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Lessons Learned from Anatomic Susceptibility in Vitiligo Patients: A Systematic Review. CURRENT DERMATOLOGY REPORTS 2023. [DOI: 10.1007/s13671-023-00384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Lee JH, Ju HJ, Seo JM, Almurayshid A, Kim GM, Ezzedine K, Bae JM. Comorbidities in Patients with Vitiligo: A Systematic Review and Meta-Analysis. J Invest Dermatol 2022; 143:777-789.e6. [PMID: 36574529 DOI: 10.1016/j.jid.2022.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Abstract
Vitiligo has been reported to be associated with a variety of diseases, but it has not been systematically reviewed. Therefore, we aimed to identify prevalent diseases in patients with vitiligo and quantify their associations compared with those in healthy controls. A comprehensive search of MEDLINE and EMBASE from the inception to June 2022 was conducted. Observational studies on prevalent diseases in patients with vitiligo compared with those in healthy controls were included, whereas studies limited to pediatrics or providing only laboratory results were excluded. A total of 78 studies were eligible for analyses. Patients with vitiligo showed higher risks of having comorbid autoimmune and connective tissue diseases, including alopecia areata (OR = 2.63, 95% confidence interval [CI] = 2.50‒2.78), discoid lupus erythematosus (OR = 2.54, 95% CI = 1.74‒3.72), Sjogren's syndrome (OR = 2.50, 95% CI = 1.98‒3.16), myasthenia gravis (OR = 2.30, 95% CI = 1.74‒3.02), systemic lupus erythematosus (OR = 1.96, 95% CI = 1.52‒2.52), and rheumatoid arthritis (OR = 1.82, 95% CI = 1.55‒2.15). Thyroid diseases, diabetes mellitus, metabolic syndrome, sensorineural hypoacusis, and ophthalmic abnormalities were also more prevalent in patients with vitiligo. In conclusion, vitiligo is associated with various systemic diseases. Physicians should evaluate and manage potential comorbid conditions in patients with vitiligo.
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Affiliation(s)
- Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Min Seo
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Abdurrahman Almurayshid
- Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj City, Saudi Arabia
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henry Mondor Hospital, Paris Est Créteil University, Créteil, France
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Kang P, Zhang WG, Ji ZH, Shao ZJ, Li CY. Zusammenhang zwischen Vitiligo und wichtigen Komponenten des metabolischen Syndroms: eine systematische Übersicht und Metaanalyse. J Dtsch Dermatol Ges 2022; 20:629-642. [PMID: 35578427 DOI: 10.1111/ddg.14717_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/05/2021] [Indexed: 01/10/2023]
Abstract
HINTERGRUND UND ZIELE Ziel dieser Studie war die Untersuchung des Zusammenhangs zwischen Vitiligo und dem metabolischen Syndrom (MetS) sowie dessen relevanten Komponenten. MATERIAL UND METHODEN Die Datenbanken PubMed, Web of Science, Cochrane Library und Embase wurden von deren Beginn bis zum 30. März 2021 nach relevanten Studien durchsucht. Querschnitts- und Fall-Kontroll-Studien, die entweder die Prävalenz oder die Odds-Ratio [OR] des MetS oder seiner Komponenten bei Vitiligo-Patienten berichteten, wurden eingeschlossen. Die Daten wurden entsprechend der Heterogenität entweder mit einem Zufallseffektmodell oder einem Modell mit festen Effekten gepoolt. ERGEBNISSE Es wurden 30 Studien mit insgesamt 28.325 Vitiligo-Patienten eingeschlossen. Signifikante Zusammenhänge wurden zwischen Vitiligo und Diabetes mellitus (gepoolte OR, 3,30; 95 %-Konfidenzintervall [KI], 2,10-5,17) sowie zwischen Vitiligo und Adipositas (gepoolte OR, 2,08; 95 %-KI, 1,40-3,11) ermittelt. Die Gesamtprävalenz der Hypertonie bei Patienten mit Vitiligo betrug 19,0 % (95 %-KI, 2,0 %-36,0 %). SCHLUSSFOLGERUNGEN Unserer Ergebnisse lassen auf einen Zusammenhang zwischen Vitiligo und Diabetes mellitus sowie Hypertonie schließen. Dermatologen wird empfohlen diese Zusammenhänge zu berücksichtigen, um potenzielle Begleiterkrankungen bei Vitiligo-Patienten zeitnah zu identifizieren. Zudem wird Vitiligo-Patienten empfohlen, Parameter wie BMI, Blutzuckerspiegel und Blutdruck zu überwachen und bei auffälligen Veränderungen dieser Parameter unverzüglich einen Spezialisten zu konsultieren.
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Affiliation(s)
- Pan Kang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.,Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei-Gang Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhao-Hua Ji
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhong-Jun Shao
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chun-Ying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Kang P, Zhang WG, Ji ZH, Shao ZJ, Li CY. Association between vitiligo and relevant components of metabolic syndrome: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2022; 20:629-641. [PMID: 35499212 DOI: 10.1111/ddg.14717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to investigate the association of vitiligo with metabolic syndrome (MetS) and its relevant components. MATERIAL AND METHODS We searched PubMed, Web of Science, Cochrane Library and Embase databases from inception to March 30, 2021, for relevant studies. Cross-sectional and case-control studies that reported either the prevalence or odds ratio [OR] of MetS or its components in vitiligo patients were included. Data were pooled using either random-effects model or fixed-effects model according to the heterogeneity. RESULTS Thirty studies with a total of 28,325 vitiligo patients were included. Significant associations were found between vitiligo and diabetes mellitus (pooled OR, 3.30; 95 % confidence interval [CI], 2.10-5.17) and between vitiligo and obesity (pooled OR, 2.08; 95 % CI, 1.40-3.11). The overall prevalence of hypertension in the patients with vitiligo was 19.0 % (95 % CI, 2.0 %-36.0 %). CONCLUSIONS Our findings suggest the association of vitiligo with diabetes mellitus, obesity, and hypertension. It is recommended for dermatologists to take these associations into account so as to identify potential comorbidities promptly in vitiligo patients. Additionally, vitiligo patients are advised to monitor the indexes including BMI, blood glucose, and blood pressure levels and the consultation with specialists is necessary upon abnormal changes of these indexes.
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Affiliation(s)
- Pan Kang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.,Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei-Gang Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhao-Hua Ji
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhong-Jun Shao
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chun-Ying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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5
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Troshina EA, Volnukhin VA, Petrov VA, Nuralieva NF, Yukina MY, Orlova EM, Frigo NV. [The prevalence of autoimmune endocrine diseases in vitiligo patients]. TERAPEVT ARKH 2020; 92:88-96. [PMID: 33346485 DOI: 10.26442/00403660.2020.10.000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
Vitiligo is a common polygenic autoimmune disease in which the foci of depigmentation are formed on the skin and/or mucous membranes as a result of the death of melanocytes. There are several hypotheses for the pathogenesis of the disease, the leading role among them is played the autoimmune hypothesis. This review summarizes the available literature data on the prevalence and structure of comorbid endocrine autoimmune pathology in vitiligo patients. In most studies conducted in Europe, America and Asia the prevalence of autoimmune thyroid diseases (including autoimmune thyroiditis and Graves disease), diabetes mellitus and autoimmune adrenal insufficiency was higher in vitiligo patients than in the general population. The results of some studies indicate a frequent association of vitiligo with autoimmune polyglandular syndromes. In the structure of comorbid pathology the highest prevalence was in autoimmune thyroid diseases. A number of studies have established a higher prevalence of autoimmune endocrine diseases in women, as well as in nonsegmental vitiligo patients and in cases of family history of vitiligo and/or other autoimmune diseases. In addition, it was shown that the prevalence of endocrine diseases increases with increasing area of depigmentation. The data obtained justify the advisability of conducting a timely examination of vitiligo patients with the aim of early detection of comorbid diseases and the appointment of appropriate treatment. Further studies are needed to investigate the effect of the identified associations on the course of vitiligo and comorbid endocrinopathies, as well as the effectiveness of therapy and the quality of life of patients.
