Biomimetic polydopamine loaded with janus kinase inhibitor for synergistic vitiligo therapy via hydrogel microneedles

BACKGROUND

Both oxidative stress and autoimmune responses play crucial roles in the development of vitiligo. Under oxidative stress, the apoptotic melanocytes expose self-antigens and release high mobility group box 1 (HMGB1), triggering autoimmune activation and recruiting CD8+ T cells. This process further leads to the destruction of melanocytes, resulting in the lack of melanin granules. Additionally, the accumulated CD8+ T cells release interferon-γ (IFN-γ) to activate janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in keratinocytes. Both oxidative stress and IFN-γ-JAK-STAT activation induce keratinocytes to express and release T cell chemotactic factors, exacerbating the process of vitiligo. Reducing the accumulation of CD8+ T cells by safeguarding melanocytes and keratinocytes from oxidative stress may be contemplated as a promising approach for vitiligo therapy.

RESULTS

In this study, we introduce a novel therapeutic agent called PDA-JAKi, which is capable of both eliminating oxidative stress and inhibiting T cell activation. Specifically, we have incorporated the janus kinase inhibitor (JAKi) tofacitinib into antioxidant polydopamine (PDA) nanoparticles, resulting in the formation of uniform PDA-JAKi nanodrug. PDA-JAKi effectively mitigates oxidative stress-induced apoptosis in melanocytes, reducing the antigen presentation and release of HMGB1. In addition, PDA-JAKi simultaneously attenuates oxidative stress and blocks the IFN-γ-JAK-STAT pathway to reduce the expression of C-X-C motif chemokine ligand 9/10/16 (CXCL9/10/16) in keratinocytes. We precisely deliver this therapeutic agent to the dermis using microneedle (MN) patches, aiming to enhance therapeutic efficacy compared to traditional drug administration methods. After PDA-JAKi MN treatment, the symptoms of vitiligo in mice are alleviated, and the affected areas regain pigmentation. Enhancements have been observed in the dermal thickness, the numbers of melanocytes and the content of melanin within the treated skin area. Moreover, there is a notable reduction in reactive oxygen species (ROS) level. Concurrently, substantial decreases were noted in CD8+ T cell infiltration, as well as the levels of IFN-γ and chemotactic factors CXCL9/10/16.

CONCLUSIONS

In summary, PDA-JAKi MN patches emerge as a promising therapeutic agent for vitiligo treatment.

Study of cathelicidin (LL-37) immunoexpression in the skin of vitiligo patients

Vitiligo is a pigmentary disorder acquired and caused by the loss or destruction of melanocytes from the epidermis. There is strong proof that vitiligo is mainly an autoimmune disease. Cathelicidin (LL37), an antimicrobial polypeptide, is an important part of the innate immune system and has a role in different skin autoimmune diseases. The present work aimed to study the immunoexpression of cathelicidin in the vitiligo patients' skin to elucidate its possible role in vitiligo pathogenesis. Twenty vitiligo patients and 20 controls of matched sex and age were included. A 3 mm punch biopsy was taken from the non-lesional and lesional skin of each patient and controlled subjects. Each was stained with hematoxylin and eosin (H&E) and subjected to cathelicidin immunostaining detection. A significant difference was detected between the two studied groups regarding cathelicidin immunohistochemical expression (Pvalue < 0.001). The lesional immunohistochemical expression of cathelicidin showed a mean of 2.85 ± 0.67. The non-lesional immunohistochemical expression of cathelicidin showed a mean of 2.05 ± 0.51 with a statistically significant higher mean value in the patients' group than the controls (P < 0.001) which recommends that cathelicidin may play a role in the vitiligo pathogenesis. The immunohistochemical scores of the lesional and non-lesional cathelicidin levels were significantly related to the VIDA score (p < 0.001 and = 0.016, respectively) which suggests a role of cathelicidin in vitiligo activity. A significant elevation was indicated in the non-lesional cathelicidin expression, indicating that cathelicidin may be able to predict the appearance of future lesions in non-lesional skin, this requires further longitudinal studies to be confirmed.

Genetics and epigenetics in vitiligo

Vitiligo, a complex autoimmune disorder characterized by melanocyte destruction, arises from an intricate interplay of genetic, epigenetic, immune, and environmental factors. Genome-wide association studies (GWAS) have identified over 50 susceptibility loci, including key genes within the MHC region and those involved in immunity, oxidative stress, and melanogenesis. Concurrently, epigenetic research has unraveled regulatory networks critical to vitiligo pathogenesis, with a focus on DNA methylation and non-coding RNAs (e.g., microRNAs, long non-coding RNAs, and circular RNAs). These advancements provide deeper insights into gene regulation, immune processes, and cellular dynamics. This review integrates findings from genetic and epigenetic studies to offer a comprehensive understanding of molecular mechanisms of vitiligo, paving the way for innovative, personalized therapeutic approaches.

Dietary Interventions, Supplements, and Plant-Derived Compounds for Adjunct Vitiligo Management: A Review of the Literature

Vitiligo is a chronic autoimmune pigmentation disorder shaped by a complex interplay of genetic predispositions and environmental triggers. While conventional therapies-phototherapy, corticosteroids, and immunosuppressants-can be effective, their benefits are often partial and temporary, with recurrence common once treatment stops. As such, there is increasing interest in exploring complementary approaches that may offer a more sustainable impact. Emerging evidence suggests that macronutrient and micronutrient-level changes could be beneficial for managing progression and, in some cases, facilitating repigmentation. Antioxidant-rich foods, such as apples, green tea, Indian gooseberry, onions, and peppers, may help mitigate oxidative stress, while inflammatory foods, such as gluten and high-phenol nuts and berries, may exacerbate the condition. Certain supplements, including high-dose vitamin D, vitamin C, vitamin E, and selenium, may enhance phototherapy outcomes. Omega-3 and other unsaturated fatty acids, in addition to prebiotics and probiotics, are under active investigation for their roles in gut health and immune regulation. Notably, plant-derived compounds, i.e., Ginkgo biloba, have demonstrated promise in promoting repigmentation and managing disease progression. However, it must be emphasized that these nutritional interventions remain exploratory, and more research is needed to establish their efficacy, safety, and optimal usage before they can be recommended as part of a standard treatment regimen.

Preparation of Ethosome Gel with Total Flavonoids from Vernonia anthelmintica (L.) Willd. for the Treatment of Vitiligo

Vernonia anthelmintica (L.) Willd. is a traditional medicinal herb in Chinese medicine, extensively used by various ethnic groups due to the numerous advantages derived from its total flavonoids. These benefits encompass anti-inflammatory and antioxidant effects, and the promotion of melanin production, showcasing its significant efficacy in addressing vitiligo. To improve transdermal absorption and enhance the antioxidant effectiveness of the treatment, ethosome containing total flavonoids were prepared utilizing the ultrasound injection technique. The resulting ethosome was then carefully mixed with 0.7% Carbomer 934 gel in equal parts, yielding a gel concentration of 0.302 mg/g. This formulation produced small, consistent ethosome that exhibited high encapsulation efficiency and notable stability. In vitro analyses demonstrated sustained release characteristics of the gel and considerable therapeutic effectiveness against vitiligo resulting from hydroquinone exposure. Histological examinations performed through hematoxylin and eosin (H&E) staining of mouse skin revealed increased melanin production and increased activities of tyrosinase (TYR), cholinesterase (CHE), and mouse monoamine oxidase (MAO), while levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were reduced. These findings underscore the promising effectiveness of this treatment strategy and validate the efficacy of the dosage form.

Tissue-resident immune cells: from defining characteristics to roles in diseases

Tissue-resident immune cells (TRICs) are a highly heterogeneous and plastic subpopulation of immune cells that reside in lymphoid or peripheral tissues without recirculation. These cells are endowed with notably distinct capabilities, setting them apart from their circulating leukocyte counterparts. Many studies demonstrate their complex roles in both health and disease, involving the regulation of homeostasis, protection, and destruction. The advancement of tissue-resolution technologies, such as single-cell sequencing and spatiotemporal omics, provides deeper insights into the cell morphology, characteristic markers, and dynamic transcriptional profiles of TRICs. Currently, the reported TRIC population includes tissue-resident T cells, tissue-resident memory B (BRM) cells, tissue-resident innate lymphocytes, tissue-resident macrophages, tissue-resident neutrophils (TRNs), and tissue-resident mast cells, but unignorably the existence of TRNs is controversial. Previous studies focus on one of them in specific tissues or diseases, however, the origins, developmental trajectories, and intercellular cross-talks of every TRIC type are not fully summarized. In addition, a systemic overview of TRICs in disease progression and the development of parallel therapeutic strategies is lacking. Here, we describe the development and function characteristics of all TRIC types and their major roles in health and diseases. We shed light on how to harness TRICs to offer new therapeutic targets and present burning questions in this field.

