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Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22:757-774. [PMID: 34554406 PMCID: PMC8566637 DOI: 10.1007/s40257-021-00631-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cain CD. The Effects of Prayer as a Coping Strategy for Nurses. J Perianesth Nurs 2019; 34:1187-1195. [PMID: 31301963 DOI: 10.1016/j.jopan.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/03/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the effects of prayer as a coping strategy for nurses. DESIGN Quantitative descriptive design. METHODS The population was the 15,000 members of the American Society of Perianesthesia Nurses. Twelve hundred fifty nine subjects completed a demographic questionnaire and the Prayer Functions Scale. The surveys were available on SurveyMonkey.com for 2 weeks in the fall of 2014. FINDINGS Results indicated at α = 0.05 that the nurses surveyed experienced the effects of prayer, providing assistance, providing acceptance, providing calm, and deferring as benefits of use of prayer as a coping strategy. CONCLUSIONS Reduction of nurses' stress through prayer is one way to ameliorate the ill effects that can impact nurses through stress. Nursing administration, nursing organizations, and academics could consider use of prayer as an effective coping mechanism in teaching, studying, and exploration of methods to help nurses cope with the inherent stressors of their profession.
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Affiliation(s)
- Cynthia D Cain
- Cynthia D. Cain, MS, RN, Oklahoma Wesleyan University, Bartlesville, OK.
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Dragoni F, Conti R, Cazzaniga S, Colucci R, Pisaneschi L, Naldi L, Moretti S. No Association between Vitiligo and Obesity: A Case-Control Study. Med Princ Pract 2017; 26:421-426. [PMID: 28903118 PMCID: PMC5757571 DOI: 10.1159/000481436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 09/12/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between vitiligo and body mass index (BMI) to assess the possible association between vitiligo and obesity. SUBJECTS AND METHODS This was a case-control study on a total of 400 participants, i.e., 200 patients with vitiligo and 200 healthy volunteers. Medical assessments were performed by dermatologists using the modified Vitiligo European Task Force form. The height and weight of all of the participants were measured and used to calculate the BMI. Data were analyzed using multivariate logistic regression models. Adjustment for age and gender was carried out preliminarily in the case-control analysis, whereas a forward stepwise selection algorithm was used to assess which independent factors were associated with a BMI ≥30 or a BMI ≤18.5. RESULTS Comparison of the vitiligo and control groups revealed the absence of a significant association. The multivariate analysis of factors associated with a high BMI (≥30) in vitiligo patients showed a significant association between a high BMI and a sudden onset of vitiligo (p = 0.021; OR = 3.83; 95% CI 1.22-11.99) and the presence of inflammation and pruritus (p = 0.031; OR = 3.26; 95% CI 1.11-9.57). No significant association was observed in the analysis of factors associated with a low BMI (≤18.5) in vitiligo patients. CONCLUSION In this study, vitiligo did not appear to be associated with a high BMI; obesity might not be a risk factor for vitiligo, in contrast to most autoimmune diseases which are significantly associated with obesity.
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Affiliation(s)
- Federica Dragoni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence
- *Dr. Federica Dragoni, Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, IT-50125 Florence (Italy), E-Mail
| | - Rossana Conti
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence
| | | | - Roberta Colucci
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence
| | - Lisa Pisaneschi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence
| | - Luigi Naldi
- GISED Study Centre, Ospedali Riuniti, Bergamo, Italy
| | - Silvia Moretti
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence
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The link between autoimmune diseases and obsessive-compulsive and tic disorders: A systematic review. Neurosci Biobehav Rev 2016; 71:542-562. [DOI: 10.1016/j.neubiorev.2016.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022]
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Adult Onset Vitiligo: Multivariate Analysis Suggests the Need for a Thyroid Screening. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8065765. [PMID: 27747240 PMCID: PMC5055927 DOI: 10.1155/2016/8065765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/30/2016] [Indexed: 12/02/2022]
Abstract
Background. There are limited epidemiological studies evaluating the effect of age at onset on disease features in vitiligo. Objectives. To identify factors associated with adult onset vitiligo in comparison with childhood onset vitiligo. Patients and Methods. We retrospectively collected medical records of 191 patients. Such records included clinical examination, personal and familial medical history, laboratory evaluations, concomitant vitiligo treatment and drug assumption. Results. 123 patients with a disease onset after the age of 40 (adult onset vitiligo) were compared with 68 patients who developed vitiligo before the age of 12 (childhood onset vitiligo). Multivariate analysis revealed that personal history of thyroid diseases (P = 0.04; OR 0.4), stress at onset (P = 0.002; OR = 0.34), personal history of autoimmune thyroid disease (ATD) (P = 0.003; OR = 0.23), and thyroid nodules (P = 0.001; OR 0.90) were independently associated with adult onset vitiligo, whereas family history of dermatological diseases (P = 0.003; OR = 2.87) and Koebner phenomenon (P < 0.001; OR = 4.73) with childhood onset vitiligo. Moreover, in the adult onset group, concomitant thyroid disease preceded vitiligo in a statistically significant number of patients (P = 0.014). Conclusions. Childhood onset and adult onset vitiligo have different clinical features. In particular, ATD and thyroid nodules were significantly associated with adult onset vitiligo, suggesting that a thyroid screening should be recommended in this group of patients.
