Depigmented Areas Research Articles

Evaluation of auditory system in vitiligo patients: A case-control study

BackgroundVitiligo is a common acquired pigmentary disorder characterized by well-defined areas of depigmentation due to loss of melanocytes. Vitiligo can affect melanocytes in the auditory system and potentially hearing. ObjectiveThe aim of this study was to investigate hearing changes in vitiligo patients. MethodsTwenty-six with vitiligo patients and 26 demographically matched healthy controls were included in this study. Audiological function was evaluated using pure tone audiometry (PTA), speech audiometry and tympanometry tests in all subjects. ResultsThe mean hearing threshold of the left ear at frequencies of 250 and 8000 Hz in vitiligo patients was significantly higher than the control group. Sensorineural hearing loss (SNHL) was seen in 14 (53.8 %) vitiligo patients and 5(19.2 %) control group (p < 0.05). Most affected patients (10/14; 71 %) had bilateral hearing loss especially in high frequency (8000 Hz). A significant association was identified between vitiligo and SNHL (OR 4.9; 95 % CI, 1.41–16.98, P = 0.01). There was a statistically significant correlation between hearing impairment and age in both groups. Gender, severity, activity and duration of vitiligo had no a significant effect on the results of audiometric tests. ConclusionThis study confirmed that the auditory system was affected in vitiligo patients. Vitiligo patients might be at a higher risk for auditory abnormalities at a younger age than control subjects. Auditory evaluation of vitiligo patients should be considered for early detection of hearing loss.

Analysis of the Role of Cosmetic Dermatology in Improving the Quality of Life of Patients with Vitiligo: Observational Study at Busan Hospital, South Korea

Introduction: Vitiligo is an autoimmune disease that causes skin depigmentation. This can have a significant impact on the patient's quality of life. Dermatological cosmetics can be used to cover depigmented areas and improve the patient's quality of life. Methods: This observational study was conducted on vitiligo patients treated at Busan Hospital, South Korea. Patients were given a questionnaire to assess their quality of life before and after using dermatology cosmetics. A total of 250 research subjects took part in this study. Data were analyzed using appropriate statistical tests. Results: The results showed that the use of dermatological cosmetics significantly improved the quality of life of vitiligo patients. Patients report improvements in self-satisfaction, self-image, and social interactions. Conclusion: Cosmetic dermatology is a safe and effective therapeutic option to improve the quality of life of vitiligo patients.

Allergic Dermatitis in Pêga Breed Donkeys (Equus asinus) Caused by Culicoides Bites in the Amazon Biome, Pará, Brazil.

An allergy to bites from Culicoides (Diptera: Ceratopogonidae) occurs because of a hypersensitivity reaction caused by the inoculation of insect salivary antigens during the bite, resulting in immune-mediated dermatitis. To the best of our knowledge, no previous studies have focused on allergic dermatitis in donkeys in Brazil. Therefore, this study aimed to describe the epidemiological, clinicopathological, and therapeutic aspects of allergic dermatitis in donkeys and to identify the insects involved in its epidemiology. This study reported the occurrence of dermatitis in 17 animals. The clinical signs were restlessness and severe itching. Skin lesions were found on the head, depigmented areas of the muzzle and cheeks, flanks, pelvic and thoracic limbs, and the scrotal sac. The lesions were characterized by areas of alopecia with crusts accompanied by serosanguineous exudates. Histologically, the lesions were characterized as moderate superficial dermatitis with irregular epidermal acanthosis and pronounced diffuse orthokeratotic hyperkeratosis. In total, 378 Culicoides specimens were collected, with Culicoides ocumarensis Ortiz being the most abundant species. The combined application of copaiba oil and a multivitamin emulsion exhibited potential for topical treatment of allergic dermatitis caused by insect bites in donkeys. Our study revealed an association between allergic dermatitis in donkeys and Culicoides.

Transcutaneous Auricular Vagus Nerve Stimulation Alleviates Monobenzone-Induced Vitiligo in Mice.

