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Li C, Hu Y, Mu Z, Shi L, Sun X, Wang X, Wang Y, Li X. Comparison of various excimer laser (EL) combination therapies for vitiligo: a systematic review and network meta-analysis. J DERMATOL TREAT 2024; 35:2302064. [PMID: 38230424 DOI: 10.1080/09546634.2024.2302064] [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: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
AIM This study aimed to compare the efficacy and safety of excimer laser (EL)-based combination regimens in improving repigmentation. METHODS A comprehensive search was conducted in PubMed, Web of Science, Cochrane Library, and Embase on July 1, 2023, to include randomized controlled trials of EL combination treatments for vitiligo that met the criteria. The primary outcome measure was a repigmentation rate ≥ 75%, and the secondary outcome measures were a repigmentation rate of ≤ 25% and adverse events. RESULTS Eleven studies involving 348 patients were included. Network Meta-Analysis showed that EL combined with antioxidants (SUCRA = 98.8%), EL combined with calcipotriol (SUCRA = 59.8%) and EL combined with tacalcitol (SUCRA = 59.6%) were the three optimal interventions achieving repigmentation rates ≥ 75%. EL alone (SUCRA = 77.6%), EL combined with tacalcitol (SUCRA = 61.7%) and EL combined with antioxidants (SUCRA = 57.2%) were the three interventions with the highest rates of treatment failure. Adverse events in all groups mainly included erythema, burning sensation and hyperpigmentation. Based on the results of the current study, EL combination therapies were safe with mild adverse events. CONCLUSION EL combined with antioxidants was the preferred regimen for vitiligo, whereas EL alone was the regimen with the highest rate of treatment failure in vitiligo.
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Affiliation(s)
- ChanXiu Li
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Yue Hu
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - ZengYi Mu
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Lei Shi
- Department of Otorhinolaryngology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Xiao Sun
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - XinYue Wang
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - YaPing Wang
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - XinHong Li
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
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Passeron T, Ezzedine K, Hamzavi I, van Geel N, Schlosser BJ, Wu X, Huang X, Soliman AM, Rosmarin D, Harris JE, Camp HS, Pandya AG. Once-daily upadacitinib versus placebo in adults with extensive non-segmental vitiligo: a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-ranging study. EClinicalMedicine 2024; 73:102655. [PMID: 38873632 PMCID: PMC11169949 DOI: 10.1016/j.eclinm.2024.102655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
Background Janus kinase (JAK) inhibition is a promising approach for treating vitiligo. We aimed to assess the efficacy and safety of upadacitinib, an oral selective JAK inhibitor, in adults with non-segmental vitiligo. Methods This was a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-ranging study completed at 33 clinical centres in the United States, Canada, France, and Japan. Eligible patients were aged 18-65 years with non-segmental vitiligo and had a Facial Vitiligo Area Scoring Index (F-VASI) ≥0.5 and a Total Vitiligo Area Scoring Index (T-VASI) ≥5. Patients were randomly assigned (2:2:2:1:1) using an interactive response technology to receive upadacitinib 6 mg (UPA6), upadacitinib 11 mg (UPA11), upadacitinib 22 mg (UPA22), or placebo (PBO; preassigned to switch to either UPA11 or UPA22 in period 2) once daily for 24 weeks (period 1). For weeks 24-52 (period 2), patients randomly assigned to upadacitinib continued their treatment, and patients receiving PBO switched to their preassigned upadacitinib dose in a blinded fashion. The primary endpoint was the percent change from baseline in F-VASI at week 24. Efficacy was analysed in the intention-to-treat population, and safety was examined in all randomly assigned patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT04927975. Findings Between June 16, 2021, and June 27, 2022, 185 patients (including 115 [62%] who were female and 70 [38%] who were male) were randomly assigned to UPA6 (n = 49), UPA11 (n = 47), UPA22 (n = 43), or PBO (n = 46). At week 24, the