Classification of vitiligo: a challenging endeavor

Emerging therapies and innovations in vitiligo management: a comprehensive review

Vitiligo is a common skin disorder where melanocytes, the cells that produce skin pigment, are destroyed by the immune system, leading to white patches on the skin and mucous membranes. This condition affects 0.4% to 2.0% of the global population, with a higher prevalence in females and often beginning in childhood. In India, about 1% of the population is affected, particularly in northern regions, with a higher incidence in females and links to other autoimmune diseases. This review examines recent progress in understanding vitiligo and its treatment. It focuses on the genetic, autoimmune, and environmental factors involved in the disease and highlights new therapies, such as targeted molecular treatments and advanced repigmentation methods. Current research shows that oxidative stress and genetic predispositions contribute to the autoimmune destruction of melanocytes. Novel drug delivery systems, including liposomes, nanoemulsions, and nanostructured lipid carriers, have improved treatment effectiveness. Clinical trials are exploring new treatments like Ruxolitinib cream and melanocyte transplantation, while teledermatology is becoming useful for managing patients. Vitiligo also poses a significant economic burden due to its impact on patients' quality of life. Continued research is essential to develop better, more accessible treatments and reduce the economic impact of vitiligo.

The potential effect of smart devices and other stressful factors on Vitiligo in Nassiriah City/Iraq

BACKGROUND

Vitiligo is a disease that occurs due to dysfunction in the autoimmune system that attacks the skin pigment cells (melanocytes) leading to the appearance of light-colored spots on the skin.

OBJECTIVE

The study was carried out to investigate the effect of smart devices on the children inflicted with vitiligo, and the correlation of vitiligo with other factors such as performance in the school, the marital status of their parents, type of smart devices (games, YouTube), and others.

MATERIALS AND METHODS

The study was carried out on 49 children diagnosed with vitiligo in Nassiriah City, Iraq. The data of all the variable factors were collected and classified according to the types of smart applications (YouTube and/or games), the status of their parents, and hours spent on using these applications.

RESULTS

The collected data were analyzed into five figures; according to the children's performance in the school and the highest percentage were in the no failure category, or in the high achiever category constituting 38.77% to each one. The percentage of children who lives with both parents is 79.5%. Most of the affected children are the 2nd in order in their families representing 40.8% of children under study. The number of diseased children who use YouTube are 23, their percentage is the highest constituting 46.94%.

CONCLUSIONS

Seven conclusions were drawn in this novel study, among them are; that most of the affected children are 2nd in order in their families, and the highest percent of the affected children with vitiligo are those who use YouTube.

Nevus depigmentosus: the analysis of 37 cases

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Patient-reported outcomes: A 5-year long study reveals previously unreported therapeutic, demographic, socio-economic, and other correlations in vitiligo

Vitiligo is a non-lethal, non-communicable, immune-mediated, and generally progressive skin disease, with poorly understood etiopathogenesis and weak evidence base. The aim of the study is to contribute to the scant research on the patient-reported outcomes in vitiligo, and to examine the presence of associations between various inputs for possible use in clinical practice. The study was designed as a web-based questionnaire with 40 inputs across seven dimensions. The questions include demographics, skin type, eye and natural hair color, age of respondent and age of onset, possible triggers, disease extent, localization, progression and activity, the efficacy of most common treatment modalities, medication side-effects, heredity and diseases among parents, and out-of-pocket expenses for treatments to date. The analysis presented with this work contributes to the discussion about the relation between therapies, socio-economic factors, and treatment outcomes in vitiligo. All physicians should adequately manage patient expectations in terms of overall treatment duration and expected out-of-pocket expenses, and actively evaluate patients at shorter intervals. A more aggressive therapeutic approach using telehealth devices should be considered to supplement therapy, monitor treatment progress, and protocol compliance.

The expression change of RORγt, BATF, and IL-17 in Chinese vitiligo patients with 308 nanometers excimer laser treatment

This study aims to explore the expression of RORγt, BATF, and IL-17 in Chinese vitiligo patients with 308 nm excimer laser treatment. One hundred and sixty-four vitiligo patients treated with 308 nm excimer laser were enrolled as Case group and 137 health examiners as Control group. Quantitative real-time polymerase chain reaction and immunohistochemistry were conducted to detect the expressions of RORγt, BATF, and IL-17. Expression of RORγt, BATF, IL-17A, and IL-17F were higher in Case group than Control group, with the diagnostic accuracy of 88.04, 87.38, 97.34, and 89.04%, respectively. Pearson correlation analysis showed a positive correlation in RORγt, BATF, IL-17A, and IL-17F mRNAs in vitiligo patients. Moreover, their expressions were higher in active vitiligo patients than stable ones. Besides, the expressions of RORγt, BATF, IL-17A, and IL-17F in vitiligo skin were significantly higher than those in non lesional skin and normal controls. After treatment, their expressions were significantly decreased. Active vitiligo and the high expressions of RORγt, BATF, and IL-17F were the independent risk factors for the ineffectiveness of 308 nm excimer laser treatment. The expressions of RORγt, BATF, IL-17 were significantly enhanced in vitiligo patients, which were correlated with the activity of vitiligo and 308 nm excimer laser therapeutic effects.