Correlation Between the Koebner Phenomenon and Clinical Features in Vitiligo

Purpose

To investigate the correlation between the presence of the Koebner phenomenon (KP) and clinical features of patients with vitiligo.

Patients and Methods

The clinical characteristic data, including age, age of onset, disease duration, gender, clinical stage, clinical type, family history, and comorbid immune-related diseases, of 1472 patients with/without KP were analyzed with SPSS 17.0 software.

Results

Of the 1472 patients, 290 (19.70%) were positive for KP. The clinical course (6.95 vs 5.62, P = 0.015), percentage of patients with progressive stage (78.97% vs 70.05%, P = 0.002), the acrofacial type (4.49% vs 1.69%, P = 0.004), comorbid immune-related diseases (28.29% vs 19.04%, P = 0.001) and lesion area ≥2% (47.24% vs 38.24%, P = 0.005) in KP-positive group were significantly greater than those in KP-negative group. Binary logistic regression analysis found that progressive stage (P = 0.003, OR = 1.60, 95% confidence interval (CI): 1.17-2.18), area of skin lesion ≥2% (P = 0.008, OR = 1.44, 95% CI: 1.10-1.88) and comorbid immune-related diseases (P = 0.001, OR = 1.63, 95% CI: 1.21-2.20) were significantly associated with KP.

Conclusion

The presence of KP in patients with vitiligo is associated with clinical progression, the acrofacial type, comorbid immune-related disease and a larger lesion area. This study suggested the presence of KP may be an indicator of disease activity and aggression, and underlay its importance in the management of disease.

Recent clinical and mechanistic insights into vitiligo offer new treatment options for cell-specific autoimmunity

Vitiligo is an autoimmune disease that has been recognized, stigmatized, and treated for millennia. Recent translational research has revealed key mechanisms of disease, including cellular stress, innate immune activation, T cell-mediated elimination of melanocytes from the skin resulting in clinically apparent white spots, as well as stem cell regeneration that reverses established lesions. Many of these pathways have been targeted therapeutically, leading to the first FDA-approved medication to reverse the disease, with many more in clinical trials. Despite these impressive advances, many questions remain, which will be answered through integration of additional basic, translational, and clinical research studies. This vitiligo revolution has led to great excitement for individuals with vitiligo, those who know them, and the dermatologists who care for their patients. But just as importantly, these advances have great potential to shed light on autoimmune diseases that are more difficult to study, possibly leading to treatment advances that could not be achieved otherwise.

Pathogenesis and regenerative therapy in vitiligo and alopecia areata: focus on hair follicle

Vitiligo is an autoimmune disease characterized by the loss of functional melanocytes in the hair follicles and epidermis, leading to white patches on the skin and mucous membranes. Alopecia areata (AA) is a common immune-mediated condition in which autoimmune attack on hair follicles cause non-scarring hair loss. Both diseases significantly impact patients's physical and mental health. Hair follicles, dynamic mini-organs, house diverse stem cell populations that form hair structures. Melanocyte stem cell (McSCs) and hair follicle stem cells (HFSC) located in the hair follicle bulge contribute to follicular structures during each anagen phase of the hair cycle, synchronizing periodic activities to impact color to the hair. Hair follicle dysfunction may contribute to hair loss and could potentially interfere with repigmentation efforts in vitiligo lesions. This article reviews the role of hair follicles in the pathogenesis, clinical manifestations, and therapeutic options for vitiligo and AA, aiming to deepen clinicians' understanding of follicular involvement in these diseases and explore potential treatment avenues.

Assessing the causal effect of genetically predicted metabolites and metabolic pathways on vitiligo: Evidence from Mendelian randomization and animal experiments

Vitiligo is a common chronic skin depigmentation disorder that seriously decreases the patients' overall quality of life. Human blood metabolites could contribute to unraveling the underlying biological mechanisms of vitiligo. We used GWAS summary statistics to assess the causal association between genetically predicted 1400 serum metabolites and vitiligo risk by Mendelian randomization (MR). Then, after constructing the mouse model of vitiligo, we did non-targeted metabolomics analysis on the mouse serum and validated MR's pathway enrichment results ulteriorly. In the initial phase, MR analysis revealed causative associations between 36 metabolites and vitiligo risk, including 8 metabolite ratios and 28 individual metabolites (19 known and 9 unknown metabolites). In the validation stage, 7 metabolites were successfully validated. Of the 28 individual metabolites, most are related to lipid metabolism. Genetically predicted higher 4-oxo-retinoic acid showed the strongest protective effect on vitiligo, while the most potent risk effect was the increase in quinate. The metabolites associated with vitiligo risk are mainly enriched in alpha-linolenic acid metabolism, linoleic acid metabolism, arginine biosynthesis and metabolism pathways, validated through the serum metabolomics of vitiligo mouse. By integrating genomics and metabolomics, this study provides new insights into the association between metabolites and vitiligo, highlighting the potential roles of specific metabolites in the pathogenesis of vitiligo. These metabolites associated with vitiligo could serve as new biomarkers, further research could help to reveal how these metabolites influence specific pathways in the development of vitiligo.

Comorbidities Associated with Vitiligo: Results from the EpiChron Cohort

Background: Vitiligo is a pigmentation disorder that impacts approximately 0.5% to 2% of the global population. Growing interest surrounds the comorbidities associated with vitiligo. This study aimed to describe the socio-demographic characteristics of the patients with vitiligo in Aragón (Spain) and to investigate their associated comorbidities. Methods: A retrospective observational study was conducted using clinical data from individuals in the EpiChron Cohort (reference population of 1.3 million) who were diagnosed with vitiligo between 1 January and 31 December 2019. The prevalence of chronic comorbidities was calculated using logistic regression models, obtaining the odds ratio (OR) of each comorbidity (dependent variable) according to the presence or absence of vitiligo (independent variable). We used a cut-off point for a statistical significance of p-value < 0.05. Results: In total, 218 patients diagnosed with vitiligo were analyzed. The mean age was 44.0 years, and 56.42% were female. The largest proportion of patients (34.86%) were aged between 18 and 44 years. Among all vitiligo patients included, 71.5% presented multimorbidity, with an average of 3.21 diagnosed comorbidities. The conditions most frequently associated with vitiligo included thyroid disorders (OR: 3.01, p < 0.001), ocular and hearing abnormalities (OR: 1.54, p < 0.020), inflammatory skin disorders (OR: 2.21, p < 0.001), connective tissue diseases (OR: 1.84, p < 0.007), lower respiratory tract diseases (OR: 1.78, p < 0.014), urinary tract infections (OR: 1.69, p < 0.032), and cardiac arrhythmias (OR 1.84, p < 0.034). Conclusions: This research highlights the importance of understanding the broader health implications of vitiligo and provides a foundation for further exploration into the complex interplay between this dermatologic condition and a diverse range of comorbidities.

A randomized prospective study to compare the efficacy of 308-nm light-emitting diode and 308-nm excimer lamp in the treatment of facial vitiligo

BACKGROUND

Previous studies have proven that 308-nm light-emitting diode(308-nm LED)and 308-nm excimer lamp(308-nm MEL) are effective in treating vitiligo, but there is a lack of comparison of their efficacy for facial lesions.

OBJECTIVE

To evaluate and contrast the treatment success rates of 308-nm LED versus 308-nm excimer lamp in managing facial lesions among patients suffering from stable non-segmental vitiligo.

METHODS

The enrolled 119 patients with 145 lesions were randomly assigned to receive 308-nm LED or 308-nm MEL for two months. Two independent investigators graded repigmentation at the end of the 2-month treatment period.

