Clinical Types Of Vitiligo Research Articles

Medical management of vitiligo: a narrative review

Vitiligo is a chronic cutaneous disease presenting with asymptomatic depigmented macular lesions without any signs of inflammation. Since time immemorial, treatment has been sought for this disorder due to the substantial stigma associated with it, more so in patients with skin of color. Vitiligo can be divided into two major clinical types − segmental vitiligo (SV) and non-segmental vitiligo (NSV). The pathophysiological basis for the loss of functional melanocytes resulting in vitiligo includes genetic predisposition, autoimmune mechanisms, and oxidative stress, among others. Thus, combination therapies targeting the autoimmune nature of disease, activation of melanocytes, and reduction of oxidative stress often yield a successful treatment response. There are very few FDA-approved options for vitiligo, and certain recently introduced modalities may modify the way vitiligo is conventionally treated. This review summarizes the conventional as well as the newer medical treatment options for different clinical types of vitiligo.

Retrospective evaluation of epidemiological and clinical data of patients diagnosed with vitiligo in our outpatient clinic

Objective: It was aimed to evaluate retrospectively the epidemiological and clinical data of patients who applied to our clinic and were diagnosed with vitiligo. Epidemiological and clinical evaluation guide the progression, choice of treatment, and diagnosis of the comorbidities of the disease. Methods: 327 patients evaluated as non-segmental vitiligo were included in the study. Demographic characteristics of the patients (age and gender), age at onset of vitiligo, treatments used for vitiligo, clinical type of vitiligo, location of lesions, and accompanying autoimmune thyroid disease data were evaluated. Results: Of 327 patients, 169 (51.7%) were male and 158 (48.3%) were female. The male/female ratio was found to be 1,1:1. The mean age of the patients was 37.26±18.07 years, and the mean age according to gender was 37.44±18.19 years in females and 37.08±18 years in males. The mean age of onset of the disease was 29.17±15.79 years, and the mean age of onset by gender was 29.13±16.46 years in females and 29.2±15.15 years in males. Regarding onset of the disease, 54% of the patients were <30 years old, and 46% of the patients were 30 years or older. Generalized vitiligo (58.8%) and acrofacial vitiligo (29.9%) were the most common clinical types. Head and neck (68.9%) and extremities (64%) were the most common locations of the lesions. Concomitant autoimmune thyroid disease was seen in 13.5% of the patients. Accompanying autoimmune thyroid disease according to gender was 19.5% in females and 7.4% in males, and there was a statistically significant difference between the groups. It was observed that 89.5% of the patients received treatment for vitiligo, and 10.5% did not receive any treatment. The most commonly used treatments were found to be topical treatment (76.1%) and topical treatment+phototherapy (14.6%). Conclusion: The epidemiological and clinical characteristics of the patients in our study were similar to other studies in the literature. Concerning the highest prevalence of generalized vitiligo in our study, phototherapy and/or systemic therapy use should have been considered when their use was indicated, and factors precluding their more widespread use could be investigated in other studies.

Relationship between risk factor and clinical type of vitiligo in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital Surabaya

Vitiligo is a skin and mucosa depigmentation condition caused by the loss of functioning melanocytes. Various pathological mechanisms are involved in melanocytes, their full details are often difficult to explain and several risk factors for vitiligo are thought to play a role. This study describe the relationship between risk factors and clinical type of vitiligo. This study is an analytic observational study with a retrospective cross sectional design based on the medical records patients who were treated in Dermatology and Venerology Outpatient Clinic Dr. Soetomo General Academic Hospital Surabaya. The result of this study found 115 new vitiligo patients with the following characteristics were female (53.9%), late adolescence (26.96%) and students (25.22%). The most common risk factors were idiopathic (51.3%) and emotional (28.7%). The most common clinical type was non-segmental vitiligo (53.04%). There was relationship between emotional and the clinical type of vitiligo (p=0.023 p<0.05) and there was relationship between idiopathic risk factors and the clinical type of vitiligo (p=0.019 p<0.05). There was relationship between emotional risk and idiopathic factors with the clinical type of vitiligo that were related to pathogenesis becomes important to understand to identify therapeutic targets and prognostic implications to stop the progression of the disease.

