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Molla A, Alayoubi AM, Jannadi R. First Cousin Marriages and the Risk of Childhood-Onset Vitiligo: Exploring the Genetic Background: A Cross-Sectional Study. Clin Cosmet Investig Dermatol 2024; 17:1471-1479. [PMID: 38919171 PMCID: PMC11198003 DOI: 10.2147/ccid.s470937] [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: 03/27/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
Background Vitiligo, a condition characterized by depigmented skin, has been observed to have a higher incidence in patients with a family history of the disease. This study investigates the relationship between parental consanguinity, family medical history, and the onset of childhood vitiligo, hypothesizing that genetic factors play a significant role. Methods A cross-sectional study was conducted involving 382 people diagnosed with vitiligo in Saudi Arabia. The study assessed the prevalence of parental consanguinity and its correlation with the disease's onset, employing statistical analysis to evaluate the data collected through medical records and family history questionnaires. Results The findings reveal a significant association between parental consanguinity, particularly among first cousins, and the incidence of childhood-onset vitiligo. Additionally, a notable correlation was found between family medical history and the onset of the condition, with familial vitiligo being more prevalent in patients with adult-onset vitiligo. Conclusion This study underscores the critical role of genetic predispositions in the development of childhood-onset vitiligo, highlighting the influence of parental consanguinity. The results advocate for increased awareness and screening in populations with high rates of consanguinity to facilitate early detection and management of vitiligo. Future research should focus on exploring the genetic mechanisms underlying this association to develop targeted interventions.
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Affiliation(s)
- Amr Molla
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Abdulfatah M Alayoubi
- Department of Basic Medical Sciences, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Raed Jannadi
- Department of Family & Community Medicine &, Medical Education, College of Medicine, Taibah University, Madinah, Saudi Arabia
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Renert-Yuval Y, Ezzedine K, Grimes P, Rosmarin D, Eichenfield LF, Castelo-Soccio L, Huang V, Desai SR, Walsh S, Silverberg JI, Paller AS, Rodrigues M, Weingarten M, Narla S, Gardner J, Siegel M, Ibad S, Silverberg NB. Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients. JAMA Dermatol 2024; 160:453-461. [PMID: 38477910 DOI: 10.1001/jamadermatol.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Importance Evidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed. Objective To develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients. Evidence Review A process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale. Findings Articles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream-used off-label for patients younger than 12 years and limited to nonsegmental vitiligo-were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources. Conclusions and Relevance Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.
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Affiliation(s)
- Yael Renert-Yuval
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khaled Ezzedine
- Hôpital Henri Mondor, Department of Dermatology and Université Paris Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics, Créteil, France
| | - Pearl Grimes
- Departments of Dermatology, University of California, Los Angeles
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis
| | - Lawrence F Eichenfield
- Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego
- Pediatrics and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland
| | - Victor Huang
- Department of Dermatology, University of California, Davis
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
- Innovative Dermatology, Plano, Texas
| | | | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michele Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Weingarten
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shanthi Narla
- Department of Dermatology, St Luke's University Health Network, Easton, Pennsylvania
| | | | - Michael Siegel
- Pediatric Dermatology Research Alliance, Portland, Oregon
| | - Sidra Ibad
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nanette B Silverberg
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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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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Dai J, Hight RS, Grullon K, Xiao TL, Stein SL. Vitiligo-like manifestations of graft-versus-host disease in a pediatric population. Pediatr Dermatol 2023; 40:157-161. [PMID: 36063124 DOI: 10.1111/pde.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
Vitiligo-like changes are an uncommon cutaneous manifestation of graft-versus-host disease (GVHD). We report three cases and review the literature of pediatric patients with vitiligo-like changes associated with GVHD. Improved characterization of this phenomenon may lend insight into the biologic pathways that underlie both vitiligo and GVHD.
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Affiliation(s)
- Julia Dai
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert S Hight
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Karina Grullon
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Teresa L Xiao
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.,Department of Pediatrics, University of Chicago Medical Center, Chicago, Illinois, USA
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5
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Sink JR, Silverberg NB. Genital vitiligo in children: Factors associated with generalized, non-segmental vitiligo. Pediatr Dermatol 2020; 37:64-68. [PMID: 31682011 DOI: 10.1111/pde.13998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES It remains uncertain as to whether genital vitiligo of childhood is segmental or a forme fruste of non-segmental disease. This type of vitiligo is sometimes termed figure-of-eight disease due to female predominance and perineal and perianal hypopigmentation or depigmentation around two orifices, the anal and vaginal introitus. The objective of this series was to categorize the features of genital-limited vitiligo of childhood including comorbidities, family history, and long-term course. METHODS IRB-approved retrospective chart review of vitiligo cases. RESULTS Eight cases of vitiligo that began in childhood in the genital area were identified, including clinical course and comorbidities. Involvement of the contiguous skin, including inner thighs, buttocks, and scrotum, was noted in all males. In females, only 1 patient had other sites of vitiligo, which was a solitary lesion on the chest. Therapeutic response to topical corticosteroids for perianal skin was seen in five of six children and topical calcineurin inhibitors with or without calcipotriene in four out of four patients. CONCLUSIONS Segmental disease limited to the genitalia was more common in females than males, suggesting that perhaps intervention and work-up for comorbid autoimmune diseases may be required for males with genital-limited vitiligo at onset, but may be deferred in females and added if observation of spread is noted. Differentiation from lichen sclerosus et atrophicus may require biopsy.
