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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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Khalili M, Amiri R, Mohammadi S, Iranmanesh B, Aflatoonian M. Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article. J Cosmet Dermatol 2022; 21:2360-2373. [DOI: 10.1111/jocd.14899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Maryam Khalili
- Department of Dermatology Kerman University of Medical Sciences Iran
| | - Rezvan Amiri
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Saman Mohammadi
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Behzad Iranmanesh
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Mahin Aflatoonian
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
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Gan EY, Eleftheriadou V, Esmat S, Hamzavi I, Passeron T, Böhm M, Anbar T, Goh BK, Lan CCE, Lui H, Ramam M, Raboobee N, Katayama I, Suzuki T, Parsad D, Seth V, Lim HW, van Geel N, Mulekar S, Harris J, Wittal R, Benzekri L, Gauthier Y, Kumarasinghe P, Thng STG, Silva de Castro CC, Abdallah M, Vrijman C, Bekkenk M, Seneschal J, Pandya AG, Ezzedine K, Picardo M, Taïeb A. Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2017; 30:28-40. [PMID: 27864868 DOI: 10.1111/pcmr.12561] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/10/2016] [Indexed: 02/01/2023]
Abstract
The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.
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Affiliation(s)
- Emily Y Gan
- National Skin Centre, Singapore City, Singapore
| | | | - Samia Esmat
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Iltefat Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France.,INSERM U1065, Team 12, C3M, Nice, France
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Tag Anbar
- Dermatology Department, Minia University, Minia, Egypt
| | - Boon Kee Goh
- Skin Physicians, Mount Elizabeth Medical Center, Singapore City, Singapore
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - M Ramam
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ichiro Katayama
- Department of Dermatology Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tamio Suzuki
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vaneeta Seth
- Department of Dermatology, Newton Wellesley Hospital, Newton, MA, USA
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Sanjeev Mulekar
- National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia.,Mulekar Clinic, Mumbai, India
| | - John Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard Wittal
- Department of Dermatology, University of New South Wales, Sydney, NSW, Australia.,Skin and Cancer Foundation, Darlinghurst, NSW, Australia.,Beecroft Dermatology, Beecroft, Sydney, NSW, Australia
| | - Laila Benzekri
- Mohammed V University in Rabat, Department of Dermatology, Ibn Sina University Hospital, Rabat, Morocco
| | - Yvon Gauthier
- Pigmentary Disorders Outpatient Clinic, Bordeaux, France
| | - Prasad Kumarasinghe
- Department of Dermatology, Fiona Stanley Hospital and University of Western Australia, Perth, WA, Australia
| | | | | | - Marwa Abdallah
- Dermatology, Andrology & Venereology Department, Ain Shams University, Cairo, Egypt
| | - Charlotte Vrijman
- Department of Dermatology, Academic Medical Centre, Netherlands Institute for Pigment Disorders, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Bekkenk
- Department of Dermatology, Academic Medical Centre, Netherlands Institute for Pigment Disorders, University of Amsterdam, Amsterdam, The Netherlands
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France.,INSERM U 1035, University of Bordeaux, Bordeaux, France
| | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France.,EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil, Créteil, France
| | - Mauro Picardo
- Cutaneous pathophysiology, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France.,INSERM U 1035, University of Bordeaux, Bordeaux, France
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Orouji Z, Bajouri A, Ghasemi M, Mohammadi P, Fallah N, Shahbazi A, Rezvani M, Vaezirad F, Khalajasadi Z, Alizadeh A, Taghiabadi E, Dashtbozorgi S, Aghdami R, Hosseini SE, Bahahrvand H, Shafieyan S, Aghdami N. A single-arm open-label clinical trial of autologous epidermal cell transplantation for stable vitiligo: A 30-month follow-up. J Dermatol Sci 2017; 89:52-59. [PMID: 29103774 DOI: 10.1016/j.jdermsci.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recently, we introduced intralesional injection of autologous epidermal cells as a safe and feasible approach for transplantation in patients with stable vitiligo. This approach resulted in less pain during and after the procedure, no scarring or cobblestone formation at the recipient site, and was more feasible to perform on curved surfaces such as joints, lips, eyelids, ears, and face. OBJECTIVE In this study, we aimed to investigate the long-term efficacy and safety of this transplantation technique. METHODS In this open-label and single-arm clinical trial, we enrolled 300 patients with stable vitiligo. We obtained a partial thickness normo-pigmented skin specimen from the patients' thigh-buttock junction with an area of one tenth to one third of the recipient site area. The epidermal cell suspension was prepared by processing the autologous skin specimen. We injected the cell suspension into 1060 vitiligo patches in 300 patients. Patients did not use any adjuvant phototherapy during the study. An experienced dermatologist and patients respectively defined the repigmentation score and self-assessment score at regular follow-up visits for up to 30 months after treatment. The scores represented the repigmentation percentage as follows: 0 (0), I (1%-24%), II (25%-49%), III (50%-74%), and IV (75%-100%). RESULTS The mean repigmentation score at 3 months post-transplantation was 1.12±0.73. A significant upward trend existed in the mean repigmentation score until 9 months after cell transplantation, when the mean repigmentation score reached to 1.98±1.20. At 9 months after treatment, repigmentation of >50% was obtained in 32.2% of treated patches. Acquired repigmentation remained stable in 79.3% of treated patches during the follow-up period. The number of received cells per cm2 positively influenced the repigmentation score. Patches located on face, neck and trunk showed significantly higher response to the treatment. CONCLUSION The results of our study demonstrated efficacy and safety of autologus epidermal cell transplantation on repigmentation of vitiligo patches. The achieved repigmentation was stable in the majority of treated patches during the follow-up period.