Estimate the Serum Level of IL-17A and TGF-?1 1 in Iraqi Generalized Vitiligo Patients

Vitiligo is an acquired idiopathic skin disease characterized by white macules result from the destruction ofmelanocytes. Several cytokines have been implicated in the pathogenesis of vitiligo, keeping this in viewthe current study aimed to evaluate the serum levels of IL-17A and TGF-?1 in 25 patients with generalizedvitiligo and compared them with healthy individuals in order to investigate whether these cytokinesimbalances plays a role in the pathogenesis of this depigmentary disorder. Results of the present studyshowed that the serum level of IL-17A in vitiligo patients was increased significantly (p? 0.05) while theserum level of TGF-?1 was decreased significantly (p? 0.05) as compared with healthy control. Accordingto the gender of patients, males had a slightly non-significant increased (p<0.05) in the level of IL-17A andTGF-?1 as compared with females. Patients with early onset vitiligo had non-significant increased (p<0.05)in the level of IL-17A and TGF-?1 as compared with late onset vitiligo patients. No significant differences(p<0.05) were detected in the levels of IL-17A and TGF-?1 in patients regarding the clinical types of vitiligo,family history and Koebner phenomenon. Patients with active disease had a significant increase (p?0.05) inthe level of IL-17A, though a significant decrease (p?0.05) in the level of TGF-?1 was noticed as comparedwith both patients with stable disease and healthy control groups. Serum levels of both IL-17A and TGF-?1have been shown to be negatively correlated with the disease duration (r=-0.174, p=0.405) and (r=-0.057,p=0.788) respectively

CDH1 and DDR1 common variants confer risk to vitiligo and autoimmune comorbidities

The weaker expression of the two main proteins adhering melanocytes to the epidermis basal layer, Epithelial Cadherin (E-cadherin) and Discoidin Domain Receptor Tyrosine kinase 1 (DDR1), has been implicated as one of the aggravating factors in the loss of melanocytes in vitiligo. The present study was designed to assess the association between single nucleotide polymorphisms (SNP) in the genes encoding these proteins, CDH1 and DDR1, and the risk of developing vitiligo. The independent case-control study was conducted on the sample including152 patients with vitiligo and 152 matched controls. A questionnaire was completed for recording demographic and clinical characteristics of vitiligo patients. Venous blood samples were taken from all the subjects. Genotype frequencies were determined for CDHI C/T (rs 10431924) and DDRI A/C (rs 2267641) genes polymorphisms using polymerase chain reaction (PCR) amplification method and Restriction Fragment Length Polymorphism (RFLP) analysis. The CDH1 CC genotype was found to be significantly associated with the risk of developing vitiligo. The results of stratified analysis revealed a correlation between CDH1 CC genotype and late age of onset, clinical type of vitiligo, the absence of autoimmune comorbidities and family history of autoimmune disorders. However, the expression level of CDH1 TT genotype increased significantly in patients with autoimmune comorbidities. There was also a significant relationship between the DDR1 CC genotype and the risk of developing vitiligo. The results of stratified analysis revealed a correlation between DDR1 CC genotype and early age of onset, clinical type of vitiligo and absence of family history of autoimmune disorders. The findings of the study confirm the conjecture previously made in the literature regarding the melanocytes' adhesion deficit as an initial step for pigment loss in vitiligo and emphasize the substantial role of friction and koebner phenomenon in the pathogenesis of vitiligo. Moreover, a probable association can be proposed between the adhesion deficit involved in vitiligo and autoimmune disorders.

Clinical Types of Vitiligo

Clinical Types of Vitiligo

Treatment of Patients with Vitiligo by Intradermal Pricking of Vitiligenous Skin Using Sharp and Blunt Needle

Background: Vitiligo is a well known autoimmune disease, both cell mediated and humeral reaction are implicated in its etiopathogensis. Pricking of marginal pigmented of vitiligo skin to stimulate normal melanocytes to migrate into vitiligenous area and induce new melanogenesis and this is well known mechanism to induce repigmentation and supported by publications. Objective: To use needling technique by using blunt and sharp needle by doing pricking completely white vitiligo skin in order to stimulate residual melanocytes of basal layer and or the melanocytes of outer root sheath of hair follicles to proliferate and induce active melanogenesis. Patients and Methods: This is an interventional, therapeutic, comparative, study that was done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq from April 2014-March 2015. Thirty five patient with vitiligo were enrolled in this study, their ages ranged from 5 - 55 (22.28 ± 12.09) years; 15 patients treated with sharp needle, 2 males and 13 females and 20 patients treated with blunt needle, 4 males and 16 females. All clinical types of vitiligo including the generalized, localized and segmental were treated. The number of vitiligo patches varied between patients and the treated patches by sharp needle were 22 and by blunted needle were 20 patches. In both groups, needling was done geometrically, softly and rapidly in systemic horizontal rows away from pigmented margin and pigmented spot inside the patches and was not repeated. In Group A needle gauge 18 hold at 45° to skin surface and the distance between each pricking was 5 - 10 mm and similarly was done in Group B by using blunt needle. Each patient was advised to have daily sun light exposure for at least 15 min. Measuring the surface area of the lesions and calculating the reduction rate was done by using transparent with square paper and this was carried out every month till the end of the 4th month period of the treatment. All patients in both groups were evaluated every 2 weeks for the 1st month and then monthly for 3 months and the rate of reduction in surface area was measured. Also to record any side effects and complications. Results: After 2 week, 2 months, and 4 months of treatment, there was 0.5%, 4.31%, and 10% respectively reduction in the surface area of lesions in Group A, while in Group B, there was 7%, 18.42%,and 13.5% respectively reduction in the surface area. Conclusions: Pricking the vitiligo skin by needle, gauge 18 gave success rate 10% and 13.5% at four months after therapy and needling could be repeated once a week to accelerate melanogenesis and until get complete repigmentation.