Vitiligo is a complex skin disorder that involves oxidative stress and inflammatory responses and currently lacks a definitive cure. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive method for targeting the auricular branch of the vagus nerve and has gained widespread attention for potential intervention in the autonomic nervous system. Although previous research has suggested that vagus nerve stimulation can potentially inhibit inflammatory responses, its specific role and mechanisms in vitiligo treatment remain unknown. This study aimed to explore the therapeutic effects of taVNS in a mouse model of vitiligo induced by monobenzone. Initially, a quantitative assessment of the treatment effects on vitiligo mice was conducted using a scoring system, revealing that taVNS significantly alleviated symptoms, particularly by reducing the depigmented areas. Subsequent immunohistochemical analysis revealed the impact of taVNS treatment on melanocyte granules, mitigating pigment loss in the skin of monobenzone-induced vitiligo mice. Further analysis indicated that taVNS exerted its therapeutic effects through multiple mechanisms, including the regulation of oxidative stress, enhancement of antioxidant capacity, promotion of tyrosine synthesis, and suppression of inflammatory responses. The conclusions of this study not only emphasize the potential value of taVNS in vitiligo therapy, but also lay a foundation for future research into the mechanisms and clinical applications of taVNS.

Adjuvant therapy with topical silymarin nanomicelles attenuates skin and hair depigmentation in a C57/BL6 mouse model of vitiligo

Nanomedicine holds great promise for delivering drugs to the skin. In this study, we explored the use of silymarin, a natural extract from Silybum marianum seeds, encapsulated in a micellar structure for topical treatment of vitiligo. The nanomicelles were characterized using dynamic light scattering (DLS). A C57/BL6 mouse model with vitiligo was utilized, and the depigmented skin area was topically treated with either silymarin nanomicelles or clobetasol for four consecutive weeks. Skin samples were collected for histopathological analysis and gene expression PCR analysis, while liver tissues were assessed for lipid peroxidation. DLS analysis revealed that more than 90% of the nanomicelles had a diameter below 30 nm and exhibited a narrow distribution. The in vivo study demonstrated that the nanomicellar form of silymarin was highly effective in suppressing vitiligo compared to clobetasol. Histopathological investigations indicated significant activation of melanocytes and reduced inflammation following treatment with silymarin nanomicelles. Moreover, lipid peroxidation analysis confirmed the antioxidant role of silymarin nanomicelles in scavenging reactive oxygen species. The downregulation of MITF, TRP1, and TRP2 expression following silymarin nanomicelle therapy was also found to be significant. Overall, the study demonstrated significant improvement of the depigmented skin patches, reduced skin inflammation, and downregulation of key genes involved in vitiligo, suggesting that silymarin nanomicelles hold promise as a viable therapeutic option for treating depigmented skin.

Butterfly-shaped Pattern Dystrophy : Findings of Retinal Imaging

Butterfly shaped pattern dystophy (BPD) is a inherited macular disease which is characterized by the accumulation of pigment/lipofuscin in the retinal pigment epithelium, it might be misdiagnosed as age-related macular degeneration (AMD). Retinal imaging is a useful tool for the differential diagnosis of pattern dystrophy. In this report, we describe a 64 year old man presented metamorphopsia and reduced visual acuity in both eyes. Fundus examination showed an area of depigmentation delimited resembling a butterfly. The OCT revealed a subfoveal hyperreflective deposit above the retinal pigment epithelium (RPE) while fundus autofluorescence (FAF) shows hypoautofluorescent areas outlined by a lipofuscin deposits as hyperautofluorescent Finally, fluoroscein angiography (FFA) revealed early macular hyperfluorescence.

Retinal pigment epithelium-Bruch's membrane volume in grading of age-related macular degeneration.

