Achromic Macules Research Articles

Vitiligo: Prevalence, Clinical Patterns, and Efficacy of Narrow Band Ultraviolet B Phototherapy

Background: Vitiligo denotes an acquired primary, usually progressive, melanocytopenia of unknown etiology, and clinically manifested by circumscribed achromic macules often associated with leukotrichia. Objective: The objective was to assess the prevalence and various clinical patterns of vitiligo and to study the efficacy of narrow-band ultraviolet B (NB-UVB) radiation. Materials and Methods: A prospective case series study was carried out at dermatology outpatient department (OPD), of tertiary care center in Central India on 50 patients of Vitiligo, who were diagnosed clinically, age ranging from 5 to 70 years of age. A thorough history and clinical examination as per institutional protocol was done for all the patients included in the study. Patients were exposed to NB-UVB rays in a phototherapy unit (Dermaindia Spiegel Series) with a standard protocol. Two scores designed for the assessment of vitiligo are Vitiligo Area Severity Index and Wallace Rule of Nines. Results: During the period of two years, 6638 patients were seen in dermatology OPD, out of which 129 patients were having vitiligo clinically. Thus, the prevalence of vitiligo was 1.9% in our study. The mean age in male was 40.4 years and that of female was 30.85 years. The female-to-male ratio was 2:3. 6% had a positive family history of vitiligo. The most common site affected was leg (pretibial region) (48%). Two patients (4%) were in Category– 0, 12 patients (24%) were in Category– I, 24 patients (48%) were in Category-II, and 12 patients (24%) were in Category– III, when graded according to their improvement. Forty-five patients (90%) had vitiligo vulgaris, two patients (4%) had segmental vitiligo, and one patient (2%) each of acrofacial vitiligo, lip-tip vitiligo, and focal vitiligo. On comparing the level of significance before treatment and after 2 months of treatment, after 4 and 6 months of treatment, and before treatment and at the end of treatment, it was found that the results were statistically highly significant. Thus, indicating that the improvement in the disease after NB-UVB therapy is statically significant. Conclusion: Our study found 1.9% prevalence of vitiligo among patients attending OPD. On comparing the level of significance, before treatment and at the end of treatment, it was found that the results were statistically highly significant with respect to improvement. Side effects were minimal in our participants. Thus, our study concludes that NB-UVB radiation is an effective and safe therapy for vitiligo.

Vitiligo: A Narrative Review.

Vitiligo, a common depigmenting cutaneous condition, is thought to affect 0.5%-2% of the world's population. During this condition, melanocytes are selectively lost, resulting in non-scaly, chalky-white macules. Achromic macules and patches are side effects of the multifaceted disease vitiligo, defined as the absence of epidermal pigmentation. The causes of this disaster are three significant factors. A suppressed reaction to touch allergens is one of many abnormal activities of the hypopigmented epidermis, which has also been observed in hypopigmented rats. The white epidermis of people with albinism, which is the same color as vitiligo, is more vulnerable to skin carcinoma; the white epidermis of people with vitiligo does not develop non-melanoma skin carcinoma. The overall etiology of vitiligo, which is now categorically recognized as an immunological illness, has made significant strides in recent years. Even though vitiligo is frequently dismissed as an esthetic issue, it can have serious mental consequences and significantly interfere with daily life. A global consensus in 2011 classified segmental vitiligo separately from all other types of vitiligo. The term vitiligo has been repurposed to refer to various types of nonsegmental vitiligo. There are numerous pharmaceutical procedures available on the market that aim to stop the development of and induce epidermal repigmentation. Variable levels of skin pigmentation have been observed with such therapies, either alone or in combination, and their predominance was safe and efficient. There are few vitiligo treatments available, and none of them can reliably cause repigmentation in every individual. Individualized management is required depending on geography, physical appearance, and the presence of illness activities. The preceding study aims to provide insight into the potential prospects of vitiligo medication while also summarizing the current body of knowledge on the condition.

Association of rs4711998 of IL-17A, rs2275913 of IL-17A and rs763780 IL-17F gene polymorphisms with non-segmental vitiligo in a Mexican population.

