1
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Aulakh S, Goel S, Kaur L, Gulati S, Kaur M, Chopra D, Sarangal R, Batra J. Differential expression of serum CXCL9 and CXCL10 levels in vitiligo patients and their correlation with disease severity and stability: A cross-sectional study. Indian J Dermatol Venereol Leprol 2024; 0:1-7. [PMID: 39152845 DOI: 10.25259/ijdvl_793_2023] [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: 08/03/2023] [Accepted: 12/30/2023] [Indexed: 08/19/2024]
Abstract
Background Vitiligo is an acquired disorder of pigmentation with an elusive pathogenesis, though various theories have been proposed. The presence of peri-lesional autoreactive CD8+ T cell infiltrate suggests the involvement of abnormal immune responses and autoimmunity in vitiligo. Recent studies have identified the IFN-γ-CXCL9/CXCL-10 axis as a key component of the autoimmune response that perpetuates disease activity in vitiligo. Objectives The primary objective was to estimate serum CXCL9 and CXCL10 levels in vitiligo patients compared to age- and sex-matched controls. Additionally, the study aimed to find correlations between CXCL9 and CXCL10 levels and disease severity and stability. Secondary objectives included comparing levels in segmental/nonsegmental vitiligo and stable/progressive vitiligo and assessing the impact of age and gender. Methods A hospital-based cross-sectional study included 60 vitiligo patients and 30 age- and sex-matched controls. Serum levels of CXCL9 and CXCL10 were assessed using Enzyme-linked immunosorbent assay (ELISA). Cases were clinically evaluated for the type of vitiligo (segmental or non-segmental), disease severity (VASI score), and disease stability (VIDA score). Statistical analysis included t-tests, chi-square tests, and correlation coefficients. P value less than 0.5 was taken as significant. Results Serum CXCL9 and CXCL10, both, were significantly raised in vitiligo patients as compared to controls (p-value = 0.001* & 0.001* respectively) and correlated positively with both VASI score (p-value = 0.001* & 0.001* respectively) and with VIDA score (p-value = 0.032* & 0.001* respectively). Serum CXCL10 showed significant elevation in progressive vitiligo, and CXCL9 exhibited a non-significant trend. No significant difference was observed between segmental and non-segmental vitiligo. Both chemokines positively correlated with disease severity and stability, while age and gender did not significantly impact chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlated positively with disease severity & instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. Both serum CXCL9 and CXCL10 were significantly elevated in vitiligo patients compared to controls and they can be used as potential serum biomarkers for assessing the disease activity. Limitations Small sample size of control population. The voluntary sampling technique led to an unequal number of patients in progressive and stable vitiligo groups, as well as in segmental and non-segmental groups. The current study did not include blister fluid analysis and the effect of therapy on the chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlates positively with disease severity and instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. *represents statistically significant results.
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Affiliation(s)
- Shayna Aulakh
- Department of Dermatology, Venereology, Leprology, Government Medical College, Patiala, India
| | - Seema Goel
- Department of Dermatology, Venereology, Leprology, Government Medical College, Patiala, India
| | - Loveleen Kaur
- Department of Dermatology, Mata Kaushalya Hospital, Patiala, India
| | - Samridhi Gulati
- Department of Dermatology, Venereology, Leprology, Government Medical College, Patiala, India
| | - Maninder Kaur
- Department of Biochemistry, Government Medical College, Patiala, India
| | - Dimple Chopra
- Department of Dermatology, Venereology, Leprology, Government Medical College, Patiala, India
| | - Rishu Sarangal
- Department of Dermatology, Venereology, Leprology, Government Medical College, Patiala, India
| | - Jayati Batra
- Department of Dermatology, Mata Kaushalya Hospital, Patiala, India
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Peralta-Pedrero ML, Morales-Sánchez MA, Cruz-Peralta A, Guerrero-Oliva G. Quantification of the Progression Rate in Vitiligo and Prognostic Implications. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:505-507. [PMID: 36925099 DOI: 10.1016/j.ad.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 03/17/2023] Open
Affiliation(s)
- M L Peralta-Pedrero
- Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, México; Universidad Nacional Autónoma de México, Ciudad de México, México.
| | | | - A Cruz-Peralta
- Universidad Nacional Autónoma de México, Ciudad de México, México
| | - G Guerrero-Oliva
- Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, México; Universidad Nacional Autónoma de México, Ciudad de México, México
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3
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Peralta-Pedrero ML, Morales-Sánchez MA, Cruz-Peralta A, Guerrero-Oliva G. [Translated article] Quantification of the Progression Rate in Vitiligo and Prognostic Implications. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T505-T507. [PMID: 38479692 DOI: 10.1016/j.ad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 05/05/2024] Open
Affiliation(s)
- M L Peralta-Pedrero
- Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, Mexico; Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | | | - A Cruz-Peralta
- Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - G Guerrero-Oliva
- Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, Mexico; Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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Delbaere L, van Causenbroeck J, Duponselle J, Van Goethem C, Speeckaert R, van Geel N. Hot spots for clinical signs of disease activity in vitiligo. Exp Dermatol 2024; 33:e14975. [PMID: 37975576 DOI: 10.1111/exd.14975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
There is evidence of a link between disease activity in vitiligo and clinical visible signs such as confetti-like depigmentation, Koebner phenomenon and hypochromic areas/borders. Despite its established value, dermatologists and researchers continue to have a limited understanding of the vitiligo disease activity signs. The primary goal of this study was to identify 'hot spots' of disease activity signs in vitiligo patients in order to improve detection in clinical practice. Furthermore, the prevalence, clinical profiles of predisposed patients, interrelationship between the disease activity signs and potential pitfalls in the recognition of the signs were evaluated. The Vitiligo Signs of Activity Score (VSAS) was used to score the presence of the disease activity signs in 441 non-segmental and 57 segmental vitiligo patients. More detailed predilection areas were scored in a subset of patients, using 65 predefined body locations. At least one disease activity sign was observed in 51.0% and 8.8% of the non-segmental and segmental vitiligo patients, respectively. Confetti-like depigmentation was most observed on the elbows, Koebner phenomenon on the back of the hands, and hypochromic areas/borders in the armpits. The three signs were significantly more observed in patients with more involved body locations. Moreover, hypochromic areas/borders were more common in younger patients. Confetti-like depigmentation had the highest interrelationship with the other signs and was the easiest to recognise. Knowledge around hot spots of the disease activity signs will enhance and simplify their detection in clinical practice. Based on the results, confetti-like depigmentation appears to be the most straightforward sign to evaluate.