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Affiliation(s)
| | - V A Volnukhin
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
| | - V A Petrov
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
| | | | | | | | - N V Frigo
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
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Liu CW, Huang YC. Vitiligo and autoantibodies: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2018; 16:845-851. [DOI: 10.1111/ddg.13574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Che-Wei Liu
- Department of Orthopedics; Cathay General Hospital; Taipei Taiwan
| | - Yu-Chen Huang
- Department of Dermatology; Wan Fang Hospital; Taipei Medical University; Taipei Taiwan
- Department of Dermatology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
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Liu CW, Huang YC. Vitiligo und Autoantikörper: Systematischer Review und Metaanalyse. J Dtsch Dermatol Ges 2018; 16:845-853. [DOI: 10.1111/ddg.13574_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Che-Wei Liu
- Department of Orthopedics; Cathay General Hospital; Taipei Taiwan
| | - Yu-Chen Huang
- Department of Dermatology; Wan Fang Hospital; Taipei Medical University; Taipei Taiwan
- Department of Dermatology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
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Dahir AM, Thomsen SF. Comorbidities in vitiligo: comprehensive review. Int J Dermatol 2018; 57:1157-1164. [PMID: 29808541 DOI: 10.1111/ijd.14055] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Vitiligo is a common skin disorder characterized by idiopathic, progressive cutaneous hypomelanosis. Vitiligo is associated with several comorbid autoimmune, systemic, and dermatological diseases, primarily thyroid disease, alopecia areata, diabetes mellitus, pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, Addison's disease, inflammatory bowel disease, Sjögren's syndrome, dermatomyositis, scleroderma, ocular and audiological abnormalities, psoriasis, and atopic dermatitis. It is essential to increase awareness of these comorbidities in order to improve the disease burden and quality of life of patients with vitiligo. Herein, we review the association with the most frequent comorbidities associated with vitiligo.
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Affiliation(s)
- Aisha M Dahir
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yuan J, Sun C, Jiang S, Lu Y, Zhang Y, Gao XH, Wu Y, Chen HD. The Prevalence of Thyroid Disorders in Patients With Vitiligo: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2018; 9:803. [PMID: 30697190 PMCID: PMC6340922 DOI: 10.3389/fendo.2018.00803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Abstract
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.
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Mohamed ES, Said EA, Sayed DS, Awad SM, Ahmed MH. Auditory system dysfunction in patients with vitiligo: is it a part of a systemic autoimmune process? THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017. [DOI: 10.4103/ejo.ejo_6_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Liu M, Murphy E, Amerson EH. Rethinking screening for thyroid autoimmunity in vitiligo. J Am Acad Dermatol 2017; 75:1278-1280. [PMID: 27846959 DOI: 10.1016/j.jaad.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Liu
- School of Medicine, University of California, San Francisco, California
| | - Elizabeth Murphy
- Department of Medicine, Division of Endocrinology, University of California, San Francisco, California
| | - Erin Huiras Amerson
- Department of Dermatology, University of California, San Francisco, California.
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12
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Bae JM, Lee JH, Yun JS, Han B, Han TY. Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea. J Am Acad Dermatol 2017; 76:871-878. [PMID: 28238453 DOI: 10.1016/j.jaad.2016.12.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/17/2016] [Accepted: 12/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Associations between vitiligo and thyroid diseases have been reported repeatedly. OBJECTIVE We investigated the associations between vitiligo and overt autoimmune thyroid diseases and thyroid cancer using the Korean National Health Insurance claims database. METHODS We defined patients with vitiligo as those whose records showed ≥4 physician contacts between 2009 and 2013 in which vitiligo was the principal diagnosis. We also established an age- and sex-matched control group without vitiligo (2 per 1 vitiligo patient). The outcomes of interest were concurrent Graves disease and Hashimoto thyroiditis (the patients were taking relevant thyroid medications) and thyroid cancer. RESULTS The study enrolled 73,336 vitiligo patients and 146,672 controls. Patients with vitiligo were at increased risks of Graves disease (odds ratio [OR] 2.610 [95% confidence interval {CI} 2.319-02.938]), Hashimoto thyroiditis (OR 1.609 [95% CI 1.437-1.802]), and thyroid cancer (OR 1.127 [95% CI 1.022-1.242]), compared with the controls. The associations were consistently stronger in males and younger patients. LIMITATIONS Individual clinical information was not available, and the homogeneous population may limit the generalizability of the results. CONCLUSION Vitiligo was significantly associated with overt autoimmune thyroid diseases and overt thyroid cancer.
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Affiliation(s)
- Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - June Hyunkyung Lee
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byeol Han
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
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de Menezes AF, Shanmugam S, Gomes IA, de Carvalho FO, Quintans-Júnior LJ, Gurgel RQ, de Santana Silva B, Serafini MR, Araújo AADS. Synthetic drugs for the treatment of vitiligo: a patent review (2010–2015). Expert Opin Ther Pat 2016; 26:1175-1187. [DOI: 10.1080/13543776.2016.1215434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Khurrum H, AlGhamdi KM. The Relationship Between the Serum Level of Vitamin D and Vitiligo: A Controlled Study on 300 Subjects. J Cutan Med Surg 2015; 20:139-45. [PMID: 26458407 DOI: 10.1177/1203475415610071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Low vitamin D levels have been associated with several autoimmune diseases. Vitiligo could be associated with low vitamin D levels. OBJECTIVE To determine the level of serum vitamin D in vitiligo patients compared to controls and reveal the possible association of vitamin levels with the pathogenesis of vitiligo. PATIENTS AND METHODS A case-controlled study was conducted. After excluding factors that may affect serum vitamin D levels, blood samples were taken from vitiligo patients and controls. The association between vitamin D levels and various vitiligo subgroups (duration of vitiligo, site of onset, age, etc) was measured and correlated. RESULTS A total of 150 vitiligo patients, 90 (60%) males with a mean age of 30.6 ± 11.4 years, were recruited. The study also had 150 age- and gender-matched vitiligo-free control subjects. There was no significant difference in median serum vitamin D levels between the cases and the controls (P = .25). The serum levels of vitamin D of the vitiligo patients were found to be lower in males (P = .01), the younger age group (P = .01), and patients not treated with ultraviolet (UV) treatment (P = .01). CONCLUSION There is no difference between the vitamin D levels of the vitiligo patients and the control subjects. However, deficiency of 25(OH)D levels within the vitiligo subgroups may be linked to younger age, male gender, short duration of vitiligo, and non-use of phototherapy.