LS mean difference versus PBO in the percent change from baseline in F-VASI was -7.60 (95% CI -22.18 to 6.97; p = 0.3037) for UPA6, -21.27 (95% CI -36.02 to -6.52; p = 0.0051) for UPA11, and -19.60 (95% CI -35.04 to -4.16; p = 0.0132) for UPA22. The LS mean difference versus PBO in the percent change from baseline in T-VASI was -7.45 (95% CI -16.86 to 1.96; p = 0.1198) for UPA6, -10.84 (95% CI -20.37 to -1.32; p = 0.0259) for UPA11 and -14.27 (95% CI -24.24 to -4.30; p = 0.0053) for UPA22. Ongoing treatment with upadacitinib induced continuous skin repigmentation over time without reaching a plateau through week 52. The rates for study drug discontinuation and serious treatment-emergent adverse events (TEAEs) were higher in the UPA22 group than in the UPA11 and UPA6 groups. Eight serious TEAEs, including one death of unknown cause and one case of infiltrating lobular breast carcinoma, were reported through 52 weeks; only two serious TEAEs (coronary artery arteriosclerosis [UPA6 (n = 1)] and non-fatal ischemic stroke [UPA11 (n = 1)]) were deemed by the investigator to have a reasonable possibility of being related to study drug. The one case of breast cancer in the UPA11 group was deemed unrelated to study drug, and the one death of unknown cause in the UPA22 group was reviewed and adjudicated and was deemed to be unrelated to study drug. The most common TEAEs were COVID-19, headache, acne, and fatigue. No new safety signals were observed. Interpretation Upadacitinib monotherapy led to substantial repigmentation of both facial and total body vitiligo lesions and may offer an effective treatment option for adults with extensive non-segmental vitiligo. Based on these findings, upadacitinib 15 mg is being investigated in adults and adolescents with non-segmental vitiligo in an ongoing phase 3 randomised controlled trial. Funding AbbVie Inc.
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Affiliation(s)
- Thierry Passeron
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire (C3M), Côte d’Azur University, Nice, France
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, Côte d’Azur University, Nice, France
| | - Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, Créteil, France
- EA 7379 EpidermE, Université Paris-Est Créteil, UPEC, Créteil, France
| | - Iltefat Hamzavi
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Hospital, Detroit, MI, USA
| | - Nanja van Geel
- Department of Dermatology, Gent University Hospital, Gent, Belgium
| | | | | | | | | | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John E. Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Amit G. Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wang Z, Hu H, Ou Y, Wang C, Yue K, Lin K, Ou J, Zhang J. Computer-aided assessment of repigmentation rates in vitiligo patients: Implications for treatment efficacy - a retrospective study. J Invest Dermatol 2024:S0022-202X(24)01733-0. [PMID: 38909840 DOI: 10.1016/j.jid.2024.05.016] [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: 11/11/2023] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/25/2024]
Abstract
Precise evaluation of repigmentation in vitiligo patients is crucial for monitoring treatment efficacy and enhancing patient satisfaction. This study aimed to develop a computer-aided system for assessing repigmentation rates in vitiligo patients, providing valuable insights for clinical practice. A retrospective study was conducted at the Dermatology Department of Shenzhen People's Hospital between June 2019 and November 2022. Pre- and post-treatment images of vitiligo lesions under Wood's lamp were collected, involving 833 participants stratified by sex, age, and pigmentation patterns. Our results demonstrated that the 'marginal' pigmentation pattern exhibited a higher repigmentation rate of 72% compared to the 'central non-follicular' pattern at 45%. Males had a slightly higher average repigmentation rate of 0.37 in comparison to females at 0.33. Among age groups, individuals aged 0-20 years showed the highest average repigmentation rate at 0.41, while the oldest age group (61-80 years) displayed the lowest rate at 0.25. Analysis of multiple visits identified the 'marginal' pattern as the most prevalent (60%), with a mean repigmentation rate of 40%. This study introduced a computational system for evaluating vitiligo repigmentation rates, enhancing our comprehension of patient responses, ultimately contributing to enhanced clinical care.