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Affiliation(s)
- Zahra Orouji
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Amir Bajouri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mahshid Ghasemi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Parvaneh Mohammadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Nasrin Fallah
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Atefeh Shahbazi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mohammad Rezvani
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Fatemeh Vaezirad
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Zahra Khalajasadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ehsan Taghiabadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sara Dashtbozorgi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Raheleh Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Seyedeh Esmat Hosseini
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hossein Bahahrvand
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Saeed Shafieyan
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | - Nasser Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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6
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Mohamed Mohamed EE, Younes AK, Osmand A, Mohamed R, Makki M, Younis M. Punch graft versus follicular hair transplantation in the treatment of stable vitiligo. J COSMET LASER THER 2017; 19:290-293. [PMID: 28272910 DOI: 10.1080/14764172.2017.1303170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the efficacy of follicular hair transplantation and mini punch graft in the treatment of stable vitiligo. METHODS Thirty-two patients with stable vitiligo were included in this comparative study. A single patch from each patient was divided into two halves: one half was treated by punch graft, while the other half was treated by follicular hair transplantation followed by excimer light twice weekly, and the outcome was assessed at 0, 1, 3 and 6 months post operatively by photography and quartile scale. RESULTS At the final visit, the percentage of improvement of vitiligo in punch graft-treated side was significantly higher than that in follicular hair transplantation-treated side (p < 0.05). Also, repigmentation after punch grafting occurred after a mean period of 2.5 ± 0.5 weeks (range, 2-3 weeks), while after follicular hair transplantation, repigmentation occurred after 5.2 ± 1.9 weeks (range, 5-8 weeks) (p < 0.05). Cobblestone appearance was the most common complication after punch graft; it occurred in 29 patients (90%), while no reported side effects occurred after follicular graft technique. CONCLUSION Punch grafting is more effective than follicular grafting in the treatment of stable vitiligo; however, follicular hair transplantation is cosmetically better, so we recommend it in exposed areas as face.
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Affiliation(s)
| | | | - Ahmed Osmand
- b Plastic Surgery Department , Assiut University , Assiut , Egypt
| | - Refaat Mohamed
- a Department of Dermatology , Al Azhar University (Assiut) , Egypt
| | - Mahmoud Makki
- a Department of Dermatology , Al Azhar University (Assiut) , Egypt
| | - Marwa Younis
- c Dermatology and Andrology Clinic , Government of Health , Assiut , Egypt
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7
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Komen L, Vrijman C, Prinsen CAC, van der Veen JPW, Luiten RM, Wolkerstorfer A. Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial. J DERMATOL TREAT 2016; 28:86-91. [DOI: 10.1080/09546634.2016.1179251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lisa Komen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Vrijman
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cecilia A. C. Prinsen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - J. P. Wietze van der Veen
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Medical Center Haaglanden, Hague, The Netherlands
| | - Rosalie M. Luiten
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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8
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Tsuchiyama K, Watabe A, Sadayasu A, Onodera N, Kimura Y, Aiba S. Successful Treatment of Segmental Vitiligo in Children with the Combination of 1-mm Minigrafts and Phototherapy. Dermatology 2016; 232:237-41. [PMID: 26836583 DOI: 10.1159/000442666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Minigrafts using a 1-mm biopsy punch (1-mm minigrafts) are being increasingly used to treat vitiligo. However, there have been few reports of the use of 1-mm minigrafts in pediatric patients. OBJECTIVE To examine the effectiveness of combination therapy with 1-mm minigrafts and phototherapy in children with segmental vitiligo. METHODS Minigrafts were placed in 13 patients aged ≤16 years with segmental vitiligo. Following surgery, 11 patients underwent irradiation with excimer laser light and 2 with narrow-band ultraviolet B light. RESULTS A mean repigmentation of 81.6% was obtained. A particularly high mean repigmentation of 87.9% was seen in patients aged ≤12 years, indicating greater efficacy in these patients than in patients aged ≥13 years (mean, 67.5%). Although a transient cobblestone appearance occurred as an adverse effect, it improved over time. CONCLUSIONS Combined treatment of segmental vitiligo with 1-mm minigrafts and phototherapy can be performed safely and is highly effective in young patients.
