Vitiligo and leukoderma in children

Nevus depigmentosus: the analysis of 37 cases

BACKGROUND

Nevus depigmentosus (ND) is an uncommon congenital nonprogressive hypopigmented skin disorder that can be seen anywhere on the body. We considered other depigmenting disorders and focused on distinguishing ND from vitiligo and tuberous sclerosis complex in infancy.

METHODS

The diagnosis of patients with nevus depigmentosus was made differentiating it from nevus anemicus, pityriasis alba, tuberous sclerosis complex, vitiligo and other depigmenting disorders.

RESULTS

Of the 37 individuals with nevus depigmentosus evaluated, 36 were children, twenty-two (59.4%) were males and 15 (40.5%) were females, with male to female ratio 1.4:1.

CONCLUSIONS

Distinguishing ND from other disorders with depigmentation can be challenging, in particular in case of tuberous sclerosis complex and vitiligo in infancy.

Acquired disorders with depigmentation: A systematic approach to vitiliginoid conditions

Acquired disorders with depigmentation are commonly encountered by dermatologists and present with a wide differential diagnosis. Vitiligo, the most common disorder of acquired depigmentation, is characterized by well-defined depigmented macules and patches. Other conditions, such as chemical leukoderma, can present with similar findings, and are often easily mistaken for vitiligo. Key clinical features can help differentiate between acquired disorders of depigmentation. The first article in this continuing medical education series focuses on conditions with a vitiligo-like phenotype. Early recognition and adequate treatment of these conditions is critical in providing appropriate prognostication and treatment.

Neural and Endocrinal Pathobiochemistry of Vitiligo: Comparative Study for a Hypothesized Mechanism

The etiology of vitiligo is still unclear. The aim is to investigate a neural and hormonal etio-pathology of vitiligo. Sixty acrofacial vitiligo patients were divided into two subgroups as active vitiligo patients group (AVPs; n = 35) and stable vitiligo patients group (SVP; n = 25). Forty healthy subjects without any systemic or dermatological disease were used as controls. Blood samples were collected, and the samples were used for measurement of free triiodothyronine (fT₃), free thyroxine (fT₄), thyroid-stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), cortisol, estrogen, testosterone, melatonin, and prolactin levels by ELISA, while norepinephrine (NE), epinephrine (Epi), dopamine (DA), homo-vanillic acid (HVA), serotonin, and 5-hydroxyindoleacetic acid (5-HIAA) by high-pressure liquid chromatography. The current results showed a significant increase in plasma levels of Epi, NE, DA, HVA, serotonin, 5-HIAA, melatonin, and in serum level of TSH and prolactin either in SVP or AVP groups than the control group and in AVP than SVP group. The serum levels of fT₃ and fT₄ were significantly decreased either in SVP or AVP groups than the control group. A significant increase in estradiol levels was observed in females within AVP than females in either SVP or control groups. There was a significant increase in serum level of cortisol in AVP than either SVP or control group. There was a significant decrease in serum level of ACTH in either AVP or SVP than control and in AVP than SVP group. In conclusion, there are some neural and endocrine markers that play a pivotal role in pathogenesis and/or consequences of vitiligo. The abnormally disturbed levels of theses markers lead to melanocyte destruction and/or depigmentation.

The Prevalence of Thyroid Disorders in Patients With Vitiligo: A Systematic Review and Meta-Analysis