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Affiliation(s)
- Huma Khurrum
- Vitiligo research chair, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M AlGhamdi
- Dermatology Department, Director Vitiligo Research Chair, College of Medicine, King Saud University,Riyadh, Saudi Arabia
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Schunter JA, Löffler D, Wiesner T, Kovacs P, Badenhoop K, Aust G, Tönjes A, Müller P, Baber R, Simon JC, Führer D, Pfäffle RW, Thiery J, Stumvoll M, Kiess W, Kratzsch J, Körner A. A novel FoxD3 Variant Is Associated With Vitiligo and Elevated Thyroid Auto-Antibodies. J Clin Endocrinol Metab 2015; 100:E1335-42. [PMID: 26267147 DOI: 10.1210/jc.2015-2126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Vitiligo frequently coincides with autoimmune endocrinopathies, particularly Hashimoto's thyroiditis (HT). Genetic susceptibility may underlie this coincident occurrence. One candidate region is the autoimmunity susceptibility locus on chromosome 1, which encompasses forkhead transcription factor D3 (FoxD3), a gene involved in embryonal melanogenesis. We identified a promotor variant (rs78645479) in an index case of vitiligo + HT + candidiasis and evaluated its clinical and functional relevance. DESIGN We genotyped 281 patients with variable autoimmune endocrinopathies: HT, Graves' disease (GD), type 1 diabetes (T1D), Addison's disease (AD), autoimmune polyglandular syndrome (APS), and/or vitiligo and 1858 controls. Furthermore, we experimentally assessed the effect of the variant on promotor activity and assessed the expression of FoxD3 in human thyroid tissue samples. RESULTS Patients with vitiligo had a higher frequency of the risk allele (30%) compared with healthy controls (18.2%). In addition, the variant was associated with the incidence of elevated anti-TPO antibodies and anti-Tg antibodies, but not with TSH, FT3, or FT4 levels and also not with GD, T1D, AD, or APS. Functionally, the variant increased transcriptional activity in Jurkat and in Hek293 cells. We confirmed gene expression of FoxD3 in human thyroid tissue, which seemed elevated in thyroid tissue samples of some patients with GD and nonautoimmune goiter but not in patients with HT. CONCLUSION In addition to a possible association of rs78645479 in FoxD3 with vitiligo, our data on the association of this FoxD3 variant with thyroid autoantibodies suggest a potential involvement of FoxD3 in thyroid immunoregulation.
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Affiliation(s)
- Jo Ana Schunter
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Dennis Löffler
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Tobias Wiesner
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Peter Kovacs
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Klaus Badenhoop
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Gabriela Aust
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Anke Tönjes
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Peter Müller
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Ronny Baber
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Jan C Simon
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Dagmar Führer
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Roland W Pfäffle
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Joachim Thiery
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Michael Stumvoll
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Wieland Kiess
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Jürgen Kratzsch
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
| | - Antje Körner
- Center for Paediatric Research Leipzig (J.A.S., D.L., R.W.P., W.K., A.K.), University Hospital for Children & Adolescents, 04103 Leipzig, Germany; Ambulatory Health Care Center Metabolic Medicine (T.W., P.M.), 04103 Leipzig, Germany; Integrated Research and Treatment Center (P.K., M.S., A.K.), University of Leipzig, Leipzig, Germany; Department of Internal Medicine 1, Division of Endocrinology & Metabolism (K.B.), Goethe-University Hospital, 60590 Frankfurt, Germany; Department of Surgery, Research Laboratories and Clinic of Visceral, Transplantation, Thoracic, and Vascular Surgery (G.A.), University of Leipzig, 04103 Leipzig, Germany; Deptartment of Medicine, Division of Endocrinology and Nephrology (A.T., D.F., M.S.), University of Leipzig, 04103 Leipzig Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (R.B., J.T., J.K.), University Hospital Leipzig, 04103 Leipzig, Germany; and Department of Dermatology, Venereology, and Allergology (J.C.S.), University of Leipzig, 04103 Leipzig Germany
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Naveen N, H H. CLINICO - EPIDEMIOLOGICAL STUDY OF VITILIGO AND ITS CORRELATION WITH THYROID FUNCTION. ACTA ACUST UNITED AC 2015. [DOI: 10.18410/jebmh/2015/858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Güngör Ş, Nurözler A, Akbay G, Ekşioğlu M. Tear functions in patients with vitiligo. Int J Dermatol 2015; 54:e466-8. [DOI: 10.1111/ijd.12779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/31/2014] [Accepted: 06/02/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Şule Güngör
- Department of Dermatology; Okmeydanı Training and Research Hospital; Istanbul Turkey
| | - Ayşe Nurözler
- Department of Ophthalmology; Ankara Training and Research Hospital; Ankara Turkey
| | - Gülfer Akbay
- Department of Dermatology; Ankara Training and Research Hospital; Ankara Turkey
| | - Meral Ekşioğlu
- Department of Dermatology; Ankara Training and Research Hospital; Ankara Turkey
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Clinico-epidemiological profile of vitiligo patients in Najran Region, Saudi Arabia. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2015. [DOI: 10.1016/j.jdds.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Al-Shobaili HA, Rasheed Z. Mitochondrial DNA acquires immunogenicity on exposure to nitrosative stress in patients with vitiligo. Hum Immunol 2014; 75:1053-61. [DOI: 10.1016/j.humimm.2014.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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20
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Yang Y, Huang G, Yan X, Qing Z. Clinical Analysis of Thyroglobulin Antibody and Thyroid Peroxidase Antibody and their Association with Vitiligo. Indian J Dermatol 2014; 59:357-60. [PMID: 25071254 PMCID: PMC4103271 DOI: 10.4103/0019-5154.135485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Recently, the abnormal presence of thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) has been reported in vitiligo patients, but presence of TG-Ab and TPO-Ab in patients of different ages and gender, and its association with vitiligo and thyroid autoimmunity has rarely been reported. The aim of our research was to determine whether vitiligo was associated with thyroid autoimmunity and figure out its relationship with age and gender. Materials and Methods: We analyzed TG-Ab, TPO-Ab in age and gender matched 87 vitiligo patients and 90 healthy controls, the patients of vitiligo who were positive for the presence of TG-Ab and TPO-Ab were followed up to confirm autoimmune thyroid disease subsequently. Results: Results showed that the frequencies of TG-Ab (23.0%, 20/87) positivity and TPO-AB (24.1%, 21/87) in vitiligo patients were significantly higher than that in healthy controls (P < 0.05). Moreover, The positivity for of TG-Ab and TPO-Ab was higher in 11-20-year age group and 21-40-year age group than that in age matched healthy controls. We found female patients with vitiligo had higher positive frequencies of TG-Ab and TPO-Ab than healthy female controls. (34.1% vs. 8.8% and 34.1% vs. 11.1%, P = 0.000 and P = 0.011). When 20 patients with TG-Ab and TPO-Ab positivity were followed up for three monthes, 14 of them (70%) were diagnosed as having autoimmune thyroid disease compared with age-matched healthy controls (16.7%, χ2 = 5.4, P = 0.02). Conclusion: TG-Ab and TPO-Ab are likely to be found in female teenagers with vitiligo, and are relevant with respect to subsequent development autoimmune thyroid disease.
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Affiliation(s)
- Yifen Yang
- Department of Clinical Laboratory, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gan Huang
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, China
| | - Xiang Yan
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, China
| | - Zhiju Qing
- Department of Clinical Laboratory, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
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Ingordo V, Cazzaniga S, Raone B, Digiuseppe MD, Musumeci ML, Fai D, Pellegrino M, Pezzarossa E, Di Lernia V, Battarra VC, Sirna R, Patrizi A, Naldi L. Circulating autoantibodies and autoimmune comorbidities in vitiligo patients: a multicenter Italian study. Dermatology 2014; 228:240-9. [PMID: 24603479 DOI: 10.1159/000357807] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors. OBJECTIVE To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients. METHODS 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies. RESULTS At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported. CONCLUSION The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.
