Vitiligo is a non-contagious disease in which there is loss of natural skin pigmentation, and it can be localized, affecting only one segment of the body, or generalized, with several affected areas, or universal, when more than 50% of the body surface suffers depigmentation. This condition is presented in the form of plaques, most frequently in regions such as wrists, back of hands, fingers, armpits, neck, genitals, face (around the mouth and eyes), elbows, knees, groin and forearms. Vitiligo takes on a whitish appearance on the skin, which becomes very sensitive to the sun and which requires extra protection. 

With the exception of the increased risk of burns, discoloration does not cause serious damage to the patient’s health. However, it is common for the aesthetic changes resulting from the disease to produce psychological disorders, which are aggravated by the weight that contemporary society gives to personal appearance. Studies show that at least half of vitiligo sufferers experience social discrimination. This finding makes psychological monitoring an ally of treatment. Vitiligo is present in at least 1% of the general population, with a predilection for the 10 to 30 age group. 

At first, spots appear slightly lighter than the body's natural skin tone. Over time, they evolve to acromic spots, that is, colorless spots with well-demarcated edges, often accompanied by a thin outline of darker skin around them. The lesions can remain stable for years, develop again or even regress spontaneously. In general, people go to the dermatologist for aesthetic discomfort or, because they have acquired severe burns in depigmented areas. 

The causes of vitiligo are still unclear. One of the most well-accepted theories suggests that the disease is determined by an autoimmune process, that is, by a lack of control in the immune system that leads the body to produce antibodies against melanocytes, which are the skin cells that manufacture the pigment - melanin - which gives color to the skin. This idea gains even more strength when it is observed that many people with vitiligo have antibodies against melanocytes in their bloodstream and that many of them also have other autoimmune diseases, such as diabetes and thyroid disorders. However, the origin of autoimmune processes is still unknown. Some theories argue that the inactivation of these cells may be due to the action of residues produced during the synthesis of melanin - the famous free radicals - and others support the possibility that the process involves neurotransmitters and defects in the metabolism of melanocytes. 

There are several techniques for the treatment of vitiligo, but all of them require patience, as there are areas that have greater difficulty in recovering pigmentation. For localized and even generalized stains, easily accessible, treatment usually involves applications of corticoid-based ointments and lotion, which reduce the inadequate response of the immune system, phototherapy, which consists of the local use of photosensitizing substances, and exposure to ultraviolet radiation, which is the same as that of the sun. Another possibility to cover the most resistant areas is micropigmentation with oxidized iron pigment - a kind of permanent tattoo, made by several techniques. In the case of universal vitiligo, with more than 50% of the body surface being affected, the treatment option may be the total depigmentation of the skin, in order to obtain a uniform shade. 

For people who have had stable patches for a long time, it is possible to use graft surgery or melanocyte transplantation on the injured areas. In addition to these conventional forms, there are many alternative therapies that have been gaining ground in the treatment of vitiligo, and with satisfactory results. But one of the great promises is the use of last generation immunomodulators, orally, to inhibit the uncontrolled immune system that seems to trigger the attack on melanocytes. The results of these drugs have also been shown to be positive in other skin diseases, although confirmatory studies are lacking. Since the causes of vitiligo are not clear, there are no effective preventive measures that really reduce the chance of developing the disease. 

References:

https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912  

https://www.nhs.uk/conditions/vitiligo/