Abstract
Background: Vitiligo is a common skin disease of unknown etiology characterized clinically by depigmented patches, which can be localized or generalized; it usually runs a chronic course with an un predictable outcome and failure of complete cure in many affected individuals. Many communities consider it a contagious disease which leads to a great psychological and social stigma for patients; previous studies showed that copper might be associated with the pathogenesis of vitiligo. The aim of this study was to assess copper level in Sudanese vitiligo patients.
 Methods: This is a case-control study conducted in dermatology clinics in Khartoum state during the period from November 2018 to February 2019. Blood samples were obtained from 100 participants, 50 from vitiligo patients and 50 from non-vitiligo subjects representing a control group. Serum copper was measured by mind-ray (automation).
 Results: A highly significant increase (P-value = 0.000) in the copper level was seen in vitiligo patients compared with the control group. Of the total number of patients, 17 (34%) were females and 33 (66%) were males. According to the duration of the disease, the copper level was significantly increased in patient group with a disease duration of > one year compared to the patient group six months–one year and patient group < 6 months; we found no significance of the family history, 18% of the case group had a family history while 42 (82%) had no family history. Discussion: The relationship between the serum level of copper and vitiligo has been assessed by many studies. Copper is one of the trace elements that was found to be important for tyrosinase enzyme that catalyzes the first steps in melanin synthesis in the skin. Some studies showed that the disease was associated with low serum levels of copper and since vitiligo is a disease that is characterized clinically by white areas of skin with no melanin, these studies seem to be logical. However, in this study, the serum level of copper was found to be high in vitiligo patients which might be justified by the release of copper from the destroyed melanocytes. Another justification might be a defect in the carrier protein for copper.
 Conclusion: The study found that the serum copper was significantly increased in vitiligo patients compared to the control and it is recommended that serum copper level and copper profile should be assessed routinely in vitiligo patients.
 Keywords: vitiligo, depigmentation, copper, Sudanese
Highlights
Vitiligo is a chronic idiopathic skin disease, characterized by sharply marginated depigmented patches [1]
The first observation pointed to the possible role of copper in melanin synthesis and the second is more supportive to this hypothesis since melanogenesis occurs in the epidermis, but till that time no one had talked about the nature of melanocytes and their location within epidermal keratinocytes
These studies had raised the suspicion of the role of copper in the pathogenesis of vitiligo in humans and since that time many other researches had talked about the possible role of trace elements in the etiology of vitiligo with the hope of finding promising treatment for this condition which is still idiopathic and all the possible etiologies are stated as hypotheses
Summary
Vitiligo is a chronic idiopathic skin disease, characterized by sharply marginated depigmented patches [1]. Lesions often start on sun-exposed areas [2] Both genetic and environmental factors are believed to play a role in the pathogenesis of the disease [1, 2]. The risk factors for developing vitiligo include family history and other autoimmune diseases [2]. Tyrosinase enzyme catalyzes the first two reactions in the pathway of melanogenesis [7]. It is found in animal and plant tissues responsible for the production of melanin as well as other pigments in these tissues [8]. Tyrosinase is a copper-containing enzyme encoded by the TYR gene in humans [9]
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