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Affiliation(s)
- Vito Ingordo
- Outpatient Department of Dermatology, District No. 6, Health Local Unit, Taranto, Italy
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22
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High prevalence of antinuclear antibodies in children with thyroid autoimmunity. J Immunol Res 2014; 2014:150239. [PMID: 24741574 PMCID: PMC3987791 DOI: 10.1155/2014/150239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antinuclear antibodies (ANA) are a hallmark of many autoimmune diseases and can be detected many years before disease onset. Autoimmune thyroid diseases (AITD) are frequently associated with other organ- and non-organ-specific autoimmune disorders. Objectives. To assess the prevalence of ANA in pediatric patients with AITD and their clinical correlations. METHODS Ninety-three consecutive pediatric patients with AITD were enrolled (86 children with chronic lymphocytic thyroiditis and 7 with Graves' disease). ANA, anti-double DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen (anti-ENA), anti-cyclic citrullinated peptide antibodies (anti-CCP), and rheumatoid factor (RF) was obtained. Signs and symptoms potentially related to rheumatic diseases in children were investigated by a questionnaire. RESULTS ANA positivity was found in 66/93 children (71%), anti-ENA in 4/93 (4.3%), anti-dsDNA in 1/93 (1.1%), RF in 3/93 (3.2%), and anti-CCP in none. No significant differences were found between the ANA-positive and ANA-negative groups with respect to age, sex, L-thyroxine treatment, or prevalence of other autoimmune diseases. Overall, parental autoimmunity was found in 23%. CONCLUSIONS ANA positivity was demonstrated in 71% of children with AITD. ANA positivity was not related to overt immune-rheumatic diseases. However, because the positivity of ANA can occur even many years before the onset of systemic autoimmune diseases, prospective studies are warranted.
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Shahmoradi Z, Najafian J, Naeini FF, Fahimipour F. Vitiligo and autoantibodies of celiac disease. Int J Prev Med 2013; 4:200-3. [PMID: 23543680 PMCID: PMC3604853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 06/04/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Vitiligo is an acquired, idiopathic disorder characterized by circumscribed depigmented macules and patches. The exact etiology and pathogenesis of vitiligo is not clear. Many theories have been presented regarding this subject among them aautoimmune theory is the most important one. The association of vitiligo with other autoimmune disorders has been reported, but the relationship between vitiligo and celiac disease is controversial. The aim of this study was to study the frequency of celiac autoantibodies in a group of vitiligo patients compared with control. METHODS This was a cross sectional case control study that involved 128 individuals, 64 vitiligo patients and 64 individuals as control group. The means age of participants was 30.3 ± 14.4 years. IgA anti Endomysial antibody and IgA anti-glutaminase antibody were measured by ELISA method in the serum of all participants. Data were analyzed by SPSS software version 15. RESULTS The serum of two vitiligo patients (3.1%) was positive for antibodies. All control groups were seronegative for these antibodies (P < 0.05). There was no significant effect of sex and job on seropositivity. CONCLUSION There may be a relationship between celiac disease and vitiligo. This may indicate a common basic autoimmune mechanism that is an explanation for few case reports that gluten free diets were effective in the treatment of vitiligo patients. Both T test and exact fisher test showed no effect of age, sex and job on seropositivity of these patients (P = 0.56 and P = 0.74, respectively).
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Affiliation(s)
- Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Department of Cardiology, Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences Isfahan, Iran
| | - Farahnaz Fatemi Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Associate Prof. Farahnaz Fatemi Naeini, Dermatology Department Skin Diseases and Leishmaniasis Research Center Department of dermatology Isfahan University of Medical Sciences, Isfahan, Iran E-mail:
| | - Farinaz Fahimipour
- Department of Dermatology, Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Vrijman C, Kroon MW, Limpens J, Leeflang MMG, Luiten RM, van der Veen JPW, Wolkerstorfer A, Spuls PI. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol 2012; 167:1224-35. [PMID: 22860695 DOI: 10.1111/j.1365-2133.2012.11198.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thyroid disease has been suggested to be associated with vitiligo. However, the outcomes of prevalence studies on thyroid disease in vitiligo vary widely. OBJECTIVES To summarize and critically appraise current evidence of the prevalence of thyroid diseases in vitiligo. METHODS A systematic review was performed searching the electronic databases OVID MEDLINE, OVID EMBASE and PubMed. Guidelines for the critical appraisal of studies on prevalence of a health problem were adapted to evaluate the methodological quality of the included studies. Results were analysed in a meta-analysis with a risk ratio (RR). RESULTS Forty-eight studies published between 1968 and 2012 met the inclusion criteria. Most of the studies (50%) were of fair methodological quality, whereas 18 studies (38%) were of poor quality and six studies (12%) were of good quality. Thyroid disease, autoimmune thyroid disease and presence of thyroid-specific autoantibodies showed a mean prevalence of, respectively, 15·1%, 14·3% and 20·8% in patients with vitiligo and an RR of, respectively, 1·9, 2·5 and 5·2 (all statistically significant). This review shows an increased prevalence and an increased risk of (autoimmune) thyroid disease in patients with vitiligo compared with nonvitiligo. This risk seems to increase with age. CONCLUSIONS Clinicians should be aware of this increased risk in patients with vitiligo and should be attentive for symptoms of thyroid disease. To make recommendations on screening for thyroid disease in patients with vitiligo future research of good methodological quality, including differentiation of vitiligo types and the use of standardized outcome measures, is needed.
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Affiliation(s)
- C Vrijman
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
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Kumar KVSH, Priya S, Sharma R, Kapoor U, Saini M, Bisht YS. Autoimmune thyroid disease in patients with vitiligo: prevalence study in India. Endocr Pract 2012; 18:194-9. [PMID: 21940277 DOI: 10.4158/ep11205.or] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify the prevalence of autoimmune thyroid disease (AITD) in Asian Indian patients with vitiligo and to compare the clinical profile between thyroid peroxidase (TPO) antibody-positive and TPO antibody-negative groups. METHODS In this cross-sectional, case-controlled study, 50 patients with vitiligo (29 women and 21 men) were included. Patients with previous disorders, irradiation, or surgical procedures involving the thyroid were excluded from the study. All participants underwent a complete physical examination, and a single fasting blood sample was analyzed for thyroid function (triiodothyronine, thyroxine, thyroid-stimulating hormone, and TPO and thyroglobulin antibodies), inflammatory and immunologic markers (erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor), and serum calcium, phosphorus, and alkaline phosphatase concentrations. All patients underwent thyroid ultrasonography, and the data were analyzed by appropriate statistical methods. RESULTS The mean age of the study participants was 42.7 ± 17 years, and 14 of 50 patients (28%) had TPO antibody positivity. A goiter was present in 11 of 50 patients, and the thyroid volume by ultrasonography was similar between the 2 groups. Subclinical hypothyroidism was found in 14 of 50 patients (28%) but more frequently in the TPO antibody-positive group (8 of 14 or 57%) than in the TPO antibody-negative group (6 of 36 or 17%). The prevalence of AITD was 20 of 50 patients (40%) when the TPO antibody-positive group and those with subclinical hypothyroidism were considered collectively. None of the patients had overt hypothyroidism or hyperthyroidism. All other clinical, biochemical, and inflammatory variables did not differ significantly between the TPO antibody-positive and antibody-negative groups. CONCLUSION Our data showed a 40% prevalence of thyroid disease in patients with vitiligo in India. The risk is exacerbated in patients with thyroid autoimmunity; thus, regular screening of patients with vitiligo for AITD is needed.
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Affiliation(s)
- K V S Hari Kumar
- Department of Endocrinology, Command Hospital, Lucknow Cantt, UP 226002 India.
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Kroon MW, Joore ICKW, Wind BS, Leloup MAC, Wolkerstorfer A, Luiten RM, Bos JD, Geskus RB, van der Veen JPW. Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo. Br J Dermatol 2012; 166:532-8. [PMID: 22050082 DOI: 10.1111/j.1365-2133.2011.10717.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. OBJECTIVE To investigate the prevalence of thyroid dysfunction and thyroid peroxidase-specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. METHODS A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti-TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. RESULTS Forty-three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results <3months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. CONCLUSION The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti-TPO antibodies is advisable in these high-risk subpopulations.