Background: Associations between vitiligo and thyroid disorders have been suggested, However, the prevalence of thyroid disorders in vitiligo vary widely. Purpose: To conduct a systematic review and meta-analysis assessing the prevalence of thyroid disorders in patients with vitiligo. Method: The PubMed, Cochrane Library, EMBASE, CNKI (China National Knowledge Infrastructure), Chongqing VIP database, and Wanfang database from inception to August 2, 2018 were systematically searched. The pooled prevalence and its 95% confidence interval (CI) were calculated. Results: A total of 77 eligible studies were identified and included, published from 1968 to 2018. Six thyroid disorders including subclinical hyperthyroidism, overt hyperthyroidism, subclinical hypothyroidism, overt hypothyroidism, Graves disease, and Hashimoto thyroiditis were described. The numbers of relative studies were 54 in overt hypothyroidism, 50 in overt hyperthyroidism, 25 in subclinical hypothyroidism, 19 in Hashimoto thyroiditis, 16 in Graves disease, and 10 in subclinical hyperthyroidism. The highest prevalence was 0.06 (95% CI: 0.04-0.07) in subclinical hypothyroidism, and the lowest was 0.01 in subclinical hyperthyroidism (95% CI: 0.00-0.01) or Graves disease (95% CI: 0.01-0.02). Conclusion: Six thyroid disorders showed various prevalence in vitiligo. The highest prevalence was in subclinical hypothyroidism, and the lowest was in subclinical hyperthyroidism or Graves disease. Screening vitiligo patients for thyroid disorders seem plausible, in an effort to detect potential thyroid diseases or to assess the risk of future onset.

Pharmacologic Treatment of Vitiligo in Children and Adolescents: A Systematic Review

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.

[Leucoderma in children: Review of the literature]

BACKGROUND

Leucoderma is a frequent presenting complaint in children and it is sometimes difficult to make a definite diagnostic during the first consultation. The aim of this study is to analyse the diagnoses associated with leucoderma in children in order to propose a practical approach to their differential diagnosis.

MATERIAL AND METHODS

We performed a review of the literature using the keywords "leucoderma children review", "leucoderma Ito" and "nevus depigmentosus" in the Medline database. All relevant articles were included.

RESULTS

Four hundred and thirty-five articles were retrieved and 179 were analysed. A clinical approach was proposed in 6 articles and investigations in 15 articles.

DISCUSSION

Causal diagnosis of leucoderma may frequently be made on clinical grounds by determining the age of onset and distribution of lesions. Nevertheless, some situations require investigation. The literature is limited regarding clinical approaches and examinations in leucoderma. Herein, we present a systematic clinical and laboratory approach to the differential diagnosis of these skin disorders.

Oral manifestations of vitiligo

Background:

Vitiligo is one of the disorder that has social impact. Both skin and mucous membrane show depigmentation in vitiligo. Depigmentation in oral cavity can be more easily observed and the patient can be given awareness regarding the condition if they are unaware of vitiligo elsewhere in their body and can be guided for treatment.

Aim and objectives:

The aim of this study is to determine the frequency of occurrence of oral mucosal vitiligo in vitiligo patients and to determine the most commonly involved oral mucosal site.

Materials and methods:

The study sample included 100 vitiligo patients. The patients of all age groups and both genders were included. Vitiligo patients associated with systemic conditions such as thyroid disorders, juvenile diabetes mellitus, pernicious anemia, Addison's disease were excluded in this study.

Results:

Out of 100 vitiligo patients 44 % male and 56% were female. The oral presentation of vitiligo in this study showed depigmentation of buccal mucosa in 5% of patients, labial mucosa in 5% of patients, palate in 8% of patients, gingiva in 2% of patients and alveolar mucosa 1%. Depigmentation of lip was seen in 42% of patients. Lip involvement refers to depigmentation of both the lips or either lip. Also vermilion border involvement was noted in majority of cases. In some cases, the depigmentation of lip extended to the facial skin also.

Conclusion:

In this study 55 patients out of 100 patients showed depigmentation in the oral cavity. Lip involvement was most common in this study showing about 42% of patients. Intraoral mucosal involvement was found in 21% of patients. Among intraoral mucosal site palate was common followed by buccal and labial mucosa, gingiva. Two patients had lip pigmentation as the only manifestation without any depigmentation in the skin.

