1
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Seneschal J. Clinical Features of Vitiligo and Social Impact on Quality of Life. Dermatol Pract Concept 2023; 13:dpc.1304S2a312S. [PMID: 38241394 PMCID: PMC10824319 DOI: 10.5826/dpc.1304s2a312s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
Vitiligo is the most common cause of depigmentation and its estimated worldwide prevalence ranges from 0.5% to 2%. The disease is characterized by the development of white macules resulting from a loss of epidermal melanocytes. The term vitiligo (nonsegmental) is now a consensus umbrella term for all forms of generalized vitiligo. Two other subsets of vitiligo are segmental vitiligo and unclassified/undetermined vitiligo, which corresponds to focal disease and rare variants. A series of hypopigmented disorders may masquerade as vitiligo, and some of them need to be ruled out by specific procedures including a skin biopsy. The skin plays an important role in our interaction with the world and any change in the skin colour can have important psychological consequences. In this line, vitiligo has a major impact on quality of life.In this review, we will detail the most recent data on the clinical features of vitiligo and its impact on quality of life.
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Affiliation(s)
- Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin disorders, Hôpital Saint-André, Bordeaux, France
- University of Bordeaux, CNRS, Immuno ConcEpT, UMR 5164, Bordeaux, France
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2
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Gauthier Y, Lepreux S, Cario‐Andre M, Rambert J, Dakdaki A, Lafon M, Abouqal R, Benzekri L. Varicella-zoster virus in actively spreading segmental vitiligo skin: Pathological, immunochemical, and ultrastructural findings (a first and preliminary study). Pigment Cell Melanoma Res 2023; 36:78-85. [PMID: 36112095 PMCID: PMC10092484 DOI: 10.1111/pcmr.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 12/31/2022]
Abstract
Segmental vitiligo (SV) is a unilateral subtype of vitiligo which is clinically characterized by a cutaneous depigmentation and histologically by a melanocyte loss from the epidermis and hair follicle reservoirs. To date, its pathogenesis remains a mystery. In many cases, this skin depigmentation shares several clinical features and dysfunctions with herpes zoster (HZ). So, for the first time, we examined whether any nucleus and cell fusion associated with a positive immunolabelling of varicella-zoster virus (VZV) and VZV mature virions could be found in SV skin samples as in herpes zoster (HZ). A total of 40 SV samples were used for histological and immunochemical studies. Control samples were obtained from three HZ, and 10 generalized vitiligo lesions. For ultrastructural study, three recent SV and one HZ as controls were recruited. Here, we report that nuclear fusion in epidermal cells were statistically associated with recent SV (p < .001), whereas syncytia formation was associated with long-lasting SV (p = .001). A positive detection of VZV antigen was statistically associated in the epidermis with recent SV and in the dermis with long-lasting SV (p = .001). Finally, the discovery of mature virions in 3/3 recent SV samples provides additional arguments for our viral hypothesis.
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Affiliation(s)
- Yvon Gauthier
- Vitiligo and Melasma Research Association (V.M.R.A.)BordeauxFrance
| | | | - Muriel Cario‐Andre
- Bordeaux University, INSERM, BRIC, U1312BordeauxFrance
- National Reference Center for Rare skin DiseasesBordeaux University HospitalBordeauxFrance
- AquidermBordeauxFrance
| | - Jérome Rambert
- National Reference Center for Rare skin DiseasesBordeaux University HospitalBordeauxFrance
| | - Adrien Dakdaki
- Tumor Bank and Tumor Biology LaboratoryCHU BordeauxPessacFrance
| | - Marie‐Edith Lafon
- Department of Virology Bordeaux University HospitalBordeaux University, CNRS, UMR5234BordeauxFrance
| | - Redouane Abouqal
- Laboratory of Biostatistics, Clinical Research and EpidemiologyMohammed V University in Rabat, Acute Medical Unit, Ibn Sina Teaching HospitalRabatMorocco
| | - Laila Benzekri
- Dermatology Department, Ibn Sina Teaching HospitalMohammed V University in Rabat, Pigmentary Disorders Outpatient ClinicRabatMorocco
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3
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Kumar S, Vinay K, Choudhary R, Thakur V, Bishnoi A, Kumaran MS, Parsad D. Clinicodemographic features of mixed vitiligo: a case–control study. Int J Dermatol 2022; 61:982-987. [DOI: 10.1111/ijd.16090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sheetanshu Kumar
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rajat Choudhary
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vishal Thakur
