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Marchioro HZ, Castro CCSD, Fava VM, Sakiyama PH, Dellatorre G, Miot HA. Update on the pathogenesis of vitiligo. An Bras Dermatol 2022; 97:478-490. [PMID: 35643735 PMCID: PMC9263675 DOI: 10.1016/j.abd.2021.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Vitiligo is a complex disease whose pathogenesis results from the interaction of genetic components, metabolic factors linked to cellular oxidative stress, melanocyte adhesion to the epithelium, and immunity (innate and adaptive), which culminate in aggression against melanocytes. In vitiligo, melanocytes are more sensitive to oxidative damage, leading to the increased expression of proinflammatory proteins such as HSP70. The lower expression of epithelial adhesion molecules, such as DDR1 and E-cadherin, facilitates damage to melanocytes and exposure of antigens that favor autoimmunity. Activation of the type 1-IFN pathway perpetuates the direct action of CD8+ cells against melanocytes, facilitated by regulatory T-cell dysfunction. The identification of several genes involved in these processes sets the stage for disease development and maintenance. However, the relationship of vitiligo with environmental factors, psychological stress, comorbidities, and the elements that define individual susceptibility to the disease are a challenge to the integration of theories related to its pathogenesis.
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Elsherif R, Mahmoud WA, Mohamed RR. Melanocytes and keratinocytes morphological changes in vitiligo patients. A histological, immunohistochemical and ultrastructural analysis. Ultrastruct Pathol 2022; 46:217-235. [PMID: 35243959 DOI: 10.1080/01913123.2022.2044946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vitiligo is an idiopathic acquired chronic stigmatizing disease. It is a pigmentary disorder that affects the skin and the mucous membranes, and it is characterized by well-circumscribed, depigmented milky white macules and patches. It has an estimated prevalence of 0.5-2% of the population worldwide. In the previous studies, several mechanisms such as autoimmune, oxidative stress, genetic factors, melanocytorrhagy, and neural hypothesis have been suggested for vitiligo pathogenesis.We aimed to assess the morphological changes of epidermal melanocytes and keratinocytes in patients with vitiligo. This aim will be fulfilled by histological, ultrastructural, and immunohistochemical analysis of skin biopsies from lesioned and non-lesioned sites in vitiligo patients.The study was carried out on 15 selected patients with stable vitiligo vulgaris but not receiving treatment in the last year and they fulfilled our inclusion criteria.Biopsies were taken from lesioned and non-lesioned sites in the same vitiligo patients, and they are processed for examinations by LM (using Hx & E, and Masson Fontana stain), immunohistochemical analysis (using Melan-A, E-cadherin, and caspase-3), and TEM (to demonstrate the ultra-structures).By LM, staining with Hx & E, lesioned skin in vitiligo patients showed hyperkeratosis, basal vacuolization, acanthosis with an increase in the epidermal thickness, ballooning of keratinocytes, and spongiosis. Regarding melanocytes, we observed a few numbers of melanocytes, also we detected some basal epidermal cells contain brown melanin granules. Using Fontana-Masson stain, we found that the melanin pigment is present in both lesioned and non-lesioned skin of vitiligo patients. We confirmed the presence of melanocytes in the lesioned skin by the immunohistochemical staining with Melan-A. The epidermal cells in lesioned skin of vitiligo patients showed weak positive expression of E-cadherin between them and an increase in the number of apoptotic Caspase-3 positive cells. BY TEM, the lesioned skin in vitiligo patients showed that the keratinocytes and melanocytes had various degenerative changes, disturbance of desmosomes in between keratinocytes, and absence of melanosomes in the keratinocytes. The detected melanocytes were degenerated and contained some melanosomes, melanin granules, and autophagosomes.We concluded that vitiligo pathogenesis is a combination of several factors and cannot be explained by only one mechanism. The pathology in the lesioned vitiliginous skin is a combination of several degenerative changes in keratinocytes, and melanocytes.