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Affiliation(s)
- Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha 410205, China; Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China; Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Hui Hu
- School of Computer Science, Hunan First Normal University, Changsha 410205, China; Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Yangyang Ou
- School of Computer Science, Hunan First Normal University, Changsha 410205, China; Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Chong Wang
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China; Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen 518020, Guangdong, China
| | - Kejuan Yue
- School of Computer Science, Hunan First Normal University, Changsha 410205, China; Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Kaibin Lin
- School of Computer Science, Hunan First Normal University, Changsha 410205, China; Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Jiarui Ou
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen 518020, Guangdong, China; Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China; Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen 518020, Guangdong, China; Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Rosmarin D, Soliman AM, Piercy J, Marwaha S, Anderson P, Camp HS. Health-Related Quality of Life Burden Among Adults with Vitiligo: Relationship to Disease Severity and Disease Location. Dermatol Ther (Heidelb) 2024; 14:1633-1647. [PMID: 38824482 PMCID: PMC11169145 DOI: 10.1007/s13555-024-01187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Vitiligo was historically regarded as a cosmetic disorder; however, it is an autoimmune disease. As a visible condition, it affects patient well-being. We assessed the impact of disease severity, lesion location, and body surface area (BSA) affected on patient health-related quality of life (HRQoL). METHODS Retrospective data were from the Adelphi Real World Vitiligo Disease Specific Programme: a cross-sectional survey of physicians and their patients with vitiligo (10/2021-07/2022). Patient-reported outcomes were assessed by the Vitiligo-Specific Quality of Life Instrument (VitiQoL), Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L. The Work Productivity and Impairment Questionnaire (WPAI) questionnaire was used to assess disease-related impairment of daily activities. Data were stratified by physician-reported disease severity, presence/absence of vitiligo on the face, and BSA percentage affected. RESULTS In total, 1388 patients were included. Mean (SD) VitiQoL, HADS depression, and anxiety scores were higher for those with severe disease [40.5 (26.1), 5.2 (4.4), and 6.8 (4.7)] than those with mild [24.8 (18.8), 3.6 (3.8), 4.2 (3.8)] or moderate [27.1 (22.6), 3.8 (4.5), 4.3 (4.4)] disease. Patients with face affected reported higher VitiQoL [30.0 (22.3) versus 23.2 (19.3)], and HADS scores [depression, 4.3 (4.3) versus 3.2 (3.9); anxiety, 5.0 (4.3) versus 3.8 (3.9)] than those without. Patients with ≥ 5% BSA affected had higher VitiQoL, depression and anxiety scores [27.9 (21.8), 4.0 (4.4), and 4.5 (4.2)] than those with 0-5% [24.6 (19.7), 3.4 (3.7), and 4.3 (4.1)]. Patients with severe vitiligo, facial lesions, or ≥ 5% BSA reported higher activity impairment. Mean EQ-5D-5L-utility score was approximately 0.9 regardless of disease severity or total BSA affected. CONCLUSIONS These data demonstrate the impact disease severity can have on HRQoL and daily activities for patients with vitiligo. Lesions that are more severe, on the face, or covering a greater BSA are more often associated with poorer outcomes and activity impairment. These data also highlight the potential insensitivity of commonly used HRQoL measures and a need for more sensitive disease-specific measures.
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Affiliation(s)
- David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, EH 139, DERM, IN, Indianapolis, IN, 46202, USA.
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Rosmarin D, Lofland JH, Marwaha S, Piercy J, Anderson P, Liu J. Patient Burden of Nonsegmental Vitiligo: A US Real-World Survey of Dermatologists and Their Patients. Dermatol Ther (Heidelb) 2024; 14:1531-1546. [PMID: 38753072 PMCID: PMC11169217 DOI: 10.1007/s13555-024-01165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/10/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with ≤ 10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction. METHODS Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life. RESULTS Sixty-one dermatologists provided data for 326 patients with ≤ 10% affected body surface area (adults, n = 221; adolescents, n = 105); 90 of those patients also responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without. CONCLUSION A high patient burden was reported by dermatologists and their patients with vitiligo who had ≤ 10% affected body surface area, including psychosocial and psychological consequences. These findings highlight an unmet need in the treatment of vitiligo.
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Affiliation(s)
- David Rosmarin
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - Jinan Liu
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE, 19803, USA.