Vitiligo is the most common depigmenting disease characterized by achromic macules due to selective loss of melanocytes. The pathogenesis remains poorly elucidated, and multiple hypotheses exist regarding its pathogenesis. Evidence suggests that stress on melanocytes can result in activation of the immune system, and involvement of both activated cluster of differentiation (CD8+) cytotoxic and CD4+ T cells in the dysfunction, depigmentation, and apoptosis of melanocytes. Recent studies show that the interleukin 17 (IL-17) axis plays a central role in the pathogenesis of the disease. IL-17 is an important regulatory effector cytokine in this pathway. The aim of this study was to evaluate the association of IL-17A rs4711998 (-832A/G), IL-17A rs2275913 (-197G/A), and IL-17F rs763780 (7488A/G) with vitiligo in a Northeastern Mexican population. This was a case-control study and included 116 patients with vitiligo and 116 control subjects. Genotype characterization of IL-17A rs4711998 (-832A/G), IL-17A rs2275913 (-197G/A), and IL-17F rs763780 (7488A/G) was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. A p ≤ 0.05 was considered significant. It was observed that the combination of the genotypes GG/GA for IL-17F rs763780 (7488A/G) was associated with an increased risk for the development of vitiligo (OR 2.0943, 95% Cl 1.2375-3.5445, p = 0.0056). Regarding IL-17A rs4711998 (-832A/G) and IL-17A rs2275913 (-197G/A) genotyping, no association with vitiligo development was found. In conclusion, the SNP rs763780 in the IL-17F gene appears to be a risk factor for vitiligo development in this Mexican population and it may be useful in future studies, especially for the development of new therapies.

LIVING WITH VITILIGO: IMPACT OF THE DISEASE ON THE INDIVIDUALS’ QUALITY OF LIFE

Introduction: Vitiligo is a disease characterized by asymptomatic hypochromic and/or achromic macules, localized or generalized in the integumentary system. The visible depigmentation in the skin of the individual and usually exposed in daily life changes the body image, impacting their quality of life. Objective: To evaluate the quality of life of people living with vitiligo. Method: This is a cross-sectional study carried out with 86 individuals with vitiligo. For data collection, the Vitiligo-Specific Quality-of-Life Instrument questionnaire was used for quality of life. Results: Adult women (81.4%) (mean age 39 years old) with vitiligo had a medium impact on quality of life, and the factors that interfered with quality of life are related to intensified skin care, progression, and appearance of the disease. Conclusion: The vitiligo pathology interfered in the quality of life of adults. The factors that impacted quality of life were intensified skin care in leisure activities, the progression of the disease and the appearance of hypochromic spots.

Clinicoepidemiological Features of Childhood and Adult Vitiligo - A Cross- Sectional Observational Study

BACKGROUND
 Vitiligo is an acquired primary, usually progressive, melanocytopenia of unknown aetiology clinically manifested by circumscribed achromic macules and histologically by degeneration and disappearance of melanocytes in involved skin. Childhood vitiligo deserves special attention as it has unique epidemiological features. We wanted to determine, compare and analyze the clinical and epidemiological features and autoimmune disease associations in childhood vitiligo and adult vitiligo.
 METHODS
 It was a prospective cross-sectional observational hospital-based clinical study conducted in a suburban medical college hospital over 20 months which involved 120 patients with vitiligo who were assessed using detailed history and clinical examination for demographic and clinical data. Relevant history and family history were noted. Investigations including complete hemogram, serum biochemistry profile, thyroid profile and fasting plasma glucose examination were performed in all patients. Data were collected, tabulated, and all statistical analysis was done by using SPSS trial version 25 and in MS Excel 2007.
 RESULTS
 The majority of patients were in the age group of 16-30 years. Among 60 patients, female preponderance was noted in the study with a percentage of 53.3 % followed by 46 % males in the childhood group. The prevalence of segmental vitiligo was more in children (30 %) than in adults (5 %) which was statistically significant (P= 0.000). In adults, there was a statistically significant higher prevalence (P=0.000) of mucosal vitiligo (30 %) than in children (3.35 %). On performing statistical analysis, thyroid dysfunction (P=0.00) and diabetes mellitus (P=0.01) were found to be significantly more prevalent in adults than in children.
 CONCLUSIONS
 This study provides clinical evidence that vitiligo at different ages has different characteristics mainly regarding an increased incidence of segmental vitiligo and a more common positive family history among children than adults. A higher prevalence of thyroid dysfunction and diabetes mellitus in adult vitiligo patients compared to children warrants prompt treatment in all detected cases to prevent long-term morbidity and complications.

Updates and new medical treatments for vitiligo (Review).