To assess the agreement of optical coherence tomography (OCT) algorithm-based retinal pigment epithelium -Bruch's membrane complex volume (RBV) with fundus photograph-based age-related macular degeneration (AMD) grading. Digital color fundus photographs (CFPs) and spectral domain OCT images were acquired from 96 elderly subjects. CFPs were graded according to Age-Related Eye Disease Study (AREDS) classification. OCT image segmentation and RBV data calculation were done with Orion™ software. Univariate and multivariate analyses were performed to find out whether AMD lesion features associated with higher RBVs. RBV correlated with AMD grading (rs=0.338, P=0.001), the correlation was slightly stronger in early AMD (n=52; rs=0.432, P=0.001). RBV was higher in subjects with early AMD compared with those with no AMD lesions evident in fundus photographs (1.05±0.20 vs 0.96±0.13 mm3, P=0.023). In multivariate analysis higher RBVs were associated significantly with higher total drusen (β=0.388, P=0.027) and pigmentation areas (β=0.319, P=0.020) in fundus photographs, whereas depigmentation area (β=-0.295, P=0.015) associated with lower RBV. RBV correlate with AMD grading status, with a stronger association in patients with moderate, non-late AMD grades. This effect is driven mostly by lesions with drusen or pigmentation. Lesions with depigmentation tend to have lower values. RBV is more comprehensive measurement of the key area of AMD pathogenesis, compared to sole drusen volume analysis. RBV measurements are independent on grader variations and offer a possibility to quantify early and middle grade AMD lesions in a research setting, but may not substitute fundus photograph-based grading in the whole range of AMD spectrum.

An Update on Vitiligo Target Therapy: A Semi-Structured Systematic Review

Background: There is growing evidence to suggest a significant role for the adaptive immune system in disease progression and relapse. Therapies targeted the inflammatory responses of epidermal and immune system cells have been demonstrated effect in the treatment of vitiligo. However, more comparative studies are needed to inform the treatment decision making process. Purpose: To discuss the new target therapies modalities which are currently being trialled or recently licenced for the treatment of vitiligo. Method: A semi structured, rapid systematic review of the literature, where the findings from 11 studies was narratively discussed. Findings: The reviewed medications (ruxolitinib, baritininb, tofacitinib, ritlecitinib, afamelanotide, crisaborole and apremilast) all showed reduction in the percentage of depigmented body surface area and were well tolerated. However, no head-to-head studies were identified to compare the medications to each other or to other treatment modalities used in the treatment of vitiligo, to determine superiority.

Understanding the molecular basis of vitiligo - a systematic review

Introduction: Vitiligo is a systemic, chronic, hypopigmented dermatosis&#x0D; of unclear background. The disease is characterized by the selective loss or dysfunction of melanocytes. As a result we can observe various, well and non-squamous depigmentation areas of different size and shape. The pathogenesis of vitiligo is not fully understood, however, the current view is that the etiopathology of this disease is complex&#x0D; Purpose of the study: Current treatment models are often nonspecific, so it is important to understand the pathomechanism that can help with vitiligo lesions. It will also sensitize researchers to the search for new therapeutic options&#x0D; Material and methods: Collected scientific articles and guidelines available online of high substantive value. Expressions that were searched in databases: vitiligo, etiology, leptin, pathogenesis, reactive oxygen species, oxidative stress&#x0D; Results and conclusions: The scientific papers and researches cited in the article show that the major role is played by cellular stress and reactive oxygen forms, secondary inflammation or environmental factors. Cellular stress activates autoimmune and autoinflammatory mechanisms that destroy pigment cells. Therefore, there are probably even more mechanisms contributing to the development of vitiligo.&#x0D; Illness can affect the patient 's quality of life. In recent years, there has been significant progress in understanding the pathogenesis of vitiligo. Effective treatment of vitiligo remains a difficult challenge for both scientists and dermatologists.

A randomized prospective study to assess the role of topical tacrolimus as preventive therapy in unstable acral vitiligo.

