A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children

Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

Importance

Evidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed.

Objective

To develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients.

Evidence Review

A process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale.

Findings

Articles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream-used off-label for patients younger than 12 years and limited to nonsegmental vitiligo-were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources.

Conclusions and Relevance

Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.

Unveiling the Unseen Struggles: A Comprehensive Review of Vitiligo's Psychological, Social, and Quality of Life Impacts

This review explores the psychosocial impact of vitiligo on patients, its consequences for their quality of life, and the need for holistic support. Vitiligo's psychosocial burden, driven by the need to conceal lesions and societal beauty ideals, leads to stress, sadness, and low self-esteem. Social stigma affects self-esteem, especially in cultural contexts, exacerbating the need for culturally sensitive support. Anxiety and depression are common due to visible differences and societal pressures. Vitiligo significantly reduces the quality of life, especially in younger patients, impacting daily activities, careers, and relationships. Disease severity worsens these effects, particularly in visible areas and among individuals with darker skin tones. Long-term disease activity may improve acceptance and quality of life. Psychological support and counseling are crucial, as many patients don't seek medical help. Education plays a key role, improving understanding and reducing anxiety. Raising awareness about the impact of vitiligo can challenge perceptions and contribute to enhancing patients' well-being. In conclusion, this review highlights the interplay between psychosocial factors, quality of life, and the importance of addressing social stigma, providing psychological support, and advancing education and awareness for those with vitiligo.

Interleukin 1α and interleukin 18 in patients with vitiligo - Results of a case-control study

INTRODUCTION

Vitiligo is a depigmenting disorder resulting from loss of functional melanocytes in the skin. Variety of inflammatory mediators participate in the regulation of melanogenesis in melanocytes: interleukin-18 (IL-18), interleukin-33, granulocyte-macrophage colony stimulating factor, interferon-γ, prostaglandin E2 have the effect of promoting melanogenesis, while interleukin-1 (IL-1), interleukin-4, interleukin-6, interleukin-17 and tumor necrosis factor can inhibit melanogenesis.

AIM

Evaluation of IL-1α and IL-18 levels in peripheral blood in patients with vitiligo compared to healthy controls.

MATERIALS AND METHODS

Fifty patients aged 18-81 with vitiligo participated in the study. The control group consisted of 38 healthy people. Venous blood samples were obtained from each participant. Serum IL-1α and IL-18 concentrations were determined using the enzyme-linked immunoabsorbent assay (ELISA).

RESULTS

Among patients with vitiligo, the mean concentration of IL-1α was 0.13 (± 0.535) pg/mL, while in the control group it was 0.51 (± 1.51). There were no statistically significant differences in IL-1α concentrations between patients in the study group compared to the control group (p > 0.05). In the study group, the mean IL-18 concentration was 141.05 (± 136.33) pg/mL vs 137.33 (± 105.83) pg/mL in the controls. There were no statistically significant differences in IL-18 concentrations between patients in the study group compared to the controls (p > 0.05). In the Spearman correlation test, no correlation was confirmed between IL1α and IL-18 concentrations in the group of patients with vitiligo vs healthy people.

CONCLUSIONS

There is no correlation between Il-1 and Il-18 concentration in the blood sera of patients with vitiligo.

Evidence for Epistatic Interaction between HLA-G and LILRB1 in the Pathogenesis of Nonsegmental Vitiligo

Vitiligo is the most frequent cause of depigmentation worldwide. Genetic association studies have discovered about 50 loci associated with disease, many with immunological functions. Among them is HLA-G, which modulates immunity by interacting with specific inhibitory receptors, mainly LILRB1 and LILRB2. Here we investigated the LILRB1 and LILRB2 association with vitiligo risk and evaluated the possible role of interactions between HLA-G and its receptors in this pathogenesis. We tested the association of the polymorphisms of HLA-G, LILRB1, and LILRB2 with vitiligo using logistic regression along with adjustment by ancestry. Further, methods based on the multifactor dimensionality reduction (MDR) approach (MDR v.3.0.2, GMDR v.0.9, and MB-MDR) were used to detect potential epistatic interactions between polymorphisms from the three genes. An interaction involving rs9380142 and rs2114511 polymorphisms was identified by all methods used. The polymorphism rs9380142 is an HLA-G 3'UTR variant (+3187) with a well-established role in mRNA stability. The polymorphism rs2114511 is located in the exonic region of LILRB1. Although no association involving this SNP has been reported, ChIP-Seq experiments have identified this position as an EBF1 binding site. These results highlight the role of an epistatic interaction between HLA-G and LILRB1 in vitiligo pathogenesis.

