Vitiligo: auto-immunity and immune responses

308 nm excimer laser and tacrolimus ointment in the treatment of facial vitiligo: a systematic review and meta-analysis

This study aimed to investigate the effects and safety of 308 nm excimer laser (308 nm EL) and tacrolimus ointment (TO) in the treatment of facial vitiligo (FV). We searched Cochrane Library, PUBMED, EMBASE, CNKI, and WANGFANG from inception to June 1, 2023. Outcomes included overall response rate (ORR), total adverse reaction rate (TARR), recurrence rate at 3-month (RR-3) and recurrence rate at 6-month (RR-6). The outcome data were presented as odds ratios (OR) with 95% confidence intervals (CI). The risk of bias was assessed by Cochrane risk-of-bias tool and data analysis was performed by RevMan 5.4 software. This study included a total of 19 trials involving 2085 patients. When comparing 308 nm EL monotherapy with 308 nm EL plus TO, significant differences in the ORR (OR = 4.29, 95% CI [2.97, 6.19], I2 = 0%, P < 0.001), RR-3 (OR = 0.18, 95% CI [0.05, 0.69], I2 = 0%, P = 0.01), and RR-6 (OR = 0.38, 95% CI [0.14, 1.03], I2 = 39%, P = 0.06) were found between the two managements. When comparing TO monotherapy with TO plus 308 nm EL, its results showed significant differences in the ORR (OR = 4.21, 95% CI [2.90, 6.11], I2 = 0%, P < 0.001), TARR (OR = 0.42, 95% CI [0.22, 0.81], I2 = 4%, P = 0.009), and RR-3 (OR = 0.32, 95% CI [0.01, 8.03], P = 0.49) between the two modalities. The results of this study suggest that the combination of 308 nm EL and TO is more effective than either treatment alone for the treatment of FV.

Coexistence of eruptive syringoma and bilateral nipple vitiligo: Could there be a common immunopathogenesis?

The rarely seen eruptive syringoma (ES) is characterized by small, skin-colored, papules. Lesions are benign; however, treatment is often unsuccessful. Recent studies have a suggested role of the autoimmune response, rather than reactive proliferation of acrosyringium in the pathogenesis of ES. There are reports in the literature of an association between syringoma and diabetes mellitus as well as alopecia areata, which support a theory of an autoimmune role; however, there has been no report of coexistence of ES and vitiligo thus far. Presently described is a case of bilateral nipple vitiligo and eruptive syringoma in a 29-year old female.

Misbalanced CXCL12 and CCL5 Chemotactic Signals in Vitiligo Onset and Progression

Generalized nonsegmental vitiligo is often associated with the activation of melanocyte-specific autoimmunity. Because chemokines play an important role in the maintenance of immune responses, we examined chemotactic signatures in cultured vitiligo melanocytes and skin samples of early (≤2 months) and advanced (≥6 months) vitiligo. Analysis showed that melanocytes in early lesions have altered expression of several chemotaxis-associated molecules, including elevated secretion of CXCL12 and CCL5. Higher levels of these chemokines coincided with prominent infiltration of the skin with antigen presenting cells (APCs) and T cells. Most of the intralesional APCs expressed the CD86 maturation marker and co-localized with T cells, particularly in early vitiligo lesions. These observations were confirmed by in vivo animal studies showing preferential recruitment of APCs and T cells to CXCL12- and CCL5-expressing transplanted melanocytes, immunotargeting of the chemokine-positive cells, continuous loss of the pigment-producing cells from the epidermis, and development of vitiligo-like lesions. Taken together, our studies show that melanocyte-derived CXCL12 and CCL5 support APC and T-cell recruitment, antigen acquisition, and T-cell activation in early vitiligo and reinforce the role of melanocyte-derived CXCL12 and CCL5 in activation of melanocyte-specific immunity and suggest inhibition of these chemotactic axes as a strategy for vitiligo stabilization.

Clinical Analysis of Thyroglobulin Antibody and Thyroid Peroxidase Antibody and their Association with Vitiligo

Background:

Recently, the abnormal presence of thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) has been reported in vitiligo patients, but presence of TG-Ab and TPO-Ab in patients of different ages and gender, and its association with vitiligo and thyroid autoimmunity has rarely been reported. The aim of our research was to determine whether vitiligo was associated with thyroid autoimmunity and figure out its relationship with age and gender.

Materials and Methods:

We analyzed TG-Ab, TPO-Ab in age and gender matched 87 vitiligo patients and 90 healthy controls, the patients of vitiligo who were positive for the presence of TG-Ab and TPO-Ab were followed up to confirm autoimmune thyroid disease subsequently.