Acral vitiligo is a significantly distressing condition and tends to be treatment-resistant. The occurrence of new lesions on acral areas further causes greater psychological trauma. Topical tacrolimus has been widely used in the management of vitiligo and its role in preventing flares in other dermatoses such as atopic dermatitis has been well documented. To assess the role of topical tacrolimus as preventive therapy in unstable acral vitiligo. In this single-center randomized prospective study, 60 patients aged 16-60 years having unstable acral vitiligo with symmetrical lesions were enrolled and randomized (1:1) into two groups. Patients in group A were instructed to apply topical tacrolimus 0.1% ointment on both vitiliginous and normal skin while patients in group B were instructed to apply topical tacrolimus 0.1% ointment only on vitiliginous skin for 6-months. Only the distal hand till the wrist joint was chosen for observation. Vitiliginous patches were assessed monthly for 6 months for a change in the number of lesions and total area involved, extension of preexisting lesions, and adverse effects if any. A reduction in the number of lesions was observed in both groups. The decrease in the number of lesions in group A was 5.6% as compared to 2.3% in group B (p-0.001). The decrease in depigmented area in group A was 10.5% as compared to 4.6% in group B (p-0.048). Treatment failure was seen in 11/60 (18.3%) patients. Tacrolimus 0.1% ointment application showed effectiveness in preventing the appearance of new lesions in unstable acral vitiligo and hastening the repigmentation when applied on both lesional and perilesional skin in vitiligo.

Genetic features of Sri Lankan elephant, Elephas maximus maximus Linnaeus revealed by high throughput sequencing of mitogenome and ddRAD-seq.

Elephas maximus maximus Linnaeus, the Sri Lankan subspecies is the largest and the darkest among Asian elephants. Patches of depigmented areas with no skin color on the ears, face, trunk, and belly morphologically differentiate it from the others. The elephant population in Sri Lanka is now limited to smaller areas and protected under Sri Lankan law. Despite its ecological and evolutionary importance, the relationship between Sri Lankan elephants and their phylogenetic position among Asian elephants remains controversial. While identifying genetic diversity is the key to any conservation and management strategies, limited data is currently available. To address such issues, we analyzed 24 elephants with known parental lineages with high throughput ddRAD-seq. The mitogenome suggested the coalescence time of the Sri Lankan elephant at ~0.2 million years, and sister to Myanmar elephants supporting the hypothesis of the movement of elephants in Eurasia. The ddRAD-seq approach identified 50,490 genome-wide SNPs among Sri Lankan elephants. The genetic diversity within Sri Lankan elephants assessed with identified SNPs suggests a geographical differentiation resulting in three main clusters; north-eastern, mid-latitude, and southern regions. Interestingly, though it was believed that elephants from the Sinharaja rainforest are of an isolated population, the ddRAD-based genetic analysis clustered it with the north-eastern elephants. The effect of habitat fragmentation on genetic diversity could be further assessed with more samples with specific SNPs identified in the current study.

Single-Cell RNA Sequencing Reveals Cellular Heterogeneity in an Acral Amelanotic Melanoma After Immunotherapy Treatment.