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Affiliation(s)
- M W Kroon
- Netherlands Institute for Pigment Disorders, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Kota SK, Meher LK, Jammula S, Kota SK, Modi KD. Clinical profile of coexisting conditions in type 1 diabetes mellitus patients. Diabetes Metab Syndr 2012; 6:70-76. [PMID: 23153973 DOI: 10.1016/j.dsx.2012.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS Type 1 diabetes mellitus (T1DM) is associated with various genetic and autoimmune diseases implicated in its etiopathogenesis. We hereby profile the clinical association of such diseases among patients from our center. METHODS Consecutive patients of T1DM presenting to department of Endocrinology from May 1997 to December 2011 were retrospectively analyzed in context of associated clinical profile. RESULTS Among 260 patients diagnosed as T1DM, 21 (8%) had hypothyroidism, 4 (1.5%) had hyperthyroidism and 2 (0.7%) had primary adrenal insufficiency. Eighteen patients (7%) had celiac disease, 9 (3.5%) had Turner's syndrome, 5 patients (1.9%) had Klinefelter's syndrome, whereas Down's syndrome and Noonan's syndrome was present in 2 and 1 patients (0.7%) respectively. One patient had Wolframs' syndrome and 1 patients had myasthenia gravis. Systemic lupus erythematosus and rheumatoid arthritis were present in 3 and 1 patients respectively. Total of 5 patients with cerebral palsy, 4 cases with deaf mutism, 4 cases with acute psychosis and 16 patients with depression were noted. Mean age of study patients was 20.8±9.8 years (range, 3-23 years). CONCLUSION Various conditions including genetic (Down, Turner, Noonan, and Klinefelter's), autoimmune (thyroid and adrenal disorders, myasthenia gravis, SLE, rheumatoid arthritis) and central nervous system diseases were the associated diseases encountered in our patients. Routine screening is required for early diagnosis and treatment of associated co morbidities.
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Affiliation(s)
- Sunil K Kota
- Department of Endocrinology, Medwin hospital, Nampally, Hyderabad, Andhra pradesh, India.
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Nunes DH, Esser LMH. Vitiligo epidemiological profile and the association with thyroid disease. An Bras Dermatol 2012; 86:241-8. [PMID: 21603806 DOI: 10.1590/s0365-05962011000200006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/07/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vitiligo is considered the most frequent acquired hypomelanosis. Although its pathogenesis is uncertain, it is believed that autoimmune etiology is the most plausible. This theory is based on the coexistence of vitiligo with autoimmune diseases. OBJECTIVES To describe the epidemiological profile of vitiligo patients and to estimate the prevalence of the association of vitiligo with autoimmune thyroid diseases. METHODS A cross-sectional study was conducted through analysis of the medical records of patients diagnosed with vitiligo in the AME-UNISUL Outpatient Clinic of Dermatology and at HU-UFSC. The clinical and laboratorial characteristics of these patients were assessed. RESULTS 85 medical records were evaluated; 56 patients were female, with a mean age of 37.14 years and mean onset age of 25.25 years. Vitiligo vulgaris occurred in 70.6%. Autoimmune thyroid diseases were found in 22.4%. Other autoimmune diseases were identified in 5.9%. Patients with positive thyroid autoantibodies showed a probability of extension of vitiligo greater than 25%. There was no statistical difference with regard to the clinical characteristics of vitiligo in patients with or without autoimmune thyroiditis with hormonal change. CONCLUSION The findings of this study are similar to those obtained by other authors, showing that autoimmune thyroid diseases are more common in patients with vitiligo.
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Affiliation(s)
- Daniel Holthausen Nunes
- Outpatient Clinic of Medical Specialties, University of Southern Santa Catarina (AME-UNISUL) and Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina (HU-UFSC) - Santa Catarina (SC), Brazil
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Pradhan V, Patwardhan M, Thakkar V, Kharkar V, Khopkar U, Ghosh K, Weetman AP, Gawkrodger DJ, Kemp EH. Vitiligo patients from India (Mumbai) show differences in clinical, demographic and autoantibody profiles compared to patients in western countries. J Eur Acad Dermatol Venereol 2011; 27:279-86. [PMID: 22122088 DOI: 10.1111/j.1468-3083.2011.04367.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- V Pradhan
- Department of Autoimmune Disorders, National Institute of Immunohaematology, Indian Council of Medical Research, King Edward Memorial Hospital, Parel, Mumbai India Department of Dermatology, King Edward Memorial Hospital, Parel, Mumbai, India Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK Department of Dermatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Poojary S. Vitiligo and associated autoimmune disorders: a retrospective hospital-based study in Mumbai, India. Allergol Immunopathol (Madr) 2011; 39:356-61. [PMID: 21474231 DOI: 10.1016/j.aller.2010.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is a hospital based study focusing on epidemiological aspects of vitiligo and association with autoimmune disorders. There are few studies elucidating the association of autoimmune disorders with vitiligo in the Indian population. Our study is a small attempt in this direction. AIM To study epidemiological parameters of vitiligo and to study coexistence of autoimmune disorders. MATERIALS AND METHODS Records of 33,252 new patients attending the dermatology outpatient department from June 2002 to June 2008 were analysed for the presence of vitiligo and details of important epidemiological variables, and associated autoimmune disorders of these patients were collected and analysed. RESULTS Total number of vitiligo patients was 204. Proportion of vitiligo patients was 0.61%. Male:female proportion was almost equal. Family history of vitiligo was seen in 3.43% of cases. Associated autoimmune disorders were seen in 2.94% cases and were mainly skin associated autoimmune diseases (morphoea, alopecia areata, discoid lupus erythematosus, and pemphigus erythematosus) except for one case of Grave's disease. CONCLUSION Association of vitiligo with other autoimmune diseases emphasizes autoimmune aetiology of vitiligo. This study also emphasizes the need to actively look for, and if necessary, investigate patients with vitiligo for other autoimmune diseases.
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Abstract
Vitiligo is a common depigmenting skin disorder, characterized by acquired, idiopathic, progressive, circumscribed hypomelanosis of the skin and hair, with total absence of melanocytes microscopically. It occurs worldwide, with an incidence rate of between 0.1% and 2%. Vitiligo is an important skin disease having a major impact on the quality of life of the patient suffering from it. The causes of this condition are uncertain but seem to be dependent on the interaction of genetic, immunological and neurological factors. Vitiligo coexists with other autoimmune disorders, Sutton or halo nevus, and malignant melanoma. The substantial disfigurement associated with vitiligo can cause serious emotional stress for the patient, which necessitates treatment. Because its pathogenesis is still not understood, there is a plethora of different treatments. Among them, topical steroids and narrowband ultraviolet B monotherapy were the most common as current treatments for localized and generalized vitiligo, respectively. Cosmetic improvement can be achieved by camouflage products and self-tanning dyes. The course of vitiligo is unpredictable, but often progressive. Spontaneous repigmentation may occur in a few people (10–20%), mainly in children, but this tends to be only partial and on sun-exposed areas. In this article, we review vitiligo as a whole, including epidemiology, pathogenesis and etiology, histopathology, clinical manifestations, classification, clinical variants, diagnosis and differential diagnoses, specific investigation, treatment, prognosis, psychosocial view and its association with other disorders.
