Vitiligo: what it is, causes, and how it is treated today

Vitiligo is an autoimmune skin disease characterized by the appearance of white patches caused by the loss of melanin. This pigment is produced by melanocytes, cells that in vitiligo are progressively damaged by the immune system.

It is not a contagious or infectious disease and affects approximately 1% of the world’s population, with no significant differences between men and women or among different ethnic groups. It can appear at any age: in 36% of cases, onset occurs before the age of 15, but it may also develop in adulthood or later in life.

Today, vitiligo is no longer considered a simple skin alteration. It is recognized as a systemic immune-mediated disease, in which the skin represents the visible target of a more complex process involving the entire organism.

Causes of vitiligo

The causes of vitiligo do not depend on a single factor. Scientific research has shown that the disease develops through autoimmune mechanisms, with a loss of immune tolerance toward melanocytes.

In most patients, it is not possible to identify a precise triggering event. However, in some cases onset may be associated with:

• intense and prolonged stress

• oncological or radiological therapies

• events that significantly alter immune balance

Family history is present only in some patients and does not follow a direct genetic pattern. The more than twenty years of clinical experience of Dr. Giovanni Menchini and his team shows that genetic predisposition may play a role, but it is not sufficient on its own to explain the onset of the disease.

Vitiligo treatmentSymptoms of vitiligo

The main clinical sign of vitiligo is the appearance of white patches on the skin caused by the disappearance of melanocytes and melanin.

Other clinical signs may also be associated:

• white body hair or hair in the affected areas

• Sutton halo nevi, moles surrounded by a depigmented halo (present in approximately 30% of patients)

• progressive hypopigmentation in initially healthy areas

The most frequently involved areas are:

• face

• hands and feet

• genitals

• periarticular areas

The course of the disease is variable and may alternate between phases of activity and periods of relative stability.

Types of vitiligo

Bilateral vitiligo (or vulgaris)

It is the most common form and accounts for more than 90% of cases. The patches are distributed symmetrically on both sides of the body.

Vitiligo treatment

The main variants are:

• acrofacial vitiligo

• genital vitiligo

• generalized vitiligo

• mucosal vitiligo

• perinevic vitiligo (halo nevi)

In more than 50% of patients, the extent of the disease remains limited and involves less than 10% of the body surface area.

Segmental vitiligo

It accounts for approximately 10% of cases and is characterized by patches localized in a single body segment.

This form has some specific characteristics:

• rapid progression in the initial phases

• less frequent association with other autoimmune diseases

• greater long-term stability after repigmentation

Mixed vitiligo

It is a less frequent condition in which characteristics of segmental and bilateral vitiligo coexist in the same patient. This combination has important implications for therapeutic management.

Vitiligo and associated autoimmune diseases

Vitiligo may be associated with other autoimmune diseases. The most common are:

• Hashimoto’s thyroiditis

• celiac disease

• atrophic gastritis

• autoimmune diabetes

• chronic urticaria

• mood disorders

Among these, the most frequent is Hashimoto’s thyroiditis, especially in women over the age of 40. For this reason, periodic endocrinological monitoring is recommended even in the absence of evident symptoms.

Can vitiligo be treated?

The management of vitiligo cannot be based exclusively on local skin treatments.

Creams or cosmetic treatments, when used alone, do not act on the immune mechanisms that sustain the disease and do not reduce the risk of progression.

The clinical experience of the Dermacademy Institute starts from a key principle:

vitiligo is a systemic immune-based disease and requires an integrated therapeutic approach.

The ImmunoNova Protocol for the treatment of vitiligo

The ImmunoNova Protocol represents the most advanced evolution of the research and treatment pathway developed by Dr. Giovanni Menchini and his team.

It is an integrated and personalized approach that acts on several therapeutic levels:

• clinical evaluation of disease activity

• immune system modulation

• correction of gastrointestinal dysfunctions

• rebalancing of the gut microbiota

• vitamin D supplementation

• targeted nutritional support

• narrowband UVB phototherapy when indicated

• personalized topical therapies

The goal is not only to achieve repigmentation of the patches, but also to:

• stabilize the disease

• prevent new lesions

• reduce the risk of progression and other autoimmune diseases.

The role of the microbiota in vitiligo

The most recent research highlights a correlation between:

• intestinal dysbiosis

• increased intestinal permeability

• abnormal activation of the immune system.

In the ImmunoNova Protocol, evaluation and normalization of the gut microbiota therefore represent a fundamental step in rebalancing immunity and reducing the autoimmune stimulus that targets melanocytes.

Diet becomes an integral part of therapy, not as a simple dietary rule but as a targeted clinical tool.

The initial consultation for vitiligo

The specialist consultation represents the starting point of the therapeutic pathway.

It includes:

• detailed medical history

• clinical evaluation of vitiligo

• Wood’s lamp examination

• photographic documentation

• analysis of disease activity.

Based on this information, a personalized therapeutic protocol is created and adapted over time according to the patient’s clinical evolution.

Follow-up and monitoring: an essential part of therapy

Vitiligo is a dynamic disease and requires periodic monitoring.

Follow-up visits are generally carried out every 2–4 months and make it possible to:

• evaluate the evolution of lesions

• compare photographic images over time

• monitor the immune activity of the disease

• adapt phototherapy and topical therapies.

This approach makes it possible to intervene promptly in case of reactivation and to consolidate results over time.

Therapeutic adherence in vitiligo treatment

In the treatment of vitiligo, therapeutic continuity is a determining factor.

The immune system is dynamic and can modify its activity over time. For this reason, effective therapy requires consistency in following therapeutic instructions and respecting scheduled follow-ups.

In the ImmunoNova Protocol, adherence to the treatment pathway makes it possible to:

• monitor disease activity with precision

• adapt therapy to the different evolutionary phases

• consolidate repigmentation processes

• reduce the risk of relapse.

The patient thus becomes an active part of the therapeutic pathway, following a structured protocol that integrates clinical evaluation, systemic treatments, and monitoring over time.

The key message

With high adherence, almost 3 out of 4 patients improve. This data is at the heart of our work: vitiligo responds to treatment, provided that the treatment is complete, personalized, and followed consistently.

And what changes in children?
Vitiligo can also appear in pediatric age and requires a specific clinical assessment, with therapeutic strategies adapted to the growth phase and the activity of the disease.

Discover how vitiligo is managed in children and which therapeutic approaches are used during the different stages of growth.