Future Directions in the Treatment of Vitiligo
March 2018
TLDR New treatments for vitiligo may focus on protecting melanocyte stem cells from stress and targeting specific pathways involved in the condition.
The chapter discusses recent advancements in understanding and managing vitiligo, highlighting that repigmentation typically occurs in a perifollicular pattern, indicating melanocyte stem cells (MelSCs) in hair follicles as a source for repopulating depigmented skin. It notes the role of transcription factors in regulating the MelSCs niche and suggests that melanocytes' inability to manage increased oxidative stress may trigger an autoimmune response leading to vitiligo. The chapter identifies the interferon-gamma (IFN-γ)/CXCL10 pathway as significant in vitiligo's development and progression and mentions studies that found elevated tumor necrosis factor-alpha (TNF-α) levels in patients' lesional skin, which may contribute to melanocyte destruction. It also proposes that biomarker level changes could be a more sensitive method to assess treatment response than visible clinical improvement and mentions the use of phototherapy to maintain treatment response in conditions like psoriasis.