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Affiliation(s)
- Liesbeth Delbaere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Jolien Duponselle
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Céline Van Goethem
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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5
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Hou Y, Wei Z, Jiang Q, Chen H, Chen L, Wu J. In-depth study of Wood's lamp examination combined with reflective confocal laser scanning microscopy for the guidance of vitiligo staging and treatment. J Cosmet Dermatol 2023. [PMID: 38158739 DOI: 10.1111/jocd.16145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Both Wood's lamp and reflective confidential laser scanning microcopy are helpful for the diagnosis and treatment of vitiligo. However, there is few research that contains large samples and consistent observations. AIMS To analyze the characteristics of Wood's lamp images and reflectance confocal microscopy (RCM) images of vitiligo lesions and to evaluate their significance in vitiligo staging. METHODS We analyzed the characteristics of RCM images, Wood's lamp images, the vitiligo disease activity (VIDA) score, and clinical features to guide vitiligo staging and treatment. RESULTS The expert consensus based on the clinical features, VIDA score, Wood's lamp findings, and isomorphic response was consistent with the Wood's lamp findings (χ2 = 3.63, p > 0.05) and RCM findings (χ2 = 3.60, p > 0.05) in diagnosing vitiligo and assessing the disease stage. There was a correlation between the three lesion grades based on the Wood's lamp findings and the stage of vitiligo (p < 0.01). Lesions that appeared porcelain white under the Wood's lamp were in the slowly progressive stage; lesions that appeared gray-white or trichromatic under the Wood's lamp were in the rapidly progressive stage; lesions with clear borders under the Wood's lamp needed further analysis by RCM for the stage to be determined; lesions with blurred borders under the Wood's lamp were in the rapidly progressive stage; lesions that were visible under the naked eye and under the Wood's lamp were in the rapidly progressive stage. CONCLUSION The study demonstrates a reliable correlation between the findings of RCM (a sophisticated expensive tool) and Wood's lamp examination (a simple, readily available, inexpensive tool) in the assessment of the disease activity of vitiligo lesions.
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Affiliation(s)
- Yongqing Hou
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Zijia Wei
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Qian Jiang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Hongying Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Jiyuan Wu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
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6
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Seneschal J, Boniface K. Vitiligo: Current Therapies and Future Treatments. Dermatol Pract Concept 2023; 13:dpc.1304S2a313S. [PMID: 38241396 PMCID: PMC10824325 DOI: 10.5826/dpc.1304s2a313s] [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: 12/13/2023] [Indexed: 01/21/2024] Open
Abstract
The current management of vitiligo remains challenging; however, different strategies can be proposed to patients with a good efficacy in many cases. First, it is important to identify patients in the active phase of the disease because treatment should start as soon as possible to halt its progression. For patients with a stable disease, the treatment strategy is now well-stratified and is based on a combination of phototherapy (natural or in a cabin) and topical immunomodulatory agents. Surgical treatments are useful for localized and stable vitiligo, as well as for segmental vitiligo. Depigmentation remains indicated in very extensive forms. The recent approval of topical ruxolitinib cream in both the US and Europe brings new approaches for the management of vitiligo and paves the way for the development of new topical or oral targeted drugs.
