Bergqvist Christina, Ezzedine Khaled
Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, Créteil, France.
EA 7379 EpidermE, Université Paris-Est Créteil, UPEC, Créteil, France.
J Dermatol. 2021 Mar;48(3):252-270. doi: 10.1111/1346-8138.15743. Epub 2021 Jan 6.
Vitiligo is the most common depigmenting disorder affecting 0.1%-2% of the population worldwide. The characteristic white patches result from the selective loss of melanocytes. Sustained recent efforts have resulted in a detailed understanding of the genetic architecture of vitiligo. About 80% of vitiligo risk is attributable to genetic factors; and the rest (20%) is attributable to the environment. Over the past decade, substantial progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Melanocytes from patients with vitiligo are more susceptible to oxidative stress which begets the release of exosomes and inflammatory cytokines that will lead to activation of the innate immune response and subsequently to adaptive immune response through activation of autoreactive cytotoxic CD8+ T cells. These produce interferon-γ (IFN-γ) which promotes disease progression through IFN-γ-induced chemokine secretion from surrounding keratinocytes to further recruit T cells to the skin through a positive feedback loop. CD8 tissue-resident memory T cells are in turn responsible for long-term maintenance and potential relapse of vitiligo in human patients through cytokine-mediated recruitment of T cells from the circulation. This review summarizes the current knowledge on vitiligo and attempt to give an overview of the future in vitiligo treatment.
白癜风是最常见的色素脱失性疾病,影响着全球0.1%-2%的人口。其特征性的白色斑块是由黑素细胞的选择性缺失导致的。近期持续的研究努力已使我们对白癜风的遗传结构有了详细了解。约80%的白癜风风险归因于遗传因素,其余20%归因于环境因素。在过去十年中,我们对白癜风发病机制的理解取得了重大进展,白癜风现已明确归类为自身免疫性疾病。白癜风患者的黑素细胞更容易受到氧化应激影响,从而导致外泌体和炎性细胞因子的释放,这会引发先天性免疫反应的激活,随后通过自身反应性细胞毒性CD8+T细胞的激活引发适应性免疫反应。这些细胞产生干扰素-γ(IFN-γ),通过IFN-γ诱导周围角质形成细胞分泌趋化因子,进一步通过正反馈回路将T细胞招募至皮肤,从而促进疾病进展。CD8组织驻留记忆T细胞反过来通过细胞因子介导从循环中招募T细胞,负责人类患者白癜风的长期维持和潜在复发。本综述总结了目前关于白癜风的知识,并试图概述白癜风治疗的未来发展。