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Affiliation(s)
- Jacquelyn R Sink
- Department of Dermatology, New York Medical College-Metropolitan Hospital, New York, New York
| | - Nanette B Silverberg
- Departments of Pediatrics and Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Martins CPDS, Hertz A, Luzio P, Paludo P, Azulay-Abulafia L. Clinical and epidemiological characteristics of childhood vitiligo: a study of 701 patients from Brazil. Int J Dermatol 2019; 59:236-244. [PMID: 31544238 DOI: 10.1111/ijd.14645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/21/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo is an acquired pigmentary disorder that affects approximately 0.5-2% of the world's population, and 25% of cases begin before 10 years of age. Although prevalent, there are few studies on the characterization of childhood vitiligo. OBJECTIVE To evaluate the clinical and epidemiological characteristics of childhood vitiligo. METHODS Transverse study conducted by reviewing data records of patients under the age of 18 in which disease onset occurred before 13 years of age. RESULTS Predominance of females (62%). The most common subtype was generalized vitiligo (53.8%). The average age of disease onset was 5.9 years. The most affected initial site was head/neck (44.22%). The Koebner phenomenon was present in 38.2%, emotional triggering factors in 67.0% of the patients, halo nevus in 17.4%, and associated autoimmune disease in 6.5% of the patients. Family history of vitiligo was observed in 16.9% of the patients, and stability was reported by 20.1% of patients. The presence of positive family history did not significantly influence the age of onset. We found a significant difference between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) regarding the age of onset, Koebner phenomenon, hypothyroidism, anti-TPO antibodies, family history of psoriasis, and halo nevus. CONCLUSION Childhood vitiligo has its own characteristics. Vitiligo different subtypes have distinct characteristics. Our study presents a great number of patients, helping to elucidate the peculiarities of childhood vitiligo in the Brazilian population.
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Affiliation(s)
| | - Amanda Hertz
- Professor Rubem David Azulay Institute of Dermatology, Vitiligo Clinic, Rio de Janeiro, Brazil
| | - Paulo Luzio
- Professor Rubem David Azulay Institute of Dermatology, Vitiligo Clinic, Rio de Janeiro, Brazil
| | - Patricia Paludo
- Professor Rubem David Azulay Institute of Dermatology, Vitiligo Clinic, Rio de Janeiro, Brazil
| | - Luna Azulay-Abulafia
- Professor Rubem David Azulay Institute of Dermatology, Vitiligo Clinic, Rio de Janeiro, Brazil
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7
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Lee HH, Gwillim E, Patel KR, Hua T, Rastogi S, Ibler E, Silverberg JI. Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis. J Am Acad Dermatol 2019; 82:675-682. [PMID: 31437543 DOI: 10.1016/j.jaad.2019.08.032] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/02/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a common autoimmune alopecia with heterogeneous severity and distribution. Previous studies found conflicting results about AA epidemiology. OBJECTIVE To determine the prevalence, incidence, and predictors of AA, alopecia totalis, alopecia ophiasis, and alopecia universalis. METHODS A systematic review of all published cohort and cross-sectional studies that analyzed AA and its subtypes. MEDLINE, Embase, LILACS, Scopus, Cochrane Library, and GREAT were searched. At least 2 reviewers performed study title/abstract review and data extraction. Random-effects meta-analysis was used because of significant heterogeneity (I2 = 99.97%). RESULTS Ninety-four studies met the inclusion criteria. The pooled prevalence (95% confidence interval, N) of AA overall was 2.11% (1.82-2.42, N = 302,157,365), with differences of population-based (0.75% [0.49-1.06%], N = 301,173,403) and clinic-based (3.47% [3.01-3.96], N = 983,962) studies. The prevalences of alopecia totalis, ophiasis, and universalis were 0.08% (0.04-0.13, N = 1,088,149), 0.02% (0.00-0.06, N = 1,075,203), and 0.03% (0.01-0.06, N = 1,085,444), respectively. AA prevalence (95% confidence interval) increased over time (<2000: 1.02% [0.85-1.22]; 2000-2009: 1.76% [1.51-2.03]; >2009: 3.22% [2.59-3.92]; P < .0001) and differed by region. AA prevalence was significantly lower in adults (1.47% [1.18-1.80]) than children (1.92% [1.31-2.65]; P < .0001). CONCLUSIONS AA affects 2% of the global population. AA prevalence is lower in adults than children, is increasing over time, and significantly differs by region.
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Affiliation(s)
- Harrison H Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eran Gwillim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin R Patel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tammy Hua
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Supriya Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin Ibler
- Department of Dermatology, University of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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Abstract
Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.
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Affiliation(s)
- Electra Nicolaidou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Styliani Mastraftsi
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece.
| | - Vassiliki Tzanetakou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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9
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Khurrum H, AlGhamdi KM. Prepubertal and postpubertal vitiligo: a multivariate comparative study in 375 patients. An Bras Dermatol 2018; 92:811-815. [PMID: 29364437 PMCID: PMC5786395 DOI: 10.1590/abd1806-4841.20176154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022] Open
Abstract
Background The onset of vitiligo during childhood is common. Limited data exist that
compare the clinical associations of prepubertal and postpubertal vitiligo
in Arabs. Objective To compare the clinical profile of pre and postpubertal onset vitiligo. Methods A cross-sectional observational study was conducted. The Vitiligo European
Task Force questionnaire was completed for each patient. Results A total of 375 patients were included; 199 had postpubertal vitiligo (>12
years), and 176 had prepubertal onset vitiligo (<12years). There were
more females in the prepubertal group (49%) than in the postpubertal group
(29%), p-value <0.001. The prepubertal group has had more involvement
than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental
vitiligo were observed; five were observed in the prepubertal group of
patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus
(OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9)
were positively associated with prepubertal vitiligo. Stress, as an onset
factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with
postpubertal onset vitiligo. Study limitations A possible selection bias toward more severe vitiligo cases can be a
limitation, because the study was conducted in a clinic specialized in
vitiligo. Moreover, a likelihood of false recall bias cannot be
excluded. Conclusions Our data present clinical evidence that vitiligo behaves mostly the same way
in the prepubertal group as in the postpubertal group. However, female
over-representation, more face involvement and more halo nevi were observed
in prepubertal vitiligo, while stress was more prevalent as an aggravating
factor in postpubertal vitiligo patients.