Three-dimensional image-guided topical photodynamic therapy system with light dosimetry dynamic planning and monitoring

Photodynamic therapy (PDT) has shown significant potential for skin disease treatment. As a key element, light is critical to influencing its treatment outcome, and light dosimetry is an issue of much concern for researchers. However, because of three-dimensional irregularity in shape and patient's movement during the therapy, irradiance hardly keeps uniform on the lesion and flux measurement remains a challenge. In this work, we report the development of a three-dimensional image-guided PDT system, and the method of dynamic irradiance planning and flux monitoring for lesions in different poses. This system comprises a three-dimensional camera for monitoring patients' movement during therapy, a computer for data analysis and processing, and a homemade LED array for forming uniform irradiance on lesions. Simulations on lesions of the face and arm show that the proposed system significantly increases effective therapy area, enhances irradiance uniformity, is able to visualize flux on the lesion, and reduces risks of burns during PDT. The developed PDT system is promising for optimizing procedures of PDT and providing better treatment outcomes by delivering controllable irradiance and flux on lesions even when a patient is moving.

Blue light-emitting diodes for the treatment of localized vitiligo: A retrospective study

BACKGROUND

Vitiligo is an autoimmune dermatological disease characterized by hypopigmented macules. Treatments include topical agents, phototherapy, and laser therapies. Different lasers should be individually chosen regarding location, extent, activity of the disease.

AIMS

This article aims to demonstrate how blue LED is effective and safe, as its wavelength is very close to the UV spectrum (415 nm vs. 400 nm), but, unlike UV therapy, blue LED have not shown any long-term cancerogenic side effects.

PATIENTS/METHODS

We treated 30 patients affected by vitiligo localized on different anatomical areas with blue light-emitting diodes.

RESULTS

Complete repigmentation occurred in 75.33% of treated patients (22 out of 30 patients, 14 males, and 8 females). Partial repigmentation occurred in the remaining patients.

CONCLUSIONS

Blue LED light may be a safe and well-tolerated way to induce repigmentation in patients affected by vitiligo.

Psychiatric Consequences of Skin Conditions: Multiple Case Study Analysis with Literature Review

This review of current literature demonstrates the psychological implications of skin conditions. Skin conditions of varying severity can impact the quality of patients' lives and have psychiatric consequences. This impact provides a need for healthcare providers to consider the psychological implications of one's skin conditions and their effect on quality of life. The psychological challenges that arise from varying skin conditions show the potential need for both dermatological and psychiatric interventions. The following literature review details the psychiatric consequences of skin conditions under various conditions. It first looks at literature highlighting the psychiatric consequences experienced through various age ranges, from adults to adolescents and children. The paper then explores multiple skin conditions and their psychological effect before highlighting some of the interactions that stress has on the skin that could further exacerbate one's condition. Finally, it examines how patients characterize their experience with their skin condition and goes into some clinical case studies of patients with psychological implications as a result of their skin disorder. The paper also highlights the magnitude of dermatologic patients experiencing psychological conditions in conjunction with their skin conditions.

Clinical efficacy analysis of 110 cases of childhood vitiligo with non-surgical combined therapy

BACKGROUND

Vitiligo has a negative effect on children's physical and psychological health. Few studies have examined long-term treatment efficacy for childhood vitiligo. Therefore, we evaluated the long-term effectiveness of non-surgical combination therapy in pediatric patients with vitiligo and analyzed factors that affect its efficacy.

