Chronic Urticaria Biomarkers IL-6, ESR and CRP in Correlation with Disease Severity and Patient Quality of Life-A Pilot Study

Vitiligo: Clinical and Laboratory Characteristics in 573 Saudi Patients

Background

Vitiligo is a common disease. Limited studies in Saudi Arabia have explored the detailed clinical characteristics of vitiligo, as outlined in recent consensus reports by vitiligo experts.

Objective

To determine vitiligo prevalence and detailed clinical characteristics in a Saudi cohort.

Methods

Cross-sectional study over six years. All cases were electronically identified and manually verified. Prevalence and sex were determined based on all vitiligo cases. Detailed analysis was done only for patients seen in a specialized vitiligo clinic with standardized documentation.

Results

There were 1555 vitiligo cases (prevalence 0.235% [95% confidence interval 0.224-0.247], 938 [60.32%] were female). Detailed analysis for other variables was done in 573 patients. Onset before age 20 years was found in 49%. Family history of vitiligo was reported in 42.15%. Triggering factors were present in 32% with stress being the most common (24%). Proportion of clinical characteristics was as follows: nonsegmental vitiligo (88%), signs of activity (49%), lesional pruritus (25%), halo nevi (4%), leukotrichia (19%). Some patients had isolated facial involvement and others had leukotrichia on the eyelids (not eyelashes). Atopy and hypothyroidism were the most prevalent systemic diseases, while alopecia areata, atopic dermatitis, and psoriasis were the top skin conditions. Antithyroid antibodies were high in approximately a third of patients and the majority of patients had low vitamin D. Elevated erythrocyte sedimentation rate (ESR) was observed more in patients with clinical signs of activity (70% vs 54%, p-value 0.0007).

Conclusion

Prevalence of vitiligo was found to be similar to worldwide figures, with a higher proportion having affected family members. Stress as a trigger, lesional pruritus, signs of activity, thyroid disease, and low vitamin D were all common and should be routinely checked. Novel findings include isolated facial involvement, eyelid leukotrichia, and high ESR in active vitiligo.

Assesment of Salivary and Serum Levels of HBD2 in Patients with Chronic Angioedema

Background/Objectives: Human β-defensin 2 (HBD2) is a protein that plays an important role in activating the immune system by modulating spinal pathways and the inflammatory response. According to previous research, HBD2 was proven to be important in chronic spontaneous urticaria (CSU) (their values were significantly elevated in CSU patients, with a significant correlation between HBD2 levels and the percentage of peripheral basophils, suggesting that elevated HBD2 levels may be a potential marker of basophil and mast cell activation), which led us to additional research on the HBD2 molecule in isolated chronic angioedema. The aim of this research is to examine HBD2 values in the saliva and serum of patients with isolated angioedema, as a potential biomarker of the disease. Methods: This cross-sectional study involved a total of 102 participants, involving three groups: 33 patients with isolated chronic non-hereditary angioedema (AE) (defined as sudden onset of localized edema without chronic urticaria), 33 patients with angioedema associated with chronic urticaria (CU+AE), and 35 healthy participants (controls, CTRL). They provided a saliva sample to determine HBD2 levels using an ELISA (Enzyme-Linked Immunosorbent Assay). Subsequently, a peripheral blood sample (serum) was taken from the participants to determine HBD2 levels using the same ELISA. Results: Salivary HBD2 levels were significantly higher in those with CU+AE than in the CTRL (p = 0.019). While salivary HBD2 values differed between those with angioedema and CTRL, the serum HBD2 values did not. Also, no correlation between the levels of HBD2 in saliva and serum was found. Conclusions: Since we found that salivary HBD2 values were significantly higher in those with CU+AE than in CTRL, this points to a possible role of the HBD2 molecule in pathogenesis of AE (namely, that it induces degranulation in mast cells and vascular permeability, and has antimicrobial properties) Therefore, more research is needed to determine how reliable salivary HBD2 measurement is, as well as its significance.

The Alarmin Triad-IL-25, IL-33, and TSLP-Serum Levels and Their Clinical Implications in Chronic Spontaneous Urticaria

This study delves into the critical role of alarmins in chronic spontaneous urticaria (CSU), focusing on their impact on disease severity and the quality of life (QoL) of patients. We investigated the alterations in alarmin levels in CSU patients and their correlations with the Urticaria Activity Score (UAS7) and the Dermatology Life Quality Index (DLQI). We analyzed serum levels of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) in 50 CSU patients, comparing these to 38 healthy controls. The study examined the relationship between alarmin levels and clinical outcomes, including disease severity and QoL. Elevated levels of IL-33 and TSLP in CSU patients (p < 0.0001) highlight their potential role in CSU pathogenesis. Although IL-25 showed higher levels in CSU patients, this did not reach statistical significance (p = 0.0823). Crucially, IL-33's correlation with both UAS7 and DLQI scores underscores its potential as a biomarker for CSU diagnosis and severity assessment. Of the alarmins analyzed, IL-33 emerges as particularly significant for further exploration as a diagnostic and prognostic biomarker in CSU. Its substantial correlation with disease severity and impact on QoL makes it a compelling candidate for future research, potentially serving as a target for therapeutic interventions. Given these findings, IL-33 deserves additional investigation to confirm its role and effectiveness as a biomarker and therapeutic target in CSU.