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
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Pan C, Shang J, Jiang H, Shi Y, Zhang W, Xiong J, Mei Y, Long S, Ge G, Wang Z, Wu Z, Wang H, Wu A. Transcriptome Analysis Reveals the Molecular Immunological Characteristics of Lesions in Patients with Halo Nevi When Compared to Stable Vitiligo, Normal Nevocytic Nevi and Cutaneous Melanoma. J Inflamm Res 2021; 14:4111-4124. [PMID: 34466016 PMCID: PMC8403033 DOI: 10.2147/jir.s321672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Given their similar appearance and histology, halo nevi (HN) were considered as a type of vitiligo. However, whether HN have stronger immune response than stable vitiligo (VL) remains unclear. In addition, the molecular alterations in HN compared with normal nevocytic nevi (NN) and primary cutaneous melanoma (MM) must be determined. This study aimed to systematically characterize the molecular immunological features of HN. Methods Skin samples from patients with HN, VL, NN, and MM were obtained with informed consent. Each of the four groups underwent transcriptome sequencing and data analysis were for pairwise comparison. Quantitative real-time PCR (RT-qPCR) was conducted to confirm the transcriptional expression of some differentially expressed genes (DEGs) that were closely related to immunity. Results A total of 441 and 1507 DEGs were found in the HN/NN and HN/MM groups, respectively. Compared with those of VL, HN lesions contained 162 up-regulated DEGs and 12 down-regulated DEGs. Bioinformatics analysis showed that the up-regulated genes in HN were substantially enriched in immune response, immune deficiency, and immune rejection; biological stimulation (virus, bacteria); and proliferation and activation of immune cells. Immune cell composition analysis also confirmed high expression levels of multiple immunocytes in HN. Conclusion The molecular immune mechanisms of HN and VL were similar, but the immune activity of HN was stronger than that of VL. Innate and adaptive immunity were involved in the pathogenesis and progression of HN and VL.
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Affiliation(s)
- Chun Pan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Jingzhe Shang
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, People's Republic of China.,Suzhou Institute of Systems Medicine, Suzhou, 215123, People's Republic of China
| | - Haiqin Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Ying Shi
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Wenyue Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Jingshu Xiong
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Youming Mei
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Siyu Long
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Gai Ge
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Zhenzhen Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Ziwei Wu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Hongsheng Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210046, People's Republic of China
| | - Aiping Wu
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, People's Republic of China.,Suzhou Institute of Systems Medicine, Suzhou, 215123, People's Republic of China
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Thakur V, Bishnoi A, Vinay K, Kumaran SM, Parsad D. Vitiligo: Translational research and effective therapeutic strategies. Pigment Cell Melanoma Res 2021; 34:814-826. [PMID: 33756039 DOI: 10.1111/pcmr.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/28/2023]
Abstract
This is an exciting phase of vitiligo research with the current understanding of vitiligo pathogenesis and its translation to successful treatment. The pathogenetic origin of vitiligo revolves around autoimmunity with supporting role from many other factors like oxidative stress, inherent melanocyte defects, or defective keratinocytes and fibroblasts. Vitiligo can be classified into segmental or non-segmental depending upon the clinical presentation, or it can be classified as progressing or stable based on the activity of the disease. Vitiligo treatments need to be stratified depending upon which type of vitiligo we are treating and at which phase the vitiligo patient presents to us. There are two different aims of treatment of vitiligo. The first involves rescuing the melanocytes from the damage to arrest the depigmentation. The second strategy focuses on replenishing the melanocytes so that successful repigmentation is achieved. It is also important to maintain the disease in a stable phase or prevent relapse. As stability in non-segmental vitiligo is a dynamic process, maintenance of the stability of repigmentation is also an important consideration in the management of vitiligo. In this review, we shall briefly discuss the current options and future insight into the management of vitiligo.
