Microorganisms in pathogenesis and management of vitiligo

Vitiligo is an autoimmune skin depigmentation disease characterized by CD8+ T-cell-mediated loss-of-function melanocytes. The role of autoimmunity in the pathogenesis of vitiligo has been well established. However, the exact triggering factors involved in vitiligo development are unclear. The healthy skin microbiome comprises of diverse microbes, including bacteria, archaea, fungi, and viruses; the microbes interact with the immune system and regulate dermatological health. However, recent evidence has suggested the involvement of microbial infections and dysbiosis in the skin microbiome with vitiligo pathogenesis. The changes in the human skin microbiome can play a major role in triggering immune response through various mechanisms such as molecular mimicry, bystander activation, cross-reactivity, epitope spreading, and production of superantigens. Moreover, maintaining the skin microbiome and probiotics-based treatment could lead to novel immune therapeutics for vitiligo. Given the crucial role of microorganisms in vitiligo development, our chapter focuses on the role of microorganisms in vitiligo pathogenesis. Additionally, we will discuss the therapeutic potential of microorganisms in the treatment of vitiligo.