Implication of serum zinc level with duration and clinical type of vitiligo

Background: Vitiligo is a common dermatological disorder characterized by acquired, idiopathic, progressive, hypomelanosis of the skin and hair, with total absence of melanocytes microscopically. Objective: The study was conducted to find out the relationship between serum zinc level and clinical spectrum of vitiligo. Methods: A cross sectional study conducted in the departmenl of Dermatology and Venereology and department of Biochemistry, Bang­abandbu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh and the period of study was from May 2010 to October 2011. Results: The mean difference of sernm zinc level in male and female of both groups were significant (p<0.05) but the mean serum zinc level was not significantly different (p>0.05) among various clinical types ofvitiligo. ln case oflocalized vitiligo mean serum zinc level was 755.3 ± 288.6, in case of acrofacial viriligo mean serum zinc level was 821.4 ± 259.6 and in case of generalized vitiligo mean sernm zinc level was 771.6 ± 222.2. The difference of mean sernm zinc level observed between family history positive and negative group were not statistically significant (p>0.05). The difference of mean senun zinc level was also not statistically significant (p>0.05) among <1 year, 1-10 years and 11-20 years duration groups of vitiligo patients. A negative correlation (r = -0.227) was observed between duration of symptom with senun zinc level in this study. Conclusion: This study showed low level of serum zinc in vitiligo patients. Large-scale studies are needed to confirm these findings and multicenter study should be carried out to reveal the accurate pattern of zinc status in vitiligo.

Evaluation of the correlation between serum levels of vitamin D and vitamin D receptor gene polymorphisms in an Egyptian population

Vitiligo is an autoimmune depigmentation disorder. Polymorphisms in the vitamin D receptor (VDR) have been found to be associated with vitiligo. To evaluate the potential association between VDR gene polymorphisms (ApaI, TaqI, and FokI) and vitiligo susceptibility, and to detect if there is correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and vitiligo and between VDR gene polymorphisms and 25(OH)D levels in vitiligo. Seventy-five patients with vitiligo and 75 age and sex-matched controls were subjected to detailed history taking and dermatological examination to determine the extent and clinical type of vitiligo. A blood sample (5 ml) was retrieved to investigate VDR gene polymorphisms and serum 25(OH)D level. Our results showed that the serum level of vitamin D is statistically significantly lower in patients than controls. The frequency of the ApaI variant a allele, the variant genotype (aa), and the variant genotype (tt) were significantly higher among the vitiligo cases than among controls. Our study also showed that the serum 25(OH)D levels were not significantly different among the different ApaI, TaqI, and FokI genotypes. The present study showed that serum level of 25(OH)D is statistically significantly lower in patients than controls, so screening for vitamin D deficiency seems of value in patients with vitiligo for the possibility of vitamin D supplementation. We also report that VDR gene polymorphisms may be a risk for the development of vitiligo in an Egyptian population.

Relationship between autophagy of melanocytes in patients with vitiligo and clinical types

To evaluate autophagy of melanocytes and its mechanism in patients with vitiligo and to analyze its correlation with clinical types of vitiligo. Nine cases of segmental vitiligo (SV) and 11 cases of generalized vitiligo (GV) were recruited in Hangzhou Third Hospital between May 2014 and June 2015. Six people with healthy skin were recruited as controls. Epidermal melanocytes were obtained from the normal colour skin around the white spot area in SV and GV patients and from foreskin in controls for culture in vitro. Cultures for each group contained negative control and rapamycin (30 nmol/L) sub-groups. The autophagy was observed using transmission electron microscopy (TEM) and immunofluorescence laser scanning confocal microscope (LSCFM). Protein expressions of microtube-associated protein light chain 3 (LC3Ⅱ) and microphthalmia-associated transcription factor (MITF), tyrosinase (TYR), tyrosinase related protein (TYRP)1, and TYRP2 were detected by Western blot. (1)Autophagy of melanocytes was observed under TEM and LSCFM in both SV and control groups before rapamycin treatment, but not in GV patients. The expressions of autophagosome and LC3Ⅱ protein were increased in melanocytes in SV, GV and control groups after autophagy induction(SV group 0.58±0.10 vs 0.37±0.06; GV group 0.57±0.16 vs 0.22±0.08; control group 0.67±0.09 vs 0.46±0.12), and the autophagy intensity was higher in the GV group compared to the SV group and the control group. (2)Before autophagy induction, the expressions of MITF, TYR, TYRP1, and TYRP2 protein were lower in the GV and SV patients compared with the control group; after autophagy induction, the expressions of MITF, TYR, and TYRP1 statistically significantly increased in melanocytes in all the three groups(all P<0.05), while TYRP2 protein expression was not significantly changed (all P>0.05). Autophagy of melanocytes may be present in vitiligo and affect the expression of functional molecules, and is related with clinical type of vitiligo.