METHODS

Pediatric patients (⩽12 years) with vitiligo who were treated with topical corticosteroids/topical calcineurin inhibitors and phototherapy for 12 months were retrospectively studied. Short-term systemic corticosteroids were administered according to individual clinical conditions. All lesions were photographed to assess repigmentation at 3-month intervals. Clinical data, the treatment effectiveness, and factors affecting the therapeutic effect were analyzed.

RESULTS

Overall, 110 children (51 [53.6%] girls; mean [SD] age, 7.1 ± 3.0 years; 104 [94.5%] with activity status) were treated for a mean period of 23.13 ± 14.03 months (range, 5-86 months). The overall >50% repigmentation rate was 64.5%. A longer duration of treatment was associated with a higher repigmentation rate (X² _trend = 36.229, P < .001). The vitiligo disease activity score at the first visit was positively correlated with the overall repigmentation rate (r_s = 0.301, P = .001).

CONCLUSIONS

Treatment lasting longer than 1 year is recommended in children with vitiligo. The best repigmentation effect can be achieved by combination therapy in the rapid progression stage.

The potential effect of smart devices and other stressful factors on Vitiligo in Nassiriah City/Iraq

BACKGROUND

Vitiligo is a disease that occurs due to dysfunction in the autoimmune system that attacks the skin pigment cells (melanocytes) leading to the appearance of light-colored spots on the skin.

OBJECTIVE

The study was carried out to investigate the effect of smart devices on the children inflicted with vitiligo, and the correlation of vitiligo with other factors such as performance in the school, the marital status of their parents, type of smart devices (games, YouTube), and others.

MATERIALS AND METHODS

The study was carried out on 49 children diagnosed with vitiligo in Nassiriah City, Iraq. The data of all the variable factors were collected and classified according to the types of smart applications (YouTube and/or games), the status of their parents, and hours spent on using these applications.

RESULTS

The collected data were analyzed into five figures; according to the children's performance in the school and the highest percentage were in the no failure category, or in the high achiever category constituting 38.77% to each one. The percentage of children who lives with both parents is 79.5%. Most of the affected children are the 2nd in order in their families representing 40.8% of children under study. The number of diseased children who use YouTube are 23, their percentage is the highest constituting 46.94%.

CONCLUSIONS

Seven conclusions were drawn in this novel study, among them are; that most of the affected children are 2nd in order in their families, and the highest percent of the affected children with vitiligo are those who use YouTube.

Association of genetic variants of the vitamin D receptor gene with vitiligo in a tertiary care center in a Saudi population: a case-control study

BACKGROUND

Vitiligo is a common cutaneous disorder of the skin and hair caused by a systemic depigmentation disorder that affects 1% of the population or less due to its onset in early adulthood. Meta-analyses have documented a linkage between vitiligo and the vitamin D receptor (VDR) gene.

OBJECTIVE

Investigate the relationship between the ApaI, BsmI, FokI and TaqI genetic variants in the VDR gene with vitiligo in a Saudi population.

DESIGN

Case-control.

SETTING

Single tertiary care center.

PATIENT AND METHODS

The case-control study was carried out between January 2015-December 2015 in Saudi vitiligo patients and healthy controls. VDR genetic variants or polymorphisms (ApaI, BsmI, FokI and TaqI) were genotyped by polymerase chain reaction-restriction fragment length analysis followed by 3% agarose gel electrophoresis. Applicable statistical methods were used to assess relationships between vitiligo cases and controls.

MAIN OUTCOM MEASURE

Effect of genotype distribution among four single nucleotide polymorphisms.

SAMPLE SIZE

152 vitiligo (median [IQR] 23 [19] years) patients and 159 healthy controls (45 [28.5] years).

RESULTS

We found an association of vitiligo with ApaI and BsmI polymorphisms (P<.05). However, a decreased risk was noted in vitiligo patients with FokI and TaqI polymorphisms and in the diplotype and haplotype analysis within males and females. A positive association with vitiligo was observed in ACAC and AC (adjusted by gender) haplotypes (P<.05). The strongest linkage disequilibrium was observed between rs79785232 (ApaI) and rs731236 (TaqI) polymorphisms (r²=.83), followed by rs2228570 (FokI) and rs1544410 (BsmI) polymorphisms (r²=.53).

