1
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Kridin K, Kafri N, Cohen AD. Is vitiligo associated with an increased risk of cardiovascular outcomes? Perceptions from a population-based study. Australas J Dermatol 2024; 65:384-386. [PMID: 38528737 DOI: 10.1111/ajd.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/17/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Niv Kafri
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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2
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Suo DF, Zeng SW, Meng LH. 308 nm excimer laser and tacrolimus ointment in the treatment of facial vitiligo: a systematic review and meta-analysis. Lasers Med Sci 2024; 39:90. [PMID: 38456924 DOI: 10.1007/s10103-024-04033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
This study aimed to investigate the effects and safety of 308 nm excimer laser (308 nm EL) and tacrolimus ointment (TO) in the treatment of facial vitiligo (FV). We searched Cochrane Library, PUBMED, EMBASE, CNKI, and WANGFANG from inception to June 1, 2023. Outcomes included overall response rate (ORR), total adverse reaction rate (TARR), recurrence rate at 3-month (RR-3) and recurrence rate at 6-month (RR-6). The outcome data were presented as odds ratios (OR) with 95% confidence intervals (CI). The risk of bias was assessed by Cochrane risk-of-bias tool and data analysis was performed by RevMan 5.4 software. This study included a total of 19 trials involving 2085 patients. When comparing 308 nm EL monotherapy with 308 nm EL plus TO, significant differences in the ORR (OR = 4.29, 95% CI [2.97, 6.19], I2 = 0%, P < 0.001), RR-3 (OR = 0.18, 95% CI [0.05, 0.69], I2 = 0%, P = 0.01), and RR-6 (OR = 0.38, 95% CI [0.14, 1.03], I2 = 39%, P = 0.06) were found between the two managements. When comparing TO monotherapy with TO plus 308 nm EL, its results showed significant differences in the ORR (OR = 4.21, 95% CI [2.90, 6.11], I2 = 0%, P < 0.001), TARR (OR = 0.42, 95% CI [0.22, 0.81], I2 = 4%, P = 0.009), and RR-3 (OR = 0.32, 95% CI [0.01, 8.03], P = 0.49) between the two modalities. The results of this study suggest that the combination of 308 nm EL and TO is more effective than either treatment alone for the treatment of FV.
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Affiliation(s)
- Dan-Feng Suo
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24, Fukang Road, Nankai District, Tianjin, 300192, China
| | - San-Wu Zeng
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24, Fukang Road, Nankai District, Tianjin, 300192, China.
| | - Ling-He Meng
- Department of Dermatology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24, Fukang Road, Nankai District, Tianjin, 300192, China
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3
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Mascarenhas MRM, Oliveira MDC, Oliveira LFD, Magalhães AS, Machado PRL. Clinical profile of vitiligo patients and relationship with immuno-inflammatory markers. An Bras Dermatol 2024; 99:196-201. [PMID: 37985303 PMCID: PMC10943265 DOI: 10.1016/j.abd.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Vitiligo is the most common pigmentary disorder and is considered a chronic, cumulative, multifactorial disease. The crucial role of cytotoxic CD8+ T lymphocytes and the IFNγ/CXCL10 axis has been demonstrated in its pathogenesis. OBJECTIVE To evaluate the clinical profile and immuno-inflammatory markers in patients with vitiligo in a reference medical center. METHODS Cross-sectional study in which all patients with vitiligo seen at the medical center the from 2019 to 2022 were evaluated, to outline the clinical profile. Moreover, cardiovascular risk biomarkers (neutrophil/lymphocyte ratio and C-reactive protein levels) were measured, as well as cytokines and chemokines (TNFα, IFNγ, IL10, IL15 and CXCL10) in the serum of a subgroup of 30 patients. RESULTS There was a predominance of females, with a mean age of 43 years. Most were phototypes IV or V (71.3%), without comorbidities (77.55%), and without a family history of vitiligo (70.41%). Higher levels of neutrophil/lymphocyte ratio, C-reactive protein, and inflammatory cytokines/chemokines were documented in vitiligo patients when compared to the control group (non-significant). As relevant data, the highest values of CXCL10 were detected in patients with vitiligo versus controls, as well as in patients with disease of shorter duration (p<0.05). STUDY LIMITATIONS The number of assessed patients was small due to recruitment difficulties caused by the COVID-19 pandemic. CONCLUSION The present data contribute to confirming the relevant role of the IFNγ/CXCL10 axis in the pathogenesis of vitiligo, highlighting CXCL10 as a possible activity marker.
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Londoño-Garcia A, Arango Salgado A, Orozco-Covarrubias MDLL, Jansen AM, Rico-Restrepo M, Riviti MC, Velásquez-Lopera MM, Castro C. The landscape of vitiligo in Latin America: a call to action. J DERMATOL TREAT 2023; 34:2164171. [PMID: 36594681 DOI: 10.1080/09546634.2022.2164171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10-12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.
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Affiliation(s)
| | | | | | | | | | - María Cecilia Riviti
- Dermatology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Margarita María Velásquez-Lopera
- Dermatology Section, Facultad de Medicina, Center for Dermatology Investigation CIDERM, Universidad de Antioquia, Medellin, Colombia
| | - Carla Castro
- Hospital Universitario Austral, Buenos Aires, Argentina
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5
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Liu J, Chen Q. Clinical effect of stem cell transplantation combined with 308-nm excimer laser therapy for 56 cases of vitiligo. J Cosmet Dermatol 2023; 22:3276-3281. [PMID: 37366266 DOI: 10.1111/jocd.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To probe the clinical effect of stem cell transplantation in combination with 308-nm excimer laser therapy for vitiligo and to analyze its value in clinical application. METHODS A total of 56 patients with stable non-segmental vitiligo in different parts who were not cured by other therapies visiting our hospital from March 2019 to December 2021 were enrolled as study subjects. They were treated by stem cell transplantation combined with 308-nm excimer laser therapy. The treatment efficacy was observed and analyzed. RESULTS Among the 56 patients, 38 (67.85%) and 49 (87.5%) patients were cured at 6 and 12 months after treatment, respectively. CONCLUSION Stem cell transplantation combined with 308-nm excimer laser therapy for vitiligo achieves significant efficacy, with the cure rate far superior to that of other therapies for vitiligo. The therapy is worthy of popularization in the clinic.
