Alicja Konieczna, Andrzej Winnicki, Jerzy Krysiński

New perspectives in vitiligo treatment
2020-07-28

New perspectives in vitiligo treatment

Vitiligo is a chronic depigmentation disease. It is characterized by damage or destruction of melanocytes (melanin-producing cells). The desease affects about 2% of population. The pathogenesis is complex and not fully understood. Recent insights into vitiligo pathognenesis highlight impact of various factors like environmental factors, genetic factors, cellular stress and autoimmune factors. In vitiligo patients abnormal response of innate immune system is observed. The latest research shows that the IFN-γ/CXCL10 axis plays a special role in the pathogenesis of vitiligo. Interferon γ (IFN-γ) can be produced by autoreactive CD8 + T cells. Receptors for interferon gamma (IFN-γR) are located on the surface of keratinocytes. After binding IFN-γ to its receptor (IFN-γR) there is an activation of the JAK-STAT pathway. That causes the release of the chemokines like CXCL9 and CXCL10. Patients with vitiligo have a higher serum concentration of CXCL10 chemokine compared to healthy people. CXCR3 receptors for the CXCL10 chemokine are located on autoreactive CD8+ lymphocytes. The CXCL10 chemokine binds to its receptor CXCR3. That leads to the migration of autoreactive T cells to the epidermis and destruction of melanocytes. Furthermore, changes in cytokine secretion by T helper cells Th1, Th2, Th17 and regulatory T cells (Treg) may contribute to disease progression. In vitiligo is observed elevated levels of IL-2, IL-6, IL-17 and decreased level of IL-4. Current treatment methods are not satisfying and mainly based on the use of off-label drugs. Better understandig etiology of vitiligo enable searching for new effective treatment methods. To minimize systemic side effects, topical drug forms are searching. The effectiveness of new combined therapies is also being studied, including topical treatment with phototherapy, surgical methods with phototherapy, general therapy with surgical methods, etc. New potential therapies, especially with JAK/STAT inhibitors, may provide new perspectives for the treatment of vitiligo.

Keywords: vitiligo, pathogenesis, treatment.

© Farm Pol, 2020, 76(6): 324–332