Recent investigations on vitiligo vulgaris

Evaluation of the association between platelet tests and thyroid stimulating hormone levels in patients with vitiligo

OBJECTIVE

Vitiligo is a common dermatological disease of unknown cause and progressing with depigmentation and affects approximately 1% of the world population. In the study, we aimed to compare plateletcrit (PCT), mean platelet volume (MPV), platelet (PLT), and thyroid-stimulating hormone (TSH) values in vitiligo patients.

MATERIAL AND METHODS

We retrospectively evaluated the medical data of 100 patients who were admitted to the dermatology outpatient clinic between January 2020 and December 2021 with a diagnosis of vitiligo. The control group was retrospectively constituted from medical records of 190 healthy individuals. PCT, MPV, PLT, and TSH levels of both groups were compared statistically.

RESULTS

A total of 190 participants (100 vitiligo patients and 90 healthy volunteers) were included in the study. The mean age of the patient group was 38.62±1.62, while the mean age of the control group was 41.52±1.54. There were no differences between the two groups in terms of age and gender. It was found that the mean MPV value in the patient group was lower than the control group (p=0.00). PLT and PCT values were significantly higher in the patient group than the control group (p=0.00, p=0.01, respectively). There was no statistically significant difference between the two groups in terms of TSH (p>0.05). A negative correlation between MPV and PLT values in the patient group (r=-0.218, p=0.029), and a negative correlation between MPV and TSH (r=-0.218, p=0.029). -0.230, p=0.021).

CONCLUSION

In the study, a comparison of the PCT, MPV, and PLT levels showed a difference between both groups, but no differences in TSH levels. To clarify these results, comprehensive studies with more samples are needed.

Comparative study between excimer light and topical antioxidant versus excimer light alone for treatment of vitiligo

BACKGROUND

Vitiligo is an acquired idiopathic cutaneous disease characterized by pearly white patches of variable shapes and sizes. Various medical and surgical therapeutic options have been proposed to achieve repigmentation; phototherapy is one of the most efficient options. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy.

AIM OF THE WORK

To compare the efficacy of combined topical antioxidant hydrogel and excimer light versus excimer light alone in treating vitiligo.

PATIENTS AND METHODS

Thirty patients were included in this comparative, prospective, randomized study. For each patient, at least 2-4 vitiliginous macules were randomly selected and treated while an untreated vitiliginous macule served as control. Lesions were divided into two groups: Group A received combination therapy of daily topical antioxidant plus excimer light, while Group B received only excimer light. Lesions were treated twice a week for a maximum of 24 sessions. Initial fluencies were adjusted individually according to the minimal erythema dose in vitiliginous skin. Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians.

RESULTS

Group A lesions showed significant efficacy than group B (p < 0.001), specially on treating UV-sensitive lesions with no side effects.

CONCLUSION

Topical antioxidant and excimer light represents a valuable, effective therapy for localized vitiligo.

Anti-thyroid peroxidase antibody in vitiligo: a prevalence study

Aim. The aim of the study was to study the relation of vitiligo with demographic data like age, sex, and duration and determine the prevalence of thyroid autoimmunity in vitiligo patients. Materials and Methods. This study was a cross sectional study consisting of 100 patients clinically diagnosed (old and new) as having vitiligo irrespective of age or sex. Patients with known thyroid disease on supplementation therapy, or who had undergone thyroid surgery, those on antithyroid medication, patients with other causes of leukoderma, and cases who do not provide informed consent were excluded from the study. Serum TSH and anti-TPO antibodies were measured in all the patients. Results. The prevalence of anti-TPO antibody positivity was found to be 28%. Conclusion. According to our study, none of our vitiligo patients had symptoms or signs of thyroid disease at the time of presentation but, on biochemical evaluation, anti-TPO antibodies were found in a considerable number of patients. Hence, we recommend screening of these patients with thyroid antibodies.