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Affiliation(s)
- Raghda Elsherif
- Department of Histology and cell biology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Waleed Ahmed Mahmoud
- Department of Dermatology and Andrology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
| | - Refaat R Mohamed
- Department of Dermatology and Andrology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
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Shoeib M, Farag AGA, Eltorgman M, Abdou AG. Evaluation of the Langerhans cells role in vitiligo and its relationship to NB-UVB. J Cosmet Dermatol 2021; 20:3642-3648. [PMID: 33609002 DOI: 10.1111/jocd.14012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Langerhans cells (LCs) are antigen-presenting cells that are characterized by CD1a and CD207/langerin expression. The disturbance in the communication network among keratinocytes, melanocytes, and antigen-presenting cells may be involved in vitiligo pathogenesis. AIMS The current work aims to detect and quantify LCs in involved skin of patients affected by vitiligo before and after treatment with NB-UVB using CD1a immunohistochemistry, in addition to correlate percentage of LCs with the clinicopathological parameters. METHODS Twenty vitiligo patients and 10 age and sex matched controls were investigated. Patients were received NB-UVB thrice weekly for 12 weeks. RESULTS There was a significant reduction in LCs percentage in skin affected by vitiligo before treatment in comparison with normal skin. About 65% (13/20) of vitiligo patients responded to NB-UVB, and the liability to respond was correlated with LCs percentage in specimens before treatment. However, there was no statistical difference between specimens before and after treatment regarding LCs percentage. CONCLUSIONS Reduction in LCs in vitiligo may be a sign of active disease and melanocytes destruction. The percentage of LCs affects response to NB-UVB since higher percentage is associated with greater response to therapy. Therefore, modulation of LCs as a type of immunotherapy could be beneficial in improvement of vitiligo.
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Affiliation(s)
- Mohammed Shoeib
- Department of Dermatology, Andology and STDs, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Azza Gaber Antar Farag
- Department of Dermatology, Andology and STDs, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Mona Eltorgman
- Department of Dermatology, Andology and STDs, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Asmaa Gaber Abdou
- Department of Pathology, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
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Hasan R, Agarwal K, Podder I, Misitzis A, Schwartz RA, Wollina U, Lotti T, Grabbe S, Goldust M. Simvastatin in vitiligo: an update with recent review of the literature. Int J Dermatol 2021; 60:e390-e396. [PMID: 33554328 DOI: 10.1111/ijd.15330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/24/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022]
Abstract
Patients with vitiligo often seek medical attention, as it diminishes their quality of life resulting in significant morbidity. Several topical and systemic therapies are in vogue targeting the immunological aspect of this disease, but results are often unsatisfactory, and complete cure remains elusive. Recently, simvastatin, a 3-hydroxy-3-methylyglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, is being evaluated for vitiligo management because of its multimodal action, easy availability, and low cost. The proposed multimodal actions range from anti-inflammatory, antioxidant, to immunomodulatory properties which may be of therapeutic benefit in vitiligo patients. The authors intend to evaluate the role of simvastatin as a novel therapeutic agent for vitiligo along with relevant review of literature.