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Anbar T, Abdel-Rahman A, Hegazy R, El-Khayyat M, Ragaie M. Simultaneous improvement and worsening of vitiligo lesions during the course of NB-UVB phototherapy; vitiligo may not act as one unit. Dermatol Ther 2016; 30. [DOI: 10.1111/dth.12420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Tag Anbar
- Dermatology Department; Minia University; Minia Egypt
| | | | - Rehab Hegazy
- Dermatology Department; Cairo University; Cairo Egypt
| | | | - Maha Ragaie
- Dermatology Department; Minia University; Minia Egypt
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Doss RW, El-Rifaie AAA, Abdel-Wahab AM, Gohary YM, Rashed LA. Heat Shock Protein-70 Expression in Vitiligo and its Relation to the Disease Activity. Indian J Dermatol 2016; 61:408-12. [PMID: 27512186 PMCID: PMC4966399 DOI: 10.4103/0019-5154.185704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Vitiligo is a progressive depigmenting disorder characterized by the loss of functional melanocytes from the epidermis. The etiopathogenesis of vitiligo is still unclear. Heat shock proteins (HSPs) are prime candidates to connect stress to the skin. HSPs were found to be implicated in autoimmune diseases such as rheumatoid arthritis and other skin disorders as psoriasis. Aim and Objectives: The aim of this study was to map the level of HSP-70 in vitiligo lesions to declare its role in the pathogenesis and activity of vitiligo. Materials and Methods: The study included thirty patients with vitiligo and 30 age- and sex-matched healthy controls. Vitiligo patients were divided as regards to the disease activity into highly active, moderately active, and inactive vitiligo groups. Skin biopsies were taken from the lesional and nonlesional skin of patients and from the normal skin of the controls. HSP-70 messenger RNA (mRNA) expression was estimated using quantitative real-time polymerase chain reaction. Results: Our analysis revealed a significantly higher expression of HSP-70 mRNA in lesional skin biopsies from vitiligo patients compared to nonlesional skin biopsies from vitiligo patients (P < 0.001) and compared to skin biopsies from healthy controls (P < 0.001). The level of HSP-70 was not found to be correlated with age, sex, or disease duration. The expression of HSP-70 was correlated with the disease activity and patients with active vitiligo showed higher mean HSP-70 level compared to those with inactive disease. Conclusions: HSP-70 plays a role in the pathogenesis of vitiligo and may enhance the immune response in active disease.
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Affiliation(s)
- Reham William Doss
- Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Amr M Abdel-Wahab
- Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Yasser M Gohary
- Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Laila A Rashed
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
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Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study. Am J Clin Dermatol 2016; 17:305-11. [PMID: 26818062 DOI: 10.1007/s40257-016-0172-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety. OBJECTIVE The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls. METHODS Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale. RESULTS Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study. CONCLUSION Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.
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Colucci R, Dragoni F, Conti R, Pisaneschi L, Lazzeri L, Moretti S. Evaluation of an oral supplement containingPhyllanthus emblicafruit extracts, vitamin E, and carotenoids in vitiligo treatment. Dermatol Ther 2014; 28:17-21. [DOI: 10.1111/dth.12172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Roberta Colucci
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Federica Dragoni
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Rossana Conti
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Lisa Pisaneschi
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Linda Lazzeri
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Silvia Moretti
- Section of Dermatology; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
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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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Lotti T, Zanardelli M, D’Erme AM. Vitiligo: what’s new in the psycho-neuro-endocrine-immune connection and related treatments. Wien Med Wochenschr 2014; 164:278-85. [DOI: 10.1007/s10354-014-0288-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 01/09/2023]
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Giynas Ayhan M, Uguz F, Askin R, Gonen MS. The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis: a comparative study. Gen Hosp Psychiatry 2014; 36:95-8. [PMID: 24211158 DOI: 10.1016/j.genhosppsych.2013.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine the current prevalence of major depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis (HT) and euthyroid goiter. METHOD The study sample was formed by consecutive 51 and 45 patients who were admitted to the endocrinology outpatient clinic and diagnosed with euthyroid HT and endemic/nonendemic goiter, respectively, and 68 healthy controls. Current diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV. Beck Depression Inventory and Beck Anxiety Inventory were applied to the participants. RESULTS There was a statistically significant difference among the three groups in terms of major depression (P=.001), any mood or anxiety disorder (P=.000), any depressive disorder (P=.020), any anxiety disorder (P=.016) and obsessive-compulsive disorder (OCD) (P=.013). In the HT group, the prevalence of depression (P=.000), OCD (P=.005) and panic disorder (P=.041) was significantly higher than that in the control group. In the goiter group, depression (P=.006), any depressive disorder (P=.03), and any mood or anxiety disorder (P=.000) were significantly common in comparison to the control group. No significant difference was found between the HT and goiter groups. CONCLUSIONS Euthyroid HT and euthyroid goiter increase predisposition to major depression and anxiety disorders, and thyroid autoimmunity and other thyroid pathologies should be investigated in euthyroid patients with chronic and treatment-resistant complaints.