RESULTS

There were 76 lesions in the 308-nm LED group and 69 in the 308-nm MEL group. After 1 month, the average repigmentation grade of the 308-nm LED group was 1.34, with an efficacy rate of 11.84%, and the average repigmentation grade of the 308-nm MEL group was 1.17, with an efficacy rate of 7.24%.After two months of phototherapy, the average repigmentation grade of the 308-nm LED group was 2.38, and the effective rate was 42.1%. The average repigmentation grade in the 308-nm MEL group was 2.19, and the effective rate was 39.12%. The two light sources had similar effects on facial vitiligo lesions after 1 month and 2 months of treatment(P =.349, P =.416), and the incidence of side effects was also comparable between the two groups (P =.332).

CONCLUSION

The 308-nm LED is as effective and safe as 308-nm MEL in treating stable non-segmental facial vitiligo lesions.

Unfolded protein response modulates Tyrosinase levels and melanin production during melanogenesis

BACKGROUND

Melanocytes protect the body from ultraviolet radiation by synthesizing melanin. Tyrosinase, a key enzyme in melanin production, accumulates in the endoplasmic reticulum (ER) during melanin synthesis, potentially causing ER stress. However, regulating ER function for melanin synthesis has been less studied than controlling Tyrosinase activity.

OBJECTIVE

This study investigates the regulatory mechanisms of melanin production, focusing on ER stress and the ER stress-induced response.

METHODS

B16 mouse melanoma cells induced to undergo melanogenesis were treated with unfolded protein response (UPR) inhibitors or chemical chaperones, and their effects on melanogenesis were analyzed.

RESULTS

During melanogenesis in B16 cells stimulated by alpha-melanocyte-stimulating hormone (α-MSH), ER stress and UPR activation occurred, accompanied by increased Tyrosinase protein. Reducing IRE1 and ATF6 branch activity lowered melanin levels, while chemical chaperone treatment restored melanin production and increased Tyrosinase levels.

CONCLUSION

UPR activation, linked to elevated Tyrosinase levels, influences melanin production during melanogenesis. Modulating UPR can regulate melanin synthesis and provides a potential new approach for treating pigmentation disorders.

Lighting up arginine metabolism reveals its functional diversity in physiology and pathology

Arginine is one of the most metabolically versatile amino acids and plays pivotal roles in diverse biological and pathological processes; however, sensitive tracking of arginine dynamics in situ remains technically challenging. Here, we engineer high-performance fluorescent biosensors, denoted sensitive to arginine (STAR), to illuminate arginine metabolism in cells, mice, and clinical samples. Utilizing STAR, we demonstrate the effects of different amino acids in regulating intra- and extracellular arginine levels. STAR enabled live-cell monitoring of arginine fluctuations during macrophage activation, phagocytosis, efferocytosis, and senescence and revealed cellular senescence depending on arginine availability. Moreover, a simple and fast assay based on STAR revealed that serum arginine levels tended to increase with age, and the elevated serum arginine level is a potential indicator for discriminating the progression and severity of vitiligo. Collectively, our study provides important insights into the metabolic and functional roles of arginine, as well as its potential in diagnostic and therapeutic applications.

Computer-Aided Assessment of Repigmentation Rates in Vitiligo Patients: Implications for Treatment Efficacy - A Retrospective Study

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 with 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, and ultimately contributing to enhanced clinical care.

Low-Dose Baricitinib Plus Narrow-Band Ultraviolet B for the Treatment of Progressive Non-Segmental Vitiligo: A Prospective, Controlled, Open-Label Study

Vitiligo is a chronic autoimmune disease, and current treatments for vitiligo have limited efficacy. Janus kinase (JAK) inhibitors could offer new therapeutic options. To evaluate the efficacy and safety of baricitinib, an oral JAK1/2 inhibitor, combined with narrow-band ultraviolet B (NB-UVB) in vitiligo treatment. This prospective, controlled, open-label study included adults with progressive non-segmental vitiligo (NSV). Patients were assigned to combination therapy with baricitinib 2 mg daily and NB-UVB three times a week or NB-UVB alone three times a week (control). The primary endpoint was the proportion of patients achieving 50% or greater improvement from baseline in the total Vitiligo Area Scoring Index (T-VASI50) at week 16. Of the 33 patients (mean age, 34.1 years; 27.3% women) who completed the study, 12 of 17 (70.6%) patients in the combination group and 2 of 16 (12.5%) in the control group had a T-VASI50 response at week 16 (relative risk [RR] = 5.6; 95% CI = 1.5-21.4; p = 0.001). Adverse events were minor, including erythema, mild blister after phototherapy and acne. Combination therapy with low-dose baricitinib and NB-UVB was effective and well tolerated in adults with progressive NSV.

Adverse event of ruxolitinib cream: a real-world analysis based on FDA Adverse Event Reporting System from 2021 to 2024

BACKGROUND

Ruxolitinib cream, a topical Janus kinase (JAK) inhibitor, is a widely used treatment for various dermatological diseases. This study employs the FDA Adverse Event Reporting System (FAERS) database to examine adverse events (AEs) associated with ruxolitinib cream.

METHODS

This study employed disproportionate analysis methods, including reported odds ratio and proportional reporting ratio, to collate AEs reported from the fourth quarter of 2021 to the first quarter of 2024.

RESULTS

After data processing, 803 reports involving ruxolitinib cream were analyzed. Statistically significant signals were identified for 4 system organ classes (SOCs) and 29 preferred terms (PTs). The most notable signal observed in the SOCs was associated with skin and subcutaneous tissue disorders. For PTs, the AEs observed included clinical symptoms such as pruritus, skin irritation, and burning sensations, as well as signs such as rash, scratching, erythema, and dry skin. Additionally, other observed AEs included diseases such as acne, drug hypersensitivity, and herpes zoster.

CONCLUSIONS

This study offers insights into the safety of ruxolitinib cream, improving understanding of its AEs and guiding safer clinical practices. However, the FAERS database lacks data on AE severity and the ability to establish causality, requiring further research to clarify mechanisms behind certain AEs.

Efficacy and Safety of Janus Kinase Inhibitors in Patients with Vitiligo: A Systematic Review and Meta-Analysis

Although several case reports and small clinical trials have reported promising outcomes with Janus kinase (JAK) inhibitors for vitiligo, high-quality evidence and guidelines are lacking. We evaluated the efficacy and safety of JAK inhibitors for the treatment of vitiligo using a meta-analysis of randomized controlled trials (RCTs). We searched the PubMed, Embase, and Cochrane Library databases up to August 2023, with additional studies from ClinicalTrials.gov and company websites. We assessed outcomes, including percentage improvement in total vitiligo area score index (TVASI) and facial vitiligo area score index (FVASI); the proportion of patients achieving 50% improvement in TVASI (TVASI50) and 50% and 75% improvement in FVASI (FVASI50 and FVASI75); the risk of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), infections, and skin-related adverse events (AEs). Five studies with 1,550 participants were included. JAK inhibitors were associated with a higher proportion of TVASI50 (relative risk [RR] 2.67, 95% confidence interval [CI] 1.24-5.78) and FVASI75 (RR 3.97, 95%CI 2.62-6.02) responders than placebo. JAK inhibitors significantly increased the risk of skin-related AEs (RR 1.96, 95% CI 1.29-2.98) compared with placebo. However, the risk of TEAEs, SAEs, and infections was not significantly different between the JAK inhibitor and placebo groups. Subgroup analysis showed that JAK1 and JAK1/2 inhibitors were more effective than JAK3 inhibitors. However, there was insufficient evidence to suggest that the route of administration affects the efficacy and safety of JAK inhibitors in vitiligo. These findings indicate that JAK inhibitors are effective in repigmentation and well tolerated in patients with vitiligo.

Repigmentation in non-segmental vitiligo using the Janus kinase inhibitor upadacitinib, a retrospective case series

Vitiligo is the most frequently diagnosed depigmentation disease, affecting nearly 0.5-2% of individuals worldwide. This disorder is characterized by melanocyte loss, which results in skin and hair depigmentation. Psychological problems are common in patients, especially in those with the involvement of the face and hands. Several studies have recently focused on the use of JAK inhibitors for vitiligo treatment. However, studies on the selective JAK1 inhibitor upadacitinib for vitiligo treatment are limited. This study aimed to assess the efficacy and safety of upadacitinib in the treatment of vitiligo. This retrospective case series included five patients diagnosed with non-segmental vitiligo who were treated with upadacitinib for 4 months or longer. Disease severity was assessed using the Vitiligo Area Scoring Index (VASI). Five patients took 15 mg of upadacitinib orally for 4 consecutive months, and all achieved repigmentation. The plasma collected from the peripheral blood of the four patients showed that the CXCL9 level dropped after upadacitinib treatment. However, the CXCL10 level did not change significantly using enzyme-linked immunosorbent assay (ELISA). Flow cytometry revealed that the ratio of CD4 + CD3+/CD8 + CD3 + T cells in the blood samples tended to decrease through the treatment. And the Th1-like Tregs (CD4 + Foxp3 + IFN-γ + Tregs) were also downregulated in the peripheral blood. In conclusion, the JAK1 inhibitor upadacitinib was found to be effective and safe for treating non-segmental vitiligo.

