5 Things to Know for Vitiligo Awareness

Vitiligo Awareness Month and World Vitiligo Day aim to educate the public about the autoimmune skin condition's complex epidemiology, subtypes, mental health impacts, and diverse treatments. | Image Credit: JoseManuel - stock.adobe.com

June marks Vitiligo Awareness Month, and since 2011, June 25th has been recognized as World Vitiligo Day.^1,2 The Vitiligo Research Foundation and Vitiligo Support and Awareness Foundation initiated and supported the global annual campaign to bring vitiligo interviews to the public spotlight and address the challenges people impacted by it face.²

To further educate patients, experts, and caregivers, here are 5 things to know about vitiligo awareness.

1. Complex Epidemiology

Vitiligo, an autoimmune and dermatologic disease, breaks down melanin cells, creating white patches of skin that lose pigment from various parts of the body.¹ It typically progresses and has an unpredictable disease course that increases the risk of additional autoimmune comorbidities like thyroid disease, alopecia areata, and diabetes.³ The pathophysiology of vitiligo remains complex and only partly characterized, including a combination of genetic susceptibility, autoimmune dysregulation, and environmental triggers.

Low levels of certain vitamins and minerals, like vitamin D, magnesium, and copper, play a significant role in the occurrence of vitiligo.⁴ A meta-analysis found the overall prevalence of vitiligo in Middle Eastern and African regions was 3%, with a mean diagnosis age of 18.4 years. Researchers observed a higher prevalence of vitiligo among adult age groups and the African population compared with men, pediatric age groups, and the Arabian population.

Prevalence of vitiligo was 0.4%, with similar occurrence rates between men and women, based on a systematic review.³ Researchers found higher prevalence among adult patients compared with children and adolescents. They also noted Jordan had the highest incidence of vitiligo, and Sweden had the lowest. Ultimately, clinicians should pay attention to vitiligo's high prevalence and the characteristics that patients present.

2. Multiple Types and Subtypes

The common types of vitiligo are nonsegmental vitiligo and segmental vitiligo, both of which include various subtypes.⁵ Nonsegmental vitiligo, also known as generalized vitiligo, is the more common type and causes depigmentation on both sides of the body in a symmetrical pattern. Patches may begin small and gradually grow larger, merging with other areas over time.

The subtypes of nonsegmental vitiligo are:

• Focal: macules develop in a small area and don’t spread in a certain pattern within 1 to 2 years⁶
• Universal: a rare form that causes more than 80% of the skin to lack pigmentation
• Acrofacial: affects the face and hands, around body openings like the eyes, nose, and ears⁷
• Mucosal: affects mucous membranes of the mouth and/or genitals⁶
• Mixed: presents with a clear spot of segmental vitiligo on 1 side of the body, limited by the midline, but also appears on other spots on the body⁸
• Trichrome: causes a bullseye with a white or colorless center, then an area of lighter pigmentation, and an area of the natural skin tone⁶

Segmental vitiligo is less common, and it affects only 1 side of the body, but develops rapidly and then stabilizes in a certain region without spreading.⁹ This type of vitiligo also associates with hair loss in the affected areas, like the scalp and eyebrows.

Clinicians classify segmental vitiligo into 3 subtypes¹⁰:

• Unisegmental: white patches present on a single dermatome
• Bisegmental: lesions occupy 2 dermatomes
• Plurisegmental: patches extend to multiple dermatomes

Patterns of active and progressive vitiligo can also include inflammatory vitiligo, confetti-like depigmentation, and the Koebner phenomenon.¹¹

3. Mental Health Impacts

Vitiligo creates an increased risk of patients developing psychiatric disorders, commonly anxiety and depression.¹² Some scientific evidence reported that patients with vitiligo are affected by obsessive-compulsive disorder (OCD), mania, bipolar disorder, and schizophrenia. Notably, OCD and schizophrenia share a common pathogenetic ground with vitiligo, most likely because of autoimmune and inflammatory involvement.

The emotional health, social interactions, and even opportunities in employment of patients have all been shown to be impacted by vitiligo.¹³ Patients experience severe psychosocial effects like paranoia and embarrassment that ultimately interrupt daily activities, especially sleep disturbances. Patients with vitiligo experience diminished quality of life, which can interfere with intimate relationships, negatively influencing sexual relationships.

4. Treatment Methods

Current vitiligo treatments primarily focus on suppressing autoimmune damage and stimulating melanin production.¹⁴ Janus kinase (JAK) inhibitors are a key therapeutic class, targeting crucial cell signaling pathways involved in vitiligo development. Since July 2022, ruxolitinib (Opzelura; Incyte) has been the only FDA-approved JAK inhibitor for nonsegmental vitiligo in patients 12 and older, showing promise in repigmentation, especially when combined with phototherapy. Other JAK inhibitors like tofacitinib (Xeljanz; Pfizer), baricitinib (Olumiant; Eli Lilly), upadacitinib (Rinvoq; AbbVie), and ritlecitinib (Litfulo; Pfizer) also show potential, though some, like oral tofacitinib, carry FDA warnings due to cardiovascular risks, favoring topical formulations.