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Fekete L, Iantovics LB, Fekete GL. Validation of the DLQI questionnaire in assessing the disease burden and principal aspects related to life quality of vitiligo patients. Front Psychol 2024; 15:1333723. [PMID: 38873521 PMCID: PMC11171417 DOI: 10.3389/fpsyg.2024.1333723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
According to many studies, vitiligo has a negative psychological influence on the patient's life. Multiple factors contribute to the severity of the vitiligo disease burden, among which the most important are self-esteem, stress, and stigma. We aimed to measure the importance of health-related life quality in assessing disease burden in patients with vitiligo. We formulated an HA, which is the principal hypothesis, claiming a single fundamental factor that characterizes the life quality of patients with vitiligo. We also formulated 10 important research questions related to the quality of life that can be generally formulated for patients with dermatological illnesses but particularly suited for vitiligo patients. These research questions capture fundamental aspects of the health-related quality of life of vitiligo patients influenced by symptoms and feelings, daily activities, leisure, job and education, personal relationships, and treatment. These also cover specific aspects related to the quality of life, such as skin-caused sexual difficulties, difficulties in social relationships, and difficulties in performing sports, among others. The Dermatology Life Quality Index (DLQI) questionnaire measures the health-related quality of life of persons suffering from skin diseases. We applied this generic questionnaire to patients with vitiligo. Following a set of inclusion and exclusion criteria, we obtained 114 carefully selected patients who responded to all the questions. This study also validated the DLQI questionnaire on persons who suffer from vitiligo. We investigated whether DLQI has acceptable internal consistency by applying Cronbach's alpha internal consistency indicator (Cα). The obtained Cα = 0.914 indicates excellent internal consistency. We also examined whether all the questions in the questionnaire were mathematically consistent, which we finally proved. It was not necessary to remove any of the questionnaire questions. To prove our HA, a Principal Axis Factoring (PAF) was applied, verifying the assumptions regarding the Average Variance Extracted (AVE) and Convergent Validity (CV). HA proved that applying PAF on DLQI resulted in extracting a single general vitiligo latent factor of life quality, with an initial eigenvalue = 5.671, SS loadings = 5.2, and 52 % of the total cumulative variance explained. Diverse statistical analyses were applied to analyze the 10 formulated research questions. The results of the analysis of the research questions are presented and discussed in the manuscript. One of the conclusions related to the analysis of a research question was that sex had the lowest correlation with the latent life quality factor identified for vitiligo patients.
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Affiliation(s)
- Laszlo Fekete
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Laszlo Barna Iantovics
- Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Gyula Laszlo Fekete
- Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
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Augustin M, Gewiss C, Ben-Anaya N, Böhm M. [Quality of life, disease burden and healthcare need of patients with vitiligo]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:404-411. [PMID: 38466405 PMCID: PMC11065915 DOI: 10.1007/s00105-024-05312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND With a prevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has a disfiguring, often stigmatising character and is often associated with psychosocial distress. OBJECTIVE To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo. MATERIALS AND METHODS Narrative review based on a literature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided. RESULTS The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. A large number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine a high need for care in a relevant proportion of those affected. CONCLUSION Vitiligo is not primarily a cosmetic problem, but a disease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.
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Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland.
| | - Caroline Gewiss
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland
| | - Nesrine Ben-Anaya
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland
| | - Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
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Saha DR, Roy S, Ahmed R, Mahanta P. Clinico-Epidemiological Profile of Vitiligo Among Patients Attending a Tertiary Care Centre of North-East India. Cureus 2024; 16:e58804. [PMID: 38784306 PMCID: PMC11112533 DOI: 10.7759/cureus.58804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Vitiligo is a widespread cutaneous disorder. The present study aims to evaluate the epidemiologic profile of vitiligo and investigate its different clinical forms, disease activity, hereditary associations, triggering factors, and probable association with other diseases. Methods This prospective observational study was conducted over one year, from 2019 to 2020, and included 120 cases demonstrating definite clinical evidence of vitiligo. All selected patients underwent a detailed medical history interview. Specific enquiries were made regarding precipitating factors, clinical features of the disease, histories of other autoimmune diseases, and family histories. Thorough clinical, laboratory, and cutaneous examinations were performed on all patients. Descriptive statistical methods and diagrams were used to summarise the data. Results The age at presentation (31 patients, 25.8%) and the onset of the disease (32 patients, 26.6%) was predominantly in the second decade of life. The condition was usually progressive, with vitiligo vulgaris being the most prevalent type (56 cases, 46.7%). Disease onset (37 individuals, 30.8%) and the prevalence of lesions were higher in the lower leg. Body surface area involvement was ≤1% in 72 (60.0%) patients. Itching and trauma were the typical initiating factors. Leukotrichia in 38 (31.7%) cases, Koebner's phenomena in 23 (19.1%) cases, and a positive family history in 26 (21.7%) cases were observed. Thyroid dysfunction, hypertension, and various skin conditions are associated with the disease. Conclusion Vitiligo is more common in the young population. The condition is often progressive, with vitiligo vulgaris being the most common type. Itching and trauma are frequent initiating factors. Monitoring patients for associated diseases may be crucial for diagnosis and treatment outcomes.