CONCLUSIONS

Our results confirm an association of vitiligo with ApaI and BsmI polymorphisms and fail to show an association in TaqI and FokI polymorphism with vitiligo. Additional studies need to be carried out in different Arab populations to determine whether the polymorphisms are present.

LIMITATIONS

Controls not age matched, small sample size, lack of biochemical parameters.

CONFLICT OF INTEREST

None.

Meta-analysis for association of TNFA-308(G > A) SNP with vitiligo susceptibility

Vitiligo is an autoimmune progressive skin depigmenting disease. Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine and plays a crucial role in vitiligo development. Since there are conflicting results and consensus is lacking for the association of the TNFA gene -308 G > A polymorphism with vitiligo susceptibility; we performed a meta-analysis of all the available studies to investigate the association of TNFA -308 G > A polymorphism with vitiligo risk. 11 studies involving 2199 vitiligo patients and 3083 controls were included in the meta-analysis. The meta-analysis revealed an increased vitiligo risk with "AA", "GA" and "AA" + "GA" genotypes and 'A' allele in the overall (p = 0.006, p = 0.003, p = 0.001 & p = 0.003) and Egyptian populations (p = 0.001, p < 0.00001, p < 0.00001 & p = 0.002). Moreover, we found association for "GA" and "AA" + "GA" genotypes in Asian population (p = 0.0009 & p = 0.005) and for 'A' allele in Asian and middle eastern populations (p = 0.04 & p = 0.0002). Interestingly the disease activity based analysis revealed significant association for "GA", "AA" + "GA" genotypes and 'A' allele with active vitiligo patients in the North American population (p = 0.02). Moreover, we found significant association for "GA", "AA" + "GA" genotypes and 'A' allele with localized vitiligo in overall (p = 0.02, p = 0.02 & p = 0.04) and Asian (p = 0.004, p = 0.003 & p = 0.01) populations. Overall, our meta-analysis suggests the involvement of susceptible 'A' allele with: i) vitiligo susceptibility in overall population and specifically with Asian, Middle Eastern and Egyptian populations; ii) vitiligo disease activity in North American population and iii) localized vitiligo in overall population and specifically in Asian population.

Review article: Emerging issues in pediatric skin of color, part 1

Dermatology for the pediatric skin of color population is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non-White racial and ethnic groups with increased pigmentation including individuals of Asian, LatinX, African, Native American, Pacific Island descent, Indigenous Peoples, among others, with overlap in particular individuals, and mixtures thereof. Treating children of color is a unique skill set within the field of pediatric dermatology, requiring knowledge and sensitivity. The discipline of pediatric skin of color can be challenging. Difficulty in diagnosis of common conditions stems from underlying pigmentation, variations in common hairstyling practices, and differences in demographics of cutaneous disease, whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and/or therapeutics with regard to skin color. This article is the first in a series of two articles looking at recently published skin-related issues of high concern in children of color. Conditions reviewed in Part 1 include (1) hairstyling hair-related concerns (traction alopecia, central centrifugal cicatricial alopecia, endocrine disruption), (2) autoimmune concerns (cutaneous lupus, vitiligo), and (3) infections (tinea capitis, progressive macular hypomelanosis).

A practical guide to vitiligo differential diagnoses in primary care

ABSTRACT

Primary care providers often encounter different types of pigmentary disorders such as vitiligo. This article arms the provider with the most common vitiligo differential diagnoses, with key findings and tips to identify specific hypopigmentary diseases. Readers will be better-prepared to provide safe and effective care and recommend referrals to appropriate specialties.

