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Al Hammadi A, Silva de Castro CC, Parmar NV, Ubogui J, Hatatah N, Ahmed HM, Llamado L. Prevalence and burden of vitiligo in Africa, the Middle East and Latin America. SKIN HEALTH AND DISEASE 2024; 4:e317. [PMID: 38312261 PMCID: PMC10831562 DOI: 10.1002/ski2.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024]
Abstract
Vitiligo is a common chronic autoimmune disorder characterized by skin and hair depigmentation that affects 0.5%-2.0% of the global population. Vitiligo is associated with diminished quality of life (QoL) and psychosocial burden. The burden of vitiligo may vary based on skin tone and cultural differences as well as geographical variations in disease awareness, societal stigma, healthcare systems and treatment options. Data on the burden and management of vitiligo in Africa, the Middle East and Latin America are scarce. Literature searches using terms covering vitiligo in Africa, the Middle East and Latin America were conducted using PubMed to identify relevant publications that focused on disease prevalence and burden, QoL and psychosocial impact and disease management between 2011 and 2021. Most of the reviewed studies were conducted in the Middle East, and most Latin American studies were from Brazil. Most studies involved small patient numbers and may not be generalizable. Reported prevalence of vitiligo ranged from 0.18% to 5.3% in Africa and the Middle East, and from 0.04% to 0.57% in Latin America. In several studies, prevalence was higher among female participants. Generally, non-segmental vitiligo was the dominant clinical variant identified and the age at onset varied widely across studies. Common comorbidities include autoimmune diseases such as Hashimoto's thyroiditis, alopecia areata and diabetes. Few treatment guidelines exist in these regions, with the exceptions of guidelines published by the Brazilian and Argentinian Societies of Dermatology. There is a clear unmet need for large epidemiological studies with uniform methodology to accurately ascertain the true prevalence of vitiligo in Africa, the Middle East and Latin America. Additional data on vitiligo burden and management in Africa and Latin America are also needed, along with local disease management guidelines that consider genetic variation, psychosocial burden and socioeconomic diversity in all 3 regions.
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Affiliation(s)
| | | | - Nisha V. Parmar
- Department of DermatologyRashid HospitalDubaiUnited Arab Emirates
| | - Javier Ubogui
- Psoriahue Medicina InterdisciplinariaBuenos AiresArgentina
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Marchioro HZ, de Castro CCS, Jiacomini IG, Miot HA. Association between clinical features and Hsp70 plasma levels in adults with non-segmental vitiligo: a cross-sectional study. An Bras Dermatol 2023; 98:373-375. [PMID: 36863981 PMCID: PMC10173073 DOI: 10.1016/j.abd.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/21/2022] [Accepted: 09/03/2022] [Indexed: 03/04/2023] Open
Affiliation(s)
| | - Caio César Silva de Castro
- Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, PR, Brazil; Department of Dermatology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Isabella Gizzi Jiacomini
- Department of Basic Pathology, Division of Biological Sciences, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Marchioro HZ, Castro CCSD, Fava VM, Sakiyama PH, Dellatorre G, Miot HA. Update on the pathogenesis of vitiligo. An Bras Dermatol 2022; 97:478-490. [PMID: 35643735 PMCID: PMC9263675 DOI: 10.1016/j.abd.2021.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Vitiligo is a complex disease whose pathogenesis results from the interaction of genetic components, metabolic factors linked to cellular oxidative stress, melanocyte adhesion to the epithelium, and immunity (innate and adaptive), which culminate in aggression against melanocytes. In vitiligo, melanocytes are more sensitive to oxidative damage, leading to the increased expression of proinflammatory proteins such as HSP70. The lower expression of epithelial adhesion molecules, such as DDR1 and E-cadherin, facilitates damage to melanocytes and exposure of antigens that favor autoimmunity. Activation of the type 1-IFN pathway perpetuates the direct action of CD8+ cells against melanocytes, facilitated by regulatory T-cell dysfunction. The identification of several genes involved in these processes sets the stage for disease development and maintenance. However, the relationship of vitiligo with environmental factors, psychological stress, comorbidities, and the elements that define individual susceptibility to the disease are a challenge to the integration of theories related to its pathogenesis.