Anti-programmed cell death ligand-1 (anti-PD-L1) immunotherapy is often used for advanced urothelial carcinoma and melanoma, including amelanotic melanoma, a relatively rare subtype with little to no pigment in the tumor cells. However, cellular heterogeneity of amelanotic melanoma during or after anti-PD-L1 immunotherapy treatments has not been described. To investigate cellular heterogeneity in acral amelanotic melanoma after immunotherapy exposure. We evaluated subtle visual changes of the melanoma by dermoscopy and performed a pathological examination to analyze the heterogeneity of microscopic morphological and immunohistochemistry changes. The cellular transcriptional heterogeneity and corresponding biological function profiles of the melanoma were determined by single-cell RNA sequencing (scRNA-seq). The dermoscopic examination revealed black globules and scar-like depigmentation areas against a homogeneous red background. Pigmented and amelanotic melanoma cells were observed microscopically. The pigmented cells were large and contained melanin granules expressing Melan-A and HMB45; the amelanotic cells were small and did not express HMB45. Ki-67 immunohistochemical staining revealed that the pigmented melanoma cells had a higher proliferative ability than the amelanotic cells. scRNA-seq identified three cell clusters: amelanotic cell cluster 1, amelanotic cell cluster 2, and pigmented cell cluster. Furthermore, a pseudo-time trajectory analysis showed that amelanotic cell cluster 2 originated from amelanotic cell cluster 1 and transformed into the pigmented melanoma cell cluster. The expression pattern of melanin synthesis-related and lysosome-endosome-related genes in different cell clusters supported the cell cluster transformation results. Also, upregulated expression of cell cycle genes indicated that the pigmented melanoma cells had a high proliferative ability. Coexisting amelanotic and pigmented melanoma cells indicated cellular heterogeneity in an acral amelanotic melanoma from a patient who underwent immunotherapy treatment. Additionally, the pigmented melanoma cells acquired a higher proliferative ability than the amelanotic melanoma cells.

Застосування фототерапії та клітинних технологій у комплексній терапії хворих на вітиліго. Власний досвід

Vitiligo is a chronic acquired disorder of skin pigmentation, characterized by the presence of sharply limited depigmented areas of the skin as a result of the progressive loss of melanocytes. The purpose of the work: increasing the effectiveness of treatment of patients with vitiligo by shortening the treatment period, ensuring the stability of results and reducing the number of complications with combined methods of treatment of a stable form of vitiligo with the use of cultured melanocytes and keratinocytes compared to methods approved by European standards and domestic orders. Study object and methods: 107 vitiligo patients aged 19 to 65 were under our observation. Depending on the method of treatment, the patients were randomly selected into two representative groups: the main group, which received treatment according to the developed method, and the comparison group, which received traditional treatment. When evaluating the results of treatment in examined patients 8 and 16 weeks after the start of therapy, more pronounced positive dynamics were found in patients of the main group, whose complex therapy included melanocyte-keratinocyte suspension (MCS) and automesoconcentrate (AMK). Conclusions: the analysis of the results of treatment of patients with vitiligo proved not only good tolerance, but also high efficiency of treatment when using, along with traditional therapy, cellular technologies.

BENIGN FOVEAL DEPIGMENTATION: A MULTIMODAL IMAGING INVESTIGATION.

To describe the multimodal imaging characteristics of benign foveal depigmentation. The study was designed as prospective observational case series. Patients with benign foveal depigmentation were prospectively investigated by means of multimodal imaging, including blue-light and near-infrared fundus autofluorescence, optical coherence tomography (OCT), OCT angiography, color testing, microperimetry, and electrophysiology. The main outcome measures were vessel density and retinal pigment epithelium (RPE)/photoreceptor complex OCT reflectivity. Overall, 4 patients were identified, with bilateral and unilateral involvement in 1 case and 3 cases, respectively. Fundus autofluorescence provided variable results, showing more impairment on near-infrared fundus autofluorescence. Structural OCT revealed slight attenuation of the outer retinal bands in the area affected by benign foveal depigmentation, associated with choroidal hypertransmission, whereas enface OCT better delineated the attenuation of the reflectivity signal. The mean reflectivity intensity of RPE/photoreceptor complex was statistically significantly reduced in patients with respect to control subjects in the benign foveal depigmentation area. Optical coherence tomography angiography, color testing, microperimetry, electrooculogram, and electroretinogram findings were normal. Benign foveal depigmentation may represent a focal RPE disease. The limited alterations within the RPE band, as visualized on enface OCT and confirmed on near-infrared fundus autofluorescence, suggest an impairment in melanin production or distribution within the RPE cells.