Biologic drugs induced vitiligo: case reports and review of literature

Biological drugs are extensively used to treat various inflammatory diseases, including psoriasis, atopic dermatitis (AD), and rheumatoid arthritis. While generally effective and safe, these therapies have been increasingly associated with secondary development of vitiligo, especially with anti-TNF α and anti-IL17 drugs. Dupilumab, an IL-4 receptor alpha antagonist used in moderate to severe AD, rarely induces vitiligo. This study reports two cases of new-onset vitiligo following dupilumab treatment for AD. The first case involves an 80-year-old male who developed vitiligo patches appeared on the chest, back, and lower limbs after 2 months of dupilumab therapy. Despite discontinuation of dupilumab, the vitiligo did not regress. The second case describes a 14-year-old female who experienced depigmentation on her forehead one month into dupilumab treatment, with partial improvement of vitiligo lesions over time despite continued therapy. This phenomenon may be due to dupilumab blocking type 2 inflammation, disrupting normal skin homeostasis, and exacerbating type 1 inflammation. These cases, supplemented with a literature review, highlight the potential for biologic drug-induced vitiligo and underscore the need for awareness of such adverse events in clinical practice. The mechanisms underlying this phenomenon likely involve disruption of the Th1/Th2/Th17 cytokine balance, suggesting that targeted therapies may inadvertently exacerbate type 1 inflammation, leading to vitiligo. With the rising use of biologics, clinicians should carefully consider the risk of vitiligo when prescribing these treatments.

Concurrent Refractory Atopic Dermatitis and Generalized Vitiligo Successfully Treated with Abrocitinib: A Case Report

Atopic dermatitis (AD) may sometimes be comorbid with vitiligo. However, these therapeutic agents are often slow acting and lead to various adverse effects, resulting in poor patient compliance. This report describes a 65-year-old male patient with refractory moderate-to-severe atopic dermatitis (AD) and generalized vitiligo. The patient was treated with repeated antihistamine and dupilumab injections; however, erythema and pruritus did not improve. Consequently, oral abrocitinib was administered to treat AD and vitiligo, and the patient's generalized erythema, papules, and pruritus ameliorated with the repigmentation of vitiligo lesions. This case provided evidence of the efficacy and safety of oral abrocitinib for patients with concurrent refractory AD and vitiligo.

Topical 5-aminolevulinic acid photodynamic therapy for genital vitiligo

Vitiligo is an acquired chronic depigmentary skin disorder which results from the destruction of melanocytes. The clinical characteristic of vitiligo is the development of white macules due to the loss of functioning melanocytes in the skin or hair. Vitiligo in the genital area brings about a serious psychological impact on individuals. However, the choices of treatment for genital vitiligo are scarce. This study sheds light on the leverage of 5-ALA (5-Aminolevulinic Acid) Photodynamic Therapy (PDT) for the management of genital vitiligo. Nine patients with genital vitiligo who underwent 20 % ALA-PDT treatment were reported. The results revealed that the treatment protocol simulated melanocyte regeneration in the patients effectively. ALA-PDT exerts significant anti-inflammatory effects by reducing pro-inflammatory cytokines and inducing regulatory T cells, which may help suppress the autoimmune response involved in vitiligo pathogenesis. Notably, five patients who were defined as responders showed moderate to excellent improvement in repigmentation and the treatment was well tolerated in all cases. Our findings suggest that ALA-PDT is a potential treatment option for genital vitiligo.

Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence

OBJECTIVE

The relationship between vitiligo and cardiovascular diseases remains controversial. This study aimed to systematically review the evidence comparing cardiovascular disease risk factors between patients with vitiligo and controls and to perform a meta-analysis of the results.

DATA SOURCES

A comprehensive database search was performed for all studies in PubMed, EMBASE, and Cochrane Central Register databases from inception to November, 2023. The main keywords used were vitiligo, hypertension, diabetes, hyperlipidemia, metabolic syndrome, obesity, smoking, alcohol consumption, C-reactive protein, and homocysteine.

STUDY SELECTION

Only observational studies and no randomized controlled trials were included. Of the 1269 studies initially selected, the full texts of 108 were assessed for eligibility, and 74 were ultimately included in the analysis.

DATA EXTRACTION AND SYNTHESIS

Three reviewers independently extracted the following data: study design, number and characteristics of participants, inclusion indicators, and disease duration. A meta-analysis of the single-group rates was performed for the diabetes, hypertension, hyperlipidemia, and obesity groups. Random-effects or fixed-effects models were used to calculate the sample-size weighted averages for the indicators included in the studies.

MAIN OUTCOMES AND MEASURES

The primary outcomes were co-morbidity analysis and co-morbidity rates of vitiligo with metabolic syndrome, obesity, hyperlipidemia, hypertension, and diabetes mellitus. Secondary outcomes were factors associated with vitiligo and cardiovascular disease.

RESULTS

This meta-analysis concluded that comorbidities in patients with vitiligo included metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%, respectively. Simultaneously, we showed that the vitiligo group differed significantly from the control group in the following aspects: fasting blood glucose, insulin, systolic and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, homocysteine, C-reactive protein, smoking, and alcohol consumption. However, no significant differences were observed between the vitiligo and control groups in terms of waist circumference, body mass index, or phospholipid levels.

LIMITATIONS

The vast majority of the studies were from Eastern countries; therefore, extrapolation of these results to Western populations is questionable. The significant heterogeneity may be due to different protocols, doses, durations, center settings, population registries, etc., which severely compromise the validity of the results.

CONCLUSION

This study summarized not only the factors associated with, but also those not associated with, cardiovascular disease in patients with vitiligo. This study provides a foundation for the prevention and treatment of cardiovascular disease in patients with vitiligo.

Pathomechanism of Adverse Reactions to Biological Treatment of Inflammatory Skin Conditions

Biological agents are widely used across medicine, including for immune-mediated skin conditions such as psoriasis and atopic dermatitis. When used to treat a relevant pathological process, they demonstrate impressive efficacy and credible safety, helping to achieve remission and improved function and quality of life. However, with their expanded use, awareness and understanding of adverse reactions to biologicals have also increased. Herein, we discuss the pathomechanism of adverse reactions to biological agents used to treat skin conditions and apply these to Pichler's classification system. This classification differentiates five distinct types, namely overstimulation (type α), hypersensitivity or immunogenicity (β), immunodeviation (γ), cross-reactivity (δ) and nonimmunologic adverse reactions (ε). This classification covers most types of adverse reactions associated with use of biological agents and could be used to better understand the reaction pathogenesis and manage the clinical features of biological adverse effects.

New insight in treating autoimmune diseases by targeting autophagy

Autophagy is a highly conserved biological process in eukaryotes, which degrades cellular misfolded proteins, damaged organelles and invasive pathogens in the lysosome-dependent manner. Autoimmune diseases caused by genetic elements, environments and aberrant immune responses severely impact patients' living quality and even threaten life. Recently, numerous studies have reported autophagy can regulate immune responses, and play an important role in autoimmune diseases. In this review, we summarised the features of autophagy and autophagy-related genes, enumerated some autophagy-related genes involved in autoimmune diseases, and further overviewed how to treat autoimmune diseases through targeting autophagy. Finally, we outlooked the prospect of relieving and curing autoimmune diseases by targeting autophagy pathway.

Comparison of various excimer laser (EL) combination therapies for vitiligo: a systematic review and network meta-analysis

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.

