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Khan AS, Badar Q, Siddiqui K, Hanif S, Lakhan H. Reverse Koebner Phenomenon in a Vitiligo Patient Treated With Radiotherapy. Cureus 2024; 16:e60771. [PMID: 38903331 PMCID: PMC11188008 DOI: 10.7759/cureus.60771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Radiation-induced hypopigmentation resulting in a skin condition similar to vitiligo is evident in limited studies. In contrast to the typical Koebner phenomenon where new lesions develop at the site of injury, the trauma-induced disappearance of a specific rash in a patient with an already-developed skin disease is seen very rarely. This phenomenon is called "reverse Koebnerization" or "Koebner non-reaction." Herein, we submit a case of a 51-year-old female with already-developed vitiligo who came for treatment for carcinoma of the tongue with radiation therapy. Later, after the treatment, the patient developed a re-pigmentation of her skin.
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Affiliation(s)
- Asma S Khan
- Department of Radiation Oncology, Dr. Ziauddin Hospital, Karachi, PAK
| | - Quratulain Badar
- Department of Radiation Oncology, Dr. Ziauddin Hospital, Karachi, PAK
| | - Kaynat Siddiqui
- Department of Radiation Oncology, Dr. Ziauddin Hospital, Karachi, PAK
| | - Shoaib Hanif
- Department of Radiation Oncology, Dr. Ziauddin Hospital, Karachi, PAK
| | - Hafeez Lakhan
- Department of Radiation Oncology, Dr. Ziauddin Hospital, Karachi, PAK
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George EA, Nwankwo C, Castelo-Soccio L, Oboite M. Disorders in Children. Dermatol Clin 2023; 41:491-507. [PMID: 37236717 DOI: 10.1016/j.det.2023.02.014] [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] [Indexed: 05/28/2023]
Abstract
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
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Affiliation(s)
| | - Christy Nwankwo
- University of Missouri, Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michelle Oboite
- University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Farajzadeh S, Khalili M, Mirmohammadkhani M, Paknazar F, Rastegarnasab F, Abtahi-Naeini B. Global clinicoepidemiological pattern of childhood vitiligo: a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001839. [PMID: 37616066 PMCID: PMC10083860 DOI: 10.1136/bmjpo-2022-001839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/05/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Childhood vitiligo differs from adult vitiligo in many aspects. To the best of the authors' knowledge, there is no systematic review of different clinicoepidemiological patterns of vitiligo in children. This study aimed to review the characteristics of vitiligo among the paediatric population. METHODS In June 2022, a comprehensive search was conducted using MeSh-based keywords on online databases including PubMed, Scopus and Web of Sciences. The papers were assessed, and the eligible articles were selected. The selection of articles followed three distinct steps. The extracted clinicoepidemiological data were then imported into the STATA software for meta-analysis. RESULTS The meta-analysis of 17 studies with 4365 subjects yielded 2475 women (estimated=56.8%, 95% CI 54.45 to 59.22). The female-to-male ratio was determined to be 1.3:1. Meta-regression demonstrated a significant relationship between continents and gender (p=0.03). The most prevalent types of non-segmental vitiligo were vulgaris (42.49%), focal (27.21%) and acrofacial (17.8%). The pooled ratio of non-segmental to segmental was 4.6:1. The highest and lowest ratios were found in Africa with one study (estimated=11.56%, 95% CI -0.98 to 24.10) and America with two studies (estimated=3.02%, 95% CI 1.54 to 4.50), respectively. Using meta-regression, the relationship between continents and vitiligo type was found to be insignificant (p=0.47). Positive family history was recorded in 657 patients (estimated = 16.88%, 95% CI 13.37 to 20.39). Positive family history varied by country of study from 13.91% (Asia with 11 studies) to 27.01% (Europe with two studies) (p=0.11). Kobner phenomena and leukotrichia were noted in 687 (25.47%) and 461 (18.52%) patients, respectively. CONCLUSION The review indicated that childhood vitiligo is more prevalent in women. Non-segmental forms of childhood vitiligo were the most common, including vulgaris, focal and acrofacial. The clinicoepidemiological pattern of childhood vitiligo is variable in different geographic areas.