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Affiliation(s)
| | - Somnath Roy
- Internal Medicine, Gauhati Medical College and Hospital, Guwahati, IND
| | - Rashmi Ahmed
- Community Medicine, Lakhimpur Medical College, Lakhimpur, IND
| | - Putul Mahanta
- Forensic Medicine and Toxicology, Nalbari Medical College and Hospital, Nalbari, IND
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Hwang HW, Ryou S, Jeong JH, Lee JW, Lee KJ, Lee SB, Shin HT, Byun JW, Shin J, Choi GS. The Quality of Life and Psychosocial Impact on Female Pattern Hair Loss. Ann Dermatol 2024; 36:44-52. [PMID: 38325433 PMCID: PMC10861302 DOI: 10.5021/ad.23.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Alopecia, a benign dermatologic condition affecting both genders, particularly harms female patients due to psychosocial effects. Female pattern hair loss (FPHL), the primary cause of hair loss in women, lacks sufficient Korean epidemiological studies examining its psychosocial aspects. OBJECTIVE This study aimed to explore FPHL's psychosocial impacts, including quality of life (QoL), depression, anxiety, medical consumption, and hair loss factors in Korean women. METHODS A total of 202 patients with FPHL were interviewed using a validated questionnaire to assess the QoL, psychological impact, and pattern of medical consumption. The severity of hair loss was evaluated using the "basic and specific (BASP) classification" by dermatologists. The Hair-Specific Skindex-29 (HSS29) was used to assess the QoL and Beck depression inventory (BDI), Beck anxiety inventory (BAI) to evaluate psychological aspects, and medical expenses and the number of clinic visits to determine medical consumption. RESULTS The global HSS29 score of FPHL was 40.97±18.92, indicating a notable impact on QoL. The mean BDI and BAI scores were 14.47 and 10.06, respectively. In multivariable regression analysis, HSS29, BDI, and BAI scores were most affected by the severity of hair loss (p<0.001). CONCLUSION FPHL damages the psychosocial aspects of patients, such as QoL, depression, and medical consumption, according to the severity of hair loss.
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Affiliation(s)
- Hye Won Hwang
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Sunmin Ryou
- Department of Dermatology, Inha University Hospital, Incheon, Korea
| | - Jun Hyeong Jeong
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jae Won Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Kyung-Ju Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Seon Bok Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Hyun-Tae Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Ji Won Byun
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea.
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10
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Enomoto Y, Kanayama Y, Ikumi K, Sakurai M, Yamamoto A, Morita A. Cigarette smoking is an independent risk factor for developing vitiligo on the hands. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40. [PMID: 38288764 DOI: 10.1111/phpp.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Vitiligo presents with varying clinical features based on the type and location. Treatment tends to be more effective on the face, neck, trunk, and mid-extremities, while the lips and distal extremities may be more resistant. Vitiligo in frequently exposed areas such as the face, arms, legs, and hands is typically associated with a lower Dermatology Life Quality Index. OBJECTIVES We aimed to identify the characteristics and potential causes of vitiligo in challenging-to-treat regions, with particular focus on the hands. METHODS We analyzed the clinical data of 337 patients with generalized vitiligo who visited our hospital between 2016 and 2022. For this study, we focused on patients with non-segmental vitiligo (NSV) specifically on their hands. Of the 337 patients, 248 had NSV and 89 had segmental vitiligo; 119 (47%) of those with NSV had vitiligo on their hands. Logistic regression models were applied to identify factors the factors linked to hand vitiligo, such as age, sex, duration of the condition, and smoking and alcohol history. RESULTS AND CONCLUSIONS We developed a model to predict the risk of hand vitiligo using several factors. Among the factors analyzed, only smoking history was significantly associated with an increased risk (odds ratio: 3.13). In addition, we used clinical photography to evaluate color-graded frequency heat maps comprising 528 pixels. Vitiligo in nonsmokers widely distributed over the hand, predominantly the fingertips and joints, whereas vitiligo in smokers tended to be distributed mostly at the fingertips.