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Affiliation(s)
- Reza Yaghoobi
- Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. Vitiligo and autoimmunity: an epidemiological study in a representative sample of young Italian males. J Eur Acad Dermatol Venereol 2011; 25:105-9. [PMID: 20477923 DOI: 10.1111/j.1468-3083.2010.03696.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is stated that patients with vitiligo have an increased risk of developing autoimmune diseases. OBJECTIVE The aim of this study was to estimate the prevalence of autoantibodies or overt autoimmune diseases in a group of vitiligo patients examined among a sample deemed to be representative of the general population of young men living in southern Italy. METHODS A total of 60 vitiligo patients were identified among 34,740 potential conscripts visited to evaluate their fitness to compulsory service in Italian Navy, obtaining a prevalence of 0.17% (95% CI: 0.13-0.22), which was deemed the prevalence of vitiligo in the Italian general population of the same age and sex. Forty of these vitiligo patients underwent blood test including also the search of the main autoantibodies. RESULTS Circulating autoantibodies were detected in 42.5% of subjects. Anti-thyroglobulin antibodies were documented in 27.5%, anti-thyroperoxidase in 22.5%, anti-smooth muscle in 17.3%, anti-nuclear, anti-mitochondrial and anti-gastric parietal cells in 2.5% respectively. Only in two cases (5%) an overt thyroid disease was diagnosed. No significant association between the extension of the skin involved ⁄ clinical course of the disease and circulating autoantibodies was detected. Circulating autoantibodies (particularly anti-thyroid antibodies) were statistically associated with a lower duration of the disease. CONCLUSIONS In agreement with other studies, autoantibodies in the lack of clinical manifestations have been frequently observed in our vitiligo patients, especially during the early phase of the disease. The clinical significance of this finding seems to be limited, with the possible exception of thyroid disease, and it needs further exploration, through large cohort studies.
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Affiliation(s)
- V Ingordo
- Department of Italian Navy Health, Taranto, Italy.
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Li Q, Lv Y, Li C, Yi X, Long HA, Qiao H, Lu T, Luan Q, Li K, Wang X, Wang G, Gao T. Vitiligo Autoantigen VIT75 Is Identified as Lamin A in Vitiligo by Serological Proteome Analysis Based on Mass Spectrometry. J Invest Dermatol 2011; 131:727-34. [DOI: 10.1038/jid.2010.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Introduction, Autoimmune diseases are chronic conditions initiated by the
loss of immunological tolerance to self-antigens. They constitute
heterogeneous group of disorders, in which multiple alterations in the immune
system result in a spectrum of syndromes that either target specific organs
or affect the body systematically. Recent epidemiological studies have shown
a possible shift of one autoimmune disease to another or the fact that more
than one autoimmune disease may coexist in a single patient or in the same
family. Numerous autoimmune diseases have been shown to coexist frequently
with thyroid autoimmune diseases. Autoimmune thyroid disease and other organ
specific non-endocrine autoimmune diseases. This part of the study reviews
the prevalence of autoimmune thyroid disease coexisting with: pernicious
anaemia, vitiligo, celiac disease, autoimmune liver disease, miastenia
gravis, alopecia areata and sclerosis multiplex, and several recommendations
for screening have been given. Autoimmune thyroid disease and other organ
non-specific non-endocrine autoimmune diseases. Special attention is given to
the correlation between autoimmune thyroid disease and rheumatoid arthritis,
systemic lupus erythematosus, syndrome Sj?gren, systemic sclerosis and mixed
connective tissue disease. Conclusions. Screening for autoimmune thyroid
diseases should be recommended in everyday clinical practice, in patients
with primary organ-specific or organ non-specific autoimmune disease.
Other?wise, in patients with primary thyroid autoimmune disease, there is no
good reason of seeking for all other autoimmune diseases, although these
patients have a greater risk of developing other autoimmune disease. Economic
aspects of medicine require further analyzing of these data, from
cost/benefit point of view to justified either mandatory screening or medical
practitioner judgment.
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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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Abstract
BACKGROUND Vitiligo is a depigmenting disease of unknown etiology. A more complete understanding of vitiligo and associated conditions will provide better insight into the etiology and potential treatment options for this condition. We sought to gather information regarding associated conditions and other epidemiologic data on vitiligo. METHODS A retrospective chart review was performed of 135 patients with vitiligo seen between July 1, 2002 and June 30, 2005 at an academic medical center. Epidemiologic characteristics were recorded. RESULTS The patient population consisted of 80 women and 55 men with mean age of presentation of 36.8 years and average disease duration of 5.7 years. Vitiligo vulgaris was the predominant type of vitiligo and hypothyroidism was the most common co-morbidity. Anti-thyroid peroxidase and anti-thyroglobulin antibodies were found in 37% and 18% of patients, respectively. The highest proportion of thyroid abnormalities was found in age of onset category 21-30. Anti-nuclear antibodies were found in 33% of patients. CONCLUSION The prevalence of anti-nuclear and anti-thyroid peroxidase antibodies was higher in our vitiligo study than that reported elsewhere. In addition, autoimmune thyroid disease may be more common in adult-onset vitiligo.
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Affiliation(s)
- Taraneh Paravar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Cario-André M, Pain C, Gauthier Y, Taïeb A. The melanocytorrhagic hypothesis of vitiligo tested on pigmented, stressed, reconstructed epidermis. ACTA ACUST UNITED AC 2007; 20:385-93. [PMID: 17850512 DOI: 10.1111/j.1600-0749.2007.00396.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Common generalized vitiligo is an acquired depigmenting disorder characterized by a chronic and progressive loss of melanocytes from the epidermis and hair follicles. We previously proposed a new theory that vitiligo involves the chronic detachment and transepidermal loss of melanocytes caused by autoimmune, neural and impaired redox mechanisms associated with mechanical trauma. In this study, we reconstructed epidermis on dead de-epidermized dermis with normal and/or non-segmental non-lesional vitiligo (NSV) cells and tested catecholamines or sera or hydrogen peroxide. Under unstressed conditions, the number of melanocytes located in the basal layer was significantly lower in reconstructs made with melanocytes from non-lesional NSV skin and normal keratinocytes compared with controls made with autologous normal melanocytes. The number of non-lesional NSV melanocytes was even lower in reconstructs made with keratinocytes from non-lesional NSV skin. Epinephrine and H(2)O(2) could trigger the transepidermal loss of normal and vitiligo melanocytes. Some sera induced melanocyte detachment but without any clear correlation with disease activity in the donors. In conclusion, our results are the first step to obtaining a reproducible melanocytorrhagic model in vitro with some of the stressors investigated. They support the hypothesis that NSV melanocytes have an intrinsic defect, which limits their adhesion in a reconstructed epidermis, with an enhancer effect of the vitiligo keratinocyte milieu.
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Affiliation(s)
- M Cario-André
- Department of Dermatology, National reference center for rare skin disease, Bordeaux University Hospitals, Bordeaux Cedex, France.
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Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. The ?EpiEnlist? project: a dermo-epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions. J Eur Acad Dermatol Venereol 2007; 21:1091-6. [PMID: 17714131 DOI: 10.1111/j.1468-3083.2007.02205.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies on the prevalence and incidence of many skin conditions in the general population are available because it is difficult to submit to dermatologic examination large samples of seemingly healthy population. OBJECTIVE The aim of this study was to estimate the prevalence of several skin conditions among a sample that is deemed to be representative of the general population of young men living in southern Italy. PATIENTS/METHODS Potential conscripts resident in the coastal regions of southern Italy and called at the age of 18 to the Draft's Council Medical Unit in Taranto underwent a clinical and instrumental examination to evaluate their psycho-physical fitness to compulsory service in Italian Navy. From January 1998 to April 2004 a dermo-epidemiologic project named EpiEnlist (EPIdemiology in ENLISTed Men) project was carried out by the Department of Dermatology of the Italian Navy Hospital in Taranto under the auspices of the Italian Group for Epidemiological Research in Dermatology. All the subjects showing skin lesions evocative of neurofibromatosis (NF), congenital melanocytic nevus (CMN), Becker nevus (BN), and vitiligo were referred to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis. The confirmed cases were recorded in a predefined patient's card, containing the main anamnestic, clinical, instrumental, and laboratory data. RESULTS Because the recording of the various conditions started and ended in different times, the total number of examined subjects varied. NF type 1 was diagnosed in 6 of 34 740 subjects [prevalence 1:5735 or 0.017%; 95% confidence interval (95% CI), 0.0008-0.0037], CMN in 157 of 23 354 (prevalence 1:148 or 0.67%; 95% CI, 0.57-0.79). BN was observed in 70 of 27 954 young men (prevalence 1:399 or 0.25%; 95% CI, 0.15-0.35), and its mean age of appearance was 11.9 years (minimum 5-maximum 17). In 41 subjects (58.6%), the age of appearance was over 10 years. Vitiligo was recorded in 60 of 34 740 persons (prevalence 1:579 or 0.17%; 95% CI, 0.13-0.22). In 40 subjects with vitiligo, the blood test was done: in 40% of these circulating autoantibodies, mainly anti-thyroid (25.6%) and anti-smooth muscle (17.3%) autoantibodies were detected, but only in 5% of cases, a thyroid disease was diagnosed, and no other sign of autoimmune diseases was observed. CONCLUSIONS The epidemiological data of the skin conditions considered in the present study can be considered roughly in agreement with those reported in the available surveys. Because they were obtained in a large sample of Italian young males from the general population, they can be useful for therapeutic and preventive interventions by the public health organizations.
