Unveiling the Unseen: Exploring Cellular Dynamics in Nonlesional Vitiligo Skin

Vitiligo is a multifactorial disease involving genetic predispositions, intrinsic melanocyte abnormalities, and deregulated immune response. Recent studies show nonlesional skin involvement. Nonlesional melanocytes display mitochondrial dysfunction and increased oxidative stress affecting their adhesion and function and contribute to immune activation. Keratinocytes and fibroblasts display structural and functional abnormalities impairing melanocyte support and differentiation. They also contribute to the altered immune response by secreting proinflammatory chemokines. Despite immune cell infiltration, nonlesional skin remains clinically unaffected, suggesting that regulatory mechanisms maintain immune activation at a subclinical level. This review provides an overview of the cellular alterations in vitiligo nonlesional skin.