Increased splicing of CXCR3 isoform B (CXCR3B) by impaired NRF2 signaling leads to melanocyte apoptosis in active vitiligo

Apoptotic melanocytes (MCs) may release neoantigenic epitopes preceding epidermal infiltration by autoreactive CD8+ T cells in early vitiligo. However, the mechanism by which vitiligo MCs are prone to apoptosis under oxidative stress remains elusive. Pro-apoptotic receptor C-X-C motif chemokine receptor 3 isoform B (CXCR3B) is critical for inducing MC apoptosis in the inflammatory microenvironment of lesional vitiligo skin. Here, we show that C-X-C motif chemokine ligand 10 (CXCL10), a functional ligand for CXCR3B, is upregulated in primary dermal fibroblasts and in CD90+ reticular fibroblasts of vitiligo skin. The number of CXCR3B+ MCs was increased in active vitiligo skin compared with healthy skin and stable vitiligo skin. Mechanistically, impaired nuclear factor erythroid 2-related factor 2 (NRF2) signaling in oxidatively stressed MCs leads to the elevated expression of CXCR3B and increased apoptosis. The overexpression of NRF2 prevents MCs from CXCL10-induced apoptosis through upregulation of pro-survival receptor CXCR3 isoform A (CXCR3A). Overall, MCs expressing CXCR3B are more susceptible to apoptosis. Suppressing CXCR3B could be a promising therapeutic approach to extinguish inflammation in vitiligo skin.

Healthy lifestyle choices: new insights into vitiligo management

Background

The treatment of vitiligo is complex, and providing guidance based on lifestyle habits is a good option that has not been summarized or analyzed.

Objective

To elucidate the relationship between vitiligo and lifestyle factors.

Methods

Four databases (PubMed, Embase, Cochrane, and China National Knowledge Internet) were searched for articles published between 1980 and December 2022. Keywords such as smoking, drinking, exercise, diet, and sleep were used.

Results

Based on the search strategy, 875 relevant studies were retrieved, and 73 were included in this study, of which 41 studies with 8,542 patients with vitiligo were included in the meta-analysis. Vitamin C [mean difference (MD), -0.342; 95% confidence interval (CI), -1.090-0.407; p >0.05), folic acid (MD, -1.463; 95% CI, -7.133-4.208; p >0.05), and selenium (MD, 0.350; 95% CI, -0.687-1.387; p >0.05) levels did not differ between the groups. Vitamin E (MD, -1.408; 95% CI, -2.611--0.206; p <0.05), vitamin B12 (MD, -0.951; 95% CI, -1.672--0.275; p <0.05), copper (MD, -0.719; 95% CI, -1.185--0.252, p <0.005), and zinc (MD, -0.642; 95% CI, -0.731--0.554; p <0.001) levels were lower in the vitiligo group than in the control group. The serum iron level of the vitiligo group was significantly higher than that of the control group (MD, 1.181; 95% CI, 0.390-1.972; p <0.005). Finally, more participants in the vitiligo group smoked and drank alcohol than those in the control group.

Limitations

Most studies are from Eastern countries; thus, extrapolating these results to Western populations is questionable. The significant heterogeneity may be attributed to the different stages, types, duration, center settings, population registries, etc., which seriously impair the validity of the results.

Conclusions

Patients with vitiligo should reduce smoking and alcohol consumption and take appropriate vitamin E, B12, copper, and zinc supplements. However, vitamin C, vitamin D, selenium, iron, and folic acid supplements are unnecessary. Moreover, they should consider sun protection and avoid permanent hair dye use. Patients with vitiligo may experience sleep disturbances and sexual dysfunction, and these patients should seek help from a specialist if necessary.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42023480757.

Exploration of the mechanism of Qinglongyi-Buguzhi drug pair in treating vitiligo based on network pharmacology, molecular docking and experimental verification

ETHNOPHARMACOLOGICAL RELEVANCE

The Qinglongyi-Buguzhi herbal pair (QB) is one of commonly used herbal combinations for treating vitiligo in traditional Chinese medicine, consisting of the exocarp of the immature fruit of Juglans regia L. or Juglans mandshurica Maxim., and dried, mature fruit of Psoralea corylifolia L. However, the active components and potential mechanisms of QB in the treatment of vitiligo are still unclear.

AIM OF THE STUDY

The purpose of this study is to clarify the effects and mechanisms of QB on vitiligo treatment through integration of network pharmacology and empirical examinations.

MATERIALS AND METHODS

The active components and targets of QB as well as the targets linked to vitiligo were obtained from network databases. Visualization networks were constructed with Cytoscape 3.9.1. GO and KEGG enrichment analysis were conducted to investigate the possible mechanism. Molecular docking was employed to evaluate the binding affinities between the primary active ingredients of QB and essential targets of the PI3K/Akt/Nrf2 pathway. In vivo and in vitro experiments were carried out to confirm the results of network pharmacology.

RESULTS

We evaluated 44 active compounds and 602 genes from QB, and 107 of these genes linked to vitiligo. GO analysis suggested QB might lessen vitiligo by regulating oxidative stress. KEGG pathway analysis indicated the PI3K/Akt pathway may be crucial for treating vitiligo. Molecular docking results demonstrated the key active ingredients of QB had good binding activity with the major targets in the PI3K/Akt/Nrf2 pathway. In vivo, QB significantly ameliorated vitiligo model mouse's skin pathologies by reducing ROS, elevating CAT and SOD levels. Western blot showed that QB increased the phosphorylation of PI3K and Akt and the expressions of Nrf2 and HO-1 in the skin. In vitro, QB reversed H2O2-induced oxidative injury of melanocytes, enhanced cell survival rate, reduced ROS level, upregulated SOD and CAT activities, and raised the content of melanin. Moreover, QB upregulated the expression levels of Akt, Nrf2, HO-1 mRNA, Akt phosphorylation, HO-1, and nuclear Nrf2 proteins, and also encouraged the nuclear translocation of Nrf2. However, LY294002 treatment significantly reversed the regulatory effect of QB on oxidative damage of melanocytes.

CONCLUSIONS

This study revealed that the therapeutic effect of QB on vitiligo was achieved through multiple components, targets and pathways. Experimental investigation demonstrated that QB could improve vitiligo via reducing oxidative stress, which was probably accomplished by activating the PI3K/Akt/Nrf2 signaling pathway.

FOXO3 induces TUG1-mediated miR-375/GATA3 signaling axis to promote the survival of melanocytes in vitiligo

Vitiligo is characterized by the depletion of melanocytes due to the activation of CD8+ T cells. Taurine-upregulated gene 1 (TUG1), a long noncoding RNA, is involved in melanogenesis. This study aimed to explore the role and mechanism of TUG1 in vitiligo. RT-qPCR and western blot analyses demonstrated decreased TUG1 levels and increased miR-375 levels in patients with vitiligo. MTT and transwell assays indicated that TUG1 upregulation facilitated melanocyte survival and inhibited CD8+ T cell migration. Dual luciferase reporter and chromatin immunoprecipitation assays verified that Forkhead box O3 (FOXO3) directly interacted with the TUG1 promoter, leading to the positive regulation of TUG1 expression. In addition, FOXO3 promoted melanocyte survival by enhancing the transcription of TUG1. Luciferase reporter assay and RNA immunoprecipitation assay confirmed that TUG1 upregulated GATA binding protein 3 (GATA3) expression by targeting miR-375. TUG1 facilitated melanocyte survival by regulating the miR-375/GATA3 axis. In vitiligo, melanocyte survival is promoted by the induction of the TUG1-mediated miR-375/GATA3 axis by FOXO3, which offers new therapeutic targets for vitiligo treatment.

Exploring mechanisms of skin aging: insights for clinical treatment

The skin is the largest organ in the human body and is made up of various cells and structures. Over time, the skin will age, which is not only influenced by internal factors, but also by external environmental factors, especially ultraviolet radiation. Aging causes immune system weakening in the elderly, which makes them more susceptible to dermatosis, such as type 2 inflammatory mediated pruritus. The immune response in this condition is marked by senescent cells consistently releasing low amounts of pro-inflammatory cytokines through a senescence-associated secretory phenotype (SASP). This continuous inflammation may accelerate immune system aging and establish a connection between immune aging and type 2 inflammatory skin diseases. In addition, two chronic pigmentation disorders, vitiligo and chloasma, are also associated with skin aging. Aged cells escape the immune system and accumulate in tissues, forming a microenvironment that promotes cancer. At the same time, "photoaging" caused by excessive exposure to ultraviolet radiation is also an important cause of skin cancer. This manuscript describes the possible links between skin aging and type 2 inflammation, chronic pigmentation disorders, and skin cancer and suggests some treatment options.