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Affiliation(s)
- Rashidul Hasan
- Department of Dermatology & Venereology, Us-Bangla Medical College & Hospital, Narayangonj, Bangladesh
| | | | | | - Angelica Misitzis
- Department of Dermatology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Torello Lotti
- Professor of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Fernandez-Flores A, Diep M, Cassarino D. Thickening of the basement membrane as a diagnostic sign of mycosis fungoides. J Cutan Pathol 2020; 48:356-363. [PMID: 32829519 DOI: 10.1111/cup.13853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
The epidermal basement membrane (BM) is readily identified on skin biopsy specimens stained with periodic acid-Schiff (PAS) and PAS with diastase (PAS-D). Thickening of BM can be evidenced in several inflammatory and tumoral conditions. We noticed that most of our biopsy specimens of mycosis fungoides (MF) showed thickening of the BM. We decided to retrospectively study BM thickness in 27 biopsy specimens of MF and compare them with 27 cutaneous biopsy specimens of inflammatory diseases. We studied PAS and PAS-D stains in all cases and we measured BM thickness with an ocular micrometer. Cases were scored in a four-tiered system: 0: no detectable staining; 1+ (mild: < 5 μm); 2+ (moderate: 5-9 μm); and 3+ (prominent: >9 μm). The difference between both groups (MF vs controls) was highly significant for BM thickness values by both one- and two-tailed t tests (P < 0.0006). While only 3 biopsy specimens from the controls (11.11%) showed areas of 3+ thickening, 12 biopsy specimens of MF (44.44%) showed areas of 3+ thickening, and most cases showed diffuse, at least 2+ thickening, while the controls showed more segmental, mostly 1 or 2+ staining. We conclude that thickening of BM can be useful in the differential diagnosis with inflammatory conditions.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital Universitario El Bierzo, Ponferrada, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain.,Research Department. Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | - My Diep
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California, USA
| | - David Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Angeles, California, USA
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Bellei B, Picardo M. Premature cell senescence in human skin: Dual face in chronic acquired pigmentary disorders. Ageing Res Rev 2020; 57:100981. [PMID: 31733332 DOI: 10.1016/j.arr.2019.100981] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Although senescence was originally described as an in vitro acquired cellular characteristic, it was recently recognized that senescence is physiologically and pathologically involved in aging and age-related diseases in vivo. The definition of cellular senescence has expanded to include the growth arrest caused by various cellular stresses, including DNA damage, inadequate mitochondria function, activated oncogene or tumor suppressor genes and oxidative stress. While senescence in normal aging involves various tissues over time and contributes to a decline in tissue function even with healthy aging, disease-induced premature senescence may be restricted to one or a few organs triggering a prolonged and more intense rate of accumulation of senescent cells than in normal aging. Organ-specific high senescence rate could lead to chronic diseases, especially in post-mitotic rich tissue. Recently, two opposite acquired pathological conditions related to skin pigmentation were described to be associated with premature senescence: vitiligo and melasma. In both cases, it was demonstrated that pathological dysfunctions are not restricted to melanocytes, the cell type responsible for melanin production and transport to surrounding keratinocytes. Similar to physiological melanogenesis, dermal and epidermal cells contribute directly and indirectly to deregulate skin pigmentation as a result of complex intercellular communication. Thus, despite senescence usually being reported as a uniform phenotype sharing the expression of characteristic markers, skin senescence involving mainly the dermal compartment and its paracrine function could be associated with the disappearance of melanocytes in vitiligo lesions and with the exacerbated activity of melanocytes in the hyperpigmentation spots of melasma. This suggests that the difference may arise in melanocyte intrinsic differences and/or in highly defined microenvironment peculiarities poorly explored at the current state of the art. A similar dualistic phenotype has been attributed to intratumoral stromal cells as cancer-associated fibroblasts presenting a senescent-like phenotype which influence the behavior of neoplastic cells in either a tumor-promoting or tumor-inhibiting manner. Here, we present a framework dissecting senescent-related molecular alterations shared by vitiligo and melasma patients and we also discuss disease-specific differences representing new challenges for treatment.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Tsutsumi R, Sugita K, Abe Y, Hozumi Y, Suzuki T, Yamada N, Yoshida Y, Yamamoto O. Leukoderma induced by rhododendrol is different from leukoderma of vitiligo in pathogenesis: A novel comparative morphological study. J Cutan Pathol 2018; 46:123-129. [PMID: 30456919 DOI: 10.1111/cup.13396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhododendrol (rhododenol), an inhibitor of tyrosinase activity, is used as a skin-whitening component. Many cases of leukoderma after the application have been reported, termed rhododenol-induced leukoderma (RIL). The aim of this study was to clarify the pathogenesis of RIL morphologically through comparison with vitiligo. METHODS We examined 14 cases of RIL and 15 cases of vitiligo using routine histopathology and immunohistochemistry. Thirteen cases of RIL, six cases of vitiligo and specimens of the RIL mouse model were evaluated by electron microscopy. RESULTS There were common findings in RIL and vitiligo at the light-microscopic level: (a) vacuolar changes in the dermo-epidermal junction, (b) melanophages in the papillary dermis, (c) perifollicular lymphocyte infiltration, (d) loss or decrease of basal melanin pigment and (e) decrease of melanocytes in the lesions. The ultrastructural observations showed specific findings of RIL: (a) remaining melanocytes in depigmented lesions, (b) inhomogeneous melanization in melanocytes and (c) degenerated melanosomes in melanocytes. Some of the findings were observed in a RIL mouse model. Furthermore, it is notable that cell organelles of melanocytes were intact in our RIL cases. CONCLUSION Morphological changes of RIL targeting melanosomes in melanocytes without degeneration of organelles reflect the reversible clinical course of most cases.