Vitiligo: What's old, what's new

Vitiligo is an acquired pigmentary disorder afflicting 0.5-2% of the world population for both sexes and all races with a capricious and unpredictable course. It has a complex etiology and varies in its manifestation, progression and response to treatment. Even if the precise aetiology and pathobiology of the disease are complex and still debated, recent evidence supports that vitiligo is a T CD8+ cell-mediated autoimmune disease triggered by oxidative stress. To date no clinical, biological and histological criteria allow us to establish the prognosis with certainty. The choice of the best therapy for adult and childhood vitiligo is based on various factors, such as the patient's age, psychological condition and expectations, distribution and extension of skin lesions, type of vitiligo (stable or not) and availability and cost of therapeutic options. Since vitiligo has a deep psychological impact on patients and their quality of life, treating the disease is very important. As dermatologists, we have important goals in the treatment of vitiligo patients: stabilization of the disease progression, repigmentation of the lesions and especially the persistence of the aforementioned repigmentation. Although several medical and surgical therapeutic options have been proposed, no definite cure has yet been developed and the long-term persistence of repigmentation is unpredictable. We review the different therapeutic options with particular attention on the recurrence rate.

Skin manifestations in pediatric patients with primary immunodeficiency diseases (PIDs) in a tertiary care hospital in Colombia

Background

The current literature describes the characteristics of some skin manifestations in the context of primary immunodeficiency diseases (PIDs), also known as inborn errors of the immune system. However, there are hardly any data on the epidemiological trends of skin manifestations and PIDs in Latin America (LA). We aimed to describe the characteristics of patients with skin manifestations and the diagnosis of a PID treated at a tertiary hospital in Colombia.

Methods

This was a retrospective observational study. Data were taken from the institutional database of pediatric PIDs, which includes 306 patients under 18 years of age who attended a tertiary care center in Cali, Colombia for inpatient or outpatient services between December 2013 and December 2018. A trained third-year dermatology resident reviewed the electronic clinical records of all the patients in the database and double-checked patients who presented with cutaneous signs and symptoms.

Results

A total of 83 patients out of the original 306 patients (27.1%) presented with some type of cutaneous manifestation. Of these patients, 56.6% had atopic dermatitis, 56.6% reported at least one episode of skin infection, and some of the patients had both of these manifestations. Infections were more frequent in the PID group of combined immunodeficiency associated with well-defined syndromes and atopic dermatitis in the group of antibody deficiencies.

Conclusions

It is important to recognize dermatological clinical characteristics in patients with PIDs. More studies are necessary to establish recommendations regarding the approach of diagnosis and management of these patients.

Association of GZMB polymorphisms and susceptibility to non-segmental vitiligo in a Korean population

Non-segmental vitiligo (NSV) is the most common type of vitiligo, which is characterized by chronic and progressive loss of melanocytes. Genetic factors have been shown to play a key role in NSV in association and family studies. Granzyme B is a serine protease found in the cytoplasmic granules of cytotoxic T lymphocytes and natural killer cells that play an important role in inducing apoptotic changes of target cells. Several recent studies have provided evidence that polymorphism in the GZMB gene might be associated with autoimmune disease. A total of 249 NSV patients and 455 healthy controls were recruited to determine whether single nucleotide polymorphisms (SNPs) [rs2236337 (3′ untranslated region, UTR), rs2236338 (Tyr247His), rs11539752 (Pro94Ala), rs10909625 (Lys80Lys), rs8192917 (Arg55Gln), and rs7144366 (5′ near gene)] in GZMB gene contribute to the risk of developing NSV. Genotyping was performed using a single 192.24 Dynamic Array IFC. Data were analyzed using EP1 SNP Genotyping Analysis software to obtain genotype calls. Among the six SNPs tested, five SNPs (rs2236337, rs2236338, rs11539752, rs10909625, and rs8192917) showed significant association with NSV susceptibility. Among them, rs2236338, rs11539752, rs10909625, and rs8192917 remained a statistically significant association following multiple correction test. The five SNPs were located within a block of linkage disequilibrium. Haplotypes T–A–G–T–T and C–G–C–C–C consisting of rs2236337, rs2236338, rs11539752, rs10909625, and rs8192917 demonstrated significant association with NSV. Our results suggest that GZMB polymorphisms are associated with the development of NSV.