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Affiliation(s)
- Jingwei Liu
- Nanhai Renshu International Skin Hospital (Hainan) Co., Ltd., Haikou, China
| | - Qingqing Chen
- Nanhai Renshu International Skin Hospital (Hainan) Co., Ltd., Haikou, China
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6
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Hu Z, Wang T. Beyond skin white spots: Vitiligo and associated comorbidities. Front Med (Lausanne) 2023; 10:1072837. [PMID: 36910477 PMCID: PMC9995999 DOI: 10.3389/fmed.2023.1072837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Vitiligo is a common depigmentation disorder of an unknown origin characterized by the selective loss of melanocytes, resulting in typical white macules and patches. However, vitiligo is now recognized as more than just a skin disease, what a dermatologist observes as a white spot of skin is just the "tip of the iceberg" of the condition. We attempt to clarify the classification of comorbidities associated with vitiligo from various reviews and reports, and describe their possible pathogenesis. In conclusion, the literature provides evidence of an association between vitiligo and ocular and auditory abnormalities, autoimmune disorders, other dermatological diseases, metabolic syndrome and related disorders, and psychological diseases. These associations highlight the importance of a multidisciplinary approach in managing vitiligo patients.
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Affiliation(s)
- Zhonghui Hu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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7
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Ezzeldine SM, Hasan MS, Abdelmaksoud GI, Ibrahim EN, Rageh MA. Ocular changes of non-segmental vitiligo: A case-control study. Australas J Dermatol 2022; 63:e305-e311. [PMID: 35971248 DOI: 10.1111/ajd.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Vitiligo is a skin disorder in which the melanocytes are destroyed. Melanocytes can be destroyed anywhere in the body, compromising the function of the organs where they are found. Melanocytes in the epidermis and the uveal tract share a common embryological origin in addition to physiological and morphological similarities. Our aim was to detect ocular changes in non-segmental vitiligo patients. METHODS This study included 40 non-segmental vitiligo patients and 40 healthy volunteers as a control. Visual acuity testing, slit lamp examination and optical coherence tomography were performed on all patients as well as controls. RESULTS Patients with non-segmental vitiligo had a considerably greater incidence of ocular alterations than controls, although there was no significant difference in visual acuity. CONCLUSIONS Vitiligo is a systemic condition that can affect the activity of melanocytes in organs besides the skin. The depigmentation process can influence ocular melanocytes. Ocular problems may be closely connected to vitiligo. Because ocular melanocytes aren't involved in the detection or transmission of visual pathway, there is no vision impairment.
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Affiliation(s)
- Shaker M Ezzeldine
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed S Hasan
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ghada I Abdelmaksoud
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ezzat N Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud A Rageh
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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8
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Sorrick J, Huett W, Byrne KA, Erf GF. Immune Activities in Choroids of Visually Impaired Smyth Chickens With Autoimmune Vitiligo. Front Med (Lausanne) 2022; 9:846100. [PMID: 35547230 PMCID: PMC9082495 DOI: 10.3389/fmed.2022.846100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Vitiligo is a common dermatological disorder affecting 1–2% of the world’s population. It is characterized by postnatal, autoimmune destructions of melanocytes in the skin, resulting in patches of depigmentation. Autoimmunity in vitiligo may also affect melanocytes in non-integumental tissues, including the eyes where choroidal melanocytes are the target of the autoimmune response. The Smyth line (SL) of chicken is the only animal model that spontaneously and predictably develops all clinical and biological manifestations of autoimmune vitiligo. In SL vitiligo (SLV), destruction of epidermal melanocytes in growing feathers (GFs) involves a melanocyte-specific, Th1-mediated cellular immune response. Smyth chickens may also exhibit uveitis and vision impairment. Previous studies established a strong association between SLV and vision impairment, including similar pathology in affected eyes and GFs. To determine the presence, types, and activities of choroid infiltrating mononuclear cells, we collected eyes before, near onset, and during active SLV from sighted, partially blind, and blind SL chickens. All SL chickens with vision impairment had SLV. Immunohistochemistry and quantitative reverse transcriptase-PCR analyses revealed mononuclear cell and cytokine expression profiles in the autoimmune destruction of melanocytes in choroids that are identical to those described in GF, demonstrating the systemic nature of autoimmunity against melanocytes in SLV. In addition, we observed aberrant melanogenesis in SL eyes. The immunopathogenesis in SL vision impairment resembles human vitiligo-associated ocular diseases, especially Vogt–Koyanagi–Harada syndrome and sympathetic ophthalmia. Hence, the Smyth chicken autoimmune vitiligo model provides the opportunity to expand our understanding of spontaneous autoimmune pigmentation disorders and to develop effective treatment strategies.
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Affiliation(s)
- Jordan Sorrick
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, United States
| | - Wilson Huett
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, United States
| | - Kristen A Byrne
- Department of Poultry Science, University of Arkansas System Division of Agriculture, Fayetteville, AR, United States
| | - Gisela F Erf
- Department of Poultry Science, University of Arkansas System Division of Agriculture, Fayetteville, AR, United States
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de França E, dos Santos RVT, Baptista LC, Da Silva MAR, Fukushima AR, Hirota VB, Martins RA, Caperuto EC. Potential Role of Chronic Physical Exercise as a Treatment in the Development of Vitiligo. Front Physiol 2022; 13:843784. [PMID: 35360245 PMCID: PMC8960951 DOI: 10.3389/fphys.2022.843784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Vitiligo is an autoimmune disease characterized by progressive skin depigmentation and the appearance of white patches throughout the body caused by significant apoptosis of epidermal melanocytes. Despite not causing any physical pain, vitiligo can originate several psychosocial disorders, drastically reducing patients' quality of life. Emerging evidence has shown that vitiligo is associated with several genetic polymorphisms related to auto-reactivity from the immune system to melanocytes. Melanocytes from vitiligo patients suffer from excess reactive oxygen species (ROS) produced by defective mitochondria besides a poor endogenous antioxidant system (EAS). This redox imbalance results in dramatic melanocyte oxidative stress (OS), causing significant damage in proteins, lipid membranes, and DNA. The damaged melanocytes secret damage-associated molecular pattern (DAMPs), inducing and increasing inflammatory gene expression response that ultimately leads to melanocytes apoptosis. Vitiligo severity has been also associated with increasing the prevalence and incidence of metabolic syndrome (MetS) or associated disorders such as insulin resistance and hypercholesterolemia. Thus, suggesting that in genetically predisposed individuals, the environmental context that triggers MetS (i.e., sedentary lifestyle) may also be an important trigger for the development and severity of vitiligo disease. This paper will discuss the relationship between the immune system and epidermal melanocytes and their interplay with the redox system. Based on state-of-the-art evidence from the vitiligo research, physical exercise (PE) immunology, and redox system literature, we will also propose chronic PE as a potential therapeutic strategy to treat and prevent vitiligo disease progression. We will present evidence that chronic PE can change the balance of inflammatory to an anti-inflammatory state, improve both EAS and the mitochondrial structure and function (resulting in the decrease of OS). Finally, we will highlight clinically relevant markers that can be analyzed in a new research avenue to test the potential applicability of chronic PE in vitiligo disease.