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Affiliation(s)
- Huma Khurrum
- Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M AlGhamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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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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11
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Gianfaldoni S, Wollina U, Tchernev G, Lotti J, França K, Lotti T. Vitiligo in Children: A Review of Conventional Treatments. Open Access Maced J Med Sci 2018; 6:213-217. [PMID: 29484026 PMCID: PMC5816302 DOI: 10.3889/oamjms.2018.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/17/2017] [Accepted: 11/08/2017] [Indexed: 11/05/2022] Open
Abstract
Vitiligo is an important skin disease of childhood, which may lead to deep psychological trauma, resulting in a poor quality of life and low self-esteem. The Authors discuss a short review of the more conventional therapies available for the treatment of vitiligo in children.
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Affiliation(s)
| | - Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria
| | - Jacopo Lotti
- University G. Marconi of Rome - Dept. of Nuclear, Subnuclear and Radiation Physics, Rome, Italy
| | - Katlein França
- University of Miami School of Medicine Ringgold standard institution, Miami, Florida, United States and Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy
| | - Torello Lotti
- University G. Marconi of Rome, Dermatology and Venereology, Rome, Italy
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13
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Abstract
Childhood vitiligo differs from adult-onset vitiligo for several features including increased incidence of the segmental variant, higher prevalence of halo nevi, and more common family history for autoimmune diseases and atopic diathesis. The major differential diagnoses are the postinflammatory hypomelanoses for nonsegmental vitiligo and nevus depigmentosus for segmental vitiligo. From a therapeutic standpoint, early awareness of the diagnosis seems to correlate with a good treatment outcome in this age group.
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Solak B, Dikicier BS, Cosansu NC, Erdem T. Effects of age of onset on disease characteristics in non-segmental vitiligo. Int J Dermatol 2017; 56:341-345. [PMID: 28054375 DOI: 10.1111/ijd.13425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/10/2016] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Abstract
In patients with vitiligo, the clinical and laboratory features of the disease may vary according to time of onset. This is addressed in the literature by only a few studies with conflicting results. The aim of this study was to determine the demographic and clinical features of patients with non-segmental vitiligo and to establish the association between vitiligo and autoimmune diseases with a focus on time of disease onset. A total of 224 vitiligo patients for whom complete medical records were available were evaluated retrospectively. Demographic data, scores on the Vitiligo Area Score Index (VASI), clinical features, vitiligo disease activity, repigmentation status, presence of any accompanying autoimmune disease, antinuclear antibody (ANA) titers, serum levels of glucose, thyroid-stimulating hormone (TSH), thyroxine (T4) hormone, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-TG) were recorded. The prevalence of halo nevi was significantly higher (P < 0.001) among children than in other patient groups. The prevalence of leukotrichia was higher in adults with adult-onset disease than in either pediatric patients or adults with childhood-onset disease (P = 0.002). Both anti-TG and anti-TPO levels were significantly higher in adults with adult-onset disease than in pediatric patients and adult patients with childhood-onset disease. The prevalence of autoimmune disease was 22.2%. Anti-TG levels were significantly higher in patients with treatment-related repigmentation than in those without repigmentation. This study shows that clinical features and associations with autoimmune disease may vary according to the age of onset of vitiligo.
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Affiliation(s)
- Berna Solak
- Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Bahar Sevimli Dikicier
- Department of Dermatology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Nur C Cosansu
- Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Teoman Erdem
- Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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de Menezes AF, Oliveira de Carvalho F, Barreto RSS, de Santana Silva B, Shanmugam S, Gurgel RQ, de Souza Araújo AA. Pharmacologic Treatment of Vitiligo in Children and Adolescents: A Systematic Review. Pediatr Dermatol 2017; 34:13-24. [PMID: 27878842 DOI: 10.1111/pde.13024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The true pathogenic mechanism of vitiligo is still unknown. About half of the patients with this disease have onset before the age of 20 years, making it a serious dermatologic disorder in childhood. OBJECTIVES The objective of this study was to review the literature in a systematic way and identify the main pharmacologic treatments and outcomes in children and adolescents with vitiligo. METHODS Four databases-the National Library of Medicine (MEDLINE-PubMed), Web of Science, Scopus, and Latin American and Caribbean Health Sciences (LILACS)-were used for the search up to January 2015. All electronic search titles, selected abstracts and full-text articles were independently reviewed by a minimum of two reviewers. RESULTS There were 15 articles from 13 different countries: 3 were retrospective and 12 were prospective; the number of participants in the studies varied between 9 and 400, ages ranged from 0 to 18 years, and the duration of disease ranged from 1 to 17 years. The most commonly used drugs were tacrolimus alone (or combined with clobetasol), pimecrolimus, corticosteroids, and calcipotriol. Treatment duration ranged from 10 days to 6 months with a topical route of administration. CONCLUSIONS The main outcome measurements were morphometric analysis performed using a computer program, hematologic or biochemical change, and photography (predominant). It is unclear which was the most effective treatment for vitiligo, however, it was found that these therapies are all promising in the treatment of the disease. With proper care, disease control and repigmentation, even if partial, can be achieved.