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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
| | - Katia Boniface
- University of Bordeaux, CNRS, Immuno ConcEpT, UMR 5164, Bordeaux, France
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7
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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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8
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Trepanowski N, Yim RM, Wetstone R, MacDonald E, Servattalab S, Jacob-George S, Harris JE. Vitiligo progression in a patient undergoing romosozumab treatment for osteoporosis. JAAD Case Rep 2023; 42:26-30. [PMID: 37965188 PMCID: PMC10641553 DOI: 10.1016/j.jdcr.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, Massachusetts
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Rebecca M. Yim
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Tulane University School of Medicine, Tulane, Louisiana
| | - Rachel Wetstone
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Florida International University College of Medicine, Herbert Wertheim College of Medicine, Miami, Florida
| | - Elizabeth MacDonald
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Sarah Servattalab
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Subin Jacob-George
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - John E. Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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9
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van Geel N, Speeckaert R, Taïeb A, Ezzedine K, Lim HW, Pandya AG, Passeron T, Wolkerstorfer A, Abdallah M, Alomar A, Bae JM, Bekkenk M, Benzekri L, Böhm M, Eleftheriadou V, Esmat S, Ghia D, Goh BK, Grimes P, Gupta S, Hamzavi IH, Harris JE, Oh SH, Huggins R, Katayama I, Lan E, Lee AY, Leone G, Le Poole C, Lui H, Maquignon N, Meurant JM, Monteiro P, Oiso N, Parsad D, Pliszewski G, Raboobee N, Rodrigues M, Rosmarin D, Suzuki T, Tanemura A, Thng S, Xiang F, Zhou Y, Picardo M, Seneschal J. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol 2023; 37:2173-2184. [PMID: 37746876 DOI: 10.1111/jdv.19451] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, BRIC, UMR 1312, Inserm, University Bordeaux, Bordeaux, France
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Albert Wolkerstorfer
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | - Augustin Alomar
- Department of Dermatology, Clinica Dermatologica Moragas, Barcelona, Spain
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marcel Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, VU University, Amsterdam, The Netherlands
| | - Laila Benzekri
- Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital and Research Hospital and South Mumbai Dermatology Clinic, Mumbai, India
| | - Boon Kee Goh
- Skin Physicians Pte Ltd, Mount Elizabeth Medical Centre, Singapore City, Singapore
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California, USA
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Ichiro Katayama
- Pigmentation Research and Therapeutics, Osaka Metropolitan University, Osaka, Japan
| | - Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Roma, Italy
| | - Caroline Le Poole
- Departments of Dermatology, Microbiology and Immunology, Robert H. Lurie Comprehensive Cancer Center Northwestern University, Chicago, Illinois, USA
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Durban, South Africa
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Parkville, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Tanemura
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Steven Thng
- Skin Research Institute of Singapore, ASTAR, Singapore City, Singapore
| | - Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin disorders, Hospital Saint-André, University of Bordeaux, CNRS UMR 5164, ImmunoConcept, Bordeaux, France
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10
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van Geel N, Duponselle J, Delbaere L, Herbelet S, Eleftheriadou V, Ezzedine K, Forman M, Garg A, Hamzavi IH, Seneschal J, Spuls P, Terwee CB, Wolkerstorfer A, Speeckaert R, Pandya AG. Clinician-reported outcome measures for the assessment of vitiligo: A scoping review. J Eur Acad Dermatol Venereol 2023; 37:2231-2242. [PMID: 37602494 DOI: 10.1111/jdv.19448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
Clinician-reported outcome measures (ClinROMs) are essential for assessment of vitiligo in clinical trials and daily practice. Several instruments have been developed and tested to measure, for example, vitiligo extent, repigmentation and activity. The goal of this review was to identify all introductory publications of ClinROMs for vitiligo that include at least some aspects of validation and to describe the instruments' characteristics, intention for use and practical strengths and limitations. A search strategy was conducted in PubMed, Embase and Cochrane Library (CENTRAL) from inception to July 2022. Based on the literature search (n = 2860), 10 articles were identified, describing 14 different ClinROMs. Six ClinRoms measured disease extent and/or repigmentation, seven evaluated disease activity and one was a composite score. The Vitiligo Area Scoring Index (VASI), and Vitiligo Extent Score (VES and VESplus) measure overall disease extent and/or repigmentation. The VASI relies on hand units (1% body surface area), whereas the VES and VESplus use a picture-based scoring technique. The Vitiligo Extent Score for a Target Area (VESTA) measures repigmentation percentage for target lesions. One global assessment score for extent has been validated. Vitiligo disease activity scores included a static measure of clinical activity signs (Vitiligo Signs of Activity Score [VSAS]) and two measures assessing dynamic evolution (Vitiligo Disease Activity Score [VDAS] and Vitiligo Disease Improvement Score [VDIS]). The Vitiligo European Task Force assessment tool (VETFa) is a composite score. Depending on the practical strengths and limitations as well as the research question and setting (clinical trials vs. daily practice), the choice of an appropriate ClinROM may differ. Fourteen ClinROMs in vitiligo were identified to measure vitiligo extent, repigmentation, and activity. Further research evaluating the validity, reliability, and responsiveness of each instrument and worldwide consensus on which instrument to use for a specific outcome (domain) is greatly needed.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jolien Duponselle
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Delbaere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Sandrine Herbelet
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | | | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin disorders, Hospital Saint-André, University of Bordeaux, CNRS UMR 5164, ImmunoConcept, Bordeaux, France
| | - Phyllis Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Location AMC, A0-227, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Location AMC, A0-227, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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11
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Wang J, Wang D, Si G. Efficacy and safety of Chinese patent medicine compound preparation combined with routine treatment in vitiligo: A Bayesian network meta-analysis. Medicine (Baltimore) 2023; 102:e35327. [PMID: 37832097 PMCID: PMC10578774 DOI: 10.1097/md.0000000000035327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Treating vitiligo in clinical practice is challenging. Furthermore, oral drugs used in Western medicine have considerable side effects and are unsuitable for long-term treatment. In contrast, Chinese patent medicines (CPMs) are more suitable for long-term oral vitiligo treatment, but medical evidence of their efficacy and safety is lacking. Therefore, in this study, the efficacy and safety of CPMs were evaluated and ranked using a Bayesian network meta-analysis. METHODS Seven Chinese and English databases were searched for all relevant articles published up to February 2023. The Bayesian network meta-analysis method was used to analyze the extracted data to evaluate efficacy and safety. RESULTS Six common CPMs for treating vitiligo were selected in our study, and 48 targeted articles and 4446 patients were included. This study showed that Qubai Babuqi tablets (QT) were the most effective for short-term treatment of vitiligo, and that vitiligo capsules or pills (VCP) were the most effective for long-term treatment, together with compound Quchong Banjiuju pills (QP). In terms of surface area under the cumulative ranking curve (SUCRA) values, the order of efficacy of each treatment was as follows: QT (92.18%) > Taohong Qingxue pills (TP) (63.81%) > VCP (55.53%) > QP (50.72%) > Bailing tablets or capsules (BTC) (49.01%) > Baishi pills (BP) (35.69%)>routine therapy (RT) (3.1%) in terms of total effective rate and QT (92.05%) > VCP (71.50%) > QP (66.60%) > TP (42.95%) > BTC (39.66%) > BP (36.60%)>RT (0.6%) in terms of improvement rate. In addition, the safety of the 6 CPMs did not significantly differ in terms of adverse effects. The SUCRA values indicated that QT performed slightly worse than other drugs. DISCUSSION In treating vitiligo, QT is most effective but only suitable for short-term administration owing to its poor safety. VCP and QP could be used as first-choice long-term medications. TP may positively affect repigmentation in patients with limited lesion areas.
