Vitiligo is a skin disease of unknown etiology that affects 1% of the population. It affects both sexes equally and the mean age at onset is between 10 and 30 years. Some of the factors involved are: emotional or physical stress, mechanical trauma, chemicals such as phenol and certain diseases. Autoimmune diseases, especially of thyroid origin, may be linked to vitiligo. New and emerging therapies have been proposed such as topical immunomodulators, allied to traditional therapies with psoralen and steroids. The most important factor in the therapeutic success depends on the doctor and patient relationship.793335351Lerner, A.B., Nordlund, J.J., Vitiligo: What is it? Is it important? (1978) J Am Med Assoc, 239, pp. 1183-1187Nordlund, J.J., Majumder, P.P., Recent investigations on vitiligo vulgaris: Advances in clinical research (1997) Dermatol Clin, 15, pp. 69-78El-Mofty, A.M., (1968) Vitiligo and Psoralens, , Pergamon Press: New YorkNath, S.K., Majumder, P.P., Nordlund, J.J., Genetic epidemiology of vitiligo: Multilocus recessivity cross-validated (1994) Am J Hum Genetic, 55, pp. 981-990Nodlund, J.J., Hypopigmentation, vitiligo and melanoma: New data, more enigmas (1998) Arch Dermatol, 123, pp. 1005-1011Foley, N.R., Lowe, N.J., Misheloff, E., Tiwari, J.L., Association of HLA-DR4 with vitiligo (1983) J Am Acad Dermatol, 8, pp. 39-40Behl, P.N., Bhatia, R.K., Treatment of vitiligo with autologous thin Thiersch's grafts (1973) Int J Dermatol, 12, pp. 329-331Slominski, A., Paul, R., Bomriski, A., Hypothesis: Possible role of melatonin receptors in vitiligo (1989) J R Soc Med, 82, pp. 539-541Barona, M.I., An epidemiological case-control study in a population with vitiligo (1995) J Am Acad Dermatol, 33 (4), pp. 621-625Abdel-Nasser, M.B., Further evidence for involvement of both cell mediated and humoral immunity in generalized vitiligo (1994) Pigment Cell Research, 7, pp. 1-8Porter, J., Beuf, A.H., Lerner, A.B., Nodlund, J.J., Response to cosmetic disfigurementpatients with vitiligo (1987) Cutis, 39, pp. 493-494Nath, S.K., Manjumder, P.P., Nordlund, J.J., Genetic epidemiology of vitiligo: Multilocus recessivity cross-validated (1994) Am J Hum Genet, 55, pp. 981-990Majumder, P.P., Nordlund, J.J., Li, C.C., Pattern of familial aggregation of vitiligo (1993) Arch Dermatol, 129, pp. 994-998Chen, I.T., Jimbow, K., Comparison in expression of tyrosinase, TRP-1, and c-Kit between normal human melanocytes and "vitiligo"melanocytes (1994) Pigment Cell Research, 24 (SUPPL. 3)Norris, D.A., Kissinger, R.M., Naughton, G.M., Evidence for immunologic mechanisms in human vitiligo: Patients' sera induce damage to human melanocytes in vitro by complement-mediated damage and antibody-dependent cellular toxicity (1998) J Invest Dermatol, 90, pp. 783-789Ortonne, J.P., Bose, S.K., Vitiligo: Where do we stand? Pigment Cell Research, 6, pp. 61-72Bystryn, J.C., Immune mechanisms in vitiligo (1993) Clin Dermatol, 15, pp. 853-861Bystryn, J.C., Naughton, G.K., The significance of vitiligo antibodies (1985) J Dermatol, 12, pp. 1-9Zamani, M., Linkage and association of HLA class II genes with vitiligo in a Dutch population (2001) Br J Dermatol, 145, pp. 90-94Bystryn, J.C., Xie, Z., Neoplastic hypomelanoses The Pigmentary System: Physiology and Pathophysiology, pp. 647-662. , Nordlund JJ, Boissy RE, Hearing VJ, King RA, eds. New York: Oxford University PressHarning, R., Cui, J., Bystryn, J.-C., Relation between the incidence and level of pigment cell antibodies and disease activity in vitiligo (1991) J Invest Dermatol, 97, pp. 1078-1080Norris, D.A., Capin, L., Muglia, J.J., Enhaced susceptibility of melanocytes of different immunologic effector mechanisms in vitro: Potential mechanisms for postinflammatory hypopigmentation and vitiligo (1998) Pigment Cell Research, pp. 113-123Fishman, P., Vitiligo antibodies are effective against melanoma (1993) Cancer, 72, pp. 2365-2369Naughton, G.K., Reggiardo, M.D., Bystryn, J.