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Affiliation(s)
- Elias de França
- Human Movement Laboratory, São Judas University, São Paulo, Brazil
- Departamento de Biociências, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Liliana C. Baptista
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
- Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL United States
- Targeted Exercise, Microbiome and Aging Laboratory, University of Alabama, Birmingham, AL United States
| | - Marco A. R. Da Silva
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
- Department of Physical Education, Universidade da Amazônia, Belém, Brazil
| | - André R. Fukushima
- Centro Universitário das Américas – FAM, São Paulo, Brazil
- Faculdade de Ciências da Saúde – IGESP – FASIG, São Paulo, Brazil
| | | | - Raul A. Martins
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
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10
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Lim J, Tan W, Nor N. Hints from the skin beneath: Vitiligo in Vogt–Koyanagi–Harada disease. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Esmat SM, Bassiouny D, Hegazy R, Shalaby S, Ragab N, Ibrahim S, Mogawer RM. Early localized vitiligo, a medical emergency: Long-term follow-up study. Dermatol Ther 2021; 35:e15219. [PMID: 34812544 DOI: 10.1111/dth.15219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T-cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty-five patients with recent onset (<6 months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6 months plus topical treatments and NB-UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4 years. Eighty-four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65 ± 2.19 months. Complete repigmentation was achieved in a mean duration of 6.88 ± 0.2 months. At the end of the 4-year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.
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Affiliation(s)
- Samia M Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Bassiouny
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan Shalaby
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nanis Ragab
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Genedy R, Assal S, Gomaa A, Almakkawy B, Elariny A. Ocular and auditory abnormalities in patients with vitiligo: a case-control study. Clin Exp Dermatol 2021; 46:1058-1066. [PMID: 33763919 DOI: 10.1111/ced.14649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitiligo is characterized by the destruction of functional melanocytes in the skin. This destruction can target melanocytes anywhere in the body, in turn affecting the function of the organs in which the affected melanocytes reside. Melanocytes in the skin, uveal tract and ear are similar in their physiology and morphology, and share a common embryological origin. AIM To study the association of vitiligo with ocular and auditory abnormalities. METHODS This case-control study was carried out on 40 patients with vitiligo and 20 healthy controls (HCs). All patients and HCs underwent auditory examination (otoscopic examination and immittance audiometry to assess middle ear pressure and exclude tympanic membrane perforation; pure tone audiometry to assess peripheral hearing sensitivity; and transient evoked otoacoustic emissions to assess central hearing ability) and standard ocular examination including visual acuity test, slit lamp biomicroscopy and optical coherence tomography. RESULTS Compared with controls, there was a significantly higher prevalence of hearing loss and ocular abnormalities in patients with vitiligo but no significant difference in visual acuity. CONCLUSION Vitiligo is a systemic disease that can be associated with impairment of melanocyte function organs other than the skin, including the eyes and ears. The function of auditory melanocytes is related to the hearing process and thus their destruction could lead to hearing impairment. By contrast, ocular melanocytes do not play a direct role in detection or transfer of visual information, and thus should not affect vision. Vitiligo may be associated with ocular abnormalities and hearing loss.
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Affiliation(s)
- R Genedy
- Department of Dermatology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - S Assal
- Audiology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A Gomaa
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - B Almakkawy
- Department of Dermatology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A Elariny
- Department of Dermatology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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13
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Leung AKC, Lam JM, Leong KF, Hon KL. Vitiligo: An Updated Narrative Review. Curr Pediatr Rev 2021; 17:76-91. [PMID: 33302860 DOI: 10.2174/1573396316666201210125858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. OBJECTIVE This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. METHODS A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. RESULTS Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. CONCLUSION The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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Bulat V, Likic R, Bradic L, Speeckaert R, Azdajic MD. Pembrolizumab-induced vitiligo in a patient with lung adenocarcinoma: A case report. Br J Clin Pharmacol 2020; 87:2614-2618. [PMID: 33217043 DOI: 10.1111/bcp.14663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
Pembrolizumab is an immune checkpoint inhibitor designed to block the interaction between programmed cell death-1 and programmed cell death-ligands 1 and 2. It shows efficacy in the treatment of patients with advanced nonsmall-cell lung cancer, among others. Side effects may involve immune-related adverse events, including vitiligo. We hereby present a 63-year-old Caucasian female with metastatic nonsmall-cell lung cancer. Immunohistochemical analysis showed programmed death-ligand 1 expression on 100% of tumour cells. The patient was eligible for immunotherapy and received pembrolizumab every 3 weeks as the first-line treatment. Three months after initiation of immunotherapy with pembrolizumab, depigmentation appeared on her upper right thoracic area of the skin overlying the affected lung lobe. Immunotherapy was generally well tolerated. Excellent response in our subject with complete remission during 16 months of follow-up potentially indicates that cutaneous immune-related adverse events, such as vitiligo, might be associated with increased efficacy of pembrolizumab in metastatic lung adenocarcinoma.