Prevalence of co-existing autoimmune and autoinflammatory diseases in vitiligo: a survey-based study from Egypt

BACKGROUND

The exact cause of vitiligo is still unknown. Genetic factors, self-destruction of melanocytes, the autoimmune process, and oxidative stress all can contribute to the pathogenesis of vitiligo.

OBJECTIVES

The aim of this study was to figure out the frequency of coexisting autoimmune and autoinflammatory diseases (AIIDs) in Egyptian patients with vitiligo and identify the associated risk factors.

MATERIALS AND METHODS

Egyptian children and adults with vitiligo and their parents were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical, and therapeutic data. The vitiligo disease activity (VIDA) score was evaluated for all the patients. Patients were also asked about the presence of co-existing AIIDs.

RESULTS

There was a total of 294 participants, mostly females (54.8%), with a median age of 35 years and a median disease duration of 9 years. Nearly 27% had at least one AIID. The most common associated AIIDs were autoimmune thyroid disease (47 patients, 16%), followed by alopecia areata (14 patients,4.8%), then psoriasis and rheumatoid arthritis (11 patients, 3.7%). Univariate regression analysis revealed that age (OR 1.02, P = 0.036), female gender (OR 2.2, P = 0.004), disease duration (OR 1.04, P < 0.001), affected body surface area (OR 1.7, P = 0.048), and family history of AIIDs (OR 2.7, P < 0.001) were predictors for the presence of AIIDs in patients with vitiligo.

CONCLUSION

AIIDs are prevalent among vitiligo patients. Age, female gender, and family history of AIIDs are the main predictors of the presence of AIIDs in vitiligo patients.

Review of Microneedle Technology for Targeted Therapeutics in Vitiligo: Design Principles, Application Prospects

Vitiligo is a chronic autoimmune disorder characterized by depigmented patches of the skin. The treatment of vitiligo remains challenging, partly owing to the lack of efficient drug delivery system. Microneedles (MNs), an ideal transdermal drug delivery system, have emerged as promising drug delivery platform for vitiligo. Recently, the emergence of novel MNs with increased biocompatibility, including hydrogel and hollow MNs, further enhance the translational value of MNs in the treatment of vitiligo. However, up-to-date review of these advancements remains lacking. This review aims to summarize the most recent studies of MN-based drug delivery systems for vitiligo, highlighting the translational potential of MNs as a therapeutic platform for the treatment of vitiligo in the near future.

Knowledge Structure and Trends of Vitiligo From 2002 to 2023: A Bibliometric Analysis

INTRODUCTION

Vitiligo is a common acquired depigmenting dermatosis resulting from a loss of epidermal melanocytes. The academic attention to vitiligo has gradually increased over the past two decades.

OBJECTIVE

We aimed to explore the current research structure and trends of vitiligo.

METHODS

Publications about vitiligo from the Web of Science Core Collection (WoSCC) database were searched. VOSviewer, CiteSpace, GraphPad Prism 8, ArcGIS, and Charticulator were implemented for data description and visual analysis.

RESULTS

A total of 3,037 publications authored by 10,993 individuals from 2,753 institutions across 88 countries/regions were collected. These publications were published in 616 journals and cited a total of 39,433 references. China was the most productive country. Cairo University and Ezzedine Khaled were the most prolific institution and author, respectively. Additionally, the British Journal of Dermatology stood out as the journal with the highest number of publications. According to the analysis of keywords and references, "quality of life," "depression," and "validation" were hotspots in terms of clinical characteristics, while "prevalence", "comorbidity," "association," and "immunotherapy" gained more research interest with respect to epidemiology and genetics. The frontiers of pathogenesis focused on "unfolded protein response," "migration," "biomarkers," and "CXCL10." As far as treatment is concerned, there was increasing attention to "janus kinase inhibitor," "fractional carbon dioxide laser," "platelet-rich plasma," and "5-fluorouracil."

CONCLUSION

The bibliometric analysis elucidates the foundational knowledge structure on research forces and unveiled the hotspots and frontiers, aiding researchers in gaining a deeper comprehension of the future development trends in the field of vitiligo.

Nanocarrier-Based Transdermal Drug Delivery Systems for Dermatological Therapy

Dermatoses are among the most prevalent non-fatal conditions worldwide. Given this context, it is imperative to introduce safe and effective dermatological treatments to address the diverse needs and concerns of individuals. Transdermal delivery technology offers a promising alternative compared to traditional administration methods such as oral or injection routes. Therefore, this review focuses on the recent achievements of nanocarrier-based transdermal delivery technology for dermatological therapy, which summarizes diverse delivery strategies to enhance skin penetration using various nanocarriers including vesicular nanocarriers, lipid-based nanocarriers, emulsion-based nanocarriers, and polymeric nanocarrier according to the pathogenesis of common dermatoses. The fundamentals of transdermal delivery including skin physiology structure and routes of penetration are introduced. Moreover, mechanisms to enhance skin penetration due to the utilization of nanocarriers such as skin hydration, system deformability, disruption of the stratum corneum, surface charge, and tunable particle size are outlined as well.

AI fusion of multisource data identifies key features of vitiligo

Vitiligo is a skin disorder that is associated with a decreased risk of skin cancer, but it can lead to increased susceptibility to sunburn, psychological distress, and disruptions in daily life, consists of two primary subtypes: segmental and nonsegmental vitiligo, each with distinct underlying mechanisms. However, the reliable identification of diagnostic markers and the ability to differentiate between these subtypes have remained elusive challenges. This study aims to pioneer predictive algorithms for vitiligo diagnosis, harnessing the capabilities of AI (Artificial Intelligence) to amalgamate multisource data and uncover essential features for distinguishing vitiligo subtypes.An ensemble algorithm was thoughtfully developed for vitiligo diagnosis, utilizing a spectrum of machine learning techniques to evaluate the likelihood of vitiligo, whether segmental or nonsegmental. Diverse machine learning methodologies were applied to distinguish between healthy individuals and vitiligo patients, as well as to differentiate segmental from nonsegmental vitiligo. The ensemble algorithm achieved a remarkable AUC (Area Under the Curve) of 0.99 and an accuracy of 0.98 for diagnosing vitiligo. Furthermore, in predicting the development of segmental or nonsegmental vitiligo, the model exhibited an AUC of 0.79 and an accuracy of 0.73. Key parameters for vitiligo identification encompassed factors such as age, FBC (full blood count)-neutrophils, FBC-lymphocytes, LKF(liver and kidney function)-direct bilirubin, LKF-total bilirubin, and LKF-total protein levels. In contrast, vital indicators for monitoring the progression of segmental and nonsegmental vitiligo included FBC-B lymphocyte count, FBC-NK (Natural Killer) cell count, and LKF-alkaline phosphatase levels. This retrospective study underscores the potential of AI-driven analysis in identifying significant risk factors for vitiligo and predicting its subtypes at an early stage. These findings offer great promise for the development of effective diagnostic tools and the implementation of personalized treatment approaches in managing this challenging skin disorder.