Results:

Results showed that the frequencies of TG-Ab (23.0%, 20/87) positivity and TPO-AB (24.1%, 21/87) in vitiligo patients were significantly higher than that in healthy controls (P < 0.05). Moreover, The positivity for of TG-Ab and TPO-Ab was higher in 11-20-year age group and 21-40-year age group than that in age matched healthy controls. We found female patients with vitiligo had higher positive frequencies of TG-Ab and TPO-Ab than healthy female controls. (34.1% vs. 8.8% and 34.1% vs. 11.1%, P = 0.000 and P = 0.011). When 20 patients with TG-Ab and TPO-Ab positivity were followed up for three monthes, 14 of them (70%) were diagnosed as having autoimmune thyroid disease compared with age-matched healthy controls (16.7%, χ² = 5.4, P = 0.02).

Conclusion:

TG-Ab and TPO-Ab are likely to be found in female teenagers with vitiligo, and are relevant with respect to subsequent development autoimmune thyroid disease.

Genetic variants of the APE1 gene and the risk of vitiligo in a Chinese population: a genotype-phenotype correlation study

Vitiligo is an acquired depigmentation disorder, and reactive oxygen species play an important role in melanocyte damage. Base excision repair is the major pathway responsible for removing reactive oxygen species-induced DNA damage, in which APE1, ADPRT, and XRCC1 play key roles. To investigate the association between genetic variations of these genes and the risk of vitiligo in Chinese populations, we genotyped APE1-Asp148Glu, ADPRT-Val762Ala, and XRCC1-Arg399Gln polymorphisms and measured serum 8-OHdG levels in a hospital-based case-control study. We found that a significantly increased risk of vitiligo was associated with the APE1 Asp/Glu (adjusted odds ratio (OR) 1.24; 95% confidence interval (CI) 1.02-1.52) and Glu/Glu genotypes (adjusted OR 1.48; 95% CI 1.13-1.93), compared with the APE1 Asp/Asp genotype, whereas no vitiligo risk was associated with the genotypes ADPRT-Val762Ala and XRCC1-Arg399Gln. Furthermore, serum 8-OHdG levels were elevated in the APE1-148Glu allele carriers (Asp/Glu+Glu/Glu), in an allele dose-response manner, with the risk of vitiligo (Ptrend<0.05). In addition, we found that the APE1-148Glu variant increased the 8-OHdG levels of cultured human melanocytes treated with H2O2, without any impact on the endonuclease activity. These data suggest that the APE1-Asp148Glu polymorphism aggravates oxidative stress in human melanocytes and contributes to genetic predisposition to vitiligo in Chinese people.

Clinical patterns of vitiligo and its associated co morbidities: A prospective controlled cross-sectional study in South India

Aim:

The purpose of this study is to assess the clinical patterns and associations of vitiligo, audiometric functions, and ocular involvement and to correlate the morphology, clinical behaviour and comorbidities associated with vitiligo.

Settings and Design:

For this prospective and cross-sectional study 80 self-reporting patients in the age group 7-75 years with vitiligo attending the outpatient department of Manipal hospital during the period August 2008 to February 2010 were selected and the data was analysed.

Materials and Methods:

The patients were subjected to detailed history, clinical examination and investigations [complete blood count (CBC), absolute eosinophil count (AEC), erythrocyte sedimentation rate (ESR), thyroid stimulating hormone (TSH), vitamin B12 estimation, fasting blood sugar (FBS), and post prandial blood sugar (PPBS),antibody titre estimations that is antithyroid peroxidase (ATPA), antithyroglobulin (ATA), antinuclear antibodies (ANA),urine analysis], audiometric evaluation and ophthalmic examination.

Statistical Analysis Used:

The Fisher exact test has been used to find the significance of study parameters on categorical scale between two or more groups.

Results:

In the present series of 80 cases, 41 (51.25%) were males and 39 (48.75%) were females. The male to female ratio was 1.05:1. In our study 20% cases gave definite family history of vitiligo and patients in the age group of 20 - 30 years were the most commonly affected. Generalized vitiligo (31.3%) was the most common type followed by segmental (30%), focal (18.8%), acrofacial (8.8%), and mucosal vitiligo (11.3%). In the present study there was a high incidence of autoantibodies (22.5%), vitamin B12 deficiency (30%), hypothyroidism (11.3%), elevated absolute eosinophil count (16.3%), hypoacusis (10%) and retinal changes (8.8%). This suggests multisystem autoimmunity in vitiligo.