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Affiliation(s)
- Yuki Enomoto
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshifumi Kanayama
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kyoko Ikumi
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mai Sakurai
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Aya Yamamoto
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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11
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Marin Dit Bertoud Q, Bertold C, Ezzedine K, Pandya AG, Cherel M, Castillo Martinez A, Seguy MA, Abdallah M, Bae JM, Böhm M, Parsad D, Rosmarin D, Wolkerstorfer A, Bahadoran P, Blaise M, Dugourd PM, Philippo V, Delaval JM, Passeron T. Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm. Br J Dermatol 2023; 190:62-69. [PMID: 37615581 DOI: 10.1093/bjd/ljad304] [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: 03/21/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. OBJECTIVES To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. METHODS We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. RESULTS Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. CONCLUSIONS We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.
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Affiliation(s)
| | - Clémence Bertold
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Université Paris Est (UPEC), EpiDermE Research Unit, Paris, France
| | - Amit G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marie Cherel
- Newtone Technologies, Research and Development, Lyon, France
| | | | | | - Marwa Abdallah
- Department of Dermatology, Andrology and Venereology, Ain Shams University, Cairo, Egypt
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Davinder Parsad
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Philippe Bahadoran
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Manon Blaise
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Valérie Philippo
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Thierry Passeron
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
- Université Côte d'Azur, INSERM, U1065, C3M, Nice, France
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12
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Marzano AV, Alberti-Violetti S, Maronese CA, Avallone G, Jommi C. Vitiligo: Unmet Need, Management and Treatment Guidelines. Dermatol Pract Concept 2023; 13:dpc.1304S2a316S. [PMID: 38241398 PMCID: PMC10824320 DOI: 10.5826/dpc.1304s2a316s] [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 a chronic depigmenting disorder characterized by characteristic, non-scaly, chalky-white skin macules and patches, due to the loss of skin pigment. Its exact pathogenesis is still not fully understood but it seems to be an autoimmune disease where the combination of genetic, environmental, and immune factors contributes to the destruction of melanocytes in the epidermis. Vitiligo is classified into different types based on its clinical characteristics and distribution patterns. The two main forms of vitiligo are non-segmental vitiligo (NSV) and segmental vitiligo (SV). NSV is the predominant form, characterized by symmetrical skin patches, that tend to evolve over time. In contrast, SV has unilateral or band-shaped lesions that progress rapidly but often stabilize early. Herein, current unmet needs in terms of psychosocial consequences and relative lack of valid therapeutic approaches are critically analyzed and put in perspective in the Italian prescribing scenario. Finally, available management guidelines are illustrated and briefly compared, to provide context for upcoming treatment options.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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13
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Naldi L, Pagani A, Alduini C. Vitiligo: Epidemiology and Economic Impact. Dermatol Pract Concept 2023; 13:dpc.1304S2a315S. [PMID: 38241395 PMCID: PMC10824327 DOI: 10.5826/dpc.1304s2a315s] [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
INTRODUCTION Vitiligo is an acquired disorder of pigmentation, characterized by the development of white patches on the skin, often with a typical symmetrical distribution and progressive extension . Although vitiligo does not cause direct physical impairment, it can produce a relevant psychosocial burden. Despite this burden, effective treatments are lacking, emphasizing the need for new therapeutic options. OBJECTIVES The aim of this study was to systematically scan the scientific literature for studies dealing with vitiligo epidemiology. Additionally, the study aimed to assess the social costs of vitiligo, ultimately raising awareness about the societal impact of the condition. The focus was on Italian data. METHODS Our research employed a comprehensive methodology. For the epidemiology, we systematically searched PubMed database up to October 2023 and complemented the analysis with Real World Evidence. For social costs, we conducted an in-depth literature review, administered a web-survey to 20 Italian dermatologists and conducted an equivalent number of interviews during the same period in March 2022. RESULTS The data suggest that in Italy the prevalence of vitiligo increases with age, and it varies from 0.19% (age 18-21) to 0.6% (age >45) . We estimated 152,000 patients diagnosed with Non-Segmental Vitiligo (NSV) in Italy; based on Body Surface Area (BSA), 33% are Not Severe, 31% Mild, 27% Moderate/Severe, 9% Very Severe. The yearly social costs of vitiligo amount to €0.5Bln. CONCLUSIONS There is a remarkable association of vitiligo with anxiety and depression , and Mental Health is associated with 30% of social costs. Moreover, vitiligo social costs distribution highlights inequity, with patients bearing 55% of them.