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Affiliation(s)
- Saeedeh Farajzadeh
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Loganathan E, Raju S, Kaur S. Management of childhood vitiligo − a brief review. PIGMENT INTERNATIONAL 2022. [DOI: 10.4103/pigmentinternational.pigmentinternational_66_21] [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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Khaitan BK, Sindhuja T. Autoimmunity in vitiligo: Therapeutic implications and opportunities. Autoimmun Rev 2021; 21:102932. [PMID: 34506987 DOI: 10.1016/j.autrev.2021.102932] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 12/13/2022]
Abstract
Vitiligo is an acquired chronic pigmentary disorder affecting the melanocytes, mainly in the skin and mucosae. It occurs due to the dynamic interaction between genetic and environmental factors leading to autoimmune destruction of melanocytes. Defects in melanocyte adhesion and increased oxidative stress further augment the immune response in vitiligo. It is a cosmetically disfiguring condition with a substantial psychological burden. Its autoimmune nature with resultant chronicity, variable responses to therapeutic modalities, and frequent recurrences have further diminished the quality of life. Hence, treatment should aim to provide more extended remission periods, prevent recurrences, provide good cosmetic outcomes and ensure patient satisfaction. These treatment goals seem plausible with the recent progress in our understanding of the complex pathogenic mechanisms underlying vitiligo at a molecular and genetic level. We provide a literature review of the pathogenic mechanisms and the therapies targeting these mechanisms.
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Affiliation(s)
- Binod K Khaitan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
| | - Tekumalla Sindhuja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Veronesi G, Virdi A, Leuzzi M, Gurioli C, Chessa MA, Guglielmo A, Neri I. Vulvar vitiligo and lichen sclerosus in children: A clinical challenge. Pediatr Dermatol 2021; 38:1012-1019. [PMID: 34561885 DOI: 10.1111/pde.14771] [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] [Indexed: 11/29/2022]
Abstract
Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS), both feature skin and mucosal hypo-/depigmentation. The aim of this study was to describe the clinical and dermoscopic features of VV and VLS in the pediatric population, providing diagnostic clues, and to define their association. We performed a systematic literature review of the clinical and dermoscopic features of pediatric VV and VLS. An observational study was conducted on children affected by VLS associated with VV, referred to the Dermatology Unit of the Sant'Orsola Polyclinic in Bologna, Italy. Medical history, age at diagnosis, ethnicity, clinical and dermoscopic features, and symptoms were recorded for all patients. 124 cases of VLS and 10 cases of VV were reviewed. Clinical manifestations included hypo-/depigmented patches in both conditions, while ecchymosis/purpura and fissures/erosion were observed in VLS. Symptoms including pruritus, pain, or burning were reported only by VLS patients. In our study five patients with VLS associated with VV were retrieved. Clinical features included well-demarcated depigmented patches in VV and translucent areas, erythema, ecchymoses/purpura, and labial fusion in VLS. Dermoscopy showed white structureless areas with a whipped cream-like appearance, linear or dotted vessels, white chrysalis-like structures, erosion and red-purpuric blotches in VLS and reduced pigment network or pigment absence, intralesional spots of residual pigmentation and telangiectasias in VV. Symptoms were present in all patients. Both VV and VLS show hypo-/depigmented patches. In the presence of associated symptoms, possible VLS should be investigated with clinical and dermoscopic examination to achieve a prompt diagnosis.