Beyond JAK inhibitors, various other approaches are being explored. These include signal transducer and activator of transcription inhibitors like simvastatin (Zocor; Merck), which may prevent metabolic complications, and treatments that promote autophagy, such as rapamycin and metformin. Afamelanotide (Scenesse; Cinuvel), an α-melanocyte-stimulating hormone analog, aids repigmentation when combined with phototherapy by promoting melanocyte pigmentation and proliferation. Other promising avenues include phosphodiesterase-4 inhibitors, topical 5-fluorouracil, and prostaglandins like latanoprost and bimatoprost, which can induce hyperpigmentation. Further research is needed to optimize these treatments, establish maintenance strategies, and prevent vitiligo recurrence.

5. Emerging Research and Future Directions

The understanding and treatment of vitiligo continue to evolve with ongoing research.¹⁴ Areas of particular interest include the role of specific cytokines like interferon-α and tumor necrosis factor-α in inflammation and immune regulation. Additionally, research is exploring the impact of reduced cytotoxic T-lymphocyte-associated protein 4 levels in regulatory T cells on the suppression of autoreactive CD8+ T cells in vitiligo pathogenesis. Other potential treatments under investigation include pseudocatalase (Vitilase; Philadelphia), linked to oxidative stress, and trichloroacetic acid. The goal of this ongoing research is to establish effective maintenance strategies and prevent recurrence, ultimately improving the lives of individuals with vitiligo.

References

1 June 2025: Vitiligo Awareness Month. Michigan.gov. June 1, 2025. Accessed June 11, 2025. https://www.michigan.gov/whitmer/news/proclamations/2025/06/01/june-2025-vitiligo-awareness-month

2. Vitiligo Research Foundation. VR Foundation. Accessed June 11, 2025. https://vrfoundation.org/wvd

3. Haulrig MB, Al‐Sofi R, Baskaran S, et al. The global epidemiology of vitiligo: a systematic review and meta‐analysis of the incidence and prevalence. JEADV Clinical Practice. Published online August 22, 2024. doi:10.1002/jvc2.526

4. Khoury M, Dabit T, Siniora H, Fashho J, Toubasi AA. The prevalence of vitiligo and its associated risk factors in the Middle East and Africa: a systematic review and meta-analysis. Health Sciences Review. Published online June 1, 2024:100187-100187. doi:10.1016/j.hsr.2024.100187

5. Vitiligo variations: segmental vitiligo and non-segmental vitiligo. Metro Boston CP. March 11, 2025. Accessed June 11, 2025. https://metrobostoncp.com/blogs/segmental-and-non-segmental-vitiligo/

6. Vitiligo of the skin. Cleveland Clinic. November 23, 2022. Accessed June 11, 2025. https://my.clevelandclinic.org/health/diseases/12419-vitiligo

7. Vitiligo - symptoms and causes. Mayo Clinic. 2018. Accessed June 11, 2025. https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912

8. Harris JE. Patterns of vitiligo. University of Massachusetts Medical School. May 29, 2020. Accessed June 11, 2025. https://www.umassmed.edu/vitiligo/blog/blog-posts1/2020/05/patterns-of-vitiligo/

9. Segmental vitiligo: types, causes, and clinical trials overview. School of Medicine Dermatology. August 2, 2024. Accessed June 11, 2025. https://dermatrials.medicine.iu.edu/blogs/understanding-segmental-vitiligo

10. The various types of vitiligo. Typology Paris. November 20, 2024. Accessed June 11, 2025. https://us.typology.com/library/what-are-the-different-forms-of-vitiligo

11. Chang HC, Lai CY, Chang YS. Inflammatory vitiligo. Dermatol Pract Concept. 2022;12(3):e2022107. doi:10.5826/dpc.1203a107

12. Di Bartolomeo L, Custurone P, Irrera N, et al. Vitiligo and mental health: natural compounds' usefulness. Antioxidants (Basel). 2023;12(1):176. Published 2023 Jan 11. doi:10.3390/antiox12010176

13. Salama AH, Alnemr L, Khan AR, Alfakeer H, Aleem Z, Ali-Alkhateeb M. Unveiling the unseen struggles: a comprehensive review of vitiligo's psychological, social, and quality of life impacts. Cureus. 2023;15(9):e45030. Published 2023 Sep 11. doi:10.7759/cureus.45030

14. Santoro C. Future of vitiligo treatment: emerging therapies, impact on quality of life. The American Journal of Managed Care^®. May 28, 2025. Accessed June 11, 2025. https://www.ajmc.com/view/future-of-vitiligo-treatment-emerging-therapies-impact-on-quality-of-life