Vitiligo in a Patient Treated with Interferon Alpha-2a for Behçet's Disease

Behçet's disease (BD) and vitiligo are diseases of unknown etiology. Interferon (IFN) alpha therapy is commonly used in Behçet uveitis. Interferon treatment in various diseases have also been observed causing certain autoimmune diseases such as vitiligo because of its immunomodulatory activity. The association between IFN therapy and vitiligo has been reported in the literature. We report a 21-year-old man with BD in whom vitiligo occurred during IFN treatment. To the best of our knowledge, this is the first reported case of such an association.

Vitiligo and associated autoimmune disorders: a retrospective hospital-based study in Mumbai, India

BACKGROUND

It is a hospital based study focusing on epidemiological aspects of vitiligo and association with autoimmune disorders. There are few studies elucidating the association of autoimmune disorders with vitiligo in the Indian population. Our study is a small attempt in this direction.

AIM

To study epidemiological parameters of vitiligo and to study coexistence of autoimmune disorders.

MATERIALS AND METHODS

Records of 33,252 new patients attending the dermatology outpatient department from June 2002 to June 2008 were analysed for the presence of vitiligo and details of important epidemiological variables, and associated autoimmune disorders of these patients were collected and analysed.

RESULTS

Total number of vitiligo patients was 204. Proportion of vitiligo patients was 0.61%. Male:female proportion was almost equal. Family history of vitiligo was seen in 3.43% of cases. Associated autoimmune disorders were seen in 2.94% cases and were mainly skin associated autoimmune diseases (morphoea, alopecia areata, discoid lupus erythematosus, and pemphigus erythematosus) except for one case of Grave's disease.

CONCLUSION

Association of vitiligo with other autoimmune diseases emphasizes autoimmune aetiology of vitiligo. This study also emphasizes the need to actively look for, and if necessary, investigate patients with vitiligo for other autoimmune diseases.

Vitiligo in an urban academic setting

BACKGROUND

Vitiligo is a depigmenting disease of unknown etiology. A more complete understanding of vitiligo and associated conditions will provide better insight into the etiology and potential treatment options for this condition. We sought to gather information regarding associated conditions and other epidemiologic data on vitiligo.

METHODS

A retrospective chart review was performed of 135 patients with vitiligo seen between July 1, 2002 and June 30, 2005 at an academic medical center. Epidemiologic characteristics were recorded.

RESULTS

The patient population consisted of 80 women and 55 men with mean age of presentation of 36.8 years and average disease duration of 5.7 years. Vitiligo vulgaris was the predominant type of vitiligo and hypothyroidism was the most common co-morbidity. Anti-thyroid peroxidase and anti-thyroglobulin antibodies were found in 37% and 18% of patients, respectively. The highest proportion of thyroid abnormalities was found in age of onset category 21-30. Anti-nuclear antibodies were found in 33% of patients.

CONCLUSION

The prevalence of anti-nuclear and anti-thyroid peroxidase antibodies was higher in our vitiligo study than that reported elsewhere. In addition, autoimmune thyroid disease may be more common in adult-onset vitiligo.

On the role of dendritic cells in the pathogenesis of vitiligo

The authors give the results of immunohistochemistry studies of the skin of 16 healthy volunteers and 16 patients suffering from vulgar vitiligo with the determination of the contents of immature (CD1a+) and mature (CD83+) subpopulations of dendritic cells (DCs) as well as CD4+ and CD8+ lymphocytes in the epidermis and perivascular infiltrates of the derma. They revealed an increased quantity of CD1a+ and CD83+ DCs in areas of depigmented, peripheral and perifocal normally pigmented skin of vitiligo foci. DCs with the CD1a+ phenotype were revealed both in the epidermis and in the derma while DCs with the CD83+ phenotype were revealed in the derma only. A higher quantity of CD4+ and CD8+ lymphocytes than in healthy volunteers was also revealed along with the increased contents of DCs in all three areas of vitiligo foci. The authors established a strong correlation between the quantity of CD83+ DCs and CD4+ lymphocytes in the depigmentation zone (r=0.84; Р

NALP inflammasomes: a central role in innate immunity

Inflammasomes are cytoplasmic multiprotein complexes that mediate the maturation of the proinflammatory cytokines interleukin-1beta (IL-1beta), IL-18, and possibly IL-33 by controlling the activation of the inflammatory caspases-1 and -5. Assembly of inflammasomes depends on NOD-like receptor (NLR) family members such as NALPs, NAIP, and IPAF. Various microbial and endogenous stimuli activate different types of inflammasomes. This article focuses on the Pyrin domain containing NLRs, known as NALP proteins. Recent findings provide exciting insights into how these proteins might be activated and also provide evidence of the critical role of the NALP inflammasomes in innate immunity and inflammatory diseases.