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Affiliation(s)
- Luigi Naldi
- UOC Dermatologia, Ospedale San Bortolo, Vicenza, Centro Studi GISED, Bergamo
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14
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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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15
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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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16
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Ezzedine K, Seneschal J, Da Silva A, Préaubert N, Lamblin A, Delattre C, Emery C, Nevoret C, Finzi J, Bouée S, Passeron T. Vitiligo patient population and disease burden in France: VIOLIN study results from the CONSTANCES cohort. J Eur Acad Dermatol Venereol 2023; 37:2249-2258. [PMID: 37605309 DOI: 10.1111/jdv.19447] [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: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Vitiligo is a chronic autoimmune disease resulting in skin depigmentation. OBJECTIVES This study assessed the prevalence, disease burden and treatment of vitiligo in France. METHODS VIOLIN was a cross-sectional study nested in the national CONSTANCES cohort, which consists of randomly selected adults aged 18-69 years in France. In VIOLIN, longitudinal data were collected prospectively from 158,898 participants during 2012-2018 and linked to the National Health Data System (SNDS), a healthcare utilization database. Patients with physician-diagnosed vitiligo were matched (1:3) with control participants based on age, sex, geographic region, year of inclusion and skin phototype. Patients completed a questionnaire in 2022 to collect disease characteristics, disease burden and quality-of-life (QoL) data. RESULTS Vitiligo prevalence was 0.71% (681/95,597) in 2018. The mean age in the vitiligo population was 51.2 years; 51.4% were women. Most patients (63%) were diagnosed before age 30 years, mainly by dermatologists (83.5%). Most patients (81.1%) had visible lesions (i.e. on face, hands). Vitiligo was limited to <10% of the body surface area (BSA) in 85.8% of patients. Comorbidities including thyroid disease (18.0% vs. 9.0%), psoriasis (13.7% vs. 9.7%), atopic dermatitis (12.4% vs. 10.3%), depression (18.2% vs. 14.6%) and alopecia areata (4.3% vs. 2.4%) were significantly more common in patients with vitiligo versus matched controls (n = 2043). QoL was significantly impaired in patients with >5% BSA involvement or visible lesions, particularly with ≥10% facial involvement. Vitiligo-specific instruments (i.e. Vitiligo Impact Patient scale and Vitiligo-specific QoL instrument) were more sensitive to QoL differences among subgroups versus general skin instruments, and generic instruments were least sensitive. Most patients (83.8%) did not receive any prescribed treatment. CONCLUSIONS Patients with vitiligo in France have a high disease burden, particularly those with visible lesions or higher BSA involvement. Most patients are not receiving treatment, highlighting the need for new effective treatments and patient/physician education.
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Affiliation(s)
- Khaled Ezzedine
- Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, CNRS, UMR-5164, ImmunoConcEpT, Bordeaux, France
| | | | | | - Anne Lamblin
- Association Française du Vitiligo, Paris, France
| | | | | | | | | | | | - Thierry Passeron
- Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- INSERM U1065, C3M, Université Côte d'Azur, Nice, France
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17
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Alkhowailed M, Alotaibi HM, Alshwieer MA, Alazmi AK, Alotaibi NM, Alotaibi AF. The Psychological Impact of Vitiligo in Saudi Arabia. Cureus 2023; 15:e43767. [PMID: 37727157 PMCID: PMC10506855 DOI: 10.7759/cureus.43767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
Background Vitiligo, the most common pigment disorder, impacts 0.5-2% of the global population, often causing psychological distress due to appearance changes and potential discrimination. Existing data on depressive symptoms and quality of life (QoL) effects in Saudi Arabian vitiligo patients are limited and inconsistent. Hence, this multi-center investigation was conducted in Saudi Arabia to determine the prevalence of depressive symptoms and quality of life (QoL) impairment in patients with vitiligo and to identify factors linked to increased psychological distress in this population. Methods We conducted a multi-center cross-sectional study in Saudi Arabia, employing two validated Arabic questionnaires, the Dermatology Life Quality Index (DLQI) and the Patient Health Questionnaire-9 items (PHQ-9), along with demographic information. Appropriate statistical analyses were performed. Results In total, 204 patients completed the survey. The median DLQI was 4 (range: 25), while the median PHQ-9 was 5 (range: 27). Factors associated with worse QoL included an early age of onset (under 18 years) and a disease duration exceeding five years. Conversely, only disease duration correlated with worse PHQ-9 scores. Vitiligo lesions on the lower extremities, feet, and genitalia were linked to poorer DLQI scores, while only genitalia were associated with worse PHQ-9 scores. We recommend further social awareness campaigns emphasizing the role of supportive families to improve the well-being of vitiligo patients.