Vitiligo is a multifactorial disease characterized by the loss of skin pigment, which results in achromic macules and patches. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. These treatments alone or combined have exhibited varying degrees of pigmentation, and the majority are safe and effective. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Individualized treatment is appropriate according to the location, clinical presentation and the presence of disease activity. The present review summarizes the medical treatments available for vitiligo: Systemic and topic pharmacological therapies, physical and depigmentation treatments. Several treatments are still underway and have not yet been approved. However, due to the promising preliminary results, these are also mentioned in the present review.

Consensus on the treatment of vitiligo – Brazilian Society of Dermatology

BackgroundVitiligo 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. ObjectivesThe 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. MethodsSeven 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/ConclusionThe 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.

803 NB-UVB induces melanocyte migration on a collagen IV-coated surface through the activation of the P53/miR211/MMP9 axis

Vitiligo is the most commonly acquired depigmented disorder of the skin that is characterized by the destruction of melanocytes (MCs) resulting in achromic macules. Although narrow-band UVB (NB-UVB) has been clinically proven to be an effective therapeutic option in the treatment of vitiligo, the mechanism by which how NB-UVB induces repigmentation in vitiligo has not been clearly elucidated. In this study, we examined the role of P53/miR211/MMP9 in the migration of MCs upon NB-UVB exposure. The primary human epidermal MCs were cultured from human foreskin. The mRNA and protein levels of P53, TRPM1, and MMP9 were measured using qPCT and western blotting assay. Transwell ®-collagen IV-coated membrane inserts were used for measuring the MCs migration ability. The migration ability was also examined in the MCs transfected with hsa-mir211 mimic and lentivirus-P53 in the presence or absence of NB-UVB irradiation. The results showed that in NB-UVB-exposed MCs, there was a significant increase in P53 and MMP9 levels alongside a decrease in TRPM1 and miR211 levels. We also found that the migration ability and MMP9 level of MCs transfected with hsa-miR211 mimic or/ lentivirus-P53 were significantly changed as compared with controls. Collectively ， our results indicate that the P53/miR211/MMP9 axis plays a critical role in facilitating the migration of MCs exposed to NB-UVB irradiation, which may serve as a provocative target for promoting vitiligo repigmentation. (This study was supported by grant from the National Natural Science Foundation of China, NSFC#: 81573028)

Objective Assessment of Skin Repigmentation Using a Multilayer Perceptron.

Background:Vitiligo is a pathology that causes the appearance of achromic macules on the skin that can spread on to other areas of the body. It is estimated that it affects 1.2% of the world population and can disrupt the mental state of people in whom this disease has developed, generating negative feelings that can become suicidal in the worst of cases. The present work focuses on the development of a support tool that allows to objectively quantifying the repigmentation of the skin.Methods:We propose a novel method based on artificial neural networks that use characteristics of the interaction of light with the skin to determine areas of healthy skin and skin with vitiligo. We used photographs of specific areas of skin containing vitiligo. We select as independent variables: the type of skin, the amount of skin with vitiligo and the amount of repigmented skin. Considering these variables, the experiments were organized in an orthogonal table. We analyzed the result of the method based on three parameters (sensitivity, specificity, and F1-Score) and finally, its results were compared with other methods proposed in similar research.Results:The proposed method demonstrated the best performance of the three methods, and it also showed its capability to detect healthy skin and skin with vitiligo in areas up to 1 × 1 pixels.Conclusion:The results show that the proposed method has the potential to be used in clinical applications. It should be noted that the performance could be significantly improved by increasing the training patterns.

Multiple hypochromic or achromic macules in children and risk of tuberous sclerosis

To describe in a large paediatric cohort the characteristics of hypopigmented and depigmented (hypochromatic and achromic) macules with no clear diagnosis but potentially evocative of tuberous sclerosis (TS). This was a retrospective multicentre study performed between 2010 and 2017 at a reference centre for rare skin diseases; it included all children consulting for hypochromic and achromic macules. A descriptive analysis was made of the characteristics of macules with no clear diagnosis, enabling them to be classified in three secondary groups: TS certain, TS ruled out, TS uncertain. Of the 3300 children seen during this 7-year period 7,265 were consulting for hypochromic or achromic macules, with no clear diagnosis in 18 cases: 7 girls and 11 boys of median age at 7.21 years (range: 4 months to 16 years and 7 months). The lesions were congenital in 7 cases. The number of macules varied, with over 20 in some cases. The majority were in the form of ash-leaf spots, followed by the oval form. Two children were diagnosed at clinical examination, and 16 underwent it is not examinations, resulting in a diagnosis of certain ST in 6 of these cases. No particular characteristics of the macules appeared to guide the clinical examination towards ST or isolated lesions. Café-au-lait spots were more frequent in the group in which ST was ruled out than in the other two groups: 67% vs. 33% and 33%. Neurologic involvement was more common in children with certain or uncertain ST than in children in whom ST was ruled out (83% and 67% vs. 11%). No identified characteristics of stains enabled the clinical examination to confirm or rule out tuberous sclerosis. Screening for acute any signs of ST is essential. Diagnostic efficacy is enhanced by additional exams.