Vitiligo in Children: A Better Understanding of the Disease

Vitiligo is an important skin disease of childhood. The authors briefly discuss the etiopathobiology, clinics and comorbidities of the disease.

Genetic variants of interferon-gamma and its mRNA expression and inflammatory parameters in the pathogenesis of vitiligo

Although genetics plays an essential role in the pathogenesis of vitiligo, vitiligo pathogenesis is still unclear. Our aim was to investigate the role of IFN-γ expression and polymorphism in vitiligo susceptibility and whether intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor (TNF)-α, and TNF-β play a role in vitiligo pathogenesis as important inflammatory parameters. Eighty-five patients with vitiligo and 90 controls were investigated for IFN-γ gene expression by quantitative real-time PCR and genotyped for IFN-γ +874T/A (rs2430561) and IFN-γ +2109A/G (rs1861494) gene polymorphisms by sequence-specific primer (SSP)-PCR and PCR-restriction fragment length polymorphism (RFLP), respectively. Serum levels of inflammatory parameters were measured using ELISA. Frequencies of the +874 TT genotype and T allele were significantly higher in patients with active vitiligo than in stable patients (P = 0.01 and 0.03, respectively). Calculation of odds ratio suggested a 1.7-fold increased risk of vitiligo in individuals having the TA haplotype. We observed overexpression of IFN-γ mRNA with elevated serum levels of IFN-γ, ICAM-1, TNF-α, and TNF-β in patients with vitiligo when compared with the control group (P = 0.001, for all). In addition, these levels were elevated in patients with active vitiligo compared with stable patients with vitiligo (P = 0.008, 0.006, 0.01, 0.01, and 0.03, respectively), which suggests the involvement of these cytokines in disease activity. In conclusion, IFN-γ is a promising immunological marker in vitiligo pathogenesis.

The role of neuropeptides in the control of regional immunity

Neuropeptides (NPs) and neurotransmitters are a heterogeneous group of soluble factors that make connections within the neuroendocrine and immune systems. NPs, including substance P (SP), vasoactive intestinal peptide (VIP), α melanocyte-stimulating hormone (α-MSH), and calcitonin gene-related peptide (CGRP), released by nerves that innervate the skin, can modulate the action of innate and adaptive skin immunity as well as the skin cells functions. Their role in several inflammatory skin diseases, such as atopic dermatitis, psoriasis, and vitiligo, and in the isotopic response has been reported. Further progress in understanding the various processes that modulate the interactions of the nervous and the skin immune system is essential to develop effective treatment for inflammatory skin conditions with neurogenic components and for understanding signs and symptoms in the isotopic response and, in general, in the control of global and regional immunity.

Vitiligo treatment demystified: a flowchart for stratified treatment approaches

The recent publication by Anbar et al. in the April issue of this journal, delineating and prioritizing treatment options for vitiligo, is both timely and significant. First and foremost, this work brings to the forefront the important message that vitiligo truly is a treatable disease. All too often, patients refrain from seeking treatment as public opinion dictates that vitiligo is not an important disease, there are no effective treatments available, and insurance will not cover attempts to treat. By providing clear guidelines of treatments to be considered, practicing physicians seeing an occasional vitiligo patient will be more readily inclined to explore the possibilities currently available for enhancing the quality of life of this patient group.

Association of CYP2C9 Genetic Variants with Vitiligo

BACKGROUND

Vitiligo is a depigmenting skin disorder in which genetic factors play an important role.

OBJECTIVE

To examine the association of CYP2C9 (*) 1/(*) 2/(*) 3 gene polymorphism with vitiligo.

METHODS

In this case controlled study, 95 Saudi patients with vitiligo (50 men and 45 women), with a mean age of 27.3 years, were analyzed. Patients were compared to 86 healthy controls from the same locality (76 men and 10 women), with a mean age of 20.1 years. In all participants, DNA was extracted and processed for characterization of 2C9 (*) 1/(*) 2/(*) 3 gene variants using real time-polymerase chain reaction.

RESULTS

Vitiligo patients have a significantly higher CYP2C9 (*) 3 allele carriage rate compared to controls (32.7% versus 4.7%, p=0.00, odds ratio=9.9, 95% confidence interval=3.3~29.6). On the other hand, frequencies of CYP2C9 (*) 2 genotypes and alleles did not show any significant difference between vitiligo cases and controls. When the frequencies of CYP2C9 genotypes were compared among subgroups of age, gender, family history, and disease patterns, the cases with positive consanguinity had significantly higher frequencies of homozygous genotypes than others (p=0.029).

CONCLUSION

CYP2C9 (*) 3 allele carriage is probably associated with vitiligo susceptibility.

Vitiligo as a systemic disease

Vitiligo is an acquired depigmentary skin disorder of unknown etiology. Vitiligo is not only a disease of melanocytes of the skin. Human melanocytes are derived from the neural crest and are located on various parts of the body. The involvement of skin melanocytes is the most visible one, but a systemic involvement of melanocytes can be observed. Some types of vitiligo (nonsegmental vitiligo) may also be associated with various diseases, mainly with autoimmune pathogenesis. Vitiligo represents a spectrum of many different disorders with different etiologies and pathogeneses, causing a common phenotype: the loss of melanocytes and/or their products. This phenotype is always consistent with a systemic involvement.