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Affiliation(s)
- Jianfeng Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dingding Wang
- Jining Hospital of Traditional Chinese Medicine, Jining, Shandong, China
| | - Guomin Si
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
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12
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Post NF, Van Broekhoven NX, Lommerts A, Bae JM, Bekkenk MW, de Castro CCS, Eleftheriadou V, Esmat S, Ezzedine K, van Geel N, Hamzavi I, Leone G, Pandya AG, Passeron T, Rodrigues MA, Seneschal J, Th'ng S, Wolkerstorfer A. Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study. Arch Dermatol Res 2023; 315:2289-2294. [PMID: 36964767 PMCID: PMC10462531 DOI: 10.1007/s00403-023-02611-8] [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: 09/13/2022] [Revised: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.
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Affiliation(s)
- Nicoline F Post
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Noah X Van Broekhoven
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annelies Lommerts
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jung M Bae
- Department of Dermatology, St. Vincent's Hospital, Seoul, South Korea
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | | | - Samia Esmat
- Department of Dermatology, Cairo University, Giza, Egypt
| | - Khaled Ezzedine
- Department of Dermatology, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
| | - Thierry Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, Nice, France
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, University Hospital, Bordeaux, France
| | - Steven Th'ng
- Department of Dermatology, Skin Research Institute of Singapore, Singapore, Singapore
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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13
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Gupta P, Vinay K, Bishnoi A, Kumaran MS, Parsad D. A prospective observational study to sequentially determine the dermoscopic features of vitiligo and its association with disease activity in patients on medical treatment: Dermoscopy and disease activity in vitiligo. Pigment Cell Melanoma Res 2023; 36:33-41. [PMID: 36112075 DOI: 10.1111/pcmr.13069] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 12/31/2022]
Abstract
Prospective data on correlation between dermoscopic features of vitiligo and disease activity are scarce. This study was conducted to sequentially determine the dermoscopic features of vitiligo and to evaluate their association with disease activity. A cohort of 30 patients with 60 active vitiligo patches on medical therapy was subjected to sequential clinical and dermoscopic examination at four weekly intervals till 16 weeks. Disease activity at each visit was assessed using serial clinical photographs and modified vitiligo activity severity index. The dermoscopic images were merged and analysed for a predefined set of dermoscopic parameters by two blinded dermatologists. Paired analysis of dermoscopic features was done between baseline, and stabilized vitiligo patches at 12 and 16 weeks. Pigment network changes (absent and reduced pigment network, p < .001), perifollicular depigmentation (p = .02), ill-defined margins (p = .04) and satellite lesions and micro-Koebner phenomenon (p < .001) were associated with active vitiligo while perifollicular repigmentation (p < .001) was associated with stabilizing and repigmenting vitiligo. Satellite lesions and micro-Koebner's phenomena were suggestive of unstable disease irrespective of site of target lesion, while perifollicular repigmentation was suggestive of stabilized/repigmenting disease only at non-acral sites. We found sequential dermoscopy to be useful to assess disease activity and potential for repigmentation in localized vitiligo.
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Affiliation(s)
- Priyansh Gupta
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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van Geel N, Saeys I, Van Causenbroeck J, Duponselle J, Grine L, Pauwels N, Hilhorst N, Herbelet S, Ezzedine K, Speeckaert R. Image Analysis Systems to Calculate the Surface Area of Vitiligo Lesions: a Systematic Review of Measurement Properties. Pigment Cell Melanoma Res 2022; 35:480-494. [PMID: 35822353 DOI: 10.1111/pcmr.13056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Several digital image analysis systems have been developed for surface calculation of vitiligo lesions. Critical assessment of their measurement properties is crucial to support evidence-based recommendations on the most suitable instruments and will reveal the need for future research. A systematic review was performed to systematically summarize, compare, and critically assess the measurement properties of digital and analogue analysis systems for surface calculation of vitiligo lesions following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations. Nineteen clinical trials were selected including 25 different instruments. Manual tracing on transparent sheets (contact planimetry) combined with digital measurement or point counting can be considered as the best validated method for the evaluation of target lesions taking into account the skin curvatures. Two-dimensional digital imaging analysis on photographs seems also robust although confirmatory data of different research groups using the same digital instrument in a wide range of skin types are missing. Analysis based on 3D photography is still in its early stage but is promising for whole-body analysis. However, the reported data on the quality of the instruments for surface area calculation of vitiligo lesions was in general rather limited. Therefore, future high-quality validation studies are required also including full body evaluations.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Imke Saeys
- Faculty of Medicine, Ghent University, Ghent, Belgium
| | | | - Jolien Duponselle
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Nele Pauwels
- Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Niels Hilhorst
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Sandrine Herbelet
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor - Université Paris-Est Créteil Val de Marne, France
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15
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van Geel N, Depaepe L, Vandaele V, Mertens L, Van Causenbroeck J, De Schepper S, Van Coile L, Van Reempts A, De Vos A, Papeleu J, Hoorens I, Mertens D, Wolkerstorfer A, Lommerts JE, Speeckaert R. Assessing the dynamic changes in vitiligo: reliability and validity of the Vitiligo Disease Activity Score (
VDAS
) and Vitiligo Disease Improvement Score (
VDIS
). J Eur Acad Dermatol Venereol 2022; 36:1334-1341. [PMID: 35398942 PMCID: PMC9543188 DOI: 10.1111/jdv.18134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
Background The assessment of the individual evolution of vitiligo is important for therapeutic decision making in daily practice. A fast, simple and validated physician‐reported score to assess clinical changes in depigmentation over time in separate parts (activity and improvement) is currently missing. Objective The main objective of the study was to develop and validate the Vitiligo Disease Activity Score (VDAS) and Vitiligo Disease Improvement Score (VDIS). Methods The Vitiligo Disease Activity Score (VDAS) and Vitiligo Disease Improvement Score (VDIS) were evaluated based on a photo set of 66 patients with two different time points. In the first (short) version, only the number of changing body regions was counted based on 15 predefined areas (VDAS15 and VDIS15), while in the second (extensive) version the degree of worsening or improvement from +4 to −4 for each body area was added for a more detailed assessment (VDAS60 and VDIS60). Content and construct validity were tested. In addition inter‐, intrarater reliability and feasibility were evaluated by 7 (test) and 5 (retest) physicians. Results Evidence for content and construct validity was provided. Overall, VDAS15, VDIS15, VDAS60 and VDIS60 demonstrated good to excellent inter‐rater reliability [intraclass correlation (ICC): VDAS: range = 0.797–0.900; VDIS: range = 0.726–0.798]. The intrarater reliability ICCs were 0.865 and 0.781 for the VDAS15 and VDIS15, respectively. Similar results were obtained for the VDAS60 and VDIS60 (ICC = 0.913 and 0.800, respectively). Completion time was short (median: 122 s/patient (first round); 95 s/patient (second round)]. Limitations Single tertiary centre mainly of skin phototype 2 to 3. Conclusion The VDAS and VDIS appear to be valid, reliable and feasible instruments to score the evolution of vitiligo lesions. This accommodates the current urgent need for a simple, standardized and practical assessment of vitiligo activity and improvement over time.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - Lien Depaepe
- Department of Dermatology, AZ Delta, Torhout Belgium
| | | | - Laura Mertens
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | | | | | - Laura Van Coile
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | | | | | - Jorien Papeleu
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - Isabelle Hoorens
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - Delphine Mertens
- Department of Dermatology, Clinic Dr. med. Rotterdam, 45883 Gelsenkirchen Germany
| | - Albert Wolkerstorfer
- Department of Dermatology Institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC Amsterdam The Netherlands
| | - Janny E Lommerts
- Department of Dermatology Institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC Amsterdam The Netherlands
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16
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1-Leitlinie: Diagnostik und Therapie der Vitiligo. J Dtsch Dermatol Ges 2022; 20:365-379. [PMID: 35304960 DOI: 10.1111/ddg.14713_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Jo Ana Schunter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Klaus Fritz
- Hautarztpraxis und Laserzentrum Landau, Landau, Deutschland
| | - Carmen Salavastru
- Universität Carol Davila, Pädiatrische Dermatologie, Bukarest, Rumänien
| | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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17
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Ismail SI, Hegazy RA, Gawdat HI, Esmat S, Mahmoud E, Rashed L, Hegazy AA, Saadi DG. Differentiating active from stable vitiligo: the role of dermoscopic findings and their relation to CXCL-10. J Cosmet Dermatol 2022; 21:4651-4658. [PMID: 35298096 DOI: 10.1111/jocd.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/11/2021] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing vitiligo activity/stability status is pivotal in the management of patients with vitiligo. CXCL10 is a chemokine released in the tissues and sera of patients with vitiligo and an indicator of disease activity. AIM This study aimed to assess the role of dermoscopy in detecting active and stable vitiligo by comparing the dermoscopic signs in vitiligo with Vitiligo Disease Activity Score (VIDA) score, clinical activity, and CXCL10 activity. METHODS Ninety-seven patients with vitiligo were enrolled in this cross-sectional study. Vitiligo activity/stability was assessed using VIDA scores, clinical examination, dermoscopy, and serum CXCL10 levels measured by enzyme-linked immunosorbent assay technique. Dermoscopic scores were calculated using BPLeFoSK score. RESULTS The dermoscopic score was concordant with the VIDA score in 83.5% of patients (n = 81), clinical assessment in 97.9% (n = 95), and serum CXCL10 level in 70.1% (n = 68). Dermoscopic signs of ill-defined border, satellite lesions, and micro-Koebner and starburst appearance were more common in active vitiligo, while a well-defined border was more common in stable lesions. CONCLUSION Dermoscopic examination is a practical, reliable, noninvasive, semi-objective tool in the assessment of vitiligo activity/stability that helps reach an informed decision on the disease status to choose the appropriate therapeutic modality.