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Affiliation(s)
- Vedrana Bulat
- Department of Dermatology and Venereology, University Hospital Centre Sestre Milosrdnice, Vinogradska cesta, Zagreb, 29, Croatia
| | - Robert Likic
- University of Zagreb School of Medicine, Zagreb, Croatia.,Associate Professor, Division for Clinical Pharmacology and Therapeutics, Department of Internal Medicine University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, Croatia
| | - Lada Bradic
- Department of Cardiology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, Croatia
| | - Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital; De Pintelaan 185, Ghent, Belgium
| | - Marija Delas Azdajic
- Department of Dermatology and Venereology, University Hospital Centre Sestre Milosrdnice, Vinogradska cesta, Zagreb, 29, Croatia
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15
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Poolsuwan P, Churee C, Pattamadilok B. Comparative efficacy between localized 308-nm excimer light and targeted 311-nm narrowband ultraviolet B phototherapy in vitiligo: A randomized, single-blind comparison study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 37:123-130. [PMID: 33047405 DOI: 10.1111/phpp.12619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are limited data to compare efficacy between recent 308-nm excimer and conventional 311-nm narrowband ultraviolet B (NB-UVB) light in the treatment of vitiligo. OBJECTIVE To compare efficacy between 308-nm excimer light and 311-nm NB-UVB in patients with symmetrical vitiligo lesions. METHODS Thirty-six symmetrically paired vitiligo lesions on the same anatomical area were enrolled. One side of the symmetrical lesions was treated with localized 308-nm excimer light, and the opposite side was treated with targeted 311-nm NB-UVB assigned randomly by computer. All lesions were treated with the same protocol, for 48 sessions. Repigmentation was evaluated using Vitiligo Area Scoring Index (VASI) and grading the repigmentation was carried out with three independent investigators. RESULTS Thirty-six symmetrically vitiligo lesions were randomly treated, one side with 308-nm excimer light and the opposite side with 311-nm NB-UVB. After 48 sessions, a significantly lower VASI score and a higher grade of repigmentation were observed in 308-nm excimer light-treated side (P < .001). Nine lesions (25%) treated with 308-nm excimer light and only five lesions (13.89%) treated with 311-nm NB-UVB achieved excellent repigmentation. The 308-nm excimer light and 311-nm NB-UVB-treated sides rapidly obtained 25% repigmentation within a mean of 19.42 sessions and 26.25 sessions, respectively (P = .002). There was no significant difference in mean cumulative UV dosage (P = .065). Side effect as phototoxicity was similar in both sides (P = .08). CONCLUSION Localized 308-nm excimer light appears to be more effective and also more rapidly induces repigmentation than targeted 311-nm NB-UVB for treatment of vitiligo.
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Affiliation(s)
- Pimsiri Poolsuwan
- Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Chutima Churee
- Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Bensachee Pattamadilok
- Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
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16
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Fouad YA, Salman AG, Mohamed TH, Abdelgawad RHA, Hassen SI. Assessment of the Effect of Vitiligo on Subfoveal Choroidal Thickness Using Spectral-Domain Optical Coherence Tomography. Clin Ophthalmol 2020; 14:2265-2270. [PMID: 32848356 PMCID: PMC7429229 DOI: 10.2147/opth.s255554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Vitiligo is a common skin condition affecting 0.5–2% of the population. The exact etiology of the condition is unknown, but the result is autoimmune destruction of melanocytes. The eye is rich in melanocytes, especially in the retinal pigment epithelium and choroid. Little is known about the effect of vitiligo on the choroid of the eye. Methods We cross-sectionally examined 31 right eyes of 31 vitiligo patients and 32 right eyes of 32 age- and sex-matched controls for signs of vitiligo affection and then measured the subfoveal choroidal thickness (SFCT) using spectral-domain optical coherence tomography. Results There was a statistically significant difference between SFCT in the cases group and the control group (Mean ± SD: 251.9 ± 42.0 μm and 296.8 ± 46.4 μm, respectively, p = 0.0002). The thickness correlated negatively with age (r = −0.5) but did not correlate significantly with disease severity or duration (r = −0.201, −0.1781, p = 0.2783, 0.3381, respectively). Additional examination findings included iris and fundus hypopigmented spots, and peripapillary atrophy. Conclusion SFCT is reduced among patients with vitiligo. The clinical implications of such a finding should be studied further, and eye screening programs should be considered.
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Affiliation(s)
- Yousef Ahmed Fouad
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Thanaa Helmy Mohamed
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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17
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Demirbaş A, Elmas ÖF, Atasoy M, Türsen Ü, Lotti T. Can monocyte to HDL cholesterol ratio and monocyte to lymphocyte ratio be markers for inflammation and oxidative stress in patients with vitiligo? A preliminary study. Arch Dermatol Res 2020; 313:491-498. [PMID: 32816078 DOI: 10.1007/s00403-020-02129-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 12/31/2022]
Abstract
Both systemic inflammation and oxidative stress play crucial roles in the pathogenesis of vitiligo. In recent studies, monocyte to high-density lipoprotein cholesterol ratio (MHR), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) and plateletcrit (PCT) have been shown to reflect inflammation and oxidative stress in chronic inflammatory and autoimmune diseases. In this study, we aimed to investigate the hematological and inflammatory parameters in patients with vitiligo and to evaluate their possible relationship with disease severity. The parameters including MHR, MLR, NLR, PLR, MPV, and PCT were retrospectively investigated in patients with vitiligo and healthy controls. Disease severity was evaluated using the vitiligo extent tensity index (VETI) score. A total of 180 patients with vitiligo, and age-gender-matched 180 healthy controls were enrolled in the study. MHR, MLR, PLR, PCT values were found to be significantly higher in patients with vitiligo (p < 0.05). MPV and NLR values showed no statistically significant difference between the two groups. A positive correlation was also detected between MHR and MLR values, disease duration, and VETI score (p < 0.05). We suggest that MHR and MLR can be used as markers of inflammation and oxidative stress in patients with vitiligo. Both markers may also reflect disease severity.
