Serum level of S100B in vitiligo patients: Is it a marker of disease activity?

Serum Calprotectin Levels in Vitiligo Patients and Disease Relation

INTRODUCTION

Vitiligo is characterized as melanocyte loss in skin and mucous membranes, the pathogenesis of which has not yet been clarified. Calprotectin is a protein secreted from neutrophils, monocytes, and dendritic cells which has an effect on cytokine receptor regulation and the production of reactive oxygen radicals. It has been the subject of research in various inflammatory and autoimmune diseases, yet not investigated in vitiligo.

OBJECTIVE

The aim of our study was to investigate the role of calprotectin in the etiopathogenesis of vitiligo and its relationship with clinical subtypes and disease scores.

METHODS

Forty-four vitiligo patients with lack of autoimmune disease and 36 age- and sex-matched healthy controls were involved in the study. Serum calprotectin levels were measured by ELISA. The results were compared with the control group, and the relationship between patients' demographic characteristics, skin phototypes, disease type, disease scores (Vitiligo Area Scoring Index and Vitiligo Disease Activity Score), disease duration, and age at onset were evaluated.

RESULTS

The median serum calprotectin level was 454.08 pg/ml (41.19-873.41) in the patient group, and the median serum calprotectin level was 223.17 pg/ml (44.88-1044.43) in the control group. Serum calprotectin level was significantly higher in the patient group than in the control group (P = 0.016). No correlation was found between serum calprotectin level and disease scores, disease duration, age, or age of onset of disease (P > 0.05).

CONCLUSIONS

In our study, serum calprotectin levels in the patient group were found to be significantly higher than in the control group. Our findings and the existing literature on calprotectin suggest its potential involvement in the pathogenesis of vitiligo, independent of disease progression and patient characteristics.

Efficacy and safety of combined fractional ablative CO2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study

BACKGROUND

Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO₂ has shown efficacy in treatment of vitiligo in combination with other modalities.

METHODS

Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores.

RESULTS

Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators.

CONCLUSION

The combination of fractional ablative CO₂ and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.

Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo

Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5-2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross- talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.

Morphological Alterations and Increased S100B Expression in Epidermal Langerhans Cells Detected in Skin from Patients with Progressive Vitiligo

The role of Langerhans cells (LCs) in vitiligo pathogenesis remains unclear, with published studies reporting contradictory results regarding the quantity of LCs and no data on the features of LCs in vitiligo. Here, we aimed to analyze the presence, density, and morphological features of LCs in the epidermis of patients with vitiligo. Skin biopsies were stained for LCs using anti-CD1a/anti-langerin antibodies and analyzed by immunocytochemistry with light and electron microscopy. Compared with healthy controls, we detected significantly increased numbers of epidermal LCs in lesional skin from vitiligo in the progressive state. These LCs exhibited striking morphological alterations, including an elevated number of dendrites, with increased length and more branches than dendrites from controls. Ultrastructure examination via immuno-electron microscopy revealed markedly reduced Birbeck granules (BGs) and shorter BG rods in LCs from progressive vitiligo, with higher expression of langerin. Additionally, expression of S100B, the activity biomarker of vitiligo, was increased in these LCs. This work provides new insight on the cellular composition of LCs in vitiliginous skin, revealing altered morphology and increased LC numbers, with elevated S100B expression. Our data suggest LCs might play a critical role in vitiligo pathogenesis and thus may represent a novel therapeutic target for this disease.