Portadores de vitiligo: estudo das emissões otoacústicas e efeito de supressão

Vitiligo é uma doença cutânea, caracterizada pela ausência da melanina, por destruição de melanócitos. OBJETIVO: Verificar a ocorrência de alteração auditiva em indivíduos com vitiligo. MÉTODO: Avaliação audiológica, pesquisa das emissões otoacústicas evocadas transientes e do efeito de supressão em estudo prospectivo de 24 pacientes com vitiligo. A faixa etária variou de 15 a 45 anos. RESULTADOS: 21 pacientes (87.5%) apresentaram audiometria normal; dois apresentaram perda auditiva unilateral em freqüências altas e um apresentou perda coclear de grau moderado à esquerda. Destes 21 sujeitos, 66,7% tiveram ausência de emissões, sugerindo disfunção coclear. As emissões estiveram presentes em todas as bandas de freqüência em apenas 7 pacientes (29,2%) e ausentes em 17 (70,8%), com maior ocorrência de falha no sexo masculino, na orelha direita. Na pesquisa da supressão, seis indivíduos falharam, todos do sexo feminino, sendo a orelha esquerda a mais afetada. CONCLUSÃO: Pela análise das emissões otoacústicas verificou-se que os portadores de vitiligo possuem maior predisposição à disfunção coclear, com maior ocorrência no sexo masculino na orelha direita. Quanto ao efeito de supressão, houve maior alteração no sistema eferente em mulheres, com maior ausência à esquerda. As alterações auditivas não diferiram quanto à idade, tipo de vitiligo e tempo de evolução da doença.

A study on otoacoustic emissions and supression effects in patients with vitiligo

Vitiligo is a skin disease characterized by absence of melanin due to melanocytes destruction.

AIM

to study the incidence of hearing alterations in patients with vitiligo.

METHOD

prospective audiological evaluation, transient-evoked otoacoustic emission recordings and study the effects of suppression in 24 patients with vitiligo. Their ages ranged from 15 to 45 years.

RESULTS

21 patients (87.5%) had normal audiometry; 2 had unilateral hearing loss in the high frequencies and 1 had cochlear moderate hearing loss in the left ear. Of these 21 subjects, 66.7% had no otoacoustic emissions, suggesting cochlear dysfunction. Only 7 patients had otoacoustic emissions present in all frequencies (29.2%) and 17 (70.8%) did not have them, and the highest rate of no otoacoustic emissions happened in the right ear of males. Regarding the suppression study, 6 subjects failed, all of them were females, and their left ears were the most affected.

CONCLUSION

the findings show that patients with vitiligo, particularly males, have a greater predisposition to cochlear dysfunction, especially in the right ear. As far as the suppression effect was concerned, there was a greater alteration in the female efferent system, particularly in the left ear. Hearing alterations did not vary as far as age is concerned, type of vitiligo and time of disease progression.

Topical tacrolimus therapy for vitiligo: therapeutic responses and skin messenger RNA expression of proinflammatory cytokines

BACKGROUND

Previous studies have documented humoral and cell-mediated immunologic defects in patients with vitiligo.

OBJECTIVE

This 24-week study assessed the efficacy and safety of tacrolimus 0.1% ointment in patients with generalized vitiligo as well as the pretreatment and post-treatment expression of cytokines in the depigmented and normal skin of patients compared with controls.

METHODS

Twenty-three patients were enrolled in this investigation, and 19 patients completed the study; 8 were male and 11 were female. Fifteen age-, race-, and sex-matched control subjects were also included. Patients were treated with tacrolimus 0.1% ointment applied twice daily. Repeat evaluations were performed at 4, 8, 12, 16, 20, and 24 weeks. Three-millimeter punch biopsy specimens were taken from the depigmented, non-sun-exposed skin and adjacent normal skin of patients at baseline and 24 weeks, and from normal, non-sun-exposed skin of controls. Cellular messenger RNA expression for interleukin 2 (IL-2), IL-4, IL-10, tumor necrosis factor alfa (TFN-alpha), and interferon gamma (IFN-gamma) were determined by real-time quantitative polymerase chain reaction.

RESULTS

At 24 weeks, 17 of 19 patients (89%) achieved varying levels of repigmentation. There was a statistically significant decrease in overall disease severity scores at 24 weeks. Thirteen patients (68%) had greater than 75% repigmentation of face and/or neck lesions. Signs and symptoms of irritation were minimal. At baseline, compared with healthy controls, vitiligo patients demonstrated a statistically significant increase in the expression of IFN-gamma in involved and adjacent uninvolved skin (P=.05 and P=.02, respectively); significantly increased TNF-alpha expression in involved and uninvolved skin (P=.01 and P=0.02, respectively); and significantly increased IL-10 expression in involved and uninvolved skin (P=.01 and P=.04, respectively). Posttreatment, TNF-alpha expression decreased in the depigmented and adjacent uninvolved skin (P <.001). There was no statistically significant change in IL-10 or IFN-gamma posttreatment. These data suggest that tacrolimus 0.1% ointment is a safe and effective therapy for patients with vitiligo. It further suggests that an imbalance in local cytokine expression may play a role in the pathogenesis of vitiligo. Suppression of TNF-alpha after topical tacrolimus application may be associated with repigmentation of vitiligo.