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Affiliation(s)
| | - Ömer Faruk Elmas
- Department of Dermatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Mustafa Atasoy
- Department of Dermatology, Health Science University, Kayseri City Hospital, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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18
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Namazi MR, Rouhani S, Moarref A, Kiani M, Tabei SS, Hadibarhaghtalab M. Vitiligo and Rise in Blood Pressure - a Case-Control Study in a Referral Dermatology Clinic in Southern Iran. Clin Cosmet Investig Dermatol 2020; 13:425-430. [PMID: 32606881 PMCID: PMC7319509 DOI: 10.2147/ccid.s257022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/15/2020] [Indexed: 01/04/2023]
Abstract
Purpose Vitiligo is an acquired hypopigmentation condition in which well-defined macules can develop virtually everywhere on the patients’ skin. This analytic case–control study was conducted in Faghihi Hospital outpatient dermatology clinic, affiliated to Shiraz University of Medical Sciences, southern Iran from June to September 2019. Furthermore, we studied the relationship of hypertension with activity, age of onset, duration, affected body surface area and type of vitiligo. Patients and Methods In the current case–control study, 166 individuals were enrolled in total (the case group was comprised of 83 vitiligo patients and 83 individuals actedas control group). The case group was made up of vitiligo patients (both segmental and non-segmental) between 20 and 50 years of age, no prior history of systemic disease and other hypopigmentation disorders, while individuals with any form of dermatologic findings were excluded from the control group. Individuals aged younger than 20 years old or older than 50, having a dermatologic disease other than vitiligo, being afflicted with the diseases which may lead to secondary hypertension, pregnancy, taking substances, and medication which can lead to hypertension were chosen as the exclusion criteria in this study. Results Data obtained from our study revealed that vitiligo patients had a higher prevalence of essential hypertension diagnosis than the control group (P=0.040). Also, no significant relationship was found between patients’ age at the first lesion appearance (P=0.856), duration of vitiligo involvement (P=0.497), and percentage of vitiligo involvement (P=0.681) with hypertension. Conclusion According to our results, vitiligo patients were more susceptible to hypertension while no association could be found between characteristics of the disease and rise in blood pressure.
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Affiliation(s)
- Mohammad Reza Namazi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shekoofe Rouhani
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moarref
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Kiani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Sajjad Tabei
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Turkowski Y, Konnikov N. Sulfasalazine-induced generalized vitiligo in a patient with dermatitis herpetiformis and celiac disease. Dermatol Ther 2019; 32:e13007. [PMID: 31237078 DOI: 10.1111/dth.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 01/17/2023]
Abstract
Vitiligo is an acquired idiopathic pigmentary skin disorder characterized by the development of white macules and patches due to the loss of functioning melanocytes. In this report, we describe a case of a patient with a longstanding history of dermatitis herpetiformis (DH) and celiac disease that developed rapidly progressing, biopsy-confirmed generalized vitiligo after 11 months of treatment with anti-inflammatory medication sulfasalazine, prescribed for the patient's DH. To the best of our knowledge, this is the first case report which has demonstrated the possible biochemical pathways, triggered by sulfasalazine, in the development of vitiligo.
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Affiliation(s)
- Yana Turkowski
- Department of Dermatology, VA Boston Healthcare System, Boston, Massachusetts
| | - Nellie Konnikov
- Department of Dermatology, VA Boston Healthcare System, Boston, Massachusetts.,Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts
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20
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Amin AM, Mostafa H, Arif NH, Abdul Kader MASK, Kah Hay Y. Metabolomics profiling and pathway analysis of human plasma and urine reveal further insights into the multifactorial nature of coronary artery disease. Clin Chim Acta 2019; 493:112-122. [DOI: 10.1016/j.cca.2019.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
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21
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Gupta I, Narang A, Singh P, Manchanda V, Khanna S, Mukerji M, Natarajan VT, Dash D. VitiVar: A locus specific database of vitiligo associated genes and variations. Gene 2019; 721S:100018. [PMID: 32550548 PMCID: PMC7286000 DOI: 10.1016/j.gene.2019.100018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/17/2022]
Abstract
Vitiligo is the most common skin pigmentation disorder which affects around 1% of the population worldwide. The disease has complex pathogenesis and is of multifactorial etiology, that finally culminates in patchy depigmentation of skin. Genetic contribution to the disease is well studied, however the information about multiple associated genes and contributing variations are scattered across the literature. To address this complex disorder affecting the skin, we systematically cataloged the genes and variations by creating a Locus Specific Database for vitiligo called, “VitiVar”. This comprehensive resource houses manually curated 322 genes and 254 variations, from 202 articles indexed in PubMed. We applied an integrative approach to stratify genes and variations to facilitate dissection of vitiligo pathogenesis by layering it with expression status in specific constituent cell types of skin and in-house vitiligo expression data. Finally, we were able to demonstrate the utility of VitiVar by generating a vitiligo interactome using GeneMANIA and overlaying the vitiligo and cell type specific information. This interaction network yielded 20 new genes (apart from 322 VitiVar genes) of which we were able to prioritize IFI27 and IFI6 for further validation. This, thereby makes VitiVar a comprehensive integrative platform in unravelling disease biology by providing meaningful leads for functional interrogation. VitiVar is freely accessible to the research community for prioritizing and validating the candidate genes and variations (http://vitivar.igib.res.in/). We developed a Vitiligo centric web resource cataloguing the associated genes and variations Overlaid the information of cell type specificity and expression status in Vitiliginous skin Utilizing the network approach, we prioritized IFI6 & IFI27 which could be functionally interrogated in disease pathology
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Affiliation(s)
- Iti Gupta
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
- Academy of Scientific and Innovative Research, CSIR Campus, CSIR Road, Chennai, India
| | - Ankita Narang
- CSIR's Ayurgenomics Unit - TRISUTRA (Translational Research and Innovative Science ThRough Ayurgenomics), CSIR-IGIB, Mathura Road, Delhi, India
| | - Prateek Singh
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
- Academy of Scientific and Innovative Research, CSIR Campus, CSIR Road, Chennai, India
| | - Vijeta Manchanda
- CSIR's Ayurgenomics Unit - TRISUTRA (Translational Research and Innovative Science ThRough Ayurgenomics), CSIR-IGIB, Mathura Road, Delhi, India
| | - Sangeeta Khanna
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
| | | | - Mitali Mukerji
- CSIR's Ayurgenomics Unit - TRISUTRA (Translational Research and Innovative Science ThRough Ayurgenomics), CSIR-IGIB, Mathura Road, Delhi, India
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
| | - Vivek T. Natarajan
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
- Academy of Scientific and Innovative Research, CSIR Campus, CSIR Road, Chennai, India
- Correspondence to: V. T Natarajan, CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi 110020, India.
| | - Debasis Dash
- CSIR's Ayurgenomics Unit - TRISUTRA (Translational Research and Innovative Science ThRough Ayurgenomics), CSIR-IGIB, Mathura Road, Delhi, India
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, Delhi, India
- Academy of Scientific and Innovative Research, CSIR Campus, CSIR Road, Chennai, India
- Correspondence to: D. Dash, CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi 110020, India.