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Affiliation(s)
- Reiko Tsutsumi
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazunari Sugita
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuko Abe
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yutaka Hozumi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Nanako Yamada
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuichi Yoshida
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
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Singh A, Gotherwal V, Junni P, Vijayan V, Tiwari M, Ganju P, Kumar A, Sharma P, Fatima T, Gupta A, Holla A, Kar HK, Khanna S, Thukral L, Malik G, Natarajan K, Gadgil CJ, Lahesmaa R, Natarajan VT, Rani R, Gokhale RS. Mapping architectural and transcriptional alterations in non-lesional and lesional epidermis in vitiligo. Sci Rep 2017; 7:9860. [PMID: 28852211 PMCID: PMC5575244 DOI: 10.1038/s41598-017-10253-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/08/2017] [Indexed: 01/31/2023] Open
Abstract
In vitiligo, chronic loss of melanocytes and consequent absence of melanin from the epidermis presents a challenge for long-term tissue maintenance. The stable vitiligo patches are known to attain an irreversible depigmented state. However, the molecular and cellular processes resulting in this remodeled tissue homeostasis is unclear. To investigate the complex interplay of inductive signals and cell intrinsic factors that support the new acquired state, we compared the matched lesional and non-lesional epidermis obtained from stable non-segmental vitiligo subjects. Hierarchical clustering of genome-wide expression of transcripts surprisingly segregated lesional and non-lesional samples in two distinct clades, despite the apparent heterogeneity in the lesions of different vitiligo subjects. Pathway enrichment showed the expected downregulation of melanogenic pathway and a significant downregulation of cornification and keratinocyte differentiation processes. These perturbations could indeed be recapitulated in the lesional epidermal tissue, including blunting of rete-ridges, thickening of stratum corneum and increase in the size of corneocytes. In addition, we identify marked increase in the putrescine levels due to the elevated expression of spermine/spermidine acetyl transferase. Our study provides insights into the intrinsic self-renewing ability of damaged lesional tissue to restore epidermal functionality in vitiligo.
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Affiliation(s)
- Archana Singh
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Vishvabandhu Gotherwal
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India.,Academy of Scientific and Innovative Research, New Delhi, India
| | - Päivi Junni
- Turku Centre for Biotechnology, University of Turku and ÅboAkademi University, Turku, Finland
| | - Vinaya Vijayan
- CSIR-National Chemical Laboratory, Chemical Engineering Division, Pune, India
| | - Manisha Tiwari
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Parul Ganju
- National Institute of Immunology, ArunaAsaf Ali Marg, New Delhi, India
| | - Avinash Kumar
- National Institute of Immunology, ArunaAsaf Ali Marg, New Delhi, India
| | - Pankaj Sharma
- Department of Dermatology, Post Graduate Institute for Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Tanveer Fatima
- Department of Dermatology, Post Graduate Institute for Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Aayush Gupta
- Department of Dermatology, Dr. D. Y. Patil Medical College, Pimpri, Pune, India
| | - Ananthaprasad Holla
- MelanoSite, Center for Advanced Vitiligo Treatment and Collaborative Pigment Cell Research, New Delhi, India
| | - Hemanta K Kar
- Department of Dermatology, Post Graduate Institute for Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sangeeta Khanna
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Lipi Thukral
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Garima Malik
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | | | - Chetan J Gadgil
- CSIR-National Chemical Laboratory, Chemical Engineering Division, Pune, India
| | - Riitta Lahesmaa
- Turku Centre for Biotechnology, University of Turku and ÅboAkademi University, Turku, Finland
| | - Vivek T Natarajan
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India. .,Academy of Scientific and Innovative Research, New Delhi, India.