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Affiliation(s)
| | | | - Rosana S S Barreto
- Núcleo de Pós-Graduação em Medicina, Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil
| | - Bruno de Santana Silva
- Núcleo de Pós-Graduação em Medicina, Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil
| | - Saravanan Shanmugam
- Núcleo de Pós-Graduação em Medicina, Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil
| | - Ricardo Queiroz Gurgel
- Núcleo de Pós-Graduação em Medicina, Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil
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Cohen BE, Mu EW, Orlow SJ. Comparison of Childhood Vitiligo Presenting with or without Associated Halo Nevi. Pediatr Dermatol 2016; 33:44-8. [PMID: 26573093 DOI: 10.1111/pde.12717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have characterized differences in vitiligo associated with halo nevi, but the features of vitiligo presenting with halo nevus in children have yet to be fully described. AIMS We sought to provide an epidemiologic and clinical comparison of cases of childhood vitiligo presenting with or without associated halo nevi. MATERIALS AND METHODS This was a retrospective chart review of children diagnosed with vitiligo in an academic pediatric dermatology practice from January 1990 to November 2014. The characteristics of children with vitiligo with or without associated halo nevi were compared. RESULTS Halo nevi were identified in 55 (26%) of 208 children with vitiligo. Patients with halo nevi were significantly more likely to be male and develop vitiligo at a later age. Children with vitiligo associated with halo nevi were more likely to present with generalized vitiligo, defined according to the presence of bilateral macules. DISCUSSION There was no significant association between groups in the percentage of body surface area with vitiligo or family history of vitiligo or autoimmune diseases. Patients with halo nevi were no more likely to develop new areas of vitiligo during the follow-up period, but there was a nonsignificant trend toward a higher rate of repigmentation in vitiligo associated with halo nevus. CONCLUSION Halo nevi are a common finding in children with vitiligo. The presence of a halo nevus in a child with vitiligo is associated with generalized vitiligo. The presence of a halo nevus does not significantly alter the risk of disease progression and rate of treatment.
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Affiliation(s)
- Brandon E Cohen
- Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York
| | - Euphemia W Mu
- Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York
| | - Seth J Orlow
- Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York
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Mu EW, Cohen BE, Orlow SJ. Early-onset childhood vitiligo is associated with a more extensive and progressive course. J Am Acad Dermatol 2015; 73:467-70. [DOI: 10.1016/j.jaad.2015.05.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/26/2022]
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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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Abstract
Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1%. The disorder can be psychologically devastating and stigmatising, especially in dark skinned individuals. Vitiligo is clinically characterised by the development of white macules due to the loss of functioning melanocytes in the skin or hair, or both. Two forms of the disease are well recognised: segmental and non-segmental vitiligo (the commonest form). To distinguish between these two forms is of prime importance because therapeutic options and prognosis are quite different. The importance of early treatment and understanding of the profound psychosocial effect of vitiligo will be emphasised throughout this Seminar.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Hôpital Pellegrin, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale. U1035, University of Bordeaux, Bordeaux, France.
| | | | - Maxine Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Abstract
Vitiligo is an acquired depigmenting disorder that affects 0.5% to 2% of the world population. Three different forms are classified according to the distribution of lesions; namely non-segmental, segmental and mixed vitiligo. Vitiligo is associated with polymorphisms in genes involved in the immune response and in melanogenesis. However, environmental factors are required for the development of manifest disease. In general, the diagnosis is clinical and no laboratory tests or biopsies are required. Metabolic alterations are central to current concepts in pathophysiology. They induce an increased generation of reactive oxygen species and susceptibility to mild exogenous stimuli in the epidermis. This produces a senescent phenotype of skin cells, leads to the release of innate immune molecules, which trigger autoimmunity, and ultimately causes dysfunction and death of melanocytes. Clinical management aims to halt depigmentation, and to either repigment or depigment the skin, depending on the extent of disease. New therapeutic approaches include stimulation of melanocyte differentiation and proliferation through α-melanocyte-stimulating hormone analogues and through epidermal stem cell engineering. Several questions remain unsolved, including the connection between melanocyte depletion and stem cell exhaustion, the underlying degenerative mechanisms and the biological mediators of cell death. Overall, vitiligo is an excellent model for studying degenerative and autoimmune processes and for testing novel approaches in regenerative medicine. For an illustrated summary of this Primer, visit: http://go.nature.com/vIhFSC.
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Affiliation(s)
- Mauro Picardo
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Maria L Dell'Anna
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Khaled Ezzedine
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
| | - Iltefat Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital Detroit, Michigan, USA
| | - John E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | - Alain Taieb
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
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23
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Zhang Y, Mooneyan-Ramchurn JS, Zuo N, Feng Y, Xiao S. Vitiligo nonsurgical treatment: a review of latest treatment researches. Dermatol Ther 2014; 27:298-303. [PMID: 25041437 DOI: 10.1111/dth.12143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yanfei Zhang
- Department of Dermatology, The Second Affiliated Hospital, College of Medicine; Xi'an Jiaotong University; Xi'an Shaanxi Province China
| | | | - Nan Zuo
- Department of Dermatology, The Second Affiliated Hospital, College of Medicine; Xi'an Jiaotong University; Xi'an Shaanxi Province China
| | - Yiguo Feng
- Department of Dermatology, The Second Affiliated Hospital, College of Medicine; Xi'an Jiaotong University; Xi'an Shaanxi Province China
| | - Shengxiang Xiao
- Department of Dermatology, The Second Affiliated Hospital, College of Medicine; Xi'an Jiaotong University; Xi'an Shaanxi Province China
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Abstract
Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue, Suite 11D, New York, NY 10025, USA.