Elaboration of novel gel-core oleosomes encapsulating phytoconstituent for targeted topical delivery in a vitiligo-induced mouse model: Focus on antioxidant and anti-inflammatory pathways

Berberine (BER) is a natural isoquinoline with promising antioxidant and anti-inflammatory effects. However, BER's low permeability hampers its topical utilization. This study aimed to elaborate and assess a novel hyaluronate integrated gel-core oleosomes nanovesicular system to ameliorate BER's dermal availability for targeted topical vitiligo treatment. Sodium hyaluronate and sodium oleate were selected as natural biological key components for their excellent skin-penetrating characteristics. Berberine-oleosomes (BER-OS) were prepared using a modified ethanol injection technique. Ex-vivo studies were performed using full-thickness human skin for simulating the real topical application. Also, in-vivo pharmacodynamic studies were conducted using a vitiligo-induced mice model. The antioxidant and anti-inflammatory effects were evaluated using depigmentation area scoring, biochemical, and gene-expression studies. BER-oleosomes attained a small particle size (186 ± 4) nm, high zeta potential (−36.0 ± 1.13) mV, excellent entrapment efficiency % (92.3 ± 0.67), outstanding sustained release of 45% after 24 h, and high physical stability. Ex-vivo study emphasized the significant capability of hyaluronate-integrated gel-core oleosomes to enhance BER retention in the human skin, enabling the effective local targeted treatment of vitiligo with minimal systemic side effects. Moreover, results displayed significant augmented anti-inflammatory and antioxidant actions for BER-oleosomes compared to BER-conventional gel. Interestingly, placebo-oleosomes possessed a significant intrinsic effect against vitiligo. Histological, immunohistochemical, and toxicological investigations confirmed BER-oleosome's safety and efficacy. Conclusively, novel BER-loaded gel-core oleosomes were considered a promising nano-topical targeted approach that overcomes delivery obstacles for vitiligo treatment.

Multimodal Imaging of Retinochoroidopathy in Choroideremia Carrier

A 48-year-old woman was referred for ocular fundus abnormality by medical checkup. She had no subjective complaints. Fundus examination revealed diffuse moth-eaten appearance with chorioretinal atrophy in both eyes. Moreover, patchy areas of depigmentation were observed around the optic disc and in the peripheral retina. Fundus autofluorescence showed mosaic appearance in widespread retina, and patchy hypoautofluorescence areas corresponding to patchy areas of depigmentation. Although optical coherence tomography scan through the fovea of both eyes showed relatively preserved foveal contour and retinal layers, subtle irregularities at the level of the retinal pigment epithelium and ellipsoid zone observed. Based on these collective findings, we diagnosed our patient with retinochoroidopathy in choroideremia carrieir. Choroideremia is rare, occurring even less frequently as a symptomatic disease in female carriers. Our findings may contribute to a better understanding of this rare condition.

Videodermoscopic Changes of the Hair in Vitiligo Lesions in Relation to Disease Duration.

Vitiligo is an acquired disease of complex pathogenesis, in which the immunologic attack to the skin and hair follicle melanocytes leads to areas of depigmentation and leukotrichia, respectively. To study the dermoscopic features of the hair changes in vitiligo lesions in comparison to perilesional control areas and in relation to disease duration. Forty-seven patients with both old and recent vitiligo lesions were included. Dermoscopic features of hair within the lesions were examined and compared to those in perilesional non depigmented skin of the same patient. Hair density (P < 0.001), terminal hair rate (P = 0.011), terminal to vellus hair ratio (P = 0.029) and mean hair shaft thickness (P = 0.031) were significantly decreased, whereas vellus hair rate (P = 0.011) was significantly increased in old vitiligo lesions compared to their respective control areas. The frequency of broken hair was significantly higher in old lesions (P < 0.001), while that of upright re-growing hair was significantly higher in recent lesions (P = 0.016). Hair involvement in vitiligo lesions is not only limited to the development of leukotrichia. Other subtle changes in hair density, anagen and telogen hair rates, and mean hair thickness can be detected. These changes may serve as objective clues to the duration of the lesions.