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Affiliation(s)
- Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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9
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Seo J, Kim J, Nam KA, Zheng Z, Oh BH, Chung KY. Reconstruction of large wounds using a combination of negative pressure wound therapy and punch grafting after excision of acral lentiginous melanoma on the foot. J Dermatol 2015; 43:79-84. [PMID: 26173565 DOI: 10.1111/1346-8138.13017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/27/2015] [Indexed: 11/28/2022]
Abstract
Melanoma in darker-pigmented individuals often develops in an acral lentiginous fashion on the foot. After surgical removal of a tumor at this site, repair of the wound can be challenging. This is because there is an insufficient local skin pool and lack of mobility of the skin in this area. Moreover, functional aspects such as walking and weight bearing should be considered. We performed a combination treatment of negative pressure wound therapy (NPWT) and punch grafting on 15 patients, after wide excision of acral lentiginous melanomas on the foot, and compared these to 26 patients who underwent either secondary intention healing (SIH, n = 13) or NPWT (n = 13) alone. The punch grafting with NPWT group showed significantly shorter healing times than those of the other two groups. Evaluation of completely healed wounds using the Vancouver Burn Scar Assessment Scale revealed that the punch grafting group had mean values better, or comparable, to the SIH or NPWT group in four of the five scales (except pigmentation). As for complications, only one patient developed a wound infection after punch grafting. Further, by utilizing NPWT for fixation of punch grafts, it was possible to treat all subjects as outpatients after punch grafting. These results show that a combination treatment of NPWT and punch grafting is an excellent therapeutic option for post-wide excision wounds on the feet, with significantly shortened healing times and favorable cosmetic outcomes.
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Affiliation(s)
- Jimyung Seo
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jihee Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Ae Nam
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Zhenlong Zheng
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Dermatology, Yanbian University College of Medicine, Yanji, China
| | - Byung Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Dermatology, Keimyung University College of Medicine, Daegu, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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10
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Faria AR, Tarlé RG, Dellatorre G, Mira MT, Castro CCSD. Vitiligo--Part 2--classification, histopathology and treatment. An Bras Dermatol 2015; 89:784-90. [PMID: 25184918 PMCID: PMC4155957 DOI: 10.1590/abd1806-4841.20142717] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 11/22/2022] Open
Abstract
In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.
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11
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Eby JM, Kang HK, Klarquist J, Chatterjee S, Mosenson JA, Nishimura MI, Garrett-Mayer E, Longley BJ, Engelhard VH, Mehrotra S, Le Poole IC. Immune responses in a mouse model of vitiligo with spontaneous epidermal de- and repigmentation. Pigment Cell Melanoma Res 2014; 27:1075-85. [PMID: 24935676 PMCID: PMC4470702 DOI: 10.1111/pcmr.12284] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/13/2014] [Indexed: 12/27/2022]
Abstract
To generate a mouse model of spontaneous epidermal depigmentation, parental h3TA2 mice, expressing both a human-derived, tyrosinase-reactive T-cell receptor on T cells and the matching HLA-A2 transgene, were crossed to keratin 14-promoter driven, stem cell factor transgenic (K14-SCF) mice with intra-epidermal melanocytes. In resulting Vitesse mice, spontaneous skin depigmentation precedes symmetrical and sharply demarcated patches of graying hair. Whereas the SCF transgene alone dictates a greater retinoic acid receptor-related orphan receptor gamma (RORγt)(+) T-cell compartment, these cells displayed markedly increased IL-17 expression within Vitesse mice. Similar to patient skin, regulatory T cells were less abundant compared with K14-SCF mice, with the exception of gradually appearing patches of repigmenting skin. The subtle repigmentation observed likely reflects resilient melanocytes that coexist with skin-infiltrating, melanocyte-reactive T cells. Similar repigmenting lesions were found in a different TCR transgenic model of vitiligo developed on an SCF transgenic background, supporting a role for SCF in repigmentation.