Melanocyte transplantation – a variation of the micrografting technique

Vitiligo is an acquired pigmentation disorder characterized by the development of well-defined achromic macules in the skin. It is deemed stable when no new lesion emerges or when pre-existing lesions do not undergo changes for at least one year. In these cases, surgical treatment is an important therapeutic option. Punch micrografting is the most commonly performed melanocyte transplantation technique, resulting in excellent repigmentation. The authors describe a variation of this technique using even smaller and finer grafts (consisting of epidermis and thin dermis), in order to achieve aesthetical outcomes that are better than those obtained with the traditional technique, especially when treating areas with significant aesthetic impairment.

Vitiligo dévéloppé sur une mélanocytose dermique (nævus de Ota) chez une patiente à peau foncée

Nevus of Ota is a rare disease most frequently found in Asians. It presents clinically as a bluish gray hyperpigmentation of one side of the face. Transformation into melanoma and glaucoma are the main risks. The appearance of vitiligo lesions with poliosis within a nevus of Ota is exceptional. A 22-year-old female patient with a nevus of Ota consulted for depigmentation of the eyelashes. Physical examination revealed hyperpigmentation in the right orbitofrontal part of her face, achromic macules and eyelash poliosis. A diagnosis was made of vitiligo developing on a nevus of Ota. Ophthalmologic examination showed hyperpigmentation of the sclera. Regular dermatologic and ophthalmologic follow-up was instituted. Vitiligo is a condition characterized by the development of depigmented lesions secondary to chronic degradation of the melanocytes of the epidermis and the follicles. Its occurrence on congenital nevus and melanoma has already been reported. However, its appearance in dermal melanocytosis is very rare. Since the first observation of this association in 1979, only 4other cases have been reported. The pathogenic mechanisms of this association are still poorly understood. Histopathological examination generally shows a loss of epidermal melanocytes, especially in the basal layer, while dermal melanocytes remain unaffected. In this context, vitiligo developed on dermal melanosis appears to result from the difference between the properties of normal (epidermal) melanocytes and ectopic (dermal) melanocytes. Association of vitiligo with nevus of Ota is rare. Herein, we report a new case in a dark-skinned subject.

Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo.

BackgroundVitiligo is a chronic disease characterized by the appearance of achromic macules caused by melanocyte destruction. Surgical treatments with melanocyte transplantation can be used for stable vitiligo cases. ObjectivesTo evaluate treatment response to the autologous transplantation of noncultured epidermal cell suspension in patients with stable vitiligo.MethodsCase series study in patients with stable vitiligo submitted to noncultured epidermal cell suspension transplantation and evaluated at least once, between 3 and 6 months after the procedure, to observe repigmentation and possible adverse effects. The maximum follow-up period for some patients was 24 months.ResultsOf the 20 patients who underwent 24 procedures, 25% showed an excellent rate of repigmentation, 50% good repigmentation, 15% regular, and 10% poor response. The best results were observed in face and neck lesions, while the worst in extremity lesions (88% and 33% of satisfactory responses, respectively). Patients with segmental vitiligo had a better response (84%) compared to non-segmental ones (63%). As side effects were observed hyperpigmentation of the treated area and the appearance of Koebner phenomenon in the donor area.Study limitationsSome limitations of the study included the small number of patients, a subjective evaluation, and the lack of long-term follow-up on the results. CONCLUSION: Noncultured epidermal cell suspension transplantation is efficient and well tolerated for stable vitiligo treatment, especially for segmental vitiligo on the face and neck.

Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo.

Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below.

Development of Vitiligo during Treatment with Adalimumab: A Plausible or Paradoxical Response?