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22
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Gianchecchi E, Fierabracci A. Recent Advances on Microbiota Involvement in the Pathogenesis of Autoimmunity. Int J Mol Sci 2019; 20:E283. [PMID: 30642013 PMCID: PMC6359510 DOI: 10.3390/ijms20020283] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Autoimmune disorders derive from genetic, stochastic, and environmental factors that all together interact in genetically predisposed individuals. The impact of an imbalanced gut microbiome in the pathogenesis of autoimmunity has been suggested by an increasing amount of experimental evidence, both in animal models and humans. Several physiological mechanisms, including the establishment of immune homeostasis, are influenced by commensal microbiota in the gut. An altered microbiota composition produces effects in the gut immune system, including defective tolerance to food antigens, intestinal inflammation, and enhanced gut permeability. In particular, early findings reported differences in the intestinal microbiome of subjects affected by several autoimmune conditions, including prediabetes or overt disease compared to healthy individuals. The present review focuses on microbiota-host homeostasis, its alterations, factors that influence its composition, and putative involvement in the development of autoimmune disorders. In the light of the existing literature, future studies are necessary to clarify the role played by microbiota modifications in the processes that cause enhanced gut permeability and molecular mechanisms responsible for autoimmunity onset.
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Affiliation(s)
- Elena Gianchecchi
- Infectivology and Clinical Trials Research Department, Children's Hospital Bambino Gesù, Viale San Paolo 15, 00146 Rome, Italy.
- VisMederi s.r.l., Strada del Petriccio e Belriguardo, 35, 53100 Siena, Italy.
| | - Alessandra Fierabracci
- Infectivology and Clinical Trials Research Department, Children's Hospital Bambino Gesù, Viale San Paolo 15, 00146 Rome, Italy.
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23
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Lotti T, Gianfaldoni S, Valle Y, Rovesti M, Feliciano C, Satolli F. Controversial issues in vitiligo patients: a review of old and recent treatments. Dermatol Ther 2018; 32:e12745. [DOI: 10.1111/dth.12745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Torello Lotti
- Dermatology and Venereology; University G. Marconi of Rome; Rome Italy
| | | | - Yan Valle
- University G.Marconi of Rome; Rome Italy
| | - Miriam Rovesti
- Dermatology and Venereology; University of Parma; Parma Italy
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24
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Valle Y, Korobko I, Sigova J, Borodina M, Lomonosov K, França K, Lotti T. Patient-reported outcomes: A 5-year long study reveals previously unreported therapeutic, demographic, socio-economic, and other correlations in vitiligo. Dermatol Ther 2018; 31:e12620. [PMID: 30253018 DOI: 10.1111/dth.12620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Abstract
Vitiligo is a non-lethal, non-communicable, immune-mediated, and generally progressive skin disease, with poorly understood etiopathogenesis and weak evidence base. The aim of the study is to contribute to the scant research on the patient-reported outcomes in vitiligo, and to examine the presence of associations between various inputs for possible use in clinical practice. The study was designed as a web-based questionnaire with 40 inputs across seven dimensions. The questions include demographics, skin type, eye and natural hair color, age of respondent and age of onset, possible triggers, disease extent, localization, progression and activity, the efficacy of most common treatment modalities, medication side-effects, heredity and diseases among parents, and out-of-pocket expenses for treatments to date. The analysis presented with this work contributes to the discussion about the relation between therapies, socio-economic factors, and treatment outcomes in vitiligo. All physicians should adequately manage patient expectations in terms of overall treatment duration and expected out-of-pocket expenses, and actively evaluate patients at shorter intervals. A more aggressive therapeutic approach using telehealth devices should be considered to supplement therapy, monitor treatment progress, and protocol compliance.
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Affiliation(s)
- Yan Valle
- Vitiligo Research Foundation, New York, New York
| | - Igor Korobko
- Vitiligo Research Foundation, New York, New York
| | - Julia Sigova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Maria Borodina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Katlein França
- University of Miami Miller School of Medicine, Miami, Florida
| | - Torello Lotti
- University G. Marconi of Rome, Institute of Dermatology, Rome, Italy
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25
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Dahir AM, Thomsen SF. Comorbidities in vitiligo: comprehensive review. Int J Dermatol 2018; 57:1157-1164. [PMID: 29808541 DOI: 10.1111/ijd.14055] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Vitiligo is a common skin disorder characterized by idiopathic, progressive cutaneous hypomelanosis. Vitiligo is associated with several comorbid autoimmune, systemic, and dermatological diseases, primarily thyroid disease, alopecia areata, diabetes mellitus, pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, Addison's disease, inflammatory bowel disease, Sjögren's syndrome, dermatomyositis, scleroderma, ocular and audiological abnormalities, psoriasis, and atopic dermatitis. It is essential to increase awareness of these comorbidities in order to improve the disease burden and quality of life of patients with vitiligo. Herein, we review the association with the most frequent comorbidities associated with vitiligo.