Zinc, copper, and selenium levels in vitiligo: a systematic review and meta-analysis

Vitiligo is a dermatological disease characterized by loss of melanocytes, causing non-scaly white macules on the skin. Zinc, copper, and selenium are important micronutrients that play a role in the normal functioning of the body and have been found to potentially aid in vitiligo treatment, although the relationship between their serum levels and vitiligo is not yet fully understood. This is a systematic review aimed at assessing the levels of serum zinc, copper, and selenium and their association with vitiligo. This review was performed following the Preferred Reporting Items of the systematic Review and Meta-Analysis (PRISMA) checklist and Cochrane guidelines. A comprehensive literature search was conducted on PubMed, Google Scholar and 41 studies published between 1970 and 2022 including 3353 vitiligo cases and 10,638 controls were included in the meta-analysis conducted from August 2022 till September 2023. The quality of the studies was assessed using the National Heart Lung and Blood Institute Study Quality Assessment tool, and the risk of bias was represented using the RobVis tool. The statistical analysis was performed using Review Manager (RevMan) Version 5.4. This meta-analysis indicate a significant decline in serum zinc levels (Z = 4.97; P < 0.0001; SMD = - 0.86; 95% CI - 1.19 to - 0.52) in vitiligo group with high statistical heterogeneity (Tau2 = 0.74; Chi2 = 513.95, d.f. = 26 [P < 0.00001]; I2 = 95%). Similarly for serum copper levels there was decline (Z = 2.43; P < 0.0001; SMD = - 0.50; 95% confidence interval [CI] - 0.91 to - 0.10) in vitiligo group and high statistical heterogeneity (Tau2 = 0.92; Chi2 = 475.10, d.f. = 22 [P < 0.00001]; I2 = 95%). On the other hand, there was a increase of serum selenium levels in the vitiligo group (Z = 0.56; P < 0.0001; SMD = 0.23; 95% confidence interval [CI], 0.58 to 1.04) and the results reveals high statistical heterogeneity among studies (Tau2 = 1.93; Chi2 = 406.44, d.f. = 11 [P < 0.00001]; I2 = 97%) in vitiligo patients compared to healthy controls. Publication bias was not found for the studies analysed. This study analyses the association of serum micronutrient levels and vitiligo among patients and controls from published research along with sub-group analysis specific to Asian populations using a meta-analysis. Low serum levels of Zinc and copper and high selenium levels are associated with Vitiligo.

Tumor cell-intrinsic Piezo2 drives radioresistance by impairing CD8+ T cell stemness maintenance

Changes in mechanosensitive ion channels following radiation have seldom been linked to therapeutic sensitivity or specific factors involved in antitumor immunity. Here, in this study, we found that the mechanical force sensor, Piezo2, was significantly upregulated in tumor cells after radiation, and Piezo2 knockout in tumor cells enhanced tumor growth suppression by radiotherapy. Specifically, loss of Piezo2 in tumor cells induced their IL-15 expression via unleashing JAK2/STAT1/IRF-1 axis after radiation. This increase in IL-15 activates IL-15Rα on tumor-infiltrating CD8+ T cells, thereby leading to their augmented effector and stem cell-like properties, along with reduced terminal exhausted feature. Importantly, Piezo2 expression was negatively correlated with CD8 infiltration, as well as with radiosensitivity of patients with rectum adenocarcinoma receiving radiotherapy treatment. Together, our findings reveal that tumor cell-intrinsic Piezo2 induces radioresistance by dampening the IRF-1/IL-15 axis, thus leading to impaired CD8+ T cell-dependent antitumor responses, providing insights into the further development of combination strategies to treat radioresistant cancers.

The role of aryl hydrocarbon receptor agonists in the treatment of vitiligo

Vitiligo is a chronic autoimmune disorder characterized by progressive skin depigmentation. Vitiligo significantly impacts patients' quality of life, contributing to psychological and social burdens. Despite readily available therapeutic options, many cases remain refractory to treatment, highlighting the critical need for safer and more effective therapies. Currently, ruxolitinib is the only FDA-approved medication for vitiligo; however, it carries a black box warning for serious adverse effects, including infections, malignancy, and major cardiovascular events, limiting its use. Recent studies have identified the aryl hydrocarbon receptor (AhR) as a promising therapeutic target, suggesting that AhR agonists could address the multifaceted pathogenesis of vitiligo. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search to analyze the role of AhR agonists in the treatment of vitiligo on PubMed, Cochrane, Embase, MEDLINE, and Web of Science databases on April 15, 2024. Fourteen studies met the inclusion criteria, comprising two clinical trials, two case reports, and nine basic science studies. Our search revealed that culturing AhR agonists with melanocytes upregulates melanin-synthesizing enzymes, reduces reactive oxygen species, and modulates pro-inflammatory cytokines such as IL-17A and IL-22. Tapinarof, a topical AhR agonist used commonly for the treatment of psoriasis, demonstrated clinical efficacy in repigmentation with a favorable safety profile compared to long-term steroid use. Although limited by the number of clinical studies, this review underscores the potential of using AhR agonists, such as tapinarof, as a transformative approach to vitiligo management. Future clinical trials are necessary to evaluate the safety, efficacy, and long-term outcomes of AhR agonists.

Cancer Therapy-induced Dermatotoxicity as a Window to Understanding Skin Immunity

Pruritus, rash, and various other forms of dermatotoxicity are the most frequent adverse events among patients with cancer receiving targeted molecular therapy and immunotherapy. Immune checkpoint inhibitors, macrophage-targeting agents, and epidermal growth factor receptor/MEK inhibitors not only exert antitumor effects but also interfere with molecular pathways essential for skin immune homeostasis. Studying cancer therapy-induced dermatotoxicity helps us identify molecular mechanisms governing skin immunity and deepen our understanding of human biology. This review summarizes new mechanistic insights emerging from the analysis of cutaneous adverse events and discusses knowledge gaps that remain to be closed by future research.

Efficacy and safety of fire needle therapy in treating non-segmental stable vitiligo: A randomized self-controlled clinical trial

BACKGROUND

Vitiligo remains a challenging condition to treat. Fire needle therapy, a traditional Chinese medicine technique, has potential as an alternative therapeutic strategy. However, rigorous evidence on its efficacy is lacking.

OBJECTIVE

We aimed to evaluate the efficacy and safety of fire needle therapy, alone and combined with topical tacrolimus ointment, for non-segmental stable vitiligo.

METHODS

In this 6-month randomized self-controlled trial, 35 vitiligo patients were enrolled, providing three similar lesions each. Lesions were randomly allocated to receive fire needle monotherapy, 0.1% tacrolimus ointment monotherapy, or combined fire needle and tacrolimus ointment therapy. The main outcome was change in vitiligo surface area.

RESULTS

In total, 29 patients completed the 6-month follow-up. The combination therapy group showed significantly greater reductions in vitiligo surface area compared to monotherapy groups starting at months 4 and 5. By the end of the study, combination therapy resulted in remarkably higher repigmentation responses, with 89.7% of lesions showing at least mild (≥25%) repigmentation and 51.7% showing good (≥50%) repigmentation. This significantly exceeded the outcomes with topical tacrolimus ointment alone, which only achieved 6.9% mild response and 6.9% good response. Fire needle monotherapy also demonstrated steady repigmentation over time, with 69% of lesions attaining a mild response by month 6. Importantly, no major adverse events occurred.

CONCLUSION

This study provides promising preliminary evidence supporting the use of fire needle therapy, alone or in combination with topical tacrolimus ointment, for inducing repigmentation in non-segmental stable vitiligo. As a non-pharmacological approach, fire needle therapy warrants further study as an alternative vitiligo treatment.

Markers of Metabolic Abnormalities in Vitiligo Patients

While vitiligo is primarily caused by melanocyte deficiency or dysfunction, recent studies have revealed a notable prevalence of metabolic syndrome (MetS) among patients with vitiligo. This suggests shared pathogenic features between the two conditions. Individuals with vitiligo often exhibit variations in triglyceride levels, cholesterol, and blood pressure, which are also affected in MetS. Given the similarities in their underlying mechanisms, genetic factors, pro-inflammatory signalling pathways, and increased oxidative stress, this study aims to highlight the common traits between vitiligo and metabolic systemic disorders. Serum analyses confirmed increased low-density lipoprotein (LDL) levels in patients with vitiligo, compared to physiological values. In addition, we reported significant decreases in folate and vitamin D (Vit D) levels. Oxidative stress is one of the underlying causes of the development of metabolic syndromes and is related to the advancement of skin diseases. This study found high levels of inflammatory cytokines, such as interleukin-6 (IL-6) and chemokine 10 (CXCL10), which are markers of inflammation and disease progression. The accumulation of insulin growth factor binding proteins 5 (IGFBP5) and advanced glycation end products (AGEs) entailed in atherosclerosis and diabetes onset, respectively, were also disclosed in vitiligo. In addition, the blood-associated activity of the antioxidant enzymes catalase (Cat) and superoxide dismutase (SOD) was impaired. Moreover, the plasma fatty acid (FAs) profile analysis showed an alteration in composition and specific estimated activities of FAs biosynthetic enzymes resembling MetS development, resulting in an imbalance towards pro-inflammatory n6-series FAs. These results revealed a systemic metabolic alteration in vitiligo patients that could be considered a new target for developing a more effective therapeutic approach.

