INTEGRATIVE APPROACHES TO VITILIGO: A MECHANISTIC REVIEW OF MODERN THERAPIES AND TRADITIONAL HERBAL INTERVENTIONS

Abstract

Vitiligo is a chronic, multifactorial skin disorder characterized by progressive epidermal depigmentation resulting from the loss or dysfunction of melanocytes-the cells responsible for melanin production and skin pigmentation. While a genetic predisposition plays a significant role, environmental triggers and immune dysregulation are also critical contributors to disease onset and progression. The global prevalence of vitiligo is estimated to range from 0.5% to 2%, with variations based on ethnicity, gender, and skin type. Several mechanisms of melanocyte destruction have been implicated, including apoptosis, necrosis, and emerging forms of regulated cell death such as oxeiptosis, ferroptosis, and necroptosis. Current therapeutic approaches include systemic and topical phototherapy, immunomodulators such as corticosteroids, calcineurin inhibitors, and vitamin D analogs, as well as cosmetic solutions aimed at improving quality of life. However, these treatments are often limited by side effects and inconsistent efficacy. As a result, increasing attention has been directed toward the therapeutic potential of herbal medicinal plants and plant-derived compounds with antioxidant, anti-inflammatory, and immunomodulatory properties. Understanding the diverse molecular pathways involved in melanocyte damage—including oxidative stress, immune-mediated mechanisms, and cell death pathways—offers a more comprehensive insight into vitiligo pathogenesis. This evolving knowledge may facilitate the identification of novel therapeutic targets and the development of more effective, well-tolerated interventions. This review aims to synthesize current research on vitiligo to better inform clinical practice and guide future therapeutic innovation, ultimately improving outcomes and quality of life for affected individuals.