-C., Correlation between vitiligo antibodies and extent of dispigmentation in vitiligo (1986) J Am Acad Dermatol, 15, pp. 978-981Ziegler, I., Production of pterdines during hematopoiesis and T-lymphocyte proliferation-potencial participation in the control of cytokine signal transmission (1998) Medicinal Research Reviews, 10, pp. 95-114Bleehen, S.S., Despigmentation of skin with 4-isopropyl-catechol, mercaptoamines, and other compounds (1968) J Invest Dermatol, 50, pp. 103-117Riley, P.A., Mechanisms of pigment cell toxicity produced by hydroxyanisole (1970) J Pathol, 101, pp. 163-169Lerner, A.B., On the etiology of vitiligo and gray hair (1971) Am J Med, 51, pp. 141-147Reedy, M.V., Regulation of melanoblast migration and differentiation (1998) The Pigmentary System Physiology and Pathophysiology, pp. 75-95. , New York: Oxford University PressBarnes, L., Vitiligo and the Vogt-Koyanagi- Harada syndrome (1988) Dermatol Clin, 6, pp. 229-239Nellhaus, G., Acquired unilateral vitiligo and poliosis of the head and subacute encephalitis with partial recovery (1970) Neurology, 20, pp. 961-974Schallreuter, K.U., Vitiligo and other disease: Coexistence or true association? Hamburg study on 321 patients (1994) Dermatology, 188, pp. 269-275Davis, M.D., (1992) 7-Tetrahydrobiopterin, a Natural Occurring Analogucof Tetrahydrobiopterin is a Cofator for, and a Potencial Inhibtor of the Aromatic Amino Acid Hydrolases, 89, pp. 10108-10113. , National Academy of Sciences, USALei, X.-D., Expression of 4a- carbinolamine dehydratasein human epidermal keratinocytes (1997) Bichem Biophys Res Commun, 238, pp. 556-559Cormane, R.H., Siddiqui, A.H., Schutgens, R.B.H., Phenylalanine and UVA light for the treatment of vitiligo (1985) Arch Dermatol Res, 277, pp. 126-130Hand, S.K., Lee, H.J., Segmental vitiligo: Clinical findings in 208 patients (1996) J Am Acad Dermatol, 36, pp. 671-674Jaisankar, T.J., Vitiligo in children (1993) Int J Dermatol, 31, pp. 621-623Pal, S.K., Thyroid function in vitiligo (1980) Clinica Chimica Acta, 106, pp. 331-332Grimes, P.E., Autoantibodies and their clinical significance in a black vitiligo population (1983) Arch Dermatol, 119, pp. 300-303Korkij, W., Tissue-specific autoantibodies and autoimmune disorders in vitiligo and alopecia areata: A retrospective study (1984) J Cutan Pathol, 11, pp. 522-530Lerner, A.B., Vitiligo (1959) J Invest Dermatol, 32, pp. 285-310Le Poole, I.C., Presence or absence of melanocytes in vitiligo lesions: An immunohistochemical investigation (1993) J Invest Dermatol, 100, pp. 816-822Hu, F., In vitro studies of vitiligo (1959) J Invest Dermatol, 33, pp. 267-280Falabella, R., Idiopathic gruttate hypomelanosis (1988) Dermatol Clin, 6, pp. 241-247Staricco, R.G., Amelanotic melanocytes in the outer sherth of the hair follicles (1959) J Invest Dermatol, 33, pp. 295-297Cui, J., Shen, L.Y., Wang, G.C., Role of hair folicles in the repigmentation of vitiligo (1991) J Invest Dermatol, 97, pp. 410-416Kandil, E., Treatment of localized vitiligo with intradermal injection of triamcinolone acetonide (1970) Dermatologica, 140, pp. 195-206Kumari, J., Vitiligo treated with topical clobetasol propionate (1984) Arch Dermatol, 120, pp. 631-635Koga, M., Vitiligo: A new classification and therapy Br J Dermatol, 97, pp. 255-261Visitha, L.K., Singh, G., Vitiligo and intralesional steroids (1979) Indian J Med Res, 69, pp. 308-311Hann, S.K., Systemic steroids suppress antimelanocyte antibodies in vitiligo (1997) J Cutan Med Surg, 1, pp. 193-195Pasricha, J.S., Oral Mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast-spreading disease (1993) Int J Dermatol, 31, pp. 753-757Kim, S.M., The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patients (1999) Int J Dermatol, 38, pp. 546-550Parrish, J.A., Fitzpatrick, T., Photochemotherapy of vitiligo. Use of orally administered psoralens and a high-intensity long-wave ultraviolet light system (1976) Arch Dermatol, 112 (11), pp. 1531-1534Grimes, P.E., Minus, H.R., Determination of optimal topical photochemotherapy for vitiligo (1982) J Am Acad Dermatol, 7 (6), pp. 771-778Halder, R.M., Grimes, P.E., Childhood vitiligo (1987) J Am Acad Dermatol, 16 (5 PART 1), pp. 948-954Ortonne, J.P., Mosher, D.V., (1993) Vitiligo and Other Hypomelanoses, , Plenum Publisshing Co., New YorkSkouge, J.W., Morison, W.L., Autografting and PUVA. A combination therapy for vitiligo (1992) J Dermatol Surg Oncol, 18 (5), pp. 357-360Bleehen, S.S., The treatament of vitiligo with topical corticosteroids. Light and electron-microscopic studies (1996) Br J Dermatol, 94 (SUPPL. 12), pp. 43-50Falabella, R., Arrunátegui, A., Barona, M.I., Alzate, A., The mini-grafting tet for vitiligo: Detection of stable lesions for melanocyte transplatation (1995) J Am Acad Dermatol, 32, pp. 228-232Moellman, G., Klein-Angerer, S., Scollay, D., Nordlund, J.J., Lerner, A., Extracelular granular material and degeneration of keratinocytes in normally pigmented epidermis of patientes with vitiligo (1982) J Invest Dermatol, 79, pp. 321-330Halder, R., Pham, H., Breadon, J., Johnson, B., Micropigmentation for the treatment of vitiligo (1989) J Dermatol Surg Oncol, 15, pp. 1092-1098Schallreuter, K.U., Pittelkow, M.R., Low catalase levels in the epidermis of patients with vitiligo (1991) J Invest Dermatol, 97, pp. 1081-1085Schallreuter, K.U., Wood, J.M., Lemke, K.R., Levenig, C., Treatament of vitiligo with a topical application of pseudocatalase and calcium in combination with short term UVB exposure: A case on 33 patients (1995) Dermatology, 190, pp. 223-229Maresca, V., Rocella, M., Camera, E., Increased sensitivity to peroxidative agents as a possible pathogenic factor of melanocyte damage in vitiligo (1997) J Invest Dermatol, 109, pp. 310-313Patipa, M., Eyelid tattooing (1987) Deramtol Clin, 5, pp. 335-348Calanchini-Postizzi, E., Frenk, E., Long-term actinic damage in sun-exposed vitiligo and mormally pigmented skin (1987) Dermatologica, 174, pp. 266-271Abdel-Malek, A., Swope, V., Dixon, K., A possible unique mechanism for UVB induced hyperpigmentation (1993) International Pigment Cell Conference, p. 5. , London, 26-30 SeptemberNordlund, J.J., Melagenina and vitiligo (Reply) (1992) Dermatology, 184 (2), pp. 154-155Morliere, P., Honigsmann, H., Averbeck, D., Phototherapeutic, photobiologic and photosensitizing properties of khellin (1998) J Invest Dermatol, 90, pp. 720-724Antoniou, C., Schulpis, H., Michas, T., Vitiligo therapy with oral and topical phenylalanine with UVA exposure (1998) Int J Dermatol, 184 (2), pp. 153-155Greiner, D., Ochsendorf, F.R., Milbradt, R., Vitiligo-therapie mit phenylalanin/UVA. Katammnestiche untersuchungen nach funf jahren (1994) Hautarzt, 45, pp. 460-463Montes, L.F., Folic acid and vitamin B 12 in vitiligo: A nutritional approach (1992) Cutis, 50, pp. 39-42Monk, B., Topical flurouracil in vitiligo (1985) Arch Dermatol, 121, pp. 25-26Picardo, M., Passi, S., Morrone, A., Grandineti, M., Di Carlo, A., Ippolito, F., Antioxidant status in the blood of patients with active vitiligo (1994) Pigment Cell Research, 7, pp. 110-115Nakamura, T., Pinnell, S.R., Darr, D., Vitamin C abrogates the deleterious effects of UVB radiation on cutaneous immunity by a mechanism that does not depend on THF-alfa (1997) J Invest Dermatol, 109, pp. 20-24Pasricha, J.S., Khera, V., Effect of prolonged treatament with levamisole on vitiligo with limited and low-spreading disease (1994) Int J Dermatol, 33 (8), pp. 584-587Gokhale, B.B., Cyclophosphamide and vitiligo (1979) Int J Dermatol, 18, p. 92Grimes, P.E., Soriane, T., Dytoc, M.T., Topical tacrolimus for repigmentation of vitiligo (2002) J Am Acad Dermatol, 47 (5), pp. 789-791Tanghetti, E.A., Tacrolimus ointrent 0,1% produces repigmentation in patients with vitiligo: Results of a prospective patients series (2003) Cutis (Cutis), 71 (2), pp. 158-162