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Ruiz-Argüelles A, García-Carrasco M, Jimenez-Brito G, Sánchez-Sosa S, Pérez-Romano B, Garcés-Eisele J, Camacho-Alarcón C, Reyes-Núñez V, Sandoval-Cruz M, Mendoza-Pinto C, López-Colombo A. Treatment of vitiligo with a chimeric monoclonal antibody to CD20: a pilot study. Clin Exp Immunol 2013; 174:229-36. [PMID: 23815517 PMCID: PMC3828826 DOI: 10.1111/cei.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/14/2022] Open
Abstract
Five patients with active disseminated vitiligo were given 1g of a chimeric (murine/human) monoclonal antibody to CD20 in a single intravenous infusion and followed-up for 6 months. Three of the patients showed an overt clinical and histological improvement of the disease, one presented slight improvement and the remaining patient showed no changes. Improvement was neither associated with changes in laboratory parameters nor to a specific human leucocyte antigen D-related (HLA-DR) phenotype. We believe that these preliminary results are encouraging, and further clinical trials should be undertaken. An important aim should be the finding of a marker with a good response to this therapeutic approach.
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Affiliation(s)
- A Ruiz-Argüelles
- Laboratorios Clínicos de Puebla, Puebla, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
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26
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de Barros JC, Filho CDSM, Abreu LC, de Barros JA, Paschoal FM, Nomura MT, Marques E, Martins LC. A study of clinical profiles of vitiligo in different ages: an analysis of 669 outpatients. Int J Dermatol 2013; 53:842-8. [DOI: 10.1111/ijd.12055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 07/16/2012] [Accepted: 10/14/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Luiz Carlosde Abreu
- Departamento de Dermatologia; Faculdade de medicina do ABC; Santo André São Paulo Brasil
| | | | | | - Mariliza Tiemi Nomura
- Departamento de Dermatologia; Faculdade de medicina do ABC; Santo André São Paulo Brasil
| | - Elaine Marques
- Departamento de Dermatologia; Faculdade de medicina do ABC; Santo André São Paulo Brasil
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27
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Sanchez-Sosa S, Aguirre-Lombardo M, Jimenez-Brito G, Ruiz-Argüelles A. Immunophenotypic characterization of lymphoid cell infiltrates in vitiligo. Clin Exp Immunol 2013; 173:179-83. [PMID: 23607858 PMCID: PMC3722918 DOI: 10.1111/cei.12096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/26/2022] Open
Abstract
The pathogenesis of vitiligo is still controversial. The purpose of this study was to gain insight into the nature of lymphoid cells infiltrating depigmented areas of skin in vitiligo. Immunochemical procedures were carried out in biopsies from 20 patients with active lesions to search for cells expressing CD1a, CD2, CD3, CD4, CD5, CD8, CD20, CD25, CD30, CD56, CD68 and CD79a. Results indicate that early lesions are infiltrated mainly by dendritic cells, whereas older lesions display significantly lower proportions of these cells and increased percentages of mature T cells. This finding might suggest that the autoimmune reactivity towards melanocyte antigens might be T cell-dependent and antigen-driven. It is possible that a non-immune offence of melanocytes is responsible for the exposure of intracellular antigens, while autoreactivity might be a secondary, self-perpetuating mechanism.
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Affiliation(s)
- S Sanchez-Sosa
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
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Kanwar AJ, Mahajan R, Parsad D. Effect of Age at Onset on Disease Characteristics in Vitiligo. J Cutan Med Surg 2013; 17:253-8. [DOI: 10.2310/7750.2013.12075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Vitiligo is a multifactorial disease in which genetic, immunologic, and environmental factors play an important part. Late-onset vitiligo is a poorly defined entity. Materials and Methods: Case records of patients who attended the pigmentary clinic at our institute from January 2001 to December 2010 were reviewed. Patients with a diagnosis of vitiligo were analyzed with respect to their demographic characteristics with special reference to their age at onset. Results: Patients with disease onset after 30 years had a significantly higher association with precipitating factors such as trauma, stress, and drugs in comparison with early-onset vitiligo ( p < .004). However, the difference did not reach statistical significance when these factors were analyzed individually. There was a significantly higher association with other nonautoimmune diseases ( p = .05), a higher incidence of positive family history ( p < .0001), and a higher association with leukotrichia ( p < .002) in late-onset disease. Early-onset nonsegmental vitiligo was associated with a higher incidence of photosensitivity and pruritus compared to early-onset segmental vitiligo. Conclusion: Late-onset vitiligo has certain distinguishing features compared to early-onset vitiligo.