| | - Rajni Rani
- National Institute of Immunology, ArunaAsaf Ali Marg, New Delhi, India.
| | - Rajesh S Gokhale
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India. .,National Institute of Immunology, ArunaAsaf Ali Marg, New Delhi, India. .,CSIR-National Chemical Laboratory, Chemical Engineering Division, Pune, India. .,Jawaharlal Nehru Centre for Advanced Scientific Research, Bengaluru, India.
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Attili VR, Attili SK. Segmental and generalized vitiligo: both forms demonstrate inflammatory histopathological features and clinical mosaicism. Indian J Dermatol 2013; 58:433-8. [PMID: 24249893 PMCID: PMC3827513 DOI: 10.4103/0019-5154.119949] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Segmental vitiligo (SV) and generalized vitiligo (GV) are perceived to evolve by different mechanisms, the former with unspecified neural mechanisms and the latter by melanocyte specific autoimmune mechanisms. However, the two diverse mechanisms are difficult to reconcile in cases of "mixed vitiligo". To test the possibility of a common pathogenesis, we reviewed clinical and histopathological features of SV and GV. MATERIALS AND METHODS As part of an ongoing histopathological study on vitiligo and vitiligo like lesions, over a 10 year period from 2002 to 2011, biopsies were taken routinely from evolving or recently evolved lesions. 50 cases of SV with quasi-dermatomal distribution and 154 cases of GV were identified and the clinical and histopathological features were compared. RESULTS Mild clinical inflammation was recorded in 33 of 154 GV cases but, none among 50 SV had such features. In addition to bilateral symmetrical involvement, mirror image lesions with unusual segmentation were observed in nine cases of GV. SV with a few bilateral lesions (4) and GV with quasi-dermatomal lesions (3), i.e., mixed vitiligo, were included in their corresponding groups for analytical purposes. Focal lichenoid inflammation of varying degrees around epidermal/adnexal melanocytes was identified as a common feature in evolving lesions of both SV (78%) and GV (70%). CONCLUSIONS SV and GV demonstrated a similar inflammatory histopathological spectrum. "Segmentation/mosaicism", identified for the first time in GV is another unifying factor. Cutaneous mosaicism harboring fragile melanocyte populations, which are susceptible to external as well as auto-inflammatory mechanisms, is an attractive hypothesis to pursue in the causation of vitiligo.
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Affiliation(s)
- Venkat Ratnam Attili
- Visakha Institute of Skin and Allergy, Marripalem, Visakhapatnam, Andhra Pradesh, India
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12
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Oiso N, Tanemura A, Kotobuki Y, Kimura M, Katayama I, Kawada A. Role of macrophage infiltration in successful repigmentation in a new periphery-spreading vitiligo lesion in a male Japanese patient. J Dermatol 2013; 40:915-8. [PMID: 24106919 DOI: 10.1111/1346-8138.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Abstract
Vitiligo is an acquired disorder in which depigmented macules result from mostly autoimmune loss of melanocytes. The initiating process in vitiligo has still been uncertain. Here, we report the case of a 19-year-old man with undetermined/unclassified vitiligo with a new periphery-spreading vitiligo lesion on the right dorsal hand after rigorous sun exposure. Histopathological evaluation showed noticeable infiltration of CD68(+) macrophages, moderate infiltration of CD3(+) T cells, little infiltration of CD8(+) T cells and CD11c(+) myeloid dendritic cells, HMB45/CD11c double-positive cells, and Melan-A/MART1(+) deposits in the dermis. We surmised that melanocyte-derived deposits were mostly phagocytosed by CD68(+) macrophages and were faintly phagocytosed by CD11c(+) myeloid dendritic cells, referring distribution of CD68(+) mononuclear cells and melanocyte biomarkers. Complete repigmentation was achieved following topical application of hydrocortisone butyrate propionate 0.1% ointment. We summarize that prompt clearance of debris by macrophages would be essential to an excellent prognosis of complete repigmentation.
