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].