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Affiliation(s)
- Sarah I Ismail
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa Mahmoud
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health and Community Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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18
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges 2022; 20:365-378. [PMID: 35246935 DOI: 10.1111/ddg.14713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Vitiligo is a common skin disorder characterized by immune-mediated destruction of melanocytes. Non-segmental vitiligo, the most common clinical subtype, has usually a chronic course and often results in significant psychosocial consequences for the affected patient. Early recognition, awareness of comorbidity, precise assessment of disease extent and activity, evaluation of impairment of quality of life as well as rapid initiation of treatment based on currently available evidence-based therapies are crucial cornerstones in the management of vitiligo. This S1 guideline helps German dermatologists to better diagnose and treat vitiligo.
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Affiliation(s)
- Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Jo Ana Schunter
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Klaus Fritz
- Dermatology Office and Laser Center Landau, Landau, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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19
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Xu X, Jiang M, Zhang C, Qiao Z, Liu W, Le Y, Wu J, Ma W, Xiang LF. New insights into segmental vitiligo: A clinical and immunological comparison with nonsegmental vitiligo. Pigment Cell Melanoma Res 2021; 35:220-228. [PMID: 34780118 DOI: 10.1111/pcmr.13022] [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: 05/11/2021] [Revised: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
The overlaps between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) suggest the underlying features of SV, which may be helpful for treating SV. In this study, 379 vitiligo patients were recruited and divided into SV (33.2%), mild-to-moderate NSV (M-NSV, affected body affected area [BSA] ≤10%, 34.0%), and severe NSV (S-NSV, affected BSA >10%, 32.7%) groups. Demographics and clinical data were collected through in-person interviews. The disease activity, progression, and prognosis were assessed through 6 months' follow-up. Serum cytokines profile and tissue-infiltrating immune cells were measured by ELISA assay and immunofluorescence, respectively. The SV exhibited lower rates of autoimmune comorbidities and recurrence than the S-NSV, but performed similar to the M-NSV. Moreover, the disease activity, progression, serum cytokines profile, and tissue-infiltrating Th/c1 cells in the active SV and M-NSV were comparable, but differed significantly from those of the active S-NSV. The clinical and immunological similarities between SV and M-NSV presented a deeper autoimmune understanding of SV. Additionally, a classification of active vitiligo according to disease extent may be more clinically meaningful than subtypes for guiding immunomodulatory treatment.
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Affiliation(s)
- Xinya Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Jiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhuhui Qiao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Le
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaqiang Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjuan Ma
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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20
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Mahmoud Marie RES, Adel AZM, Abd El-Fadeal NM, Eyada MMK. Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity. J Cosmet Dermatol 2021; 21:3515-3521. [PMID: 34783147 DOI: 10.1111/jocd.14612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vitiligo is an acquired cutaneous depigmenting disease caused by a T helper (Th) 1-cytotoxic T cells driven autoimmune attack against melanocytes, in which Th17 is also involved. Interleukin (IL)-38 belongs to the IL-1 family of cytokines and suppresses Th1 and Th17 activation. IL-38 protein and mRNA levels have been found to be elevated in various autoimmune disorders and correlated with disease severity and activity, including psoriasis, systemic sclerosis, rheumatoid arthritis, and atopic dermatitis. No previous studies have been performed to investigate the expression of IL-38 in patients with vitiligo. AIM To evaluate IL-38 serum level in patients with vitiligo compared to healthy controls (Hcs) and examine the association between IL-38 level and severity and activity of vitiligo. PATIENTS AND METHODS The study comprised 21 patients with vitiligo and 21 Hcs. Vitiligo severity and activity were evaluated via Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) Score, respectively. IL-38 serum level was evaluated by enzyme-linked immunosorbent assay. RESULTS Vitiligo patients had significantly higher serum level of IL-38 than Hcs (p < 0.001). This level was significantly higher among patients with signs of vitiligo activity (p = 0.048), correlated positively with VES (p < 0.001), and correlated negatively with the age of patients (p = 0.001) and the age of disease onset (p = 0.022). CONCLUSION IL-38 serum level was higher in patients with vitiligo than in Hcs and was related to vitiligo severity and signs of activity.
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Affiliation(s)
- Radwa El-Sayed Mahmoud Marie
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Al-Zahraa Mohamed Adel
- Department of Dermatology, Medical Services Administration, Suez Canal University, Ismailia, Egypt
| | - Noha M Abd El-Fadeal
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Oncology Diagnostic Unit, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Moustafa Mohamad Kamel Eyada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo. Clin Rev Allergy Immunol 2021; 61:299-323. [PMID: 34283349 DOI: 10.1007/s12016-021-08868-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5-2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross- talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.
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22
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Immunophenotypic Analysis Reveals Differences in Circulating Immune Cells in the Peripheral Blood of Patients with Segmental and Nonsegmental Vitiligo. J Invest Dermatol 2021; 142:876-883.e3. [PMID: 34166674 DOI: 10.1016/j.jid.2021.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022]
Abstract
Accumulating studies have indicated immune-based destruction of melanocytes in both segmental vitiligo (SV) and non-SV (NSV). Whereas SV often occurs unilaterally during childhood and stabilizes after an initial period of activity, the disease course of NSV is usually slowly progressive, with new lesions occurring bilaterally during life. This suggests an involvement of distinct pathophysiology pathways, specifically increased systemic immune activation in patients with NSV but not in patients with SV. This research aimed to identify the differences in immune cells in the blood of patients with SV and NSV through immunophenotyping of circulating cells. Regulatory T cells were unaffected in patients with SV compared with that in healthy controls but decreased in patients with NSV. In patients with NSV, the reduction in regulatory T cells was associated with the presence of other systemic autoimmune comorbidities, which were less present in SV. Similarly, the absence of a melanocyte-specific antibody response in patients with SV suggests less involvement of B-cell immunity in SV. These data show that in contrast to patients with NSV, no increased systemic immunity is found in patients with SV, indicating that SV pathogenesis is associated with a localized cytotoxic reaction targeting epidermal melanocytes.