Vitiligo: An Updated Narrative Review

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.

Low dose oral corticosteroids, microneedling, and topical 5-fluorouracil: A novel treatment for recalcitrant pediatric vitiligo

A 10-year-old boy was referred to our outpatient clinic with a 2-year history of vitiligo minimally responsive to topical corticosteroids and phototherapy. Low dose oral corticosteroids were prescribed in combination with sessions of microneedling and 5-fluourouracil 5% cream applied immediately after needling on a monthly basis. Repigmentation was initially noted after the first cycle at week 4. After 3 sessions of treatment (week 16), the patient showed a complete repigmentation of the knees.

Therapeutic options and hot topics in vitiligo with special focus on pediatrics' vitiligo: A comprehensive review study

Vitiligo is a common skin disorder with an estimated worldwide prevalence to 2.28% which is connected with selective melanocytes loss which leads to depigmentation and chalky-white macules. Vitiligo may be dismissed as a cosmetic problem and may have psychologic impacts on patients. It is occurring in both children and adults and is considered as the most common depigmenting skin disorder in the world. There are still many unknown topics about this disease regarding to its treatment in pediatrics, curable drugs and manifestations. Therefore, we decided to evaluate the recent studies about its therapeutic strategies in pediatrics. Topical therapies should be considered as first line treatment in children, but phototherapy especially NBUVB may be used after topical treatment modalities failure or in extensive or rapidly progressive disease. Our suggestion for the treatment of this disease in children is to use combine treatment modalities with observing safety according to the patient's age.

Consensus on the treatment of vitiligo - Brazilian Society of Dermatology

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.

Prevalence and age distribution of pemphigus and pemphigoid diseases among paediatric patients in Germany

BACKGROUND

Autoimmune bullous diseases are rare and mostly occur in adults. Several cases and small case series have been described in children, but no systematic study about the prevalence of autoimmune bullous diseases (AIBD) in children is available.

PATIENTS AND METHODS

We analysed data of 1.7 million children insured in the largest German health insurance company based on the ICD-10-GM classification for the year 2015. Data were adjusted to the general German population based on the data of the Federal Statistical Office for the year 2015.

RESULTS

The prevalence of AIBD was calculated to 101.1/million children in 2015, resulting in about 1351 patients below the age of 18 years in Germany. The highest prevalence of all AIBD was seen for pemphigus vulgaris (30.5/million children) followed by linear IgA disease (24.5/million children) and bullous pemphigoid (4.9/million children).

CONCLUSION

Autoimmune bullous diseases in minors are scarce but should be taken into consideration in patients with pruritus and/or blisters and erosions on the skin and/or mucous membranes. Treatment is challenging, and due to the rarity of AIBD in minors, the management of these disorders in this patient population is best performed in specialized centres in a multidisciplinary approach, including paediatric dermatologists or dermatologists and paediatricians.

VIRdb: a comprehensive database for interactive analysis of genes/proteins involved in the pathogenesis of vitiligo

Vitiligo is a chronic asymptomatic disorder affecting melanocytes from the basal layer of the epidermis which leads to a patchy loss of skin color. Even though it is one of the neglected disease conditions, people suffering from vitiligo are more prone to psychological disorders. As of now, various studies have been done in order to project auto-immune implications as the root cause. To understand the complexity of vitiligo, we propose the Vitiligo Information Resource (VIRdb) that integrates both the drug-target and systems approach to produce a comprehensive repository entirely devoted to vitiligo, along with curated information at both protein level and gene level along with potential therapeutics leads. These 25,041 natural compounds are curated from Natural Product Activity and Species Source Database. VIRdb is an attempt to accelerate the drug discovery process and laboratory trials for vitiligo through the computationally derived potential drugs. It is an exhaustive resource consisting of 129 differentially expressed genes, which are validated through gene ontology and pathway enrichment analysis. We also report 22 genes through enrichment analysis which are involved in the regulation of epithelial cell differentiation. At the protein level, 40 curated protein target molecules along with their natural hits that are derived through virtual screening. We also demonstrate the utility of the VIRdb by exploring the Protein-Protein Interaction Network and Gene-Gene Interaction Network of the target proteins and differentially expressed genes. For maintaining the quality and standard of the data in the VIRdb, the gold standard in bioinformatics toolkits like Cytoscape, Schrödinger's GLIDE, along with the server installation of MATLAB, are used for generating results. VIRdb can be accessed through "http://www.vitiligoinfores.com/".