Gingival vitiligo: report of a case and review of the literature

Rarely cases have been reported regarding depigmented lesions of the oral cavity. On reviewing the literature, only few cases of gingival vitiligo or similar lesions have been reported till date. These lesions pose a cosmetic challenge. We present here a case of vitiligo affecting gingiva. Vitiligo has been defined as an acquired, slowly progressive loss of cutaneous pigment which occurs as irregular, sharply defined patches which may or may not be surrounded by macroscopic hyperpigmentation. Differential diagnosis, detailed clinical history, histopathology, immunohistochemistry, and pathogenesis of this condition are discussed.

Pediatric vitiligo

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.

Vitiligo patients from India (Mumbai) show differences in clinical, demographic and autoantibody profiles compared to patients in western countries

BACKGROUND

Vitiligo is a common, idiopathic skin disorder characterized by depigmented skin due to the loss of cutaneous melanocytes. Several studies have reported the clinical and demographic characteristics of Indian vitiligo patients, however, none has characterized their antibody profiles.

OBJECTIVE

To establish the clinical, demographic and serological details of a population of vitiligo patients from Mumbai, India, and to evaluate the data for any associations between clinical presentations and the occurrence of antibody responses.

METHODS

Vitiligo patients (n = 79) were recruited to the study and their clinical and demographic details recorded. Serum antibodies, including those against melanocyte-specific antigens, thyroid antigens and keratinocytes, were evaluated.

RESULTS

The prevalence of vitiligo was independent of sex, and non-segmental vitiligo was the most common form of the disease occurring in 65% of the patients. Patients with segmental vitiligo (mean age = 14.4 ± 4.6 years) presented at a younger age than those with non-segmental disease (mean age = 32.5 ± 17.8 years). Personal and family histories of other autoimmune diseases occurred in 3% and 8% of patients, respectively. Antibodies were detected against tyrosinase, tyrosine hydroxylase, thyroid peroxidase, thyroglobulin and keratinocytes at frequencies of 11%, 22%, 18%, 24% and 27%, respectively. Overall, antibodies were more common in patients with non-segmental vitiligo (50-67%) than in those with segmental disease (0-17%), and were detected more frequently in patients with shorter disease durations (<10 years).

CONCLUSION

Our study provides novel information relative to the clinical details, demographic features and serological parameters of a population of vitiligo patients from Mumbai, India. Important distinctions from similar surveys conducted in European patients were evident such as an infrequency of family history, a low prevalence of clinical autoimmune disease, and an absence of particular antibody specificities. These differences may have a bearing on the pathogenesis and course of the disease in Indian patients.

Promoter variant in the catalase gene is associated with vitiligo in Chinese people

Vitiligo is an acquired depigmentation disorder, and reactive oxygen species have an important role in the physiology of cell damage. Reduced catalase enzyme activity and accumulation of excessive hydrogen peroxide have been observed in vitiligo. In a hospital-based case-control study of vitiligo patients (n=749) and age- and sex-matched healthy controls (n=763), we investigated three catalase (CAT) gene polymorphisms (-89A>T, 389C>T, and 419C>T) to examine whether CAT gene polymorphisms are associated with vitiligo susceptibility in the Chinese population. The case-control analysis revealed a 1.54-fold (95% confidence interval (CI) 1.25-1.91) increased risk of developing vitiligo for -89A>T genotype carriers. No evidence for any association between 389C>T and 419C>T polymorphisms in the catalase gene and vitiligo susceptibility was found. An analysis of haplotypes showed increased risk for T(-89)C(389) (odds ratio (OR) 1.90, 95% CI 1.26-2.86) and T(-89)T(389) (OR 2.80, 95% CI 1.24-6.30). Logistic regression analysis of catalase activity also showed a dose-response relationship between increased risk and decreased activity in CAT -89A>T variant genotype carriers, especially in vitiligo patients (P(trend) <0.001). Our molecular epidemiologic findings suggest that the CAT -89A>T variant genotypes were associated with a significant decrease in catalase enzyme activity and a genetic predisposition for vitiligo in Chinese people.

