Lessons Learned from Anatomic Susceptibility in Vitiligo Patients: A Systematic Review

Purpose of Review Vitiligo is an acquired condition resulting from melanocyte disappearance and clinically manifests as explicit white patches. Limited research exists on its distribution patterns, specifically, its predisposition for certain anatomic sites, such as the face and extensor surfaces, and any unique structure and function of these sites. Therefore, the aim of this systematic review is to summarize the existing literature on vitiligo’s main sites of involvement and give insight into vitiligo’s susceptibility. Recent Findings Nineteen observational studies were included after the Scopus and MEDLINE databases were systematically searched in accordance with the PRISMA guidelines. Particularly vulnerable anatomic sites such as the face display increased melanocyte density, melanocyte:keratinocyte ratio, cholesterol, and AH ceramides. Additionally, anatomic regions experiencing chronic friction, including the bearded area for men and axilla for women, are more vulnerable to depigmentation. These findings allude to the multidimensional pathogenesis of vitiligo and contribute partially to the explanation of anatomic susceptibility. Summary This data provides rationale into why vitiligo is rarely universal and may suggest the development of related biological testing, such as measurement of cholesterol levels, for early vitiligo detection and future research explaining depigmentation patterns. Furthermore, these observations are pertinent for future vitiligo management, specifically that treatments might be specifically directed to match the affected body site’s unique structure and function.