Vitiligo: A Review

Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.

Clinical and epidemiological characteristics of childhood vitiligo: a study of 701 patients from Brazil

BACKGROUND

Vitiligo is an acquired pigmentary disorder that affects approximately 0.5-2% of the world's population, and 25% of cases begin before 10 years of age. Although prevalent, there are few studies on the characterization of childhood vitiligo.

OBJECTIVE

To evaluate the clinical and epidemiological characteristics of childhood vitiligo.

METHODS

Transverse study conducted by reviewing data records of patients under the age of 18 in which disease onset occurred before 13 years of age.

RESULTS

Predominance of females (62%). The most common subtype was generalized vitiligo (53.8%). The average age of disease onset was 5.9 years. The most affected initial site was head/neck (44.22%). The Koebner phenomenon was present in 38.2%, emotional triggering factors in 67.0% of the patients, halo nevus in 17.4%, and associated autoimmune disease in 6.5% of the patients. Family history of vitiligo was observed in 16.9% of the patients, and stability was reported by 20.1% of patients. The presence of positive family history did not significantly influence the age of onset. We found a significant difference between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) regarding the age of onset, Koebner phenomenon, hypothyroidism, anti-TPO antibodies, family history of psoriasis, and halo nevus.

CONCLUSION

Childhood vitiligo has its own characteristics. Vitiligo different subtypes have distinct characteristics. Our study presents a great number of patients, helping to elucidate the peculiarities of childhood vitiligo in the Brazilian population.

Childhood Vitiligo

Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.

Acquired disorders with depigmentation: A systematic approach to vitiliginoid conditions

Acquired disorders with depigmentation are commonly encountered by dermatologists and present with a wide differential diagnosis. Vitiligo, the most common disorder of acquired depigmentation, is characterized by well-defined depigmented macules and patches. Other conditions, such as chemical leukoderma, can present with similar findings, and are often easily mistaken for vitiligo. Key clinical features can help differentiate between acquired disorders of depigmentation. The first article in this continuing medical education series focuses on conditions with a vitiligo-like phenotype. Early recognition and adequate treatment of these conditions is critical in providing appropriate prognostication and treatment.

Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review

Vitiligo commonly affects children, with half of affected individuals experiencing disease onset before the age of 20. Because childhood is a time of advancement in social and psychological development, understanding the extent of the effect of the disease and means of alleviation is crucial. Vitiligo has been shown to decrease children's quality of life, with greater distress in children with highly visible lesions and darker skin tones. This article reviews the literature regarding interventions that have been analyzed in children. Studies evaluating the effect of camouflage, cognitive behavioral therapy, psychological self-help tools, and support groups on the psychosocial aspects of vitiligo were included. The review highlights the ongoing need for studies to better understand the modalities described in this article, as well as others, such as skin dyes, bleaching creams, medical tattooing; week-long camps that cater to children with chronic skin disease; and biofeedback, that might have a role in preventing the psychosocial sequelae of childhood vitiligo.

Treatment outcomes of vitiligo in Asian children

This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.

Impact of Ultraviolet Light on Vitiligo

Vitiligo is a disorder of the melanocytes that results in a dynamic spectrum of skin depigmentation. Its etiology is complex and multifactorial, with data supporting several different hypotheses. Given its prominent phenotype, vitiligo has a significant negative impact on quality of life. Coupled with the chronic and incurable nature of the disease, this presents a formidable treatment challenge. Several treatment modalities have been instituted over the years, with varying efficacy. This chapter focuses on the use of ultraviolet light in vitiligo as an established therapeutic option.