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Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sendhil M Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Oh SH. Classification and diagnosis of vitiligo. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.12.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vitiligo is a relatively common, acquired hypopigmentary disorder caused by the loss of epidermal melanocytes. It is characterized by asymptomatic, well-circumscribed round to oval-shaped whitish patches that vary in size. Depending on various clinical features, vitiligo is classified into several types, that is, non-segmental, segmental, and undetermined/unclassified vitiligo. The uniform classification of vitiligo is very important in predicting its clinical course and prognosis and communication among researchers. In particular, segmental vitiligo is a highly distinctive subtype of vitiligo considering its clinical features and prognosis. It usually has an onset early in life and spreads rapidly within the affected area limited to one segment of the integument. Signs of vitiligo activity such as Koebnerʼs phenomenon, trichrome vitiligo, inflammatory vitiligo, and confetti-like lesions give useful information to start treatments to block the progression of the disease. Lastly, other hypopigmentary disorders should be distinguished from vitiligo to make the correct diagnosis and prescribe the right treatment. In this report, I review the clinical features of vitiligo, various subtypes according to classification, and the importance for differential diagnosis of hypopigmentary disorders from vitiligo.
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Speeckaert R, Lambert J, Bulat V, Belpaire A, Speeckaert M, van Geel N. Autoimmunity in Segmental Vitiligo. Front Immunol 2020; 11:568447. [PMID: 33193342 PMCID: PMC7655129 DOI: 10.3389/fimmu.2020.568447] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/08/2020] [Indexed: 12/20/2022] Open
Abstract
The autoimmune basis of segmental vitiligo (SV) has only recently been recognized. Systemic autoimmune diseases are less frequently associated compared to non-segmental vitiligo (NSV), but localized skin disorders - in particular linear morphea - have been repeatedly observed in patients with SV. The inflammatory response is documented on a clinical level with cases displaying erythematous borders or a hypochromic stage, on a histopathological level with predominantly CD8 lymphocytes migrating toward the basal layer and by flow cytometry demonstrating the antimelanocyte specificity of these cytotoxic T cells. The increased risk for halo naevi and NSV in these patients further underline the immune-mediated mechanisms of SV. Nonetheless, the localized and unique distribution pattern points to somatic mosaicism. This places SV in a category of similar diseases such as lichen striatus, blaschkitis, linear lupus erythematosus, and linear scleroderma where an immune reaction against genetically mutated skin cells is believed to be the underlying cause. All these disorders are characterized by a young age of onset, a temporary disease activity with spontaneous resolution, limited response to treatment, and often long-term sequelae. Although challenging, genetic research proving this genetic mosaicism could offer crucial insights into the pathogenesis of both segmental and non-segmental vitiligo.
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Affiliation(s)
| | - Jo Lambert
- Department of Dermatology, Gent University Hospital, Gent, Belgium
| | - Vedrana Bulat
- Department of Dermatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Arno Belpaire
- Department of Dermatology, Gent University Hospital, Gent, Belgium
| | | | - Nanja van Geel
- Department of Dermatology, Gent University Hospital, Gent, Belgium
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8
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Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
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9
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Sink JR, Silverberg NB. Genital vitiligo in children: Factors associated with generalized, non-segmental vitiligo. Pediatr Dermatol 2020; 37:64-68. [PMID: 31682011 DOI: 10.1111/pde.13998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES It remains uncertain as to whether genital vitiligo of childhood is segmental or a forme fruste of non-segmental disease. This type of vitiligo is sometimes termed figure-of-eight disease due to female predominance and perineal and perianal hypopigmentation or depigmentation around two orifices, the anal and vaginal introitus. The objective of this series was to categorize the features of genital-limited vitiligo of childhood including comorbidities, family history, and long-term course. METHODS IRB-approved retrospective chart review of vitiligo cases. RESULTS Eight cases of vitiligo that began in childhood in the genital area were identified, including clinical course and comorbidities. Involvement of the contiguous skin, including inner thighs, buttocks, and scrotum, was noted in all males. In females, only 1 patient had other sites of vitiligo, which was a solitary lesion on the chest. Therapeutic response to topical corticosteroids for perianal skin was seen in five of six children and topical calcineurin inhibitors with or without calcipotriene in four out of four patients. CONCLUSIONS Segmental disease limited to the genitalia was more common in females than males, suggesting that perhaps intervention and work-up for comorbid autoimmune diseases may be required for males with genital-limited vitiligo at onset, but may be deferred in females and added if observation of spread is noted. Differentiation from lichen sclerosus et atrophicus may require biopsy.
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Affiliation(s)
- Jacquelyn R Sink
- Department of Dermatology, New York Medical College-Metropolitan Hospital, New York, New York
| | - Nanette B Silverberg
- Departments of Pediatrics and Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Abstract
Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.