Autoimmune aspects of depigmentation in vitiligo

Autoimmune depigmentation of the skin, vitiligo, afflicts a considerable number of people, yet no effective therapeutic modalities have been developed to treat it. In part, this can be attributed to the obscure etiology of the disease, which has begun to reveal itself only recently. It is known that pigment is lost as a function of reduced melanocyte numbers in the epidermis, and that depigmentation is accompanied by T cell influx to the skin in the vast majority of patients. Characterizing such infiltrating T cells as type 1 proinflammatory cytokine-secreting cells reactive with melanocyte-specific antigen is a major step toward effective therapy. Melanoma research has shown that differentiation antigens, also expressed by normal melanocytes, can be immunogenic when expressed in the melanosomal compartment of the cell. Similar reactivity to melanosomal antigens is apparent for T cells infiltrating vitiligo skin. It may eventually be possible to treat patients with decoy antigens that anergize such Tcells, or to prevent recruitment of the T cells to the skin altogether. In this respect, it is important that T cells are recruited to the skin as a function of dendritic cell activation and that dendritic cells are likely activated at sites of epidermal trauma as a consequence of stress proteins that spill over into the microenvironment. Stress proteins chaperoning antigens representative of the cells from which they were derived are then processed by dendritic cells and contribute to their activation. Activated dendritic cells not only migrate to draining lymph nodes to recruit T cells but may execute cytotoxic effector functions as well. The contribution of the effector functions to actual depigmentation of the skin remains to be investigated.

Characteristics of genetic epidemiology and genetic models for vitiligo

BACKGROUND

Vitiligo occurs with a frequency of 0.1% to 2% in various populations and is classified into several subtypes by its clinical presentation. Although genetic factors are thought to be involved in the cause of vitiligo, the genetic models for different phenotypes of vitiligo are unknown.

OBJECTIVE

Our purpose was to explore potential genetic models for different phenotypes of vitiligo and analyze genetic epidemiologic characteristics of vitiligo in a Chinese population.

METHODS

Information from 2247 patients and members in their families was collected using a uniform questionnaire. Patients' clinical characteristics and their family history were analyzed using software. A complex segregation analysis was conducted to propose potential genetic models for vitiligo.

RESULTS

Different subtypes of vitiligo had different ages of disease onset. In relatives of patients with vitiligo, the risk of developing vitiligo increased with increasing relatedness to the patients with vitiligo. A polygenic additive model was the best model for focal vitiligo, vitiligo vulgaris, acrofacial vitiligo, and segmental vitiligo with approximately 50% heritability in each. For universal vitiligo, the best model was an environmental model.

CONCLUSION

This study indicated that different phenotypes of vitiligo had different pathogeneses and genetic backgrounds. Onset of vitiligo is possibly affected by both genetic backgrounds and common environmental factors.

Treatment of vitiligo by transplantation of cultured pure melanocyte suspension: analysis of 120 cases

BACKGROUND

Despite the availability of various medical treatments for vitiligo, a large percentage of patients fail to achieve satisfactory results. Surgical techniques offer a potential solution for patients with vitiligo who fail to respond to medical treatments.

OBJECTIVE

We evaluated the practicality in treating vitiligo by using cultured autologous pure melanocytes and investigated the different results among stable localized vitiligo, stable generalized vitiligo, and active generalized vitiligo.

METHODS

In all, 120 patients with vitiligo were treated with transplantation of autologous cultured pure melanocyte suspension after carbon-dioxide laser abrasion.

RESULTS

Patients with stable localized vitiligo experienced the highest percentage of excellent repigmentation with 84% achieving 90% to 100% coverage, followed by 54% of patients with stable generalized vitiligo, whereas only 14% of patients with active generalized vitiligo experienced good repigmentation. Age and sex of the patients, and size and location of the lesions, did not show significant influence on the results of transplantation.

CONCLUSION

Autologous cultured pure melanocyte suspension combined with carbon-dioxide laser abrasion is an effective treatment for patients with stable vitiligo who fail to respond to medical treatments, especially for those with stable localized vitiligo.

Vitiligo

O vitiligo é doença de pele de causa desconhecida que acomete cerca de 1% da população, comprometendo de modo semelhante homens e mulheres, preferencialmente entre 10 e 30 anos de idade. Alguns fatores precipitantes para essa doença são: estresse físico e emocional, traumas mecânicos e substâncias químicas, como derivados do fenol. Doenças auto-imunes, principalmente as tireoidianas, podem estar associadas ao vitiligo. Novas terapias têm sido propostas, como o uso de imunomoduladores tópicos, aliadas àquelas já consolidadas, como os psoralenos e os corticosteróides; o sucesso terapêutico, entretanto, está estritamente relacionado à qualidade da relação médico/paciente.