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Said-Fernandez SL, Sanchez-Domínguez CN, Salinas-Santander MA, Martinez-Rodriguez HG, Kubelis-Lopez DE, Zapata-Salazar NA, Vazquez-Martinez OT, Wollina U, Lotti T, Ocampo-Candiani J. Novel immunological and genetic factors associated with vitiligo: A review. Exp Ther Med 2021; 21:312. [PMID: 33717255 PMCID: PMC7885061 DOI: 10.3892/etm.2021.9743] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Vitiligo is a skin disorder characterized by depigmentation of the skin due to a lack of melanin. This condition affects men and woman of all ages and its incidence is not restricted by ethnicity or region. Vitiligo is a multifactorial disease, in which melanocytes, which serve important functions in skin pigmentation and immune processes, are impaired. There is sufficient evidence that immunological and genetic factors are primarily responsible for the destruction and dysfunction of melanocytes. Therefore, genetic DNA sequence variants that participate in skin homeostasis, pigmentation and immune response regulation, as well as altered expression patterns, may contribute to the risk of developing vitiligo. The current review presented an overview of the mechanism of pigmentation and of currently known factors involved in depigmentation, as well as the classification, epidemiology, associated comorbidities, risk factors, immunopathogenesis and several genetic and molecular changes associated with vitiligo.
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Affiliation(s)
- Salvador Luis Said-Fernandez
- Department of Biochemistry and Molecular Medicine, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | - Celia Nohemi Sanchez-Domínguez
- Department of Biochemistry and Molecular Medicine, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | | | - Herminia Guadalupe Martinez-Rodriguez
- Department of Biochemistry and Molecular Medicine, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | - David Emmanuel Kubelis-Lopez
- Dermatology Service, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | - Natalia Aranza Zapata-Salazar
- Dermatology Service, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | - Osvaldo Tomas Vazquez-Martinez
- Dermatology Service, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
| | - Uwe Wollina
- Department of Dermatology and Allergology, Skin Cancer Center, Städtisches Klinikum, D-01067 Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University Guglielmo Marconi of Rome, I-00193 Rome, Italy
| | - Jorge Ocampo-Candiani
- Dermatology Service, Jose Eleuterio Gonzalez Medicine School and University Hospital, Autonomous University of Nuevo León, Monterrey, Nuevo León 64460, Mexico
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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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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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Komnitski M, Komnitski A, Komnitski Junior A, Silva de Castro CC. Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation. An Bras Dermatol 2020; 95:473-476. [PMID: 32418716 PMCID: PMC7335860 DOI: 10.1016/j.abd.2019.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/18/2019] [Indexed: 12/14/2022] Open
Abstract
Vitiligo is a disease that causes macules and achromic and/or hypochromic patches, which can affect from small areas to the entire tegument. Treatment options are few and are generally ineffective. Recently, some case reports have appeared which show positive results with the use of Janus kinase inhibitors associated with phototherapy. This report details the case of a patient with rheumatoid arthritis associated with vitiligo in treatment for two years, whose condition partially improved initially after eight months of oral tofacitinib at a dose of 5 mg twice a day, without exposure to ultraviolet radiation and with continuous improvement during these two years of treatment.
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Affiliation(s)
- Melpone Komnitski
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
| | - Angelo Komnitski
- School of Medicine, Universidade do Vale do Itajaí, Itajaí, SC, Brazil
| | | | - Caio César Silva de Castro
- Department of Dermatology, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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8
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Induction of Pigmentation Through Microneedling in Stable Localized Vitiligo Patients. Dermatol Surg 2020; 46:434-435. [DOI: 10.1097/dss.0000000000001846] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Miot HA, Penna GDO, Ramos AMC, Penna MLF, Schmidt SM, Luz FB, Sousa MAJ, Palma SLL, Sanches Junior JA. Profile of dermatological consultations in Brazil (2018). An Bras Dermatol 2019; 93:916-928. [PMID: 30484547 PMCID: PMC6256211 DOI: 10.1590/abd1806-4841.20188802] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. OBJECTIVES To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. METHODS The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. RESULTS Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. STUDY LIMITATIONS Nonrandomized survey, with a sample period of one week. CONCLUSION This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.