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Sandru F, Carsote M, Albu SE, Dumitrascu MC, Valea A. Vitiligo and chronic autoimmune thyroiditis. J Med Life 2021; 14:127-130. [PMID: 34104234 PMCID: PMC8169145 DOI: 10.25122/jml-2019-0134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Vitiligo, the discoloration of the skin, has different autoimmune mechanisms reflected by many biomarkers as shown by skin histology, staining for CD4 and CD8 T lymphocytes, chemokine ligand 9 or circulating cytokines such as interleukin (IL)-1 beta, interferon (IFN)-gamma, transforming growth factor (TGF)-beta, antibodies, markers of oxidative stress, chemokines, and others. In this narrative review, we aim to overview vitiligo in relationship with chronic autoimmune thyroiditis. Regarding vitiligo, more than 50 different genetic loci have been associated with this disease, and the heritability is high. There is a 20% risk of an environmental connection which may also act as a trigger; moreover, the association with human leukocyte antigen (HLA) expression is well recognized. The specific lesions display CD8+ tissue-resident memory T cells as continuous key activators of melanocytes. The association with chronic thyroiditis is based on common autoimmune background and excessive reactive oxygen species that destroy melanocytes and thyrocytes (oxidative stress hypothesis) with thyroxine and melanin as target molecules, thus sharing a common origin: tyrosine. Moreover, common epigenetic anomalies or mutations of the Forkhead transcription factor D3 (FOXD3) have been described. Since vitiligo affects up to 1–2% of the population worldwide and 34% of patients have positive thyroid antibodies, apart from common autoimmunity background and oxidative stress toxicity, the association is clinically relevant for different practitioners.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, Elias Emergency University Hospital, Bucharest, Romania.,Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania.,Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Elena Albu
- Department of Obstetrics and Gynecology, Emergency University Hospital, Bucharest, Romania.,Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, Emergency University Hospital, Bucharest, Romania.,Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, Clinical County Hospital, Cluj-Napoca, Romania.,Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Dietze L, Metze D, Böhm M. Vitiligo masquerading as annular erythema in a young woman with low-grade skin phototype. Int J Dermatol 2021; 60:e273-e274. [PMID: 33660276 DOI: 10.1111/ijd.15489] [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: 11/27/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Lena Dietze
- Department of Dermatology, University of Münster, Münster, Germany
| | - Dieter Metze
- Department of Dermatology, University of Münster, Münster, Germany
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
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Peralta-Pedrero ML, Herrera-Bringas D, Torres-González KS, Morales-Sánchez MA, Jurado Santa-Cruz F, Cruz-Avelar A. Development and Validation of a New Scoring Tool to Evaluate the Clinical Evolution of Adult Patients with Nonsegmental Vitiligo. Dermatology 2021; 237:952-960. [PMID: 33486476 DOI: 10.1159/000511890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitiligo has an unpredictable course and a variable response to treatment. Furthermore, the improvement of some vitiligo lesions cannot be considered a guarantee of a similar response to the other lesions. Instruments for patient-reported outcome measures (PROM) can be an alternative to measure complex constructions such as clinical evolution. OBJECTIVE The aim of this study was to validate a PROM that allows to measure the clinical evolution of patients with nonsegmental vitiligo in a simple but standardized way that serves to gather information for a better understanding of the disease. METHODS The instrument was created through expert consensus and patient participation. For the validation study, a prospective cohort design was performed. The body surface area affected was measured with the Vitiligo Extension Score (VES), the extension, the stage, and the spread by the evaluation of the Vitiligo European Task Force assessment (VETFa). Reliability was determined with test-retest, construct validity through hypothesis testing, discriminative capacity with extreme groups, and response capacity by comparing initial and final measurements. RESULTS Eighteen semi-structured interviews and 7 cognitive interviews were conducted, and 4 dermatologists were consulted. The instrument Clinical Evolution-Vitiligo (CV-6) was answered by 119 patients with a minimum of primary schooling. A wide range was observed in the affected body surface; incident and prevalent cases were included. The average time to answer the CV-6 was 3.08 ± 0.58 min. In the test-retest (n = 53), an intraclass correlation coefficient was obtained: 0.896 (95% CI 0.82-0.94; p < 0.001). In extreme groups, the mean score was 2 (2-3) and 5 (4-6); p < 0.001. The initial CV-6 score was different from the final one and the change was verified with VES and VETFa (p < 0.05, n = 92). CONCLUSIONS The CV-6 instrument allows patient collaboration, it is simple and brief, and it makes it easier for the doctor to focus attention on injuries that present changes at the time of medical consultation.