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Affiliation(s)
- Electra Nicolaidou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Styliani Mastraftsi
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece.
| | - Vassiliki Tzanetakou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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11
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Amico S, Jacquemin C, Boniface K, Jullié ML, Taieb A, Seneschal J. An unusual presentation of Sutton's phenomenon presenting as halo cherry angioma. J Eur Acad Dermatol Venereol 2019; 33:e464-e465. [PMID: 31283033 DOI: 10.1111/jdv.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Amico
- Department of Dermatology, National Reference Center for Rare Skin Diseases, Bordeaux University Hospitals, Bordeaux, France
| | - C Jacquemin
- INSERM U 1035, BMGIC, Immuno-Dermatology, ATIP-AVENIR, Bordeaux University, Bordeaux, France
| | - K Boniface
- INSERM U 1035, BMGIC, Immuno-Dermatology, ATIP-AVENIR, Bordeaux University, Bordeaux, France
| | - M-L Jullié
- Department of Pathology, Bordeaux University Hospitals, Pessac, France
| | - A Taieb
- Department of Dermatology, National Reference Center for Rare Skin Diseases, Bordeaux University Hospitals, Bordeaux, France
| | - J Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Diseases, Bordeaux University Hospitals, Bordeaux, France.,INSERM U 1035, BMGIC, Immuno-Dermatology, ATIP-AVENIR, Bordeaux University, Bordeaux, France
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12
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Abstract
Childhood vitiligo differs from adult-onset vitiligo for several features including increased incidence of the segmental variant, higher prevalence of halo nevi, and more common family history for autoimmune diseases and atopic diathesis. The major differential diagnoses are the postinflammatory hypomelanoses for nonsegmental vitiligo and nevus depigmentosus for segmental vitiligo. From a therapeutic standpoint, early awareness of the diagnosis seems to correlate with a good treatment outcome in this age group.
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13
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Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol 2017; 77:1-13. [DOI: 10.1016/j.jaad.2016.10.048] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 02/07/2023]
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14
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15
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Kim MS, Cho EB, Park EJ, Kim KH, Kim KJ. Effect of excimer laser treatment on vitiliginous areas with leukotrichia after confirmation by dermoscopy. Int J Dermatol 2015; 55:886-92. [DOI: 10.1111/ijd.12972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/04/2015] [Accepted: 01/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Min Seok Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Eun Byul Cho
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Eun Joo Park
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Kwang Ho Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Kwang Joong Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
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16
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Ding GZ, Zhao WE, Li X, Gong QL, Lu Y. A comparative study of mitochondrial ultrastructure in melanocytes from perilesional vitiligo skin and perilesional halo nevi skin. Arch Dermatol Res 2015; 307:281-9. [PMID: 25672813 DOI: 10.1007/s00403-015-1544-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/16/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
Vitiligo and halo nevi are both pigmentary disorders of the skin characterized by the acquired loss of functional epidermal melanocytes manifesting as white macules and patches. The cellular mechanism(s) and biochemical changes that result in the appearance of these two types of achromic lesions are still uncertain; and the relationship between vitiligo and halo nevi has been in dispute. In this study, we investigated the ultrastructure of mitochondria in melanocytes and in keratinocytes from perilesional vitiligo skin and from perilesional halo nevi skin using Transmission Electron Microscopy. Furthermore, we performed a quantitative analysis of mitochondrial morphology through a stereological study. As previously reported, we found that melanocytes from perilesional active vitiligo skin were loosely connected with their surroundings by their retracted dendrites. The surface density and the volume density of mitochondria in melanocytes and in keratinocytes from perilesional vitiligo skin are increased significantly compared with the controls, especially in active vitiligo. In contrast, there are no significant differences in mitochondria in melanocytes and in keratinocytes from perilesional halo nevi skin compared with the controls. In summary, the tendency of different morphologic alterations in mitochondria from perilesional vitiligo skin and from perilesional halo nevi skin reflect heterogeneous backgrounds between the two diseases, revealing that vitiligo and halo nevi may have separate pathogenic mechanisms. These findings may help elucidate the relationship of these two diseases and their underlying mechanisms.