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Affiliation(s)
- Amrinder J. Kanwar
- From the Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- From the Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- From the Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agarwal S, Gupta S, Ojha A, Sinha R. Childhood vitiligo: clinicoepidemiologic profile of 268 children from the Kumaun region of Uttarakhand, India. Pediatr Dermatol 2013; 30:348-53. [PMID: 23278409 DOI: 10.1111/pde.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Childhood vitiligo differs from adult vitiligo in many clinical parameters. The objective of the current study was to study the clinicoepidemiologic profile of childhood vitiligo and to compare various clinical characteristics of childhood- and later-onset vitiligo. The clinical presentation of vitiligo was examined and analyzed in 762 individuals attending the Dermatology Clinic of Government Medical College, Haldwani, a referral center for the Kumaun region of Uttarakhand state, India, between January 2006 and December 2010. Of the 762 individuals with vitiligo, 268 (35.2%) were children: 152 (56.7%) female and 116 (43.3%) male. The mean age of onset of vitiligo was 6.9 years. A family history of vitiligo was found in 24.3% of children. The most common site of onset was the head and neck (36.9%), followed by the lower limbs and trunk. The most common type of vitiligo observed was acrofacial vitiligo (38.1%), followed by vulgaris, segmental, focal, and mucosal. Leukotrichia was observed in 32.5% of children and Koebner's phenomenon in 24.3%. On comparison of childhood- and later-onset vitiligo, there were statistically significant differences (p < 0.05) in sex, family history, type of vitiligo (segmental and vulgaris), and site of onset. Atopic dermatitis was one of the important cutaneous diseases associated with childhood-onset vitiligo. Thirty-five percent of all patients with vitiligo were children (≤12 yrs). Childhood-onset vitilgo differs from later-onset vitiligo in many clinical parameters such as sex, family history, types of vitiligo, and sites of onset.
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Affiliation(s)
- Saurabh Agarwal
- Department of Skin and Venereal Diseases, Government Medical College, Haldwani (Nainital), Uttarakhand, India.
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Ezzedine K, Diallo A, Léauté-Labrèze C, Seneschal J, Boniface K, Cario-André M, Prey S, Ballanger F, Boralevi F, Jouary T, Mossalayi D, Taieb A. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br J Dermatol 2013; 167:490-5. [PMID: 22512840 DOI: 10.1111/j.1365-2133.2012.11002.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Limited epidemiological data exist that compare clinical features of pre- and post-pubertal nonsegmental vitiligo. OBJECTIVES To compare factors associated with pre- and post-pubertal onset vitiligo. PATIENTS AND METHODS A prospective observational study was conducted of patients with vitiligo attending the clinic between 1 January 2006 and 1 July 2011. The Vitiligo European Task Force questionnaire was completed for each patient and thyroid function and antithyroid antibodies were screened. Other forms of vitiligo (segmental, focal, mucosal, not classifiable) were excluded. RESULTS A total of 679 patients were included; 422 had post-pubertal and 257 pre-pubertal onset of vitiligo. Vitiligo universalis was seen only in post-pubertal onset. In univariate analysis, there was no significant statistical difference for sex, Koebner phenomenon or disease activity between both groups; thyroid disease or presence of thyroid antibodies was more frequent in post-pubertal onset [odds ratio (OR) 0·31, P < 0·003] whereas atopic dermatitis was more often associated with or preceding pre-pubertal onset (OR 2·42, P = 0·006). In multivariate analysis, halo naevi, family history of vitiligo, premature hair greying, atopic dermatitis and previous episode of spontaneous repigmentation were independently associated with pre-pubertal onset. In contrast, stress as onset factor, personal history of thyroid disease and acrofacial type were associated with post-pubertal onset. CONCLUSIONS Pre-pubertal onset vitiligo is strongly associated with personal and family history of atopy, suggesting that the predisposing immune background in vitiligo is not limited to autoimmunity, as also noted in alopecia areata. This study also suggests reconsidering the epidemiological data on sex ratio in vitiligo.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology, and National Centre for Rare Skin Disorders, CHU St-André, 1 rue Jean Burguet, Hôpital Pellegrin, 33075 Bordeaux, France.
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Li Y, Xu A. Segmental vitiligo in children: a clinical epidemiologic study in China. J Eur Acad Dermatol Venereol 2012; 27:1056-7. [PMID: 23176033 DOI: 10.1111/jdv.12003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Esfandiarpour I, Farajzadeh S. Clinical characteristics of late-onset vitiligo in an Iranian population. DERMATOL SIN 2012. [DOI: 10.1016/j.dsi.2012.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nicolaidou E, Antoniou C, Miniati A, Lagogianni E, Matekovits A, Stratigos A, Katsambas A. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol 2012; 66:954-8. [DOI: 10.1016/j.jaad.2011.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/08/2011] [Accepted: 07/17/2011] [Indexed: 11/30/2022]
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Ezzedine K, Diallo A, Léauté-Labrèze C, Mossalayi D, Gauthier Y, Bouchtnei S, Cario-André M, Seneschal J, Boralevi F, Jouary T, Taieb A. Multivariate analysis of factors associated with early-onset segmental and nonsegmental vitiligo: a prospective observational study of 213 patients. Br J Dermatol 2011; 165:44-9. [DOI: 10.1111/j.1365-2133.2011.10311.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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35
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Ezzedine K, Gauthier Y, Léauté-Labrèze C, Marquez S, Bouchtnei S, Jouary T, Taieb A. Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): a retrospective case series of 19 patients. J Am Acad Dermatol 2011; 65:965-71. [PMID: 21616559 DOI: 10.1016/j.jaad.2010.08.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/30/2010] [Accepted: 08/30/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mixed vitiligo (MV), the association of segmental vitiligo (SV) and nonsegmental vitiligo, has been rarely reported. OBJECTIVE The aim of this study was to delineate the clinical spectrum of MV through a case series of patients with typical SV associated with patchy bilateral vitiligo. METHODS This was a cross-sectional evaluation in the setting of a prospective observational study conducted in the vitiligo clinic of the department of dermatology in Bordeaux, France. RESULTS Nineteen patients with MV were identified. Four were male and 15 were female. Most patients had an onset of SV before the age of 18 years (18 of 19). In all patients, SV preceded nonsegmental vitiligo with a delay ranging from 6 months to more than 24 months. LIMITATIONS This study was cross-sectional and based on a single-center experience. CONCLUSION MV is not yet part of a conventional classification. However, this entity may have been neglected until now and should be included in the classification of vitiligo in addition to SV and nonsegmental vitiligo. Moreover, MV may be essential to the understanding of the pathogenesis of vitiligo as a primary skin disorder.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and National Centre for Rare Skin Disorders, CHU St-André, Bordeaux, France.