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Affiliation(s)
- Jonathan M Eby
- Oncology Research Institute, Loyola University Chicago, Chicago, IL, USA
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12
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Mapar MA, Safarpour M, Mapar M, Haghighizadeh MH. A comparative study of the mini-punch grafting and hair follicle transplantation in the treatment of refractory and stable vitiligo. J Am Acad Dermatol 2014; 70:743-747. [DOI: 10.1016/j.jaad.2013.11.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/16/2013] [Accepted: 11/30/2013] [Indexed: 11/15/2022]
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13
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Mosenson JA, Zloza A, Nieland JD, Garrett-Mayer E, Eby JM, Huelsmann EJ, Kumar P, Denman CJ, Lacek AT, Kohlhapp FJ, Alamiri A, Hughes T, Bines SD, Kaufman HL, Overbeck A, Mehrotra S, Hernandez C, Nishimura MI, Guevara-Patino JA, Le Poole IC. Mutant HSP70 reverses autoimmune depigmentation in vitiligo. Sci Transl Med 2014; 5:174ra28. [PMID: 23447019 DOI: 10.1126/scitranslmed.3005127] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Vitiligo is an autoimmune disease characterized by destruction of melanocytes, leaving 0.5% of the population with progressive depigmentation. Current treatments offer limited efficacy. We report that modified inducible heat shock protein 70 (HSP70i) prevents T cell-mediated depigmentation. HSP70i is the molecular link between stress and the resultant immune response. We previously showed that HSP70i induces an inflammatory dendritic cell (DC) phenotype and is necessary for depigmentation in vitiligo mouse models. Here, we observed a similar DC inflammatory phenotype in vitiligo patients. In a mouse model of depigmentation, DNA vaccination with a melanocyte antigen and the carboxyl terminus of HSP70i was sufficient to drive autoimmunity. Mutational analysis of the HSP70i substrate-binding domain established the peptide QPGVLIQVYEG as invaluable for DC activation, and mutant HSP70i could not induce depigmentation. Moreover, mutant HSP70iQ435A bound human DCs and reduced their activation, as well as induced a shift from inflammatory to tolerogenic DCs in mice. HSP70iQ435A-encoding DNA applied months before spontaneous depigmentation prevented vitiligo in mice expressing a transgenic, melanocyte-reactive T cell receptor. Furthermore, use of HSP70iQ435A therapeutically in a different, rapidly depigmenting model after loss of differentiated melanocytes resulted in 76% recovery of pigmentation. Treatment also prevented relevant T cells from populating mouse skin. In addition, ex vivo treatment of human skin averted the disease-related shift from quiescent to effector T cell phenotype. Thus, HSP70iQ435A DNA delivery may offer potent treatment opportunities for vitiligo.
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Affiliation(s)
- Jeffrey A Mosenson
- Department of Pathology, Immunology/Oncology Institute, Loyola University Chicago, Maywood, IL 60153, USA
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14
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Sharma S, Garg VK, Sarkar R, Relhan V. Comparative Study of Flip-top Transplantation and Punch Grafting in Stable Vitiligo. Dermatol Surg 2013; 39:1376-84. [DOI: 10.1111/dsu.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Macedo ACBD, Oliveira CFD, Silva ECM, Andrade LASD. Efeitos da aplicação do L.A.S.E.R. HeNe e do ultravioleta B no vitiligo. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O vitiligo é uma doença crônica despigmentante da pele, ocasionada pela perda funcional dos melanócitos da epiderme. Este estudo teve como objetivo comparar os efeitos da aplicação do L.A.S.E.R. HeNe e do ultravioleta B em pacientes com vitiligo. MÉTODO: Foram selecionados 22 pacientes (11 mulheres e 11 homens), com idade entre 12 e 60 anos (31,68 ± 16,29). Os pacientes foram distribuídos aleatoriamente, de acordo com a ordem de comparecimento no serviço e foram divididos randomicamente em dois grupos: o grupo A (n = 12), submetido à aplicação do L.A.S.E.R. HeNe, para o qual a técnica utilizada foi a pontual com aproximadamente 3 cm de distância entre cada ponto, perpendicularmente à pele, e o grupo B (n = 10), exposto ao Ultravioleta B, aplicado de forma perpendicular com 10 cm de afastamento da pele do paciente. Para mensuração da área tratada, utilizou-se o programa AUTOCAD 2002, no qual foi delimitada a borda da mácula em fotos tiradas no início e no fim do tratamento. RESULTADOS: Inicialmente, no grupo A, a área era de 4,87 cm² ± 3,70 e, após a aplicação, foi de 4,15 cm² ± 2,89, com diferença média de 0,72 cm² (1,89). No grupo B, verificou-se que antes da aplicação a média era de 5,36 cm² ± 6,36 e, a após a aplicação, foi de 4,43 cm² ± 5,17, com diferença média de 0,92 cm² ± 1,29. CONCLUSÃO: Ambos os aparelhos obtiveram resultados significativos na redução da mácula, com maior redução no grupo da ultravioleta.
