Vitiligo is an acquired autoimmune disorder with a worldwide prevalence of 0.5-1%. It is characterized by depigmented macules caused by the absence of melanocytes in the epidermis.The aim of the treatment for vitiligo is disease stabilization and repigmentation. Hence, different scores have been developed to assess disease severity and repigmentation in order to infer the therapeutic efficacy of the chosen treatment. Vitiligo is associated with social stigma and has an immense effect on the patients' quality of life. Hence, scores have been developed to assess the impact of the disease. A comprehensive literature search was conducted using keywords such as "vitiligo," "scoring system," "activity," "extent," "area," "repigmentation," "quality of life," "vitiligo disease burden," and "impact," individually or in combination. Databases searched included PubMed, Embase, the Cochrane Library, and ScienceDirect. Articles published up to May 2025 were considered for inclusion. These scores are essential for evaluating vitiligo in medical research and clinical practice. These are needed for assessment, treatment evaluation, and monitoring disease progression. This review article summarizes the scoring systems used in day-to-day practice and research trials. Eleven scores assess the extent of disease and/or repigmentation, while nine monitor disease activity. Seven scores evaluate the impact on patients' or their families' quality of life. Additional research is needed to assess the validity, reliability, and responsiveness of each score.

Some genes, such as HLA class I and class II genes, play important roles in the pathogenesis of vitiligo and its associated autoimmune diseases. Attempts to identify these genes have involved several approaches, including analysis of HLA expression patterns, genetic association studies, and genome-wide association studies. These strategies employ a variety of laboratory techniques, each with distinct advantages and limitations. This review provides a comprehensive overview of current strategies for identifying HLA genes linked to vitiligo susceptibility, with a critical comparison of study designs and methodological approaches. Enhancing these methods is essential to improve accuracy and reliability, ultimately facilitating the development of therapeutic targets and clinically relevant diagnostic biomarkers for patients with vitiligo.

Vitiligo is characterized by a complex pathogenesis involving multiple factors, necessitating therapeutic strategies that simultaneously achieve immune regulation, melanocyte regeneration, and melanosome transfer modulation. Here, we designed a Janus microneedle (Janus MN) based on a core-shell bilayer structure, inspired by the melanin metabolism pathway and the stratified architecture of the skin. The shell of the MN was loaded with a complex of hypericin-assembled nanoparticles (HY-NPs) and astragalus polysaccharides, which preferentially dissolve in the epidermal hair follicle region and basal layer. This intervention ameliorated the microenvironment by scavenging reactive oxygen species and inhibiting CD8[+] T-cell-mediated immune attacks on melanocytes for repair, while simultaneously activating the MAPK pathway to enhance melanin synthesis in melanocytes for regeneration. The MN core, encapsulated with stabilized trypsin in a hyaluronic acid matrix, targeted the upper epidermal keratinocytes. It activated the PAR2 signaling pathway to enhance melanosome transfer and phagocytosis, thereby promoting visible pigmentation. It integrated dual spatially heterogeneous targets within the epidermis and hair follicles for the first time, achieving multidimensional synergistic intervention through a sequence of "repair, regeneration, and transfer". Our study provides a novel, spatiotemporally sequential drug delivery strategy for the precise treatment of vitiligo.

Facial depigmentation may remain clinically unrecognized when obscured by persistent erythema associated with steroid-induced rosacea-like dermatitis (SIRD). We report a 42-year-old woman with Fitzpatrick skin phototype IV and a history of prolonged facial topical corticosteroid use who presented with persistent centrofacial erythema. Clinical examination was consistent with SIRD. Multimodal VISIA imaging revealed findings that were not appreciable under standard visible light: red-channel (RBX®) imaging demonstrated increased vascularity and telangiectasia, while ultraviolet imaging identified patchy depigmentation with a speckled pattern and perifollicular pigment preservation. Linear depigmentation corresponding to prior eyebrow tattooing suggested a Koebner phenomenon. Although advised to discontinue corticosteroids, the patient was lost to follow-up and returned three years later with persistent erythema and progression of depigmentation. Repeat ultraviolet imaging demonstrated an increased extent and partial coalescence of the depigmented areas. The longitudinal evolution, imaging features, perifollicular pigment preservation, and trauma-induced depigmentation were most consistent with evolving vitiligo coexisting with SIRD. Following corticosteroid withdrawal, topical tacrolimus 0.1% ointment was initiated. This case highlights how persistent facial erythema can mask progressive depigmentation and demonstrates the value of multimodal VISIA imaging, particularly red-channel and ultraviolet modalities, in detecting subclinical pigmentary changes, differentiating overlapping disease processes, and documenting disease progression.