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Uncu S, Yaylı S, Bahadır S, Okten A, Alpay K. Relevance of autoimmune thyroiditis in children and adolescents with vitiligo. Int J Dermatol 2011; 50:175-9. [PMID: 21244381 DOI: 10.1111/j.1365-4632.2010.04665.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitiligo is the most common pigmentation-related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. METHODS Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid-stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. RESULTS The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris-type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. CONCLUSIONS Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris-type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.
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Affiliation(s)
- Sibel Uncu
- Department of Dermatology, Karadeniz Technical University, Trabzon, Turkey
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Akay BN, Bozkir M, Anadolu Y, Gullu S. Epidemiology of vitiligo, associated autoimmune diseases and audiological abnormalities: Ankara study of 80 patients in Turkey. J Eur Acad Dermatol Venereol 2011; 24:1144-50. [PMID: 20202047 DOI: 10.1111/j.1468-3083.2010.03605.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent clinical studies suggest that the pathogenetic mechanisms of vitiligo could be of systemic origin as vitiligo is associated with auditory abnormalities as well as other autoimmune disorders. OBJECTIVES To investigate clinical, genetic characteristics and laboratory findings of vitiligo as well as auditory abnormalities and the association of the disease with the other autoimmune disorders. MATERIALS AND METHODS From January to December 2008, we collected-data from 80 vitiligo patients to establish the clinical and epidemiological profile of vitiligo in Turkey. RESULTS Thirty patients were men and 50 were women, with a mean age of 37 years and a mean onset age of 10 years. Vitiligo vulgaris was the most common type, followed by focal, acrofacial, segmental and universal types. Forty-four (55%) patients had an associated autoimmune disease. These associated diseases were Hashimoto thyroiditis in 25, alopecia areata in 10, pernicious anaemia in seven and diabetes mellitus in two patients. Statistically significant changes in human leukocyte antigen in patients with vitiligo were HLA A24,-30, B63, CW6, DR15, DR51, DQ5,-6. Auditory problems were observed in 37.7% patients. Nine of the 20 patients showed unilateral minimal hearing loss (>30 dB), while the other 11 demonstrated bilateral hearing loss (>30 dB) over a large range of frequencies (2000-8000 Hz). CONCLUSION Our study demonstrates that vitiligo is a part of systemic autoimmune process. Audiological examination should be performed in all patients for auditory problems which are commonly presented as hypoacusis.
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Affiliation(s)
- B N Akay
- Department of Dermatology, University of Ankara School of Medicine, Ankara, Turkey.
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Hu JJ, Xu AE, Wu XG, Sun XC, Luo XY. Small-sized lesions of childhood vitiligo treated by autologous epidermal grafting. J DERMATOL TREAT 2011; 23:219-23. [DOI: 10.3109/09546634.2010.543122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Al-Jabri MM, Al-Raddadi A. Childhood vitiligo: A retrospective hospital based study, Jeddah, Saudi Arabia. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jssdds.2010.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cho SB, Kim JH, Cho S, Park JM, Park YK, Oh SH. Vitiligo in children and adolescents: association with thyroid dysfunction. J Eur Acad Dermatol Venereol 2010; 25:64-7. [DOI: 10.1111/j.1468-3083.2010.03694.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ammour A, Jouary T, Taïeb A, Mazereeuw-Hautier J. Le vitiligo de l’enfant. Ann Dermatol Venereol 2010; 137:654-8; quiz 653. [DOI: 10.1016/j.annder.2010.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
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Patel N, O'Haver J, Hansen RC. Vitiligo therapy in children: a case for considering excimer laser treatment. Clin Pediatr (Phila) 2010; 49:823-9. [PMID: 20308196 DOI: 10.1177/0009922810363169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nirav Patel
- University of Arizona College of Medicine, Phoenix, AZ, USA.
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Abstract
Vitiligo is a common depigmenting disorder affecting about 1-2% of the world population. Approximately half of the affected individuals develop the disease before adulthood. Etiologic hypotheses for vitiligo include biochemical, neural and autoimmune mechanisms. The most compelling of these suggests a combination of genetic and immunologic factors that result in an autoimmune melanocyte destruction. We reviewed studies carried out on various treatment modalities used in childhood vitiligo. Topical corticosteroids were found to have excellent repigmentation rates, whereas calcineurin inhibitors have comparable efficacy and a better safety profile compared with topical corticosteroids. These two groups of topical medications are good first-line treatment modalities for localized vitiligo. For the treatment of generalized vitiligo, phototherapy has excellent efficacy. Narrow-band ultraviolet B (UVB) has better overall repigmentation rates and safety profile than either topical or oral psoralens and ultraviolet A (PUVA). Other treatment modalities may be considered depending on a patient's specific condition, such as surgical options and depigmentation. With adequate sun protection, the option of no treatment with or without corrective camouflage, is an innocuous alternative to any of these treatment modalities.
