repigmentation in vitiligo: perifollicular, marginal, and diffuse . In our study, it has been observed that patients with vitiligo treated with phototherapy mostly developed perifollicular repigmentation, whereas marginal and diffuse repigmentations were more commonly associated with topical therapies.…”

Involvement of non‐melanocytic skin cells in vitiligo

“…Wound healing is associated with activation of keratinocytes and fibroblasts, which produce several growth factors, pro‐inflammatory cytokines and lipid mediators. During inflammatory and healing phases, the expression of matrix metalloproteinase‐2, ECM and adhesion molecules on keratinocytes is modified; these phenomena are capable to induce the migration of melanocyte stem cells from hair follicles . Moreover, lasers, probably through the same mechanisms, stimulate the melanocyte stem cells in the dermis of glabrous skin and enhance autoinoculation of melanocytes from the margin .…”

Focus Theme Issue: “Vitiligo and other pigmentary disorders”

“…We close by dedicating this issue to our esteemed colleague and dear friend, Tag Anbar from Cairo, Egypt, who passed away last year. Tag was a brilliant and original researcher in the field of vitiligo, whose substantial contributions to the field and memory we honour herewith. He was a gentle and generous colleague and has been an inspiration for those of us who had the privilege to interact and collaborate with him.…”