Dear Editor: Adalimumab is a complete human monoclonal anti-tumor necrosis factor α (anti-TNFα) that is generally well tolerated. With increasing use of adalimumab and other anti-TNFα therapies, several cutaneous adverse events have been reported during the therapy, including immune-mediated skin lesions1. A 39-year-old woman who had an 11-year history of Crohn's disease and was treated with adalimumab (40 mg administered subcutaneously every other week) presented at our clinic with multiple achromic macules and patches on the extremities (Fig. 1). The lesions developed abruptly about 12 months after the initiation of adalimumab therapy. The diagnosis of vitiligo was made after the patient's skin turned blue under a Wood's lamp. Laboratory tests were also performed to check for other autoimmune conditions, including thyroid disorders, and no abnormality was diagnosed. The patient denied any family history of vitiligo. She has been treated with a combination therapy of excimer laser and topical tacrolimus without stopping the adalimumab therapy for about 1 year, and has shown minimal response thus far. Fig. 1 Multiple well-demarcated irregularly shaped depigmented macules and patches (A) on the left proximal thigh, (B) dorsum of the right foot, (C) dorsum of the right hand, and (D) right forearm. The role of anti-TNFα inhibitors in the development of vitiligo is complicated and contradictory. There have been several case reports that showed improvement in vitiligo in patients receiving anti-TNFα therapy for other diseases2. The therapeutic effect of anti-TNFα inhibitors on vitiligo might result from stopping the physiological effect of TNFα on melanogenesis. Concretely, it has been reported that TNFα decreases the level of tyrosinase, a rate-limiting enzyme in melanin biosynthesis in vitro3. The melanocytotoxic effect of TNFα in vitiligo has also been demonstrated2. On the contrary, anti-TNFα inhibitors have been associated with the development of a considerable number of autoimmune diseases such as vitiligo, as well as leukocytoclastic vasculitis, systemic lupus erythematosus, psoriasis-like lesions, and alopecia areata1. Several theories were proposed to explain the mechanisms underlying the development of autoimmunity during treatment with anti-TNFα inhibitors. In vivo, nucleosome numbers (major autoantigens released during apoptosis) increase in patients receiving anti-TNFα therapies. This could lead to the subsequent induction of autoantibodies4. To our knowledge, only two cases of vitiligo have been attributed to adalimumab use. The first case was that of newly developed vitiligo after 8 months of adalimumab therapy for Crohn's disease; this was similar to our case5. In the second case, there was rapid deterioration of vitiligo within 3 months of adalimumab therapy for managing ankylosing spondylitis4. In our case, it could not be determined whether vitiligo was caused by adalimumab therapy or if it developed in association with Crohn's disease because the concomitant occurrence of vitiligo with inflammatory bowel disease has been rarely reported. The long duration of Crohn's disease, and the sudden onset and rapid spreading of cutaneous lesions support the former possibility. Previous reports and our case suggest that anti-TNFα agents, including adalimumab, can induce vitiligo development. Dermatologists should be aware of this possibility for an earlier detection and treatment of vitiligo in patients receiving anti-TNFα therapy.

Halo Medium-Sized Congenital Melanocytic Nevi and Vitiligo Progression in Three Children

Reports of halo nevus in medium-sized CMN are limited in the literature and its association with vitiligo is not very common. We present three healthy children with medium-sized CMN. There was no family history of vitiligo, other autoimmune disorders or melanoma. After years of follow up, the patients developed an achromic regular halo around the congenital nevus and one of them showed others halo nevi. Following these changes, achromic macules appeared and vitiligo was diagnosed. At follow-up, we observed reduction in size of the CMN and no thought-provoking malignant changes. Conclusion: We support that in halo medium sized CMN, like in other congenital nevi with unusual features, continuous observation should be recommended. Furthermore, parents should be informed about the long period of time required for complete resolution and the low possibility of malignant change in the nevus. Pediatricians should be familiar with this no life-threatening association.

A study of clinical profiles of vitiligo in different ages: an analysis of 669 outpatients

Vitiligo is a skin disorder characterized by achromic macules (white) on the skin and/or mucous membranes, which affects 0.5-2% of the population. Few publications address a vitiligo epidemiological profile worldwide. In Brazil there are only studies in children. To assess the clinical and epidemiological profile of individuals affected by vitiligo and to evaluate behavior of the disease in different age groups. We conducted a retrospective cross-sectional study in 669 patients with vitiligo from January 2001 to May 2006, who attended the Faculty of Medicine of ABC, located in the metropolitan region of São Paulo, Brazil. There was a predominance of females (62.2%) and adult age group (62.5%), with higher prevalence peaks between the second and third decades of life (18.3% and 16.9%, respectively). The most frequent phototype in skin was III (49.9%). Lesions began on the face most commonly in children and adolescents (32.6%) and the elderly (23.3%), and on hands in adults (24.0%). There was a higher prevalence of segmental vitiligo in children and adolescents (36.4%), compared with adults (11.3%) and the elderly (6.7%), and vitiligo with stable evolution was proportionately more frequent in childhood and adolescents (46.2%) than in adults (32.5%) and elderly (36.7%). Our findings are similar to other countries, mainly regarding the higher prevalence of segmental vitiligo and vitiligo with stable development among children and adolescents.