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Abstract
PURPOSE OF REVIEW This review addresses recent changes in the understanding and the treatment of vitiligo vulgaris. RECENT FINDINGS Two target genes for vitiligo have been identified, NACHT-leucine-rich-repeat protein-1 (NALP1), part of the inflammasome cascade, and tyrosinase, the enzyme that produces melanin. Identification of reactive oxidation species has furthered the understanding of melanocyte destruction. Comorbid autoimmune disease, including thyroid autoimmunity seen in 25%, is genetically linked to generalized vitiligo and is noted in both childhood vitiligo patients and their families. Screening for vitamin deficiencies and concurrent autoimmunity can be beneficial to the overall health of the child with vitiligo. About half of all vitiligo vulgaris patients have onset of their illness during childhood, causing increased psychological stress during the formative years. Fortunately, therapy has improved as well, with the development of newer topical agents for vitiligo, including topical calcineurin inhibitors; new topical combinations such as topical corticosteroids and calcipotriene; and new technological advances including narrowband ultraviolet B and excimer laser. SUMMARY A cyclic approach to therapy should be used wherein topical agents are altered every 6-8 months and technology is used as an alternative after achievement of maximal topical response. With cyclic therapy and early disease intervention, good cosmetic outcomes may be achievable, particularly in localized cases.
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Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol 2010; 62:945-9. [PMID: 20466172 DOI: 10.1016/j.jaad.2009.06.081] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vitiligo often starts in childhood. It is traditionally divided into segmental vitiligo and nonsegmental vitiligo. There are limited data regarding the clinical characteristics of both forms and no comparative study has been performed. OBJECTIVE To compare the clinical features of nonsegmental and segmental vitiligo in children. PATIENTS AND METHODS We performed a prospective observational study. Consecutive children with vitiligo seen between October 2005 and December 2007 in the 11 French Departments of Pediatric Dermatology were included. A standardized evaluation was completed after total body clinical examination. A second examination was performed 1 year after inclusion. The clinical characteristics of segmental vitiligo and nonsegmental vitiligo were compared. RESULTS A total of 114 children with vitiligo were included. Compared with segmental vitiligo, nonsegmental vitiligo was associated with a higher number of lesions (more than 5 patches in 65.17% vs 20% of patients, P < .0001) and a larger body surface area of involvement (9.8% +/- 2.51% vs 3.48% +/- 1.6%, P +/- .01). A higher incidence of the Koebner phenomenon (47.19% vs 24%, P = .03), and more frequent progression of the disease (23.29% vs 5.56%, P = .043) were found in nonsegmental vitiligo. Hyperpigmented rims surrounding patches of vitiligo were only seen in nonsegmental vitiligo (8.99% vs 0% (P = .007). Sixty-four children (56%) had laboratory investigations performed; thyroid abnormalities were found only in nonsegmental vitiligo (11.23% vs 0%, P = .0001). LIMITATIONS Not all patients underwent laboratory investigations. CONCLUSIONS Segmental and nonsegmental types of vitiligo have distinguishing clinical characteristics.
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Choi S, Kim DY, Whang SH, Lee JH, Hann SK, Shin YJ. Quality of life and psychological adaptation of Korean adolescents with vitiligo. J Eur Acad Dermatol Venereol 2010; 24:524-9. [DOI: 10.1111/j.1468-3083.2009.03452.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee KJ, Lee JH, Lee DY. Successful treatment of vitiligo in a 6-year-old child by topical anaesthesia and epidermal grafting. J Eur Acad Dermatol Venereol 2009; 23:859-60. [DOI: 10.1111/j.1468-3083.2008.03068.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Arin L Isenstein
- Department of Dermatology, University of North Carolina, Chapel Hill 27599-7287, USA.
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Farajzadeh S, Daraei Z, Esfandiarpour I, Hosseini SH. The efficacy of pimecrolimus 1% cream combined with microdermabrasion in the treatment of nonsegmental childhood vitiligo: a randomized placebo-controlled study. Pediatr Dermatol 2009; 26:286-91. [PMID: 19706089 DOI: 10.1111/j.1525-1470.2009.00926.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently, topical immunomodulators have been successfully used in monotherapy or in combination with other therapeutic modalities in vitiligo. To determine whether combination pimecrolimus 1% cream and microdermabrasion enhances response time and repigmentation rate in children with vitiligo. Sixty-five children diagnosed with vitiligo enrolled in this randomized placebo-controlled study. Three vitiliginous patches were chosen in each patient. The first lesion was treated by pimecrolimus 1% cream. On the second lesion after doing microdermabrasion on day 1, pimecrolimus 1% cream was applied. On the third lesion placebo was applied. The course of treatment was 10 days. Vitiliginous patches were measured at baseline, day 10, and months 1, 2, and 3. Sixty patients completed the 3-month study period. Clinical response (pigmentation >50%) was observed in 60.4% of the patches treated by combined pimecrolimus plus microdermabrasion at the third month of follow-up, compared with 32.1% and 1.7% for pimecrolimus alone and placebo, respectively (p = 0.000). No significant side effect was observed. Microdermabrasion exerts an additive effect in enhancing the rate and degree of repigmentation by pimecrolimus. This new combined approach appears to be safe and effective in childhood vitiligo.
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Taïeb A, Morice-Picard F, Jouary T, Ezzedine K, Cario-André M, Gauthier Y. Segmental vitiligo as the possible expression of cutaneous somatic mosaicism: implications for common non-segmental vitiligo. Pigment Cell Melanoma Res 2008; 21:646-52. [DOI: 10.1111/j.1755-148x.2008.00511.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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