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Affiliation(s)
- Gao-Zhong Ding
- Dermatology Department, The First Affiliated Hospital, Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China
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18
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Anti-thyroid peroxidase antibody in vitiligo: a prevalence study. J Thyroid Res 2015; 2015:192736. [PMID: 25653881 PMCID: PMC4306217 DOI: 10.1155/2015/192736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/20/2014] [Accepted: 12/21/2014] [Indexed: 11/18/2022] Open
Abstract
Aim. The aim of the study was to study the relation of vitiligo with demographic data like age, sex, and duration and determine the prevalence of thyroid autoimmunity in vitiligo patients. Materials and Methods. This study was a cross sectional study consisting of 100 patients clinically diagnosed (old and new) as having vitiligo irrespective of age or sex. Patients with known thyroid disease on supplementation therapy, or who had undergone thyroid surgery, those on antithyroid medication, patients with other causes of leukoderma, and cases who do not provide informed consent were excluded from the study. Serum TSH and anti-TPO antibodies were measured in all the patients. Results. The prevalence of anti-TPO antibody positivity was found to be 28%. Conclusion. According to our study, none of our vitiligo patients had symptoms or signs of thyroid disease at the time of presentation but, on biochemical evaluation, anti-TPO antibodies were found in a considerable number of patients. Hence, we recommend screening of these patients with thyroid antibodies.
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Colucci R, Lotti F, Dragoni F, Arunachalam M, Lotti T, Benvenga S, Moretti S. High prevalence of circulating autoantibodies against thyroid hormones in vitiligo and correlation with clinical and historical parameters of patients. Br J Dermatol 2014; 171:786-98. [PMID: 25059078 DOI: 10.1111/bjd.13286] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Autoantibodies against thyroid hormones (THAbs) directed towards triiodothyronine (T3-Ab) and/or thyroxine (T4-Ab) are very rare in the general population. They are increased in some nonthyroidal autoimmune diseases, where they seem to predict autoimmune thyroid disorders (ATDs). So far, their presence in patients with vitiligo has not been evaluated, but it might have a possible predictive role. OBJECTIVES To assess the prevalence of THAbs in a group of vitiligo patients and to correlate their presence with clinical and historical parameters. METHODS In total 79 patients with nonsegmental vitiligo and 100 controls were examined. Clinical characteristics of vitiligo and family and personal medical history were evaluated. Antinuclear autoantibodies, thyroid hormones and thyroid autoantibodies were measured. IgM T3-Ab, IgG T3-Ab, IgM T4-Ab and IgG T4-Ab were assayed by a radioimmunoprecipitation technique. Fisher's test, Student's t-test and χ(2)-test were used for statistical analysis. RESULTS Overall 77 of 79 patients (97%) had at least one type of THAb (11 T3-Ab, 10 T4-Ab, 56 both). In the control group, only one person (1%) had THAbs. In patients with vitiligo, T3-Abs were significantly associated with leucotrichia (IgM+IgG, P = 0.033; IgG, P = 0.039; IgM, P = 0.005) and thyroglobulin autoantibodies (IgM+IgG, P = 0.031; IgG, P = 0.058), while the absence of T3-Ab was related to personal history of cancer (IgM+IgG, P = 0.021; IgG, P = 0.039). T4-Abs were significantly associated with vitiligo activity (IgM+IgG, P < 0.001; IgM, P = 0.037) and duration (IgG, P = 0.013). CONCLUSIONS The surprisingly high prevalence of THAb in patients with vitiligo and their associations suggest a possible pathogenetic role in the disease and stress the tight link between vitiligo and ATDs. Further evaluation in a larger group of patients and an adequate follow-up are needed to define their potential predictive role.
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Affiliation(s)
- R Colucci
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Abstract
Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue, Suite 11D, New York, NY 10025, USA.