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Affiliation(s)
| | | | | | - Alwaleed K Alazmi
- Medicine, College of Medicine, King Saud University Medical City, Riyadh, SAU
| | - Nawaf M Alotaibi
- Medicine, College of Medicine, Shaqra University, Ad-Dawadmi, SAU
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18
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Rosmarin D, Passeron T, Pandya AG, Grimes P, Harris JE, Desai SR, Lebwohl M, Ruer-Mulard M, Seneschal J, Wolkerstorfer A, Kornacki D, Sun K, Butler K, Ezzedine K. Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo. N Engl J Med 2022; 387:1445-1455. [PMID: 36260792 DOI: 10.1056/nejmoa2118828] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitiligo is a chronic autoimmune disease that causes skin depigmentation. A cream formulation of ruxolitinib (an inhibitor of Janus kinase 1 and 2) resulted in repigmentation in a phase 2 trial involving adults with vitiligo. METHODS We conducted two phase 3, double-blind, vehicle-controlled trials (Topical Ruxolitinib Evaluation in Vitiligo Study 1 [TRuE-V1] and 2 [TRuE-V2]) in North America and Europe that involved patients 12 years of age or older who had nonsegmental vitiligo with depigmentation covering 10% or less of total body-surface area. Patients were randomly assigned in a 2:1 ratio to apply 1.5% ruxolitinib cream or vehicle control twice daily for 24 weeks to all vitiligo areas on the face and body, after which all patients could apply 1.5% ruxolitinib cream through week 52. The primary end point was a decrease (improvement) of at least 75% from baseline in the facial Vitiligo Area Scoring Index (F-VASI; range, 0 to 3, with higher scores indicating a greater area of facial depigmentation), or F-VASI75 response, at week 24. There were five key secondary end points, including improved responses on the Vitiligo Noticeability Scale. RESULTS A total of 674 patients were enrolled, 330 in TRuE-V1 and 344 in TRuE-V2. In TRuE-V1, the percentage of patients with an F-VASI75 response at week 24 was 29.8% in the ruxolitinib-cream group and 7.4% in the vehicle group (relative risk, 4.0; 95% confidence interval [CI], 1.9 to 8.4; P<0.001). In TRuE-V2, the percentages were 30.9% and 11.4%, respectively (relative risk, 2.7; 95% CI, 1.5 to 4.9; P<0.001). The results for key secondary end points showed superiority of ruxolitinib cream over vehicle control. Among patients who applied ruxolitinib cream throughout 52 weeks, adverse events occurred in 54.8% in TRuE-V1 and 62.3% in TRuE-V2; the most common adverse events were application-site acne (6.3% and 6.6%, respectively), nasopharyngitis (5.4% and 6.1%), and application-site pruritus (5.4% and 5.3%). CONCLUSIONS In two phase 3 trials, application of ruxolitinib cream resulted in greater repigmentation of vitiligo lesions than vehicle control through 52 weeks, but it was associated with acne and pruritus at the application site. Larger and longer trials are required to determine the effect and safety of ruxolitinib cream in patients with vitiligo. (Funded by Incyte; TRuE-V1 and TRuE-V2 ClinicalTrials.gov numbers, NCT04052425 and NCT04057573.).
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Affiliation(s)
- David Rosmarin
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Thierry Passeron
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Amit G Pandya
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Pearl Grimes
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - John E Harris
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Seemal R Desai
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Mark Lebwohl
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Mireille Ruer-Mulard
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Julien Seneschal
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Albert Wolkerstorfer
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Deanna Kornacki
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Kang Sun
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Kathleen Butler
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Khaled Ezzedine
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
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