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Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
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Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
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Linthorst Homan M, Wolkerstorfer A, Sprangers M, van der Veen J. Digital image analysis vs. clinical assessment to evaluate repigmentation after punch grafting in vitiligo. J Eur Acad Dermatol Venereol 2012; 27:e235-8. [DOI: 10.1111/j.1468-3083.2012.04568.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kroon MW, Kemp EH, Wind BS, Krebbers G, Bos JD, Gawkrodger DJ, Wolkerstorfer A, van der Veen JPW, Luiten RM. Melanocyte antigen-specific antibodies cannot be used as markers for recent disease activity in patients with vitiligo. J Eur Acad Dermatol Venereol 2012; 27:1172-5. [PMID: 22404127 DOI: 10.1111/j.1468-3083.2012.04501.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Objective parameters to assess disease activity in non-segmental vitiligo are lacking. Melanocyte antigen-specific antibodies are frequently found in the sera of patients with vitiligo and the presence of these antibodies may correlate with disease activity. OBJECTIVE To investigate the relationship between melanocyte antigen-specific antibodies and recent disease activity in patients with vitiligo and to evaluate the potential usefulness of this objective parameter in daily clinical practice. METHODS The prevalence of tyrosinase, melanoma antigen recognized by T-cells-1 (MART1), melanin-concentrating hormone receptor-1 (MCHR1), gp100 and tyrosine hydroxylase (TH) antibodies was evaluated in 21 patients with non-segmental vitiligo and in 20 healthy controls. RESULTS In 21 patients, nine (42.8%) showed antibody responses against tyrosinase, MART1, MCHR1, gp100 or TH. No antibody responses were found in the 20 controls. No correlation was found between the presence of antibodies and recent disease activity or other clinical characteristics such as age, gender, extension and duration of vitiligo. CONCLUSIONS In this study, 42.8% of the vitiligo patients showed an antibody response to melanocyte antigen-specific antigens. However, the presence of antibodies against melanocytes did not correlate with recent disease activity or other relevant disease parameters, and for the moment screening for these antibodies in individual patients does not appear to be clinically relevant.
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Affiliation(s)
- M W Kroon
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Huggins RH, Henderson MD, Mulekar SV, Ozog DM, Kerr HA, Jabobsen G, Lim HW, Hamzavi IH. Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: the experience of an academic medical center in the United States. J Am Acad Dermatol 2011; 66:785-93. [PMID: 21864935 DOI: 10.1016/j.jaad.2011.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Vitiligo is a disfiguring disease with limited treatment options. Surgical treatment is underused in the United States because of perceived risk of infection, costs, and difficulty of the procedure. OBJECTIVE We sought to determine the efficacy and safety of the melanocyte-keratinocyte transplantation procedure (MKTP) in an academic dermatology department in the United States. METHODS This prospective, uncontrolled, open-label study enrolled patients aged 18 years or older with a self-reported history of vitiligo and no new or expanding lesions for at least 6 months before surgery. Patients with a history of koebnerization or keloid formation were excluded. Patients underwent autologous MKTP. Repigmentation during a 3- to 6-month follow-up period was assessed categorically and by modified Vitiligo Area Scoring Index. Safety was assessed by frequency of adverse events. RESULTS Of the 28 patients who underwent 36 procedures, 23 patients who underwent 29 procedures completed the 3- to 6-month follow-up period. Data for these 29 procedures show excellent repigmentation (ie, 95%-100%) after the MKTP in 17%, and good repigmentation (ie, 65%-94%) in 31%. Fair (64%-25%) and poor (24%-0%) repigmentation were achieved in 10% and 41% of patients, respectively. Average percent change in Vitiligo Area Scoring Index was -45% (95% confidence interval -64% to -26%), signifying an improvement in pigmentation. LIMITATIONS Limitations include small sample size and lack of a control group. CONCLUSIONS The MKTP is an effective and well-tolerated procedure based upon categorical and Vitiligo Area Scoring Index assessments of repigmentation.
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Affiliation(s)
- Richard H Huggins
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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