Immune
Variations in genes that are part of the immune system or part of melanocytes have both been associated with vitiligo. It is also thought to be caused by the immune system attacking and destroying the melanocytes of the skin. A genome wide association study found approximately 36 independent susceptibility loci for generalized vitiligo. Autoimmune associations
Vitiligo is sometimes associated with autoimmune and inflammatory diseases such as Hashimotos thyroiditis, scleroderma, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, Addisons disease, pernicious anemia, alopecia areata, systemic lupus erythematosus, and celiac disease.Among the inflammatory products of NALP1 are caspase 1 and caspase 7, which activate the inflammatory cytokine interleukin-1β. Interleukin-1β and interleukin-18 are expressed at high levels in people with vitiligo. In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155 → His). The original protein and sequence is highly conserved in evolution, and is found in humans, chimpanzee, rhesus monkey, and the bush baby. Addisons disease (typically an autoimmune destruction of the adrenal glands) may also be seen in individuals with vitiligo. Diagnosis
An ultraviolet light can be used in the early phase of this disease for identification and to determine the effectiveness of treatment. Using a Woods light, skin will change colour (fluoresce) when it is affected by certain bacteria, fungi, and changes to pigmentation of the skin. Classification
Classification attempts to quantify vitiligo have been analyzed as being somewhat inconsistent, while recent consensus have agreed to a system of segmental vitiligo (SV) and non-segmental vitiligo (NSV).
Triggers may include inflammatory skin conditions, burns, intralesional steroid injections and abrasions.Other conditions with similar symptoms include the following:

Albinism
Halo nevus
Idiopathic guttate hypomelanosis (white sunspots)
Piebaldism
Pityriasis alba
Postinflammatory hypopigmentation
Primary adrenal insufficiency
Progressive macular hypomelanosis
Tinea versicolor
Tuberculoid leprosy

Treatment
There is no cure for vitiligo but several treatment options are available. The best evidence is for applied steroids and the combination of ultraviolet light in combination with creams. Due to the higher risks of skin cancer, the United Kingdoms National Health Service suggests phototherapy be used only if primary treatments are ineffective. Lesions located on the hands, feet, and joints are the most difficult to repigment; those on the face are easiest to return to the natural skin color as the skin is thinner in nature. Immune mediators
Topical preparations of immune suppressing medications including glucocorticoids (such as 0.05% clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such as tacrolimus or pimecrolimus) are considered to be first-line vitiligo  treatments.In July 2022, ruxolitinib cream (sold under the brand name Opzelura) was approved for medical use in the United States for the treatment of vitiligo. Phototherapy
Phototherapy is considered a second-line treatment for vitiligo. Exposing the skin to light from UVB lamps is the most common treatment for vitiligo. The treatments can be done at home with an UVB lamp or in a clinic. The exposure time is managed so that the skin does not suffer overexposure. Treatment can take a few weeks if the spots are on the neck and face and if they existed not more than 3 years.