Background Phototherapy remains central to the treatment of inflammatory and pigmentary skin disease and is especially relevant in populations with darker skin phototypes. As biologic and targeted therapies expand, the place of phototherapy in resource-limited settings is uncertain. We assessed the knowledge, perceptions, and practice of Moroccan dermatologists regarding phototherapy and identified barriers to its use. Methods A cross-sectional, self-administered, web-based survey (34 items) was distributed to Moroccan dermatologists via the Moroccan Society of Dermatology network between October and November 2025, covering demographics, access, technical competency, knowledge, prescribing, attitudes toward biologic and targeted therapies, and training needs. Exploratory cross-tabulations (Fisher's exact test) and 95% CIs (Clopper-Pearson method) were computed for the principal proportions. Results Of 53 respondents (91% female, 51% in private practice), 94% had ever prescribed phototherapy, but only 43% (95% CI: 30-58%) had access to a unit. Most respondents rated their knowledge of indications as sufficient or better; however, only 17% (95% CI: 8-30%) identified the guideline-based psoralen plus ultraviolet A risk-monitoring threshold, and 34% (95% CI: 22-48%) identified the recommended minimum age for narrowband ultraviolet B. Most (70%) considered phototherapy to retain a major role alongside biologic and targeted therapies, and a majority reported offering it before escalation in psoriasis (83%), vitiligo (76%), and atopic dermatitis (62%). Access to a phototherapy unit was strongly associated with public or university practice (p < 0.001) and with regular prescribing (p < 0.001). Logistical (79%), institutional (45%), and space-related (38%) barriers predominated; only 36% had received phototherapy training during residency. Conclusions Moroccan dermatologists express strong support for phototherapy and report offering it before biologic and targeted therapies across major indications, but deficits in equipment access, guideline-based knowledge, and postgraduate training represent barriers to optimal practice. These findings highlight the need for further research, including objective competency assessments and clinical outcome studies, to inform strategies for equipment deployment, structured training, and a national phototherapy network.

Introduction Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder increasingly recognized as a systemic immune-mediated condition. Previous studies examining AA-associated autoimmune diseases were limited by narrow disease scope, single-country cohorts, or lack of bidirectional and sex-stratified analyses. This study comprehensively evaluated over 50 autoimmune conditions in AA patients, performed bidirectional analyses exploring temporal relationships, and conducted sex-stratified assessments to identify gender-specific risk. Methods We conducted a retrospective cohort study using the TriNetX Global Health Research Network, incorporating de-identified electronic health records from over 120 million patients worldwide. Adults with AA were 1:1 propensity score-matched with controls (n=69,259) based on demographics and comorbidities. Over 50 autoimmune and inflammatory disorders were assessed using Cox proportional hazards models. Reverse analyses and sex-stratified cohorts were performed. Sensitivity analyses tested robustness through temporal restrictions, recent data periods, and stricter diagnostic criteria. Results AA was strongly associated with endocrine, rheumatologic, dermatologic, gastrointestinal, hepatic, neurologic, and systemic autoimmune diseases. Highest hazard ratios included cutaneous lupus erythematosus (HR=9.843), systemic lupus erythematosus (HR=5.807), vitiligo (HR=3.844), lichen planus (HR=3.627), and Addison's disease (HR=3.847). Reverse analyses demonstrated that lichen planus (HR=6.205), cutaneous lupus erythematosus (HR=5.579), and vitiligo (HR=4.505) markedly increased AA risk. Females with AA had higher risks of thyroid, rheumatologic, and cutaneous autoimmune disorders, while males showed higher vitiligo risk. Conclusions AA was associated with increased risk of multiple autoimmune and inflammatory diseases in both directions. These findings support considering AA as a clinically visible marker of increased autoimmune susceptibility and may justify targeted evaluation for thyroid and connective tissue disorders, particularly in females with AA, as well as clinical awareness of AA risk in patients with autoimmune skin diseases.