[Methods and means for pigmentation and depigmentation. Sense or nonsense?]

Treatment of hyperpigmentation disorders can be a lengthy process. There are several topical treatment options and hydroquinone is the most frequently used. Both combination and monotherapy are employed. These treatment options apply primarily to epidermal hyperpigmentation disorders. Dermal hyperpigmentation disorders cannot yet be effectively managed with currently available therapeutic approaches. Cosmetic disfigurement caused by hypomelanosis, especially vitiligo, can constitute a serious impairment for the patient. So far there is no definitive remedy. Better cosmetic results are generally reported for combination therapies.

The efficacy of pimecrolimus 1% cream combined with microdermabrasion in the treatment of nonsegmental childhood vitiligo: a randomized placebo-controlled study

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.

Vitiligo na infância: características clínicas e epidemiológicas

FUNDAMENTOS - O vitiligo atinge de 0,5 a 4% da população mundial, e 25% dos casos se iniciam antes dos 10 anos. Embora prevalente, estudos epidemiológicos de vitiligo na infância são raros na literatura brasileira. OBJETIVO - Avaliar características clínicas e epidemiológicas do vitiligo na infância. MÉTODO - Realizado estudo descritivo em 73 crianças com vitiligo, atendidas no Ambulatório de Dermatologia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais. Variáveis como sexo, idades ao início da doença e tratamento, superfície corporal acometida, forma clínica, localização, associação com doenças auto-imunes, história familiar de vitiligo e tratamento inicial foram avaliadas. A análise estatística foi realizada usando freqüências simples e comparação de médias pela análise de variância. RESULTADOS - 60,3% dos pacientes eram do sexo feminino. A média de idade ao início da doença foi 5,7, e a do início do tratamento, sete anos. A superfície corporal acometida foi inferior a 1% em 71,8%, e a forma localizada foi detectada em 76,7% dos casos. A localização mais comum foi o segmento cefálico. O vitiligo em familiares foi observado em 30,1% dos casos. O hipotireoidismo foi detectado em um paciente, e 11% deles relataram a presença de doença auto-imune em familiares. O corticóide tópico foi o tratamento inicial na maioria dos pacientes. CONCLUSÕES - Os achados deste estudo ambulatorial são basicamente semelhantes aos encontrados em estudos realizados em outros países.

Effect of PUVA therapy on electrodermal activity parameters in vitiligo patients

Recent electrophysiological studies on autonomic dysfunction in vitiligo patients show an autonomic dysfunction as measured by absent sympathetic skin response (SSR). Nothing is known about the reversibility of these autonomic parameters with treatment. The present study examined how Electrodermal Activity (EDA) parameters were affected from vitiligo illness before PUVA therapy and whether any electrophysiological gains acquired from PUVA therapy would influence the progression of the condition itself. We studied in 14 healthy subjectS and 14 patients with generalized vitiligo before and after treatment. EDA was recorded with a skin conductance unit connected to a personal computer. Before treatment, skin conductance level (SCL) and habituation number (HN) was higher in vitiligo group than control groups. After treatment, SCL and HN were decreased nearly to normal value. Before and after treatment, prevalence of non-responsivity was higher in vitiligo group than controls.

CONCLUSION

The sympathetic nervous system might have a particular role in the pathogenesis of vitiligo. Thus, patients with vitiligo may have changes to EDA parameters that are reversible to great extent with PUVA therapy. EDA is a useful method of studying the autonomic dysfunction in humans.

Pediatric soft tissue lesions

Soft tissue oral and perioral lesions in the pediatric population are numerous and occur in various clinical presentations. Some conditions observed in children share characteristics with adult-onset disease. Other oral lesions are limited to the pediatric population. This article focuses on the more common soft tissue manifestations in children. Rather than a comprehensive review of pediatric oral pathology, the article offers an overview of selected clinical conditions often encountered in young patients.