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Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Abstract
The disappearance of melanocytes because of defective adhesion is one of the accepted theories to explain vitiligo. Tenascin-C is a large, extracellular matrix glycoprotein that is thought to inhibit adhesion of melanocytes to fibronectin. The current study aimed to evaluate the pattern of tenascin-C expression in vitiligenous skin compared with normal pigmented skin by means of immunohistochemistry. The study was carried out on skin biopsies from lesional and perilesional skin of 30 patients with vitiligo and on normal skin of 10 healthy volunteers. Several histopathologic changes were observed in vitiliginous skin such as keratinocyte vacuolization, a thickened basement membrane, and dermal inflammatory changes. Tenascin-C was expressed in keratinocytes of the basal epidermal layer of normal skin biopsies at a mild intensity but it did not stain the dermis, whereas vitiligenous skin showed tenascin-C expression in most cases (93.3% ), in the papillary dermis, epidermis, and in both. Diffuse epidermal expression of tenascin-C correlated with more loss of pigment and continuous staining of tenascin-C in the papillary dermis correlated with progressive forms of vitiligo. Intense tenascin-C expression was associated with a more progressive course of the disease assessed by the vitiligo disease activity score. From this study, tenascin-C is highly expressed in the dermis, epidermis, and both of vitiligo as a secondary event for the disease. Keratinocyte is a source of tenascin-C in vitiligo, and diffuse epidermal expression of tenascin-C may induce more loss of melanocytes and melanin pigment. Dermal expression of tenascin-C in the vitiligenous lesion may be linked to the disease more than epidermal expression, because this pattern is only seen in a vitiligenous lesion and it is completely absent in normal and perilesional skin.
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14
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Benzekri L, Gauthier Y, Hamada S, Hassam B. Clinical features and histological findings are potential indicators of activity in lesions of common vitiligo. Br J Dermatol 2012; 168:265-71. [DOI: 10.1111/bjd.12034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: A comprehensive overview. J Am Acad Dermatol 2011; 65:473-491. [DOI: 10.1016/j.jaad.2010.11.061] [Citation(s) in RCA: 384] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/23/2010] [Accepted: 11/05/2010] [Indexed: 12/20/2022]
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Antelo DP, Filgueira AL, Cunha JMT. Reduction of skin-homing cytotoxic T cells (CD8+ -CLA+) in patients with vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:40-4. [PMID: 21198882 DOI: 10.1111/j.1600-0781.2010.00563.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitiligo is a frequently acquired, hereditary disease, characterized by achromic macules due to the absence of melanocytes. In contrast with earlier studies, in which the main pathogenic role was attributed to anti-melanocyte antibodies, recent papers have emphasized a role for CD8(+) cytotoxic T lymphocytes in melanocyte destruction. Fifteen percent of peripheral T cell express cutaneous lymphocyte-associated antigen (CLA), responsible for skin-homing T cell. Phototherapy is used to treat patients with generalized vitiligo and it has been shown to interfere with CLA(+) T cells in other skin diseases. OBJECTIVE To describe peripheral blood T cell subpopulations' frequency and ability to express the skin-homing molecule (CLA) in patients with non-segmental vitiligo, before and after photochemotherapy (PUVA). PATIENTS AND METHODS Twenty-two patients with generalized and active spreading vitiligo were submitted to 30 PUVA-8MOP sessions. Lymphocyte immunophenotyping was performed by flow cytometry using anti-CD3, anti-CD8 and anti-CLA monoclonal antibodies. Fifteen healthy volunteers, sex- and age-matched, were included as a control group. RESULTS CD8(+) -CLA(+) T cells were significantly reduced in number in untreated vitiligo patients (P=0.008) when compared with control individuals, albeit with a more intense CLA expression (P=0.028). These findings were not altered after PUVA. No significant difference was noticed in CD4/CD8 ratios nor in CD4-CLA(+) T cell numbers between vitiligo patients and controls, both before and after PUVA. CONCLUSIONS CD8-CLA(+) T cells are reduced in peripheral blood of patients with non-segmental vitiligo. This finding may be related to the previously reported increase of CD8(+) cells in both lesions and perilesional skin of these patients.