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Leung AKC, Lam JM, Leong KF, Hon KL. Vitiligo: An Updated Narrative Review. Curr Pediatr Rev 2021; 17:76-91. [PMID: 33302860 DOI: 10.2174/1573396316666201210125858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. OBJECTIVE This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. METHODS A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. RESULTS Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. CONCLUSION The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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27
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Eleftheriadou V. Reliability and validity of the Vitiligo Signs of Activity Score. Br J Dermatol 2020; 183:801-802. [PMID: 32458411 DOI: 10.1111/bjd.19164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- V Eleftheriadou
- University of Nottingham, Centre of Evidence Based Dermatology, King's Meadow Campus, Nottingham, UK
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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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Katsarou MS, Sidiropoulou P, Ieronymaki D, Mastraftsi S, Sifaki M, Xenos K, Nosyrev A, Kovatsi L, Spandidos DA, Lagiou M, Dagklis C, Gregoriou S, Tagka A, Rigopoulos D, Drakoulis N, Nicolaidou E. Impact of vitamin D receptor gene polymorphisms on vitiligo susceptibility and clinical features in a Southeastern European Caucasian population. Int J Mol Med 2020; 46:1899-1907. [PMID: 33000207 PMCID: PMC7521563 DOI: 10.3892/ijmm.2020.4732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/18/2020] [Indexed: 12/29/2022] Open
Abstract
An association of vitamin D receptor (VDR) polymorphisms and vitiligo has been suggested. However, previous studies have reported contradictory results while including limited data among Caucasians. The aim of this single-center study was to evaluate the effect of three common VDR gene polymorphisms (FokI, TaqI and BsmI) on suscep-tibility and clinical aspects of vitiligo in a Southeastern European Caucasian population. A total of 110 unrelated vitiligo cases and 509 general population controls were enrolled from October 2018 to November 2019. Genomic DNA was extracted from whole blood after de-identification and anonymization of the samples and genotyped for the selected VDR polymorphisms by the qPCR (melting curve analysis). Subgroup analysis by clinical features among subsets of patients indicated that, compared to subjects with the FokI TT genotype or T allele, carriers of the FokI CC genotype or C allele exhibited significantly decreased risk of developing vitiligo before the age of 30 [TT vs. CC: odds ratio (OR)=0.286, 95% confidence interval (CI): 0.083-0.984, P=0.041; T vs. C: OR=0.545, 95% CI: 0.313-0.948, P=0.031]. Intra-patient analysis also revealed that, compared to T allele, the presence of TaqI C allele was adversely associated with the incidence of concurrent leukotrichia (T vs. C: OR=1.874, 95% CI: 1.018-3.451, P=0.042). Comparisons between the case and control groups showed no evidence to support an association between susceptibility to vitiligo and the VDR BsmI, TaqI, and FokI polymorphisms in this cohort. Thus, the studied VDR polymorphisms might indirectly impact the clinical course and treatment decision-making despite their lack of association with vitiligo per se. Further research with larger sample sizes, especially across Caucasian individuals, should be performed to confirm these findings.
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Affiliation(s)
- Martha-Spyridoula Katsarou
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Polytimi Sidiropoulou
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Dimitra Ieronymaki
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Styliani Mastraftsi
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Maria Sifaki
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Kyriakos Xenos
- Department of Dermatology‑Venereology, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Alexander Nosyrev
- Institute for Translational Medicine and Biotechnology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia
| | - Leda Kovatsi
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54640 Thessaloniki, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Maria Lagiou
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Christos Dagklis
- Department of Statistics and Insurance Science, University of Piraeus, 18534 Piraeus, Greece
| | - Stamatis Gregoriou
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Anna Tagka
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Dimitris Rigopoulos
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Electra Nicolaidou
- 1st Department of Dermatology‑Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
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31
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van Geel N, Passeron T, Wolkerstorfer A, Speeckaert R, Ezzedine K. Reliability and validity of the Vitiligo Signs of Activity Score (VSAS). Br J Dermatol 2020; 183:883-890. [PMID: 32064583 PMCID: PMC7687072 DOI: 10.1111/bjd.18950] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 12/12/2022]
Abstract
Background The associations between disease activity and several clinical signs in vitiligo have been described, but a widely accepted and validated scoring system is lacking. Objectives To validate the Vitiligo Signs of Activity Score (VSAS) for physicians. Methods Three visible clinical signs were scored on 15 body locations: confetti‐like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (h). The inter‐ and intrarater reliability of the global VSAS and VSAS subscores (c‐VSAS, k‐VSAS and h‐VSAS) were tested by four and three raters (physicians), respectively. Construct validity and feasibility were evaluated. Results The VSAS demonstrated good inter‐rater reliability, with an intraclass correlation coefficient (ICC) of 0·87 in the first round and 0·90 in the second round. The intrarater reliability ICCs were all ≥ 0·86. The inter‐rater reliabilities of the subscores were excellent for c‐VSAS and fair for k‐VSAS and h‐VSAS (ICC 0·83, 0·51 and 0·53, respectively, in the first round). Evidence for construct validity was provided. The completion time by the raters (median 2·18 min per patient) improved during the second round (median 1·33 min per patient). A limitation of the study is the low number of patients, mainly of skin phototypes II–III, from a single tertiary centre. Conclusions The VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardized way. What is already known about this topic? Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity. A widely accepted and validated scoring system to quantify these clinical signs is lacking.
What does this study add? The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials.
What are the clinical implications of this work? VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting.
Linked Comment:Eleftheriadou. Br J Dermatol 2020; 183:801–802. What is already known about this topic? Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity. A widely accepted and validated scoring system to quantify these clinical signs is lacking.
What does this study add? The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials.
What are the clinical implications of this work? VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting.
Linked Comment:Eleftheriadou. Br J Dermatol 2020; 183:801–802.
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Affiliation(s)
- N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - T Passeron
- Department of Dermatology, Université Côte d'Azur, CHU Nice, Nice, France.,Department of Dermatology & INSERM U1065, C3M, Nice, France
| | - A Wolkerstorfer
- Department of Dermatology, Institute for Pigment Disorders and Infection & Immunity Institute Amsterdam UMC, Amsterdam, the Netherlands
| | - R Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - K Ezzedine
- Department of Dermatology, Henri Mondor Hospital, UPEC-Université Paris-Est Créteil, Paris, France
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