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Affiliation(s)
- V Ingordo
- Department of Dermatology, Italian Navy Main Hospital G. Venticinque, Taranto, Italy.
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Kwinter J, Pelletier J, Khambalia A, Pope E. High-potency steroid use in children with vitiligo: A retrospective study. J Am Acad Dermatol 2007; 56:236-41. [PMID: 17224367 DOI: 10.1016/j.jaad.2006.08.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 08/01/2006] [Accepted: 08/03/2006] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data on efficacy and safety of treatments in children with vitiligo are limited. OBJECTIVE We sought to describe the clinical outcomes and safety of children with vitiligo treated with high-potency topical corticosteroids. METHODS Clinical improvement and laboratory data were retrospectively analyzed in 101 children (0-18 years) with vitiligo treated with moderate- to high-potency topical corticosteroids. RESULTS Of patients, 64% (45 of 70) had repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of 70) were worse than at the initial presentation. Local steroid side effects were noted in 26% of patients at 81.7 +/- 44 days of follow-up. Cortisol levels were abnormal in 29% of patients (21 of 73). Two children with low cortisol levels were given the diagnosis of steroid-induced adrenal suppression. Children with normal and abnormal cortisol levels were not significantly different by sex, age of onset, potency of the corticosteroid use, or family history. However, children with head and/or neck affected areas were 8.36 times more likely to have an abnormal cortisol level compared with children affected in other body areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n = 72). Of patients, 8% (6 of 74) had an abnormal thyrotropin test result. LIMITATIONS The retrospective design of this study presents inherent limitations. CONCLUSION Moderate- to high-potency topical corticosteroids are efficacious in children with vitiligo, but may be associated with systemic absorption.
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Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, Kaloumenou E, Chrousos GP. Increased prevalence of chronic autoimmune (Hashimoto's) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol 2006; 53:220-3. [PMID: 16021113 DOI: 10.1016/j.jaad.2005.03.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND An increased prevalence of autoimmune (Hashimoto's) thyroiditis in adult patients with vitiligo has been described. This association has scarcely been studied in children. OBJECTIVE We sought to assess children and adolescents with vitiligo for autoimmune thyroid disorder and to identify any predisposing factors of this association. METHODS In all, 54 children and adolescents (23 boys, 31 girls; mean age 11.4 years) with known vitiligo were studied by physical examination and laboratory studies. RESULTS Four patients with vitiligo were already known to have Hashimoto's thyroiditis. In 9 of the remaining 50 patients, autoimmune thyroiditis was revealed at the time of the investigation. Of the 54 patients with vitiligo, 13 (24.1%) had autoimmune thyroiditis as compared with 9.6% of school-aged children from an iodine-replete area of Greece ( P = .002). There was no association between thyroiditis and clinical type of vitiligo, age at onset, mean duration of vitiligo, or sex. CONCLUSIONS Hashimoto's thyroiditis is 2.5 times more frequent among children and adolescents with vitiligo than in a healthy age- and sex-matched population. It usually follows the onset of vitiligo. We propose that children and adolescents with vitiligo should be screened annually for thyroid dysfunction, particularly autoimmune thyroiditis.
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Affiliation(s)
- Talia Kakourou
- First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Athens, Greece.
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Farrokhi S, Hojjat-Farsangi M, Noohpisheh MK, Tahmasbi R, Rezaei N. Assessment of the immune system in 55 Iranian patients with vitiligo. J Eur Acad Dermatol Venereol 2006; 19:706-11. [PMID: 16268875 DOI: 10.1111/j.1468-3083.2005.01295.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented macules resulting from the loss of cutaneous melanocytes. OBJECTIVE In order to evaluate the immune system of Iranian patients with vitiligo, this study was accomplished. METHODS Fifty-five Iranian patients with vitiligo and 60 healthy persons as control were investigated in this study. The laboratory techniques were included: antimelanocyte antibody (AMA) and antinuclear antibody (ANA) with indirect immunoflorescent test, C3 and C4 levels with single radial immunodiffusion (SRID), and rheumatoid factor (RF) with enzyme-linked immunosorbent assay (ELISA). RESULTS AMA was positive in 17 patients (30.9%) and was negative in the entire control group (P < 0.0001). ANA was positive in 4 patients (7.3%), which was insignificantly higher than control group (1.7%). IgM-RF was positive in 6 patients (10.8%) while it was negative in the entire control group (P = 0.027). C3 and C4 values decreased in 14 patients (25.5%), which was significantly higher than control group (P < 0.001). CONCLUSION The important role of the immune system in the pathogenesis of vitiligo could be suggested. In addition, the autoimmune hypothesis of vitiligo could be confirmed based on the results of this study.
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Affiliation(s)
- S Farrokhi
- Department of Immunology, Boushehr University of Medical Sciences, Boushehr, Iran.
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Koukourakis MI, Maltezos E. Amifostine administration during radiotherapy for cancer patients with genetic, autoimmune, metabolic and other diseases. Anticancer Drugs 2006; 17:133-8. [PMID: 16428930 DOI: 10.1097/00001813-200602000-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Amifostine is a broad-spectrum cytoprotective agent approved for protection against cisplatin toxicities and radiation-induced xerostomia; strong clinical evidence exists that amifostine protects normal mucosa and lung from radiation damage. Hypotension, nausea/vomiting, fatigue and fever/rash are the main side-effects associated with amifostine administration. The present study summarizes our experience on daily amifostine administration to cancer patients with various coexisting medical conditions and diseases. The tolerance and the eventual interference of amifostine with the course of the coexisting diseases is reported, providing a core list of medical conditions met in radiotherapy practice, their compatibility with amifostine administration and recommendations on how to deal with these patients. This list comprises genetic diseases (xeroderma pigmentosum, glucose-6-phosphate dehydrogenase deficiency), autoimmune disorders (vitiligo, scleroderma, thyroiditis, perforating collagenosis), metabolic diseases (diabetes mellitus), cardiovascular diseases, neuro/psychiatric diseases and other medical conditions (hypoglycemia, hepatic cirrhosis, alcoholism). A high incidence of fever/rash was noted in patients with autoimmune diseases, while all other conditions did not alter the patterns of side-effects expected following amifostine administration.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis, Greece.