The efficacy of low-dose oral corticosteroids in the treatment of vitiligo patients

BACKGROUND

One of the most probable pathogeneses of vitiligo is autoimmunity. Systemic corticosteroids suppress immunity and may arrest the progression of vitiligo and lead to repigmentation. The clinical efficacy of low-dose oral corticosteroids was assessed to minimize the side-effects in actively spreading vitiligo patients.

METHODS

Eighty-one patients with vitiligo were evaluated. The patients took daily doses of oral prednisolone (0.3 mg/kg body weight) initially for 2 months; the dosage was then reduced to half of the initial dose for the third month and was halved again for the fourth and final month. The effects of treatment were evaluated using photographs of before and after the study. Side-effects were assessed at the first, second, third and fourth month of treatment.

RESULTS

Arrested progression of vitiligo and repigmentation were noted in 87.7% and 70.4% of patients respectively. Male sex, a patient age of 15 years or under, and a duration of disease of 2 years or less showed increased repigmentation with statistical significance. The side-effects of treatment were minimal and did not affect the course of treatment.

CONCLUSIONS

Low-dose oral corticosteroids are effective without serious side-effects in preventing the progression and inducing repigmentation of actively spreading vitiligo, which is difficult to treat with topical corticosteroids or photochemotherapy.

Calcipotriol in vitiligo: a preliminary study

A large variety of therapeutic agents have been tried for the treatment of vitiligo, but psoralens continue to be the main treatment. Twenty-one patients age 5 to 17 years with vitiligo were enrolled in this study. The children were advised to apply calcipotriol 50 microg/g in the evening and expose themselves to sunlight the next day for 10 to 15 minutes. The patients were followed at 3-week intervals. Initial repigmentation occurred in the majority of children after 6 to 12 weeks of treatment. Marked to complete repigmentation was seen in 10 of 18 patients. Four patients showed moderate improvement while the remaining four patients showed minimal or no improvement. No patient developed new lesions. The repigmentation was cosmetically excellent in the majority of children. All patients tolerated the calcipotriol well except for three patients who complained of mild irritation on application. All of the laboratory investigations, including serum calcium levels remained normal. The rationale for this study originated from recent advances in the understanding of vitiligo at the molecular level. Furthermore, development of hyperpigmentation in patients with psoriasis receiving treatment with PUVA and calcipotriol has been observed. Our results are encouraging and offer a new and potentially efficacious treatment for this pigmentation disorder in children.

Vogt-Koyanagi-Harada syndrome after cutaneous injury

OBJECTIVE

To describe three patients who developed Vogt-Koyanagi-Harada syndrome (VKH) after cutaneous injury.

DESIGN

Retrospective case series.

PARTICIPANTS

Three patients seen in the uveitis clinic at Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India, participated.

MAIN OUTCOME MEASURES

The history, evaluation, and management of the three patients were summarized.

RESULTS

Three patients developed VKH syndrome shortly after cutaneous injury. In each case, the affected area of skin became vitiliginous on healing and simultaneous with the onset of ocular symptoms. One patient developed additional ectopic areas of vitiligo. All three patients developed chronic, bilateral, diffuse uveitis, one associated with an exudative retinal detachment and two with Dalen-Fuchs-like nodules. Well-recognized complications of VKH syndrome that occurred in the authors' patients included geographic atrophy of the retinal pigment epithelium (3 of 3), cataract (3 of 3), and glaucoma (1 of 3). Ocular inflammation was well controlled in each patient with local or systemic corticosteroids or both. In one patient, the area of vitiligo showed increased pigmentation in response to systemic corticosteroid treatment.

CONCLUSIONS

Vogt-Koyanagi-Harada syndrome may follow cutaneous injury, supporting the notion that this disorder may result from systemic sensitization to shared melanocytic antigens.

Cultivation of human keratinocyte stem cells: current and future clinical applications

Cultured human keratinocytes have a wide spectrum of clinical applications. Clinical results reported by several investigators are, however, contradictory. In this review, the authors discuss the biological and surgical issues which play a key role in the clinical outcome of cultured epidermal autografts used for the treatment of massive full-thickness burns. The importance of cultivation of epidermal stem cells and of their transplantation onto a wound bed prepared with donor dermis is emphasised. The paper also reviews recent data showing that: (i) cultured epidermal autografts bearing melanocytes can be used for the treatment of stable vitiligo; (ii) keratinocytes isolated from other lining epithelia, such as oral, urethral and corneal epithelia, can be cultivated and grafted onto patients suffering from disabling epithelial defects; (iii) keratinocyte stem cells can be stably transduced with retroviral vectors and are therefore attractive targets for the gene therapy of genodermatoses.