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Schallreuter KU, Salem MAEL, Holtz S, Panske A. Basic evidence for epidermal H2O2/ONOO(-)-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS. FASEB J 2013; 27:3113-22. [PMID: 23629861 DOI: 10.1096/fj.12-226779] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nonsegmental vitiligo (NSV) is characterized by loss of inherited skin color. The cause of the disease is still unknown despite accumulating in vivo and in vitro evidence of massive epidermal oxidative stress via H2O2 and peroxynitrite (ONOO(-)) in affected individuals. The most favored hypothesis is based on autoimmune mechanisms. Strictly segmental vitiligo (SSV) with dermatomal distribution is a rare entity, often associated with stable outcome. Recently, it was documented that this form can be associated with NSV (mixed vitiligo). We here asked the question whether ROS and possibly ONOO(-) could be players in the pathogenesis of SSV. Our in situ results demonstrate for the first time epidermal biopterin accumulation together with significantly decreased epidermal catalase, thioredoxin/thioreoxin reductase, and MSRA/MSRB expression. Moreover, we show epidermal ONOO(-) accumulation. In vivo FT-Raman spectroscopy reveals the presence of H2O2, methionine sulfoxide, and tryptophan metabolites; i.e., N-formylkynurenine and kynurenine, implying Fenton chemistry in the cascade (n=10). Validation of the basic data stems from successful repigmentation of skin and eyelashes in affected individuals, regardless of SSV or segmental vitiligo in association with NSV after reduction of epidermal H2O2 (n=5). Taken together, our contribution strongly supports H2O2/ONOO-mediated stress in the pathogenesis of SSV. Our findings offer new treatment intervention for lost skin and hair color.
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Affiliation(s)
- Karin U Schallreuter
- Institute for Pigmentary Disorders, E. M. Arndt University, Greifswald, Germany.
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Ezzedine K, Diallo A, Léauté-Labrèze C, Seneschal J, Boniface K, Cario-André M, Prey S, Ballanger F, Boralevi F, Jouary T, Mossalayi D, Taieb A. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br J Dermatol 2013; 167:490-5. [PMID: 22512840 DOI: 10.1111/j.1365-2133.2012.11002.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Limited epidemiological data exist that compare clinical features of pre- and post-pubertal nonsegmental vitiligo. OBJECTIVES To compare factors associated with pre- and post-pubertal onset vitiligo. PATIENTS AND METHODS A prospective observational study was conducted of patients with vitiligo attending the clinic between 1 January 2006 and 1 July 2011. The Vitiligo European Task Force questionnaire was completed for each patient and thyroid function and antithyroid antibodies were screened. Other forms of vitiligo (segmental, focal, mucosal, not classifiable) were excluded. RESULTS A total of 679 patients were included; 422 had post-pubertal and 257 pre-pubertal onset of vitiligo. Vitiligo universalis was seen only in post-pubertal onset. In univariate analysis, there was no significant statistical difference for sex, Koebner phenomenon or disease activity between both groups; thyroid disease or presence of thyroid antibodies was more frequent in post-pubertal onset [odds ratio (OR) 0·31, P < 0·003] whereas atopic dermatitis was more often associated with or preceding pre-pubertal onset (OR 2·42, P = 0·006). In multivariate analysis, halo naevi, family history of vitiligo, premature hair greying, atopic dermatitis and previous episode of spontaneous repigmentation were independently associated with pre-pubertal onset. In contrast, stress as onset factor, personal history of thyroid disease and acrofacial type were associated with post-pubertal onset. CONCLUSIONS Pre-pubertal onset vitiligo is strongly associated with personal and family history of atopy, suggesting that the predisposing immune background in vitiligo is not limited to autoimmunity, as also noted in alopecia areata. This study also suggests reconsidering the epidemiological data on sex ratio in vitiligo.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology, and National Centre for Rare Skin Disorders, CHU St-André, 1 rue Jean Burguet, Hôpital Pellegrin, 33075 Bordeaux, France.
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Li Y, Xu A. Segmental vitiligo in children: a clinical epidemiologic study in China. J Eur Acad Dermatol Venereol 2012; 27:1056-7. [PMID: 23176033 DOI: 10.1111/jdv.12003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ezzedine K, Amazan E, Séneschal J, Cario-André M, Léauté-Labrèze C, Vergier B, Boralevi F, Taieb A. Follicular vitiligo: a new form of vitiligo. Pigment Cell Melanoma Res 2012; 25:527-9. [PMID: 22417136 DOI: 10.1111/j.1755-148x.2012.00999.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CCE, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25:E1-13. [PMID: 22417114 PMCID: PMC3511780 DOI: 10.1111/j.1755-148x.2012.00997.x] [Citation(s) in RCA: 372] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner's phenomenon (KP); and 'autoimmune vitiligo'. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term 'vitiligo' be used as an umbrella term for all non-segmental forms of vitiligo, including 'mixed vitiligo' in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that 'autoimmune vitiligo' should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin Disorders, Hôpital Pellegrin, Bordeaux, France.
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