Emerging role of regulatory T cells in the immunopathogenesis of vitiligo and implications for treatment.

This article focuses on the role of regulatory T cells (Tregs) in the immunopathogenesis and treatment of vitiligo, an autoimmune skin disorder characterized by melanocyte loss and depigmentation. It reviews evidence of Treg deficiency, dysfunction, and plasticity in vitiligo patients, highlighting their impaired ability to suppress autoreactive cytotoxic CD8+ T cells and tissue-resident memory T cells that contribute to melanocyte destruction. The article also summarizes current and emerging Treg-targeted therapies—including vitamin D supplementation, low-dose interleukin-2, mammalian target of rapamycin inhibitors, Janus kinase inhibitors, and gene therapies—that aim to restore immune tolerance and promote repigmentation. While these approaches show promise, challenges remain due to Treg plasticity and the need for further clinical trials to establish long-term safety and efficacy.