The Anti-Vitiligo Effects of Feshurin In Vitro from Ferula samarcandica and the Mechanism of Action

BACKGROUND

Vitiligo is a complex disorder characterized by skin depigmentation; the canonical Wnt signaling pathway that involves β-catenin plays a crucial role in promoting the melanin production in melanocytes. Targeted inhibition of the Janus kinase JAK-STAT pathway can effectively diminish the secretion of the chemokine C-X-C motif ligand CXCL10, thereby safeguarding melanocytes. Ferula has been applied as a treatment regimen for a long period; however, its use for the treatment of vitiligo has not been previously documented.

METHODS

CCK-8 assay, Intracellular melanin content assay, Tyrosinase activity assay, Western blotting, qRT-PCR, and ELISA methods were employed. Using molecular docking verified the inhibitory effects of feshurin on the JAK1.

RESULTS

The sesquiterpene coumarin feshurin was separated from Ferula samarcandica. Feshurin was shown to induce GSK-3β phosphorylation, resulting in the translocation of β-catenin into the nucleus. This translocation subsequently upregulated the transcription of microphthalmia-associated transcription factor (MITF), leading to increased tyrosinase activity and melanin production. In addition, feshurin inhibited the production of chemokine CXCL10 via the JAK-STAT signaling pathway, which was verified by molecular docking.

CONCLUSIONS

Based on these findings, it can be concluded that feshurin exhibits significant potential for the development of novel anti-vitiligo therapeutics.

The influence of phototherapy on circadian melatonin and sleep regulation and potential benefits of these pathways in the management of vitiligo: a narrative review : Vitiligo, phototherapy, sleep and melatonin

Ultraviolet B narrow band (UVB-NB) phototherapy is the gold standard treatment for vitiligo, primarily due to its immunomodulatory effects. Additionally, it may influence circadian melatonin balance, that may indirectly induce sleep regulation, which in turn could potentially contribute to vitiligo improvement. The association between melatonin, vitiligo and phototherapy has been little investigated. The aim of this study was to evaluate the current evidence regarding the effects of circadian melatonin regulation and sleep, particularly during vitiligo treatment with phototherapy. We undertook a narrative review to synthetize the evidence on this association through the MEDLINE/PubMed database, using combined search terms: melatonin, vitiligo, phototherapy, and circadian rhythm (sleep). A total of 56 articles were included. There are few studies on this relationship, and conflicting findings. Some studies have suggested that UV exposure and phototherapy might benefit vitiligo by stimulating melanocytes, which have melatonin receptors, and this could potentially synchronize the circadian regulation of melatonin. This improved melatonin balance could result in better sleep quality further enhancing the antiinflammatory properties of melatonin and contributing to vitiligo improvement. Less is known about the possible effects of the use of topical melatonin, with or without phototherapy, to treat vitiligo lesions. In conclusion, there is some evidence that circadian melatonin regulation plays an important role in the course of vitiligo, both through sleep regulation and its anti-inflammatory properties. The evidence suggests that the systemic and physiological properties of melatonin, especially its circadian behavior regulated by phototherapy, may be more effective in respect of vitiligo improvement than the use of topical melatonin. However, the effects of the oral intake of melatonin are less clear. Phototherapy, as a potential modulator of circadian melatonin rhythm, that influences sleep and clinical improvement of vitiligo, needs further examination, as does the use of melatonin as an adjuvant treatment to UVB phototherapy in vitiligo.

Identification of dietary factors that impact the gut microbiota associated with vitiligo: A Mendelian randomization study and meta-analysis

Previous observational studies have suggested that gut microbiota might be associated with vitiligo. However, owing to the limitations in observational studies of reverse causality and confounders, it remains unclear that whether and how the causal relationships exist. The results suggested that pylum.Bacteroidetes, family.BacteroidalesS24.7, genus.LachnospiraceaeND3007, genus.Marvinbryantia are protective factors for vitiligo. Conversely, family.Lachnospiraceae, order.Burkholderiales, genus.Adlercreutzia, genus.Catenibacterium and genus.Lachnospira are risk factors for vitiligo. In addition, the causative connection between dietary factors and the gut microbiota associated with vitiligo was also investigated. The results revealed that 'alcohol intake versus 10 years pervious' results in a reduction in the abundance of genus.Lachnospiraceae ND3007 and family.BacteroidalesS24.7, bread intake leads to a reduction of genus.Marvinbryantia, 'average weekly red wine intake' is linked to a decrease in the abundance of order.Burkholderiales, tea intake is associated with an augmentation in the abundance of genus.Catenibacterium, salad/raw vegetable intake elevates the abundance of order.Burkholderiales. In summary, this Mendelian randomization study substantiates potential causal effects of gut microbiota on vitiligo. Modulating the gut microbiota through regulating dietary composition may be a novel strategy for preventing vitiligo.

Vitiligo: advances in pathophysiology research and treatment development

The autoimmune condition vitiligo, characterized by skin depigmentation, presents challenges for effective treatment design, with Janus kinase (JAK) inhibitors and other repurposed drugs offering a promising strategy for symptom management. This review explores advantages and shortcomings of current therapies, while presenting the urgent need for further innovative approaches. We emphasize the growing understanding of autoimmune involvement in vitiligo, highlighting several novel treatment avenues including relieving melanocyte stress, preventing dendritic cell activation, halting T cell migration, and suppressing inflammation and autoimmunity. Integrating psychodrama therapy to remediate stress alongside medical interventions marks a holistic approach to enhance patient well-being. The molecular underpinnings of vitiligo care are covered, emphasizing exciting advances revolutionizing vitiligo treatment and improving the quality of life for affected individuals.

The impact of lipidome on five inflammatory skin diseases: a Mendelian randomization study

OBJECTIVE

Two-sample Mendelian randomization (TSMR) was employed to examine the association between lipidome and five inflammatory skin diseases.

METHOD

To evaluate the association between various molecular subtypes of lipidome and the risk of five inflammatory skin diseases, we analyzed a comprehensive GWAS dataset comprising 179 lipidome. The Two-Sample Mendelian Randomization (TSMR) method was employed to investigate causal relationships. Heterogeneity and pleiotropy were assessed using Cochran's Q test, MR-Egger intercept test, and MR-PRESSO global test. Additionally, a sensitivity analysis was conducted to evaluate the influence of individual single nucleotide polymorphisms on Mendelian Randomization study.

RESULTS

Using 179 serum lipidome as exposures and five common inflammatory skin diseases as outcomes, we investigated their associations in this large-scale study. Our findings reveal significant impacts of glycerophospholipids, glycerolipids, and sphingomyelins on inflammatory skin diseases. Glycerophospholipids were protective against pemphigus but predominantly posed risks for other inflammatory skin diseases. Specifically, phosphatidylcholine (16:0_0:0) exhibited the most significant risk association with lichen planus (OR = 1.25, 95% CI 1.11-1.40, P < 0.001). Conversely, glycerolipids showed no effect on lichen planus but were protective against pemphigus while potentially posing risks for other conditions. Triacylglycerol (46:2) showed the most substantial risk association with vitiligo (OR = 1.99, 95% CI 1.35-2.93, P < 0.001). Furthermore, sphingomyelins had no effect on atopic dermatitis but posed potential risks for other inflammatory skin diseases. Sphingomyelin (d40:1) notably emerged as a significant risk factor for pemphigus (OR = 1.91, 95% CI 1.37-2.66, P < 0.001).

CONCLUSIONS

This study has elucidated the potential harmful effects of glycerophospholipids, glycerolipids, and sphingomyelins on inflammatory skin diseases, while also providing valuable insights for future research into the pathophysiology, prevention and treatment of these conditions.

Role of Cytokines and Chemokines in Vitiligo and Their Therapeutic Implications

Vitiligo is a persistent autoimmune disease characterized by progressive depigmentation of the skin caused by the selective destruction of melanocytes. Although its etiopathogenesis remains unclear, multiple factors are involved in the development of this disease, from genetic and metabolic factors to cellular oxidative stress, melanocyte adhesion defects, and innate and adaptive immunity. This review presents a comprehensive summary of the existing knowledge on the role of different cellular mechanisms, including cytokines and chemokines interactions, in the pathogenesis of vitiligo. Although there is no definitive cure for vitiligo, notable progress has been made, and several treatments have shown favorable results. A thorough understanding of the basis of the disease uncovers promising drug targets for future research, providing clinical researchers with valuable insights for developing improved treatment options.