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Affiliation(s)
- Giulia Veronesi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalucia Virdi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Miriam Leuzzi
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Gurioli
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Adriano Chessa
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alba Guglielmo
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology - IRCSS Azienda Ospedaliero Universitaria di Bologna, Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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7
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Ma J, Cheng L, Wu YY, Cai XY, Liang B, Xiao FL. A retrospective analysis of 925 cases of segmental vitiligo in a Chinese Han population. J Eur Acad Dermatol Venereol 2021; 35:e379-e381. [PMID: 33539593 DOI: 10.1111/jdv.17150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Affiliation(s)
- J Ma
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - L Cheng
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Y-Y Wu
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - X-Y Cai
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - B Liang
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - F-L Xiao
- Department of Dermatology of First Affiliated Hospital, Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,The Center for Scientific Research of Anhui Medical University, Hefei, China
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8
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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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9
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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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10
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Lei TC, Hearing VJ. Deciphering skin re-pigmentation patterns in vitiligo: an update on the cellular and molecular events involved. Chin Med J (Engl) 2020; 133:1231-1238. [PMID: 32433056 PMCID: PMC7249724 DOI: 10.1097/cm9.0000000000000794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Indexed: 11/26/2022] Open
Abstract
Current treatment of vitiligo is still a great challenge, since most cases of vitiligo have variable re-pigmentation outcomes due to their unpredictable responses to existing therapeutic regimens. There is an urgent need to identify this re-pigmentation process and to develop novel therapies. This review illustrates the most current research and latest understanding of vitiligo skin re-pigmentation and related regulatory mechanisms. Literature was collected from PubMed until January 2020, using the search terms including "vitiligo," "re-pigmentation," "phototherapy," "narrow-band ultraviolet B, " "excimer," "fractional carbon dioxide laser," and "melanocyte stem cells." Literature was mainly derived from English articles. Article type was not limited. Emerging evidence suggests that patients with vitiligo present various re-pigmentation patterns following ultraviolet B phototherapy, which relies on different cell reservoirs from the perilesional margins and/or from uninvolved hair follicles to replenish functional melanocytes that are lost in vitiliginous skin. The following events are likely to be involved in this re-pigmentation process, including: 1) changes in the paracrine secretion and distribution of transforming growth factor-β1 in the bulge area and in the epidermis; 2) the enhanced transfer of dermal pro-melanogenic growth factors to the epidermis; and 3) the induction of a C-X-C motif chemokine ligand (CXCL) 12-enriched micro-environment that efficiently recruits CXCR4- or CXCR7-positive melanocytes. Ongoing studies on the cellular and molecular events underlying vitiligo re-pigmentation will help design new therapeutic strategies to improve treatment outcomes.
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Affiliation(s)
- Tie-Chi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
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11
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Blanc J, Bodak N, Saada V, Zavaro A, Bagot M, Petit A, Bourrat E. [Polymorphism and differential diagnosis of neonatal lupus erythematosus]. Ann Dermatol Venereol 2020; 147:258-264. [PMID: 32171550 DOI: 10.1016/j.annder.2019.09.613] [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: 04/02/2019] [Revised: 06/25/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Neonatal lupus erythematosus (NEL) is a rare condition secondary to transplacental transfer of maternal anti-nuclear antibodies, generally anti-Ro/SSA. The most common signs are dermatological and cardiac. The most frequently reported clinical association is periorbital erythema, known as "owl eye", and bipolar erythematous maculopapular plaques with fine scales. However, many semiological variants can result in diagnostic errors or delays. PATIENTS AND METHODS This was a single-centre retrospective observational study collating all cases of NEL seen at paediatric dermatology consultations between 2010 and 2018. The diagnosis of NEL was confirmed by the presence of specific antinuclear antibodies (ANA) in the mother. The aim was to describe the different clinical forms of NEL and to discuss differential diagnosis. RESULTS AND DISCUSSION We identified ten cases of NEL, all addressed without diagnosis or with misdiagnosis. They were divided into 3 groups based on the semiology of skin lesions: 5 presented inflammatory macular papules on the cephalic extremity and head; 3 presented acquired periorbital depigmentation; 2 presented atrophic and diffuse livedoid lesions. None had heart disease and associated haematological and hepatic damage was mild. Spontaneous remission was seen in all cases before the age of 6 months. The mothers, who were generally symptom-free or paucisymptomatic, presented anti-Ro/SSA NAAs. CONCLUSION Recognition of the different clinical forms of NEL enables early institution of suitable therapy and monitoring of subsequent pregnancies.