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Affiliation(s)
- Aisha M Dahir
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Gianfaldoni S, Tchernev G, Wollina U, Lotti J, Satolli F, França K, Rovesti M, Lotti T. Vitiligo in Children: A Better Understanding of the Disease. Open Access Maced J Med Sci 2018; 6:181-184. [PMID: 29484022 PMCID: PMC5816297 DOI: 10.3889/oamjms.2018.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 11/24/2022] Open
Abstract
Vitiligo is an important skin disease of childhood. The authors briefly discuss the etiopathobiology, clinics and comorbidities of the disease.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,Onkoderma, Private Clinic for Dermatologic Surgery, Sofia, Bulgaria
| | - Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Jacopo Lotti
- University G. Marconi of Rome, Dept. of Nuclear, Subnuclear and Radiation Physics, Via Plinio 44, Rome 00193, Italy
| | - Francesca Satolli
- Department of Dermatology, University of Parma, Via Gramsci 14, Parma, Parma 43126, Italy
| | - Katlein França
- University of Miami School of Medicine, 1400 NW 10th Avenue, Miami, Florida 33136-1015, United States
| | - Miriam Rovesti
- Department of Dermatology, University of Parma, Via Gramsci 14, Parma, Parma 43126, Italy
| | - Torello Lotti
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
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27
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Abstract
Introduction There are a few studies showing an increased risk of insulin resistance, metabolic syndrome, and oxidative stress in patients with vitiligo. Aim To investigate whether systemic inflammation is increased in vitiligo patients in a case-control study design. Material and methods Nonsegmental vitiligo patients who had been followed at the outpatient dermatology clinic of a university-affiliated teaching hospital, and healthy controls were enrolled in the study. Patients who were receiving systemic treatments and having a systemic disease such as diabetes mellitus and thyroiditis were excluded. Demographic features were recorded and peripheral blood samples were taken from all participants to study serum whole blood count, creatinine, and C-reactive protein (CRP). Results Fifty patients with localized vitiligo, 43 patients with generalized vitiligo, and 50 healthy volunteers were enrolled in the study. Neutrophil to lymphocyte ratio and serum CRP levels were significantly higher in patients who have generalized vitiligo than those with localized vitiligo and healthy controls. However, there was no significant difference regarding neutrophil to lymphocyte ratio (NLR) and CRP between localized vitiligo and control groups. Conclusions Patients with generalized vitiligo seem to have increased systemic inflammation compared with localized vitiligo and control subjects in our cohort. To the best of our knowledge, this is the first study in the literature showing increased NLR values in generalized vitiligo patients. Further studies with cardiovascular disease markers are required to elicit this association better.
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28
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Meta-Analysis of the Association between Vitiligo and Human Leukocyte Antigen-A. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5412806. [PMID: 27689083 PMCID: PMC5027303 DOI: 10.1155/2016/5412806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/22/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
Objective. The objective of this study was to systematically evaluate the association between vitiligo and human leukocyte antigen- (HLA-) A. Methods. PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, and reference lists were searched for relevant original articles. Results. Nineteen case-control studies comprising 3042 patients and 5614 controls were included, in which 33 HLA-A alleles were reported. Overall, three alleles (HLA-A⁎02, A⁎33, and Aw⁎31) were significantly associated with increased risk of vitiligo, two (HLA-A⁎09 and Aw⁎19) were associated with decreased risk, and the remaining 28 were unassociated. Twelve alleles, seven alleles, and 19 alleles were common to three ethnicities, both types of vitiligo, and both typing methods, respectively. In the subgroup analysis by ethnicity and typing methods, the association of six alleles and five alleles was inconsistent in three populations and both typing methods, respectively. In the subgroup analysis by clinical type, the association of all seven alleles was consistent in both types of vitiligo. Conclusion. The meta-analysis suggests that HLA-A⁎02, A⁎33, and Aw⁎31 are associated with increased risk of vitiligo, while HLA-A⁎09 and Aw⁎19 are associated with decreased risk of vitiligo. The association of some alleles varies in terms of ethnicity and typing methods.
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29
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Ghilain V, Wiame E, Fomekong E, Vincent MF, Dumitriu D, Nassogne MC. Unusual association between lysinuric protein intolerance and moyamoya vasculopathy. Eur J Paediatr Neurol 2016; 20:777-81. [PMID: 27321952 DOI: 10.1016/j.ejpn.2016.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 03/22/2016] [Accepted: 05/25/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lysinuric protein intolerance (LPI) is a form of inherited aminoaciduria caused by a deficiency in the cationic amino acid transport process on the basolateral membrane of enterocytes and renal tubular cells. Clinical signs include gastrointestinal symptoms, failure to thrive, hepatosplenomegaly, osteoporosis, episodes of coma, intellectual deficiency, lung and renal involvement, bone marrow abnormalities, as well as altered immune response. Moyamoya disease is a cerebrovascular disorder predisposing sufferers to stroke through progressive stenosis of the intracranial internal carotid arteries and their proximal branches. Patients with characteristic moyamoya vasculopathy who also exhibit well-recognized associated conditions, such as Down syndrome or sickle-cell disease, are diagnosed with moyamoya syndrome, whereas those with no known associated risk factors are said to suffer from moyamoya disease. CASE STUDY A 5-year-old girl exhibiting aversion to protein-rich food and splenomegaly presented with a history of recurrent ischemic strokes. Cerebral angiography confirmed moyamoya vasculopathy. Metabolic investigation revealed abnormalities characteristic of LPI. This diagnosis was confirmed by the detection of a mutation within the SLC7A7 gene upon molecular investigation. CONCLUSION To the best of our knowledge, this is the first reported case of an association between moyamoya vasculopathy and LPI. While the question of association or coincidence cannot yet be answered, several pathophysiological consequences of LPI can be defined as separate, such as links between the impact of low arginine levels on the function of vascular endothelium and brain nitric oxide metabolism, as well as hemophagocytic syndrome associated with the risk of vasculitis, thus accounting for the development of moyamoya vasculopathy.
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Affiliation(s)
- Valérie Ghilain
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Elsa Wiame
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Edward Fomekong
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Dana Dumitriu
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Vaccaro M, Cicero F, Mannucci C, Calapai G, Spatari G, Barbuzza O, Cannavò SP, Gangemi S. IL-33 circulating serum levels are increased in patients with non-segmental generalized vitiligo. Arch Dermatol Res 2016; 308:527-30. [PMID: 27388717 DOI: 10.1007/s00403-016-1675-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
IL-33 is a recently identified cytokine, encoded by the IL-33 gene, which is a member of the IL-1 family that drives the production of T-helper-2 (Th-2)-associated cytokines. Serum levels of IL-33 have been reported to be up-regulated in various T-helper (Th)-1/Th-17-mediated diseases, such as psoriasis, rheumatoid arthritis, and inflammatory bowel. To investigate whether cytokine imbalance plays a role in the pathogenesis of vitiligo, we performed a case-control association study by enzyme-linked immunosorbent assay of IL-33 in our patients. IL-33 serum levels were measured by a quantitative enzyme immunoassay technique in patients with non-segmental generalized vitiligo and compared with those of healthy controls. IL-33 serum levels in patients with vitiligo were significantly increased than those in healthy controls. There was a positive correlation of IL-33 serum levels with extension of vitiligo and disease activity. This study suggests a possible systemic role of IL-33 in the pathogenesis of vitiligo. Inhibiting IL-33 activity might be a novel therapeutic strategy in the treatment of autoimmune inflammatory disease, like vitiligo.