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Fain PR, Babu SR, Bennett DC, Spritz RA. HLA class II haplotype DRB1*04-DQB1*0301 contributes to risk of familial generalized vitiligo and early disease onset. ACTA ACUST UNITED AC 2006; 19:51-7. [PMID: 16420246 DOI: 10.1111/j.1600-0749.2005.00279.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Generalized vitiligo is a common autoimmune disorder characterized by white patches of skin and overlying hair caused by loss of pigment-forming melanocytes from involved areas. Familial clustering of vitiligo is not uncommon, and patients and their relatives are at increased risk for a specific complex of other autoimmune diseases. Compared with sporadic vitiligo, familial vitiligo is characterized by earlier disease onset and greater risk and broader repertoire of autoimmunity, suggesting a stronger genetic component, and perhaps stronger associations with specific alleles. To determine whether the major histocompatibility complex (MHC) contributes to the familial clustering of vitiligo and vitiligo-associated autoimmune/autoinflammatory diseases, we performed case-control and family-based association analyses of HLA class II-DRB1 and -DQB1 alleles and haplotypes in affected probands and their parents from 76 European-American Caucasian families with familial vitiligo. Affected probands showed a significantly increased frequency of DRB1*04-DQB1*0301 and a significantly decreased frequency of DRB1*15-DQB1*0602 compared with a large sample of reference chromosomes. Family-based association analyses confirmed these results. Probands with DRB1*04-DQB1*0301 developed vitiligo an average of 13.32 yr earlier than probands with DRB1*15-DQB1*0602. Overall, our results indicate that specific MHC-linked genetic variation contributes to risk of familial vitiligo, although HLA does not completely explain familial clustering of vitiligo-associated autoimmune/autoinflammatory diseases.
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Affiliation(s)
- Pamela R Fain
- Human Medical Genetics Program, University of Colorado at Denver and Health Sciences Center, Aurora, USA
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Chistiakov DA. Immunogenetics of Hashimoto's thyroiditis. JOURNAL OF AUTOIMMUNE DISEASES 2005; 2:1. [PMID: 15762980 PMCID: PMC555850 DOI: 10.1186/1740-2557-2-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 03/11/2005] [Indexed: 02/04/2023]
Abstract
Hashimoto's thyroiditis (HT) is an organ-specific T-cell mediated disease. It is a complex disease, with a strong genetic component. To date, significant progress has been made towards the identification and functional characterization of HT susceptibility genes. In this review, we will summarize the recent advances in our understanding of the genetic input to the pathogenesis of HT.
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Affiliation(s)
- Dimitry A Chistiakov
- Laboratory of Aquatic Ecology, Katholieke Universiteit Leuven, Ch, De Beriotstraat 32, B-3000 Leuven, Belgium.
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Abstract
Autoimmune thyroid disease is frequently accompanied by other organ-specific and non-organ-specific diseases, most likely because there is sharing of genetic and possibly environmental susceptibility factors. These associations are well recognized in the autoimmune polyglandular syndromes; autoimmune thyroid disease is one of the three major endocrinopathies in the type 2 syndrome and occurs in around 4% of type 1 patients. This review considers the frequency of disease-specific autoantibodies in patients with thyroid autoimmunity and briefly examines the role of such antibodies in performing screening for the associated conditions. Recommendations are made for using such autoantibody tests in the setting of patients with autoimmune thyroid disorders, and also for the utility of screening for thyroid autoimmunity in patients with pernicious anaemia, Addison's disease, coeliac disease, primary biliary cirrhosis, myasthenia gravis, lymphocytic hypophysitis, systemic lupus erythematosus and rheumatoid arthritis. At present, however, there are no large-scale trials that have shown the cost-benefit ratio of autoantibody screening for autoimmunity screening, and clinicians must use individual judgement combined with heightened awareness to identify who to test.
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Affiliation(s)
- Anthony P Weetman
- Clinical Sciences Centre, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, UK.
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Zettinig G, Asenbaum S, Fueger BJ, Hofmann A, Diemling M, Mittlboeck M, Dudczak R. Increased prevalence of sublinical brain perfusion abnormalities in patients with autoimmune thyroiditis: evidence of Hashimoto's encephalitis? Clin Endocrinol (Oxf) 2003; 59:637-43. [PMID: 14616889 DOI: 10.1046/j.1365-2265.2003.01901.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Hashimoto's encephalitis is a term which describes encephalopathy associated with autoimmune thyroiditis, but it is not based on evidence, whether Hashimoto's encephalitis is a distinct clinical entity by itself. In previously reported cases of Hashimoto's encephalitis, abnormal brain perfusion studies have been reported. The aim of this study was to evaluate the prevalence of brain perfusion abnormalities in euthyroid patients with autoimmune thyroiditis. METHODS 99mTc Ethyl cystein dimer (ECD) single photon emission computed tomography (SPECT) studies were performed in a study group of 41 euthyroid patients with autoimmune thyroiditis and a matched control group of 35 healthy individuals. All study participants had a normal neurological investigation and a detailed neurological history taking. Individuals with known or suspected morphological brain abnormalities were excluded from the study. Zung's Self-Rating Anxiety Scale (SAS) and Zung's Self-Rating Depression Scale (SDS) were used to detect depression and mood disorders. Automatic quantification of perfusion was performed with both a voxel-based analysis as well as a volume-of-interest (VOI) based analysis of 46 predefined cortical and subcortical regions. The findings from both groups were compared to a reference template. RESULTS In the voxel-based analysis, there was a significant difference between patients and controls in the mean volume of perfusion defects deviating 2SD below the normal values (21.8 ml vs. 10.4 ml; P = 0.02). Hyperperfused areas, however, did not differ significantly between study patients and controls. A significant correlation of the perfusion defects with time since diagnosis of autoimmune thyroiditis was seen (r = 0.42). In the VOI-based analysis, abnormal regions were more frequent in the study group when compared to controls (P < 0.01) However, no topographic pattern was apparent. Regarding neurological findings, no significant difference was found between study patients and controls. However, both the SAS and SDS scores differed significantly between the two groups, but there was neither a correlation between the two scores and perfusion abnormalities nor an association with depression in our study group. CONCLUSIONS These findings of impaired brain perfusion in patients with autoimmune thyroiditis further strengthen the hypothesis of a possible cerebral involvement in autoimmune thyroiditis in individual cases. The presence of cerebral hypoperfusion suggests a cerebral vasculitis as the most likely pathogenetic model.
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Affiliation(s)
- Georg Zettinig
- Department of Nuclear Medicine, University of Vienna, Austria.
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Zettinig G, Crevenna R, Pirich C, Dudczak R, Waldhoer T. Appointments at a thyroid outpatient clinic and the lunar cycle. Wien Klin Wochenschr 2003; 115:298-301. [PMID: 12793030 DOI: 10.1007/bf03040335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Several variables of health-related human behaviour have been analysed with regard to a possible association with lunar phases. The aim of this study was to evaluate a possible relation between the lunar cycle and the number of requests for appointments at an outpatient clinic. This variable has not been studied hitherto. METHODS We analysed a total number of 11,413 requests for appointments at our thyroid outpatient clinic during one year. Access to this clinic is not restricted, and all patients with known or suspected thyroid disease living in the area of Vienna may ask for an appointment. During the study period, 8,852 patients requested a follow-up appointment, and 2561 patients asked for a new appointment. We analysed a possible cyclic pattern in these requests using a nonlinear regression model based on both groups of patients. RESULTS A cosinus curve with a period of 29.531 days (the mean length of a lunar cycle) was significantly associated with the number of requests for both follow-up appointments (p = 0.007) and new appointments (p = 0.001). Requests for follow-up appointments had their highest peaks three days after the full moon, whereas requests for new appointments were most frequent five days afterwards. CONCLUSION Our findings suggest that lunar phases may affect patients' requests for appointments at a thyroid outpatient clinic. To the best of our knowledge, this is the first study reporting a possible association between health-related behaviour and lunar phases using requests for appointments as a relevant variable. There is a need for more research into the mechanism underpinning this behaviour.
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Affiliation(s)
- Georg Zettinig
- Department of Nuclear Medicine, Ludwig Boltzmann Institute of Nuclear Medicine, University of Vienna, Vienna, Austria.
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