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Affiliation(s)
- Daniela Pereira Antelo
- Setor de Fotodermatologia, Serviço de Dermatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Lai LG, Xu AE. In vivo reflectance confocal microscopy imaging of vitiligo, nevus depigmentosus and nevus anemicus. Skin Res Technol 2011; 17:404-10. [DOI: 10.1111/j.1600-0846.2011.00521.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prignano F, Ricceri F, Bianchi B, Guasti D, Bonciolini V, Lotti T, Pimpinelli N. Dendritic cells: ultrastructural and immunophenotypical changes upon nb-UVB in vitiligo skin. Arch Dermatol Res 2010; 303:231-8. [PMID: 21174109 DOI: 10.1007/s00403-010-1109-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/28/2022]
Abstract
The role of dendritic cells in vitiligo is still unclear. Few studies have provided contradictory results about their quantitative variation and no data exist concerning their immunophenotypical distribution in diseased skin. The purpose of our study was to analyze the presence, the distribution, the immunophenotypical markers and the effects of nb-UVB therapy on dendritic cells in non-lesional, perilesional, and lesional vitiligo skin. Punch-biopsies of 6 mm were taken from lesional, perilesional, and non-lesional skin of 12 patients affected by non-segmental vitiligo, treated with nb-UVB. An immunohistochemical and an ultrastructural analysis were performed. Immunohistochemical and ultrastructural analysis showed both quantitative and qualitative modifications of Langerhans cells. Nb-UVB therapy, one of the most effective treatments for the disease, was able to reduce the Langerhans cells number and to redistribute main dendritic subsets. This study underlines the importance of dendritic cells, Langerhans cells in particular, in non-segmental vitiligo, in its pathogenesis and in its better therapeutical approach.
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Affiliation(s)
- Francesca Prignano
- Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Italy.
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Kang HY, le Duff F, Passeron T, Lacour JP, Ortonne JP, Bahadoran P. A noninvasive technique, reflectance confocal microscopy, for the characterization of melanocyte loss in untreated and treated vitiligo lesions. J Am Acad Dermatol 2010; 63:e97-100. [DOI: 10.1016/j.jaad.2010.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/29/2010] [Accepted: 02/05/2010] [Indexed: 11/29/2022]
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Diagnosis and Treatment of Vitiligo in a Sub-Adult Eastern Black Rhinoceros (Diceros bicornis michaeli). J Zoo Wildl Med 2010; 41:545-9. [DOI: 10.1638/2009-0232.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Attili VR, Attili SK. Reply: Histopathology and immunohistochemistry of depigmented lesions in lupus erythematosus. J Cutan Pathol 2010; 37:1261-2. [PMID: 20726935 DOI: 10.1111/j.1600-0560.2010.01609.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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França AFEDC, de Souza EM. Histopathology and immunohistochemistry of depigmented lesions in lupus erythematosus. J Cutan Pathol 2010; 37:559-64. [DOI: 10.1111/j.1600-0560.2009.01444.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prignano F, Pescitelli L, Becatti M, Di Gennaro P, Fiorillo C, Taddei N, Lotti T. Ultrastructural and functional alterations of mitochondria in perilesional vitiligo skin. J Dermatol Sci 2009; 54:157-67. [DOI: 10.1016/j.jdermsci.2009.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Revised: 01/09/2009] [Accepted: 02/05/2009] [Indexed: 10/21/2022]