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Affiliation(s)
- J Blanc
- Service de dermatologie, hôpital Robert-Debré, 75019 Paris, France.
| | - N Bodak
- Service de dermatologie, hôpital Trousseau, 75012 Paris, France
| | - V Saada
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - A Zavaro
- Cabinet médical, 94170 Le-Perreux-sur-Marne, France
| | - M Bagot
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital St Louis, 75010 Paris, France
| | - E Bourrat
- Service de dermatologie, hôpital Robert-Debré, 75019 Paris, France
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12
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Mathew LB, Gopinath H, Karthikeyan K. Spontaneously regressing acral congenital leucoderma. Australas J Dermatol 2019; 60:e351-e352. [PMID: 30982951 DOI: 10.1111/ajd.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lavanya Baby Mathew
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
| | - Hima Gopinath
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
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13
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Ullah F, Schwartz RA. Nevus depigmentosus: review of a mark of distinction. Int J Dermatol 2019; 58:1366-1370. [DOI: 10.1111/ijd.14393] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/28/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Forhad Ullah
- Dermatology, Pediatric Medicine, and Pathology, Rutgers New Jersey Medical School Newark NJ USA
| | - Robert A. Schwartz
- Dermatology, Pediatric Medicine, and Pathology, Rutgers New Jersey Medical School Newark NJ USA
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Boniface K, Seneschal J, Picardo M, Taïeb A. Vitiligo: Focus on Clinical Aspects, Immunopathogenesis, and Therapy. Clin Rev Allergy Immunol 2018; 54:52-67. [PMID: 28685247 DOI: 10.1007/s12016-017-8622-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vitiligo is an acquired chronic depigmenting disorder of the skin, with an estimated prevalence of 0.5% of the general population, characterized by the development of white macules resulting from a loss of epidermal melanocytes. The nomenclature has been revised after an extensive international work within the vitiligo global issues consensus conference, and vitiligo (formerly non-segmental vitiligo) is now a consensus umbrella term for all forms of generalized vitiligo. Two other subsets of vitiligo are segmental vitiligo and unclassified/undetermined vitiligo, which corresponds to focal disease and rare variants. A series of hypopigmented disorders may masquerade as vitiligo, and some of them need to be ruled out by specific procedures including a skin biopsy. Multiple mechanisms are involved in melanocyte disappearance, namely genetic predisposition, environmental triggers, metabolic abnormalities, impaired renewal, and altered inflammatory and immune responses. The auto-immune/inflammatory theory is the leading hypothesis because (1) vitiligo is often associated with autoimmune diseases; (2) most vitiligo susceptibility loci identified through genome-wide association studies encode immunomodulatory proteins; and (3) prominent immune cell infiltrates are found in the perilesional margin of actively depigmenting skin. However, other studies support melanocyte intrinsic abnormalities with poor adaptation of melanocytes to stressors leading to melanocyte instability in the basal layer, and release of danger signals important for the activation of the immune system. Recent progress in the understanding of immune pathomechanisms opens interesting perspectives for innovative treatment strategies. The proof of concept in humans of targeting of the IFNγ /Th1 pathway is much awaited. The interplay between oxidative stress and altered immune responses suggests that additional strategies aiming at limiting type I interferon activation pathway as background stabilizing therapies could be an interesting approach in vitiligo. This review covers classification and clinical aspects, pathophysiology with emphasis on immunopathogenesis, and promising therapeutic approaches.
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Affiliation(s)
- Katia Boniface
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France
| | - Julien Seneschal
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France.,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France
| | | | - Alain Taïeb
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France. .,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France. .,Department of Dermatology and Pediatric Dermatology, St André Hospital, Bordeaux University Hospitals, 1 Rue Jean Burguet, 33075, Bordeaux, France.
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Terziroli Beretta-Piccoli B, Invernizzi P, Gershwin ME, Mainetti C. Skin Manifestations Associated with Autoimmune Liver Diseases: a Systematic Review. Clin Rev Allergy Immunol 2017; 53:394-412. [DOI: 10.1007/s12016-017-8649-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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