MicroRNAs: Emerging players in the pathogenesis of vitiligo.

Vitiligo is an autoimmune skin disease characterized by presence of pale patchy areas of depigmentation. MicroRNAs (miRNAs) are important regulators of gene expression and play significant roles in diverse biological and pathological processes. Accumulating evidence has shown that miRNAs were differentially expressed in skin lesions and peripheral blood mononuclear cells of patients with vitiligo. In particular, miRNAs are significantly correlated with the development and progression of vitiligo. The abundance of some miRNAs in serum was also correlated with the vitiligo lesion severity, indicating that miRNAs might serve as prognostic biomarkers. Importantly, the direct involvement of miRNAs in the pathogenesis of vitiligo has been demonstrated. For example, increased expression of miR-25 contributes to vitiligo through promoting the dysfunction and oxidative stress-induced destruction of melanocytes. However, there are limited studies on the function and mechanism of deregulated miRNAs in vitiligo. Further studies are required to establish clinical applications of miRNAs for vitiligo. More in-depth investigations of miRNAs are needed for the understanding of the pathogenesis of vitiligo and the development of novel therapeutic targets. This present review summarizes the current literature on the deregulation and pathogenic roles of miRNAs in vitiligo. We also highlight the potential clinical applications of miRNAs in patients with vitiligo.

Clinical and pathogenetic justification of the use of methotrexate in the treatment of progressive non-segmental vitiligo

BACKGROUND: Vitiligo is an urgent problem both for patients and for the scientific community of dermatologists. There are many studies aimed at finding new methods of therapy for this disease, but there are no effective schemes for repigmentation of foci and stabilization of the process in modern dermatology. In this regard, the search for means that have a pathogenetic effect is relevant.&#x0D; AIMS: Clinical and laboratory evaluation of the effectiveness of methotrexate in vitiligo.&#x0D; MATERIALS AND METHODS: Preliminary results of a study of the effectiveness of methotrexate in the treatment of vitiligo are presented. Clinical effects were assessed using the VES index (Vitiligo extent score). The dynamics of immunological parameters and the influence of vitiligo on the quality of life were also determined.&#x0D; The study included 77 patients suffering from non-segmental vitiligo. All the subjects were divided into 2 groups. Patients of group 1 (39 patients) received methotrexate in combination with phototherapy, patients of group 2 (38 patients) underwent a course of UVB-311nm. The area of depigmentation was determined, and after treatment repigmentation, relative to the surface area of the body. The dynamics of the immune status against the background of therapy was analyzed. The correlation of the prevalence of the process with the quality of life was evaluated. The duration of the study was 4 months.&#x0D; RESULTS: There were no statistically significant differences in clinical and laboratory parameters among the groups before treatment. Patients included in group 1 and receiving combination therapy with methotrexate and medium-wave narrow-band therapy with UVB-311nm demonstrated more active repigmentation of vitiligo foci than the studied 2 groups. Also, patients of this group demonstrated the most active positive dynamics of the dermatological quality of life index, correlating with the prevalence of the process. Analysis of the dynamics of immune status indicators allowed us to conclude that the best tendency to normalize cytokine levels among group 1 patients.&#x0D; CONCLUSIONS: Our study demonstrated the clinical and pathogenetic efficacy of methotrexate. Small doses of the drug are well tolerated, which allows a long-term effect on pathogenetic mechanisms, stabilizing the skin process.

Ovoid nests in nevocellular nevus

We report the case of a 34-year-old female patient with no medical history presented herself with a lesion near the intergluteal cleft evolving for more than five years and gradually increasing in size. An examination revealed a painless nodule 1.5 × 2 cm in size, of soft consistency, and with a flesh-colored pedicle base with central hyperpigmentation and a depigmented peripheral area (Fig. 1). Dermoscopy revealed a hyperpigmented cerebriform structure in the center surmounted by several white scales and bordered by an irregular melanocytic network and multiple ovoid nests (Fig. 2).