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Affiliation(s)
- Mario Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Francesca Cicero
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmen Mannucci
- Department of Biomedical, Dental Sciences, and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Gioacchino Calapai
- Department of Biomedical, Dental Sciences, and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanna Spatari
- Department of Biomedical, Dental Sciences, and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Olga Barbuzza
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Serafinella P Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Zhou J, Ling J, Song J, Wang Y, Feng B, Ping F. Interleukin 10 protects primary melanocyte by activation of Stat-3 and PI3K/Akt/NF-κB signaling pathways. Cytokine 2016; 83:275-281. [PMID: 27186967 DOI: 10.1016/j.cyto.2016.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/25/2016] [Accepted: 05/11/2016] [Indexed: 01/16/2023]
Abstract
Vitiligo is a common melanocytopenic disorder of the skin, with acquired focal depigmentation. Normal human skin relies on melanocytes to provide photoprotection and thermoregulation by producing melanin. Interleukin 10 (IL-10) is a pleiotropic immunoregulatory cytokine drawing more and more researchers' attention. The present study was conducted to investigate the effects of IL-10 on melanocytes and elucidate the underlying mechanisms. We proved that IL-10 play no role in regulating melanogenesis of normal human foreskin-derived epidermal melanocytes (NHEM). IL-10 stimulation activated the JAK/Stat-3 and PI3K/Akt signaling pathways. Moreover, IL-10 treatment increased translocation of p65 NF-κB into the nuclear compartment, and up-regulated expression of the pro-survival proteins Bcl-2 and Bcl-xL. IL-10 restored anti-apoptotic proteins expression and suppressed cytochrome c release in H2O2-induced apoptosis. In conclusion, IL-10 may provide pro-survival cues to melanocytes and be applied in the treatment of vitiligo and other depigmenting disorders.
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Affiliation(s)
- Jia Zhou
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, PR China
| | - Jingjing Ling
- Department of Pharmacy, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, PR China
| | - Jing Song
- Laboratory Animal Center, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Yong Wang
- Department of Urological Surgical, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, PR China
| | - Bainian Feng
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, PR China
| | - Fengfeng Ping
- Department of Clinical Laboratory Science, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, PR China.
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Efficacy and Safety of 308-nm Monochromatic Excimer Lamp Versus Other Phototherapy Devices for Vitiligo: A Systematic Review with Meta-Analysis. Am J Clin Dermatol 2016; 17:23-32. [PMID: 26520641 DOI: 10.1007/s40257-015-0164-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method. OBJECTIVE We aimed to systematically review and meta-analyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo. METHODS A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy. RESULTS The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50% repigmentation [risk ratio (RR) = 0.97, 95% confidence interval (CI) 0.84-1.11] and ≥75% repigmentation (RR = 0.96, 95% CI 0.71-1.30). Likewise, no study found significant differences between excimer lamps and NB-UVB (RR = 1.14, 95% CI 0.88-1.48 for ≥50% repigmentation; RR = 1.81, 95% CI 0.11-29.52 for ≥75% repigmentation). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment. CONCLUSIONS To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo. Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. Safety, effectiveness, and cost are considerations when choosing treatment. PROSPERO REGISTRATION NUMBER CRD42014015237.
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Follicular vitiligo: A report of 8 cases. J Am Acad Dermatol 2016; 74:1178-84. [PMID: 26830867 DOI: 10.1016/j.jaad.2015.12.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/14/2015] [Accepted: 12/30/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Follicular vitiligo, a recently proposed new subtype of vitiligo, has primary involvement of the hair follicle melanocytic reservoir. OBJECTIVE We sought to characterize follicular vitiligo through a case series of 8 patients. METHODS Patients with features of follicular vitiligo who were seen at the vitiligo clinic in the National Center for Rare Skin Disorders in Bordeaux, France, were recruited. A retrospective review of case records and clinical photographs was carried out. RESULTS There were 8 male patients with a mean age of 48 years. All patients reported significant whitening of their body and, in some, scalp hairs before cutaneous depigmentation. Examination revealed classic generalized depigmented lesions of vitiligo and an impressive presence of leukotrichia, not only in the vitiliginous areas, but also in areas with clinically normal-appearing skin. Punch biopsy specimen of the leukotrichia and vitiligo lesions demonstrated loss of melanocytes and precursors in the basal epidermis and hair follicle. LIMITATIONS This was a cross-sectional study based on a single-center experience. CONCLUSION Follicular vitiligo is a distinct entity within the spectrum of vitiligo. This entity may serve as the missing link between alopecia areata and vitiligo, with probable physiopathological similarities between these conditions.
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Lotti T, Hercogova J, Fabrizi G. Advances in the treatment options for vitiligo: activated low-dose cytokines-based therapy. Expert Opin Pharmacother 2015; 16:2485-96. [DOI: 10.1517/14656566.2015.1087508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.
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Barygina V, Becatti M, Lotti T, Moretti S, Taddei N, Fiorillo C. Treatment with low-dose cytokines reduces oxidative-mediated injury in perilesional keratinocytes from vitiligo skin. J Dermatol Sci 2015; 79:163-70. [DOI: 10.1016/j.jdermsci.2015.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/11/2015] [Indexed: 01/08/2023]
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Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am 2014; 37:625-51. [PMID: 25455069 DOI: 10.1016/j.psc.2014.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin.
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Affiliation(s)
- Edgardo Rodriguez-Vallecillo
- Private Practice, 29 Washington Street, Suite 507, San Juan, PR 00907, USA; Dermatology, HIMA San Pablo Hospital, Sta. Cruz Street, Bayamon, PR 00961, USA.
| | - Michel A Woodbury-Fariña
- Department of Psychiatry, University of Puerto Rico School of Medicine, 307 Calle Eleonor Roosevelt, San Juan, PR 00918-2720, USA
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Wang X, McCoy J, Lotti T, Goren A. Topical cream delivers NB-UVB from sunlight for the treatment of vitiligo. Expert Opin Pharmacother 2014; 15:2623-7. [DOI: 10.1517/14656566.2014.978287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lotti T, Zanardelli M, D’Erme AM. Vitiligo: what’s new in the psycho-neuro-endocrine-immune connection and related treatments. Wien Med Wochenschr 2014; 164:278-85. [DOI: 10.1007/s10354-014-0288-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 01/09/2023]
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