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Attili VR, Attili SK. Lichenoid inflammation in vitiligo – a clinical and histopathologic review of 210 cases*. Int J Dermatol 2008; 47:663-9. [DOI: 10.1111/j.1365-4632.2008.03672.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Nevus depigmentosus is a congenital disorder characterized by a nonprogressive hypopigmented lesion, which may not be apparent at birth. Thus, it is sometimes difficult to differentiate vitiligo from nevus depigmentosus only by clinical features. We postulated that the histologic changes in lesional and perilesional skin might be different in the 2 conditions. We took biopsies from both lesional and perilesional skin of 100 cases of vitiligo to assess the number of melanocytes, the amount of melanin, dermal inflammatory infiltrate, and other changes. We compared them with 30 cases of nevus depigmentosus. Histologically, lesions of vitiligo showed more basal hypopigmentation and dermal inflammation than perilesional normal skin. With Fontana-Masson staining, 16% of cases of vitiligo showed the presence of melanin. The ratio of pigmented area to epidermal area was 0.06% in vitiligo, whereas 17% in perilesional normal skin and 8.9% in nevus depigmentosus. In NKI/beteb staining, 12% of vitiligo showed the presence of melanocytes, and their average number was 7.68 per square millimeter. The number of melanocytes was also decreased in nevus depigmentosus but not as much as in vitiligo. We also confirmed the presence of melanocytes in 1 of 3 cases of vitiligo by electron microscopy. In conclusion, there are a few melanocytes and melanin in some cases of vitiligo. Therefore, the diagnosis of vitiligo should be made considering these points.
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Vitiligo in a Quarter Horse Filly: Clinicopathologic, Ultrastructural, and Nutritional Study. J Equine Vet Sci 2008. [DOI: 10.1016/j.jevs.2008.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ardigo M, Malizewsky I, Dell’Anna ML, Berardesca E, Picardo M. Preliminary evaluation of vitiligo using in vivo reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2007; 21:1344-50. [DOI: 10.1111/j.1468-3083.2007.02275.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dell'anna ML, Picardo M. A review and a new hypothesis for non-immunological pathogenetic mechanisms in vitiligo. ACTA ACUST UNITED AC 2006; 19:406-11. [PMID: 16965269 DOI: 10.1111/j.1600-0749.2006.00333.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vitiligo is an acquired depigmenting disorder characterized by the loss of functioning epidermal melanocytes because of multifactorial and overlapping pathogenetic mechanisms. Besides the immunological approach, the study of the metabolic deregulations leading to toxic damage of the melanocytes appears to be more and more relevant. It was only last year that the first in vitro evidence supporting the link and the temporal sequence between the immune response and the cellular oxidative stress was provided, suggesting that the intrinsic damage of the melanocytes is primitive. What can be the guide line of the multiple altered metabolisms? A compromised membrane could render the cell sensitive to the external and internal agents differently, usually ineffective on the cell activity and survival. The primitive altered arrangement of the lipids may affect the transmembrane housing of proteins with enzymatic or receptorial activities, also conferring on them antigenic properties.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Tjioe M, Vissers WHPM, Gerritsen MJP. Topical macrolide immunomodulators: a role in the treatment of vitiligo? Am J Clin Dermatol 2006; 7:7-12. [PMID: 16489839 DOI: 10.2165/00128071-200607010-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Recently, topical macrolide immunomodulators have been successfully introduced in the treatment of atopic dermatitis. With the growing interest in this new line of topical immunosuppressants, research into the efficacy of these medicines in other T-cell-mediated skin diseases, such as psoriasis, lichen planus, and even vitiligo, is expanding rapidly. It is generally accepted that autoimmune factors play an important role in vitiligo. In this article, the possible use and mechanism of topical macrolide immunomodulators in the treatment of vitiligo are discussed, together with the current state of clinical studies and case reports. These limited reports indicate that topical macrolide immunomodulators may play a role in the treatment of vitiligo, particularly in areas where use of potent corticosteroids is contraindicated.
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Affiliation(s)
- Milan Tjioe
- Department of Dermatology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
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