Vitiligo régressif au début d’un traitement antirétroviral : syndrome de reconstitution immunitaire ?

Immune reconstitution inflammatory syndrome (IRIS) includes all signs occurring during the reconstitution of an extensive and insufficiently regulated immune response to an infective or a non-infective antigen and observed during the immune suppression phase in an individual. We report a case of vitiligo appearing after the initiation of antiretroviral treatment and with repigmentation during the course of the treatment. A 30-year-old man, seropositive for HIV1-M, consulted for a diffuse eruption of hypopigmented and achromic macules. The lesions appeared 7 weeks after the start of antiretroviral therapy with zidovudine, lamivudine and efavirenz, starting on the forearm and spreading to the remainder of the skin. At control visits during the ensuing two months, gradual repigmentation of the achromic macules was noted. Plasma viral load, determined only during the treatment period, was less than 40 copies/ml (1.60(log)). This report concerns an original case of vitiligo occurring at the start of antiretroviral treatment in an HIV-positive patient, with spontaneous repigmentation during treatment. The chronology points to a hypothesis of immune reconstitution inflammatory syndrome (IRIS), despite the absence of any indication of the patient's viral load prior to therapy.

Reduction of skin-homing cytotoxic T cells (CD8+-CLA+) in patients with vitiligo

Vitiligo is a frequently acquired, hereditary disease, characterized by achromic macules due to the absence of melanocytes. In contrast with earlier studies, in which the main pathogenic role was attributed to anti-melanocyte antibodies, recent papers have emphasized a role for CD8(+) cytotoxic T lymphocytes in melanocyte destruction. Fifteen percent of peripheral T cell express cutaneous lymphocyte-associated antigen (CLA), responsible for skin-homing T cell. Phototherapy is used to treat patients with generalized vitiligo and it has been shown to interfere with CLA(+) T cells in other skin diseases. To describe peripheral blood T cell subpopulations' frequency and ability to express the skin-homing molecule (CLA) in patients with non-segmental vitiligo, before and after photochemotherapy (PUVA). Twenty-two patients with generalized and active spreading vitiligo were submitted to 30 PUVA-8MOP sessions. Lymphocyte immunophenotyping was performed by flow cytometry using anti-CD3, anti-CD8 and anti-CLA monoclonal antibodies. Fifteen healthy volunteers, sex- and age-matched, were included as a control group. CD8(+) -CLA(+) T cells were significantly reduced in number in untreated vitiligo patients (P=0.008) when compared with control individuals, albeit with a more intense CLA expression (P=0.028). These findings were not altered after PUVA. No significant difference was noticed in CD4/CD8 ratios nor in CD4-CLA(+) T cell numbers between vitiligo patients and controls, both before and after PUVA. CD8-CLA(+) T cells are reduced in peripheral blood of patients with non-segmental vitiligo. This finding may be related to the previously reported increase of CD8(+) cells in both lesions and perilesional skin of these patients.

Tetrasomy 13q mosaicism associated with phylloid hypomelanosis and precocious puberty

Various forms of pigmentary dysplasias have been known to be associated with chromosomal mosaicism. One of these disorders, known as phylloid hypomelanosis, has been found to be predominantly associated with abnormalities in chromosome 13. Most of the reported literature involves mosaic trisomy 13 with clinical evidence of abnormal pigmentation in the form of leaf-like or oblong achromic macules following Blaschko's lines. Here, we report on an 8-year-old girl with phylloid hypomelanosis and precocious puberty who was found to have mosaicism for tetrasomy 13q in the form of inverted dup(13)(q21) on her skin fibroblasts as well as peripheral blood karyotype. A higher resolution (244K) chromosomal microarray was done on DNA from skin fibroblasts confirming the breakpoint and gain of distal 13q, which made her tetrasomic for 13q21-qter. This is the first-ever reported association of tetrasomy 13q with phylloid hypomelanosis and precocious puberty. Our report further emphasizes the need to exclude any type of abnormalities of chromosome 13 in patients with phylloid hypopigmentation.