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Affiliation(s)
| | - Hélio Amante Miot
- Board of directors of the Sociedade Brasileira de Dermatologia, Rio
de Janeiro (RJ), Brasil
| | - Gerson de Oliveira Penna
- Tropical Medicine Nucleus, Universidade de Brasília,
Brasília (DF), Brasil
- Fiocruz School of Government, Fundação Oswaldo Cruz,
Brasília (DF), Brasil
| | | | | | - Sílvia Maria Schmidt
- Board of directors of the Sociedade Brasileira de Dermatologia, Rio
de Janeiro (RJ), Brasil
| | - Flávio Barbosa Luz
- Board of directors of the Sociedade Brasileira de Dermatologia, Rio
de Janeiro (RJ), Brasil
| | | | - Sérgio Luiz Lira Palma
- Board of directors of the Sociedade Brasileira de Dermatologia, Rio
de Janeiro (RJ), Brasil
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Richard M, Corgibet F, Beylot‐Barry M, Barbaud A, Bodemer C, Chaussade V, D'Incan M, Joly P, Leccia M, Meurant J, Petit A, Geffroy BR, Sei J, Taieb C, Misery L, Ezzedine K. Sex‐ and age‐adjusted prevalence estimates of five chronic inflammatory skin diseases in France: results of the «
OBJECTIFS PEAU
» study. J Eur Acad Dermatol Venereol 2018; 32:1967-1971. [DOI: 10.1111/jdv.14959] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M.‐A. Richard
- Dermatology Department “Centre de recherche en oncologie biologique et oncophamacologie” Timone Hospital Assistance Publique Hôpitaux de Marseille Aix‐Marseille Univ UMR 911 INSERM CRO2 Marseille France
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
| | - F. Corgibet
- Société Française de Dermatologie (SFD) Paris France
- Fédération Française de Formation Continue et d'Evaluation en Dermatologie‐Vénéréologie (FFFCED) Dijon France
| | - M. Beylot‐Barry
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHU Bordeaux Bordeaux France
| | - A. Barbaud
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie AP‐HP Hôpital Tenon Paris France
| | - C. Bodemer
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHU Necker Enfants‐Malades Paris France
| | - V. Chaussade
- Société Française de Dermatologie (SFD) Paris France
- Fédération Française de Formation Continue et d'Evaluation en Dermatologie‐Vénéréologie (FFFCED) Dijon France
- Dermatologie Cabinet Libéral Paris France
| | - M. D'Incan
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHU Clermont Ferrand Clermont Ferrand France
| | - P. Joly
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHU Rouen Rouen France
| | - M.T. Leccia
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHU Grenoble Grenoble France
| | - J.M. Meurant
- Association Française du Vitiligo Paris France
- International Alliance of Dermatology Patient Organisation Paris France
| | - A. Petit
- Société Française de Dermatologie (SFD) Paris France
- Dermatologie AP‐HP Hôpital Saint Louis Paris France
| | | | - J.F. Sei
- Société Française de Dermatologie (SFD) Paris France
- Fédération Française de Formation Continue et d'Evaluation en Dermatologie‐Vénéréologie (FFFCED) Dijon France
- Dermatologie Cabinet Libéral St Germain‐En‐Laye France
| | - C. Taieb
- Société Française de Dermatologie (SFD) Paris France
| | - L. Misery
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie CHRU Brest Brest France
| | - K. Ezzedine
- Société Française de Dermatologie (SFD) Paris France
- Collège des Enseignants en Dermatologie de France (CEDEF) Paris France
- Dermatologie AP‐HP Hôpital H. Mondor Créteil France
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