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Affiliation(s)
| | - Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Rustem Askin
- Department of Psychiatry, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
| | - Mehmet Sait Gonen
- Department of Internal Medicine, Division of Endocrinology, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
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Abstract
Vitiligo is an acquired depigmentary skin disorder of unknown etiology. Vitiligo is not only a disease of melanocytes of the skin. Human melanocytes are derived from the neural crest and are located on various parts of the body. The involvement of skin melanocytes is the most visible one, but a systemic involvement of melanocytes can be observed. Some types of vitiligo (nonsegmental vitiligo) may also be associated with various diseases, mainly with autoimmune pathogenesis. Vitiligo represents a spectrum of many different disorders with different etiologies and pathogeneses, causing a common phenotype: the loss of melanocytes and/or their products. This phenotype is always consistent with a systemic involvement.
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Affiliation(s)
- Torello Lotti
- Chair of Dermatology and Venereology, University of Rome "G. Marconi," Rome, Italy
| | - Angelo Massimiliano D'Erme
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50100 Florence, Italy.
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Vrijman C, Hosseinpour D, Bakker JG, Wolkerstorfer A, Bos JD, van der Veen JPW, Luiten RM. Provoking factors, including chemicals, in Dutch patients with vitiligo. Br J Dermatol 2013; 168:1003-11. [PMID: 23252956 DOI: 10.1111/bjd.12162] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In vitiligo, many provoking factors have been described, but epidemiological data, especially on the role of contact with chemicals, are scarce. OBJECTIVE To obtain an insight into the patient-reported factors provoking vitiligo, including contact with chemicals. METHODS A retrospective cohort study was conducted on all 1264 patients with vitiligo who visited the Netherlands Institute for Pigment disorders from January 2003 to December 2007. Patients for whom an exogenous provoking factor was recorded were sent a questionnaire. Subsequently, patients who mentioned a chemical provoking factor were contacted to elucidate the alleged causal relationship between exposure to the chemical and the onset of vitiligo. RESULTS A total of 300 out of the 1264 patients indicated that provoking factors had played a role in their disease. Two hundred and forty-six patients were sent a questionnaire, which was returned by 177 (response rate of 72%). Emotional stress was indicated as a provoking factor in 98 patients (55.4%), 51 patients (28.8%) recorded sunburn, 34 patients (19.2%) recorded mechanical factors and 20 patients (11.3%) other factors. Of 29 patients (16.4%) who indicated a chemical factor, a presumed causal relationship could be corroborated in four. The chemicals involved were para-tertiary butylphenol (n = 2), captan (n = 1) and diphencyprone (n = 1). CONCLUSION The majority of the patients with vitiligo from this study did not mention provoking factors, but the ones who did point to emotional stress in more than half of the cases. Of the 29 patients who assigned chemical provoking factors, solvents were mainly indicated. However, a presumed relationship with the chemical could be corroborated in only four patients.
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Affiliation(s)
- C Vrijman
- Department of Dermatology and The Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Centre, University of Amsterdam, Amsterdam NL-1105AZ, the Netherlands.
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Mosenson JA, Eby JM, Hernandez C, Le Poole IC. A central role for inducible heat-shock protein 70 in autoimmune vitiligo. Exp Dermatol 2013; 22:566-9. [PMID: 23786523 DOI: 10.1111/exd.12183] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 12/14/2022]
Abstract
Inducible heat-shock protein 70 (HSP70i) is a protein regulated by stress that protects cells from undergoing apoptosis. Such proteins are marvellously well conserved throughout evolution, which has placed them in the spotlight for helping to understand the intriguing relationship between infection and immunity. In the presence of stress proteins, dendritic cells (DCs) will sense this alarm signal and respond by recruiting immune cells of different plumage to fit the occasion. In times of stress, melanocytes will secrete antigen-bound HSP70i to act as an alarm signal in activating DCs that comes equipped with an address of origin to drive the autoimmune response in vitiligo. Here we pose that if the autoimmune response is funnelled through HSP70i, then blocking the stress protein from activating DCs can lend new treatment opportunities for vitiligo.
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Affiliation(s)
- Jeffrey A Mosenson
- Department of Pathology, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA
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