Shedding light on vitiligo:Clinical, immunological and patients’ perspectives

Vitiligo is the most common depigmenting skin disease affecting approximately 0.5-1% of the world population, regardless of sex, ethnicity or skin type. It is an auto-immune disease characterized by the development of white macules, strongly associated with an impaired quality of life. The overall aim of this thesis is to shed light on different clinical aspects of vitiligo in order to obtain a better understanding of the current state of affairs which ultimately contributes to future improvement of vitiligo therapy and research. In chapter 2 the association between early changes within various immuno-cell types (T cell subsets and NK cells in blood and skin) and the clinical response to treatment was evaluated. In chapter 3 the clinical response to NB-UVB treatment in 19 different body regions was assessed. Chapter 4 showed a retrospective comparison between NB-UVB therapy twice a week and NB-UVB thrice a week, combined with topical agents. Chapter 5 provides an overview of the various expansion ratios used in cellular grafting and its effect on repigmentation and colour match. Chapter 6A and 6B demonstrate the first results of vitiligo and piebaldism patients treated with the Meek micrografting technique. In chapter 7, the definition of successful repigmentation was evaluated from patients’ perspective. Finally the objective of chapter 8 was to assess patients’ perspective on current and novel therapies for vitiligo. In short, this thesis addressed several aspects of vitiligo, providing an overview of current treatment results and a better understanding of patients’ point of view on vitiligo care.