Profile of childhood vitiligo with associated ocular abnormalities in South India

Background: Vitiligo is a systemic autoimmune disease due to the loss of melanocytes from the epidermis. Very few reports in the literature are available about the ocular findings and associated cutaneous abnormalities in childhood vitiligo. Aims: Objective of this study was to evaluate the ocular findings, various clinical characteristics and associated cutaneous abnormalities of childhood vitiligo. Materials and Methods: We retrospectively analyzed the clinical data of children with vitiligo who presented to the Dermatology Outpatient Department from August 2011 to August 2014. All patients were assessed for the natural history, clinical characteristics, family history, and associated ocular and cutaneous abnormalities. Results: Of the total 180 children with vitiligo studied, 64 (35.6%) were boys and 116 (64.4%) were girls. The mean current age of the children visiting our hospital was 8 years. History of trauma prior to the onset of vitiligo was present in 13 patients (7.2%). The family history of vitiligo was present in 37 patients (20.6%). Most common clinical type of vitiligo seen in our patients was vitiligo vulgaris (n = 68, 37.8%), followed by segmental (n = 41, 22.8%). The most common site of initial lesion was head and neck followed by lower limbs. Leukotrichia was seen in 65 patients (36.1%), while Koebner phenomenon was observed in 48 children (26.7%). Vitiligo disease activity (VIDA) score of +4 was most commonly seen in 108 patients (60%), followed by +3 seen in 20 patients (11.1%). VIDA score 0 and −1 were seen in 15 (8.3%) and 22 (12.2%) patients, respectively. Cutaneous associations with vitiligo were found in 24 patients (13.3%). These were halo nevi in nine patients (5%), atopic dermatitis in six patients (3.3%), alopecia areata in four patients (2.2%), premature canities in three patients (1.7%), and nevus depigmentosus and lichen nitidus in one patient each (0.6%). Thirty-eight patients (21.1%) were found to have periocular depigmentation. Depigmented spots in the iris were seen in two patients (1.1%). Other findings were lamellar cataract and persistent papillary membrane in one patient each (0.6%). Conclusion: Childhood vitiligo in our study showed preponderance in females. Majority of patients (77.9%) had <5% body surface area involvement. Limited number of patients with ocular findings in comparison with adult population might suggest that childhood vitiligo patients do not have ocular pigmentary abnormalities in the beginning, but as they age or as the disease progresses they may develop ocular pigmentary changes. Anatomical localization of vitiligo to periorbital area may alert us to look for ocular findings.

Immunohistochemical Study of Melanocyte–Melanocyte Stem Cell lineage in Vitiligo; A Clue to Interfollicular Melanocyte Stem Cell Reservoir

ABSTRACTThere has been a long lasting controversy over whether melanocytes (MCs) in vitiligo are actually lost or still present but functionally inactive. We aimed to evaluate the MC cell lineage in follicular and interfollicular vitiliginous epidermis through immunohistochemical localization of Human Melanoma Black-45 (HMB-45) and Tyrosinase Related Protein 2 (TRP2) and to correlate it with clinicopathologic parameters. Using immunohistochemical techniques, skin biopsies from 50 vitiligo patients and 20 age- and gender-matched healthy subjects were examined. Differentiated active MCs were detected in 44% of interfollicular epidermis (IFE) and 46.7% of follicular epidermis (FE) in lesional skin. Melanocyte precursors/stem cells were detected in 54% of IFE and 63.3% of FE in lesional skin. Melanocyte precursors/stem cells of IFE were significantly associated with residual melanin pigment (p = 0.007) and with absence of angiogenesis (p = 0.05). HMB-45 percentage of expression in IFE was positively correlated with MC precursors/stem cells percentage in FE (r = +0.65, p < 0.001) and IFE (r = +0.33, p = 0.01). Melanocyte precursors/stem cells positivity (p < 0.001) was progressively decreasing with advanced histopathologic grading. There was no significant association between interfollicular or follicular expression of HMB-45, TRP2 or MC precursors/stem cells and the clinical type of vitiligo or its duration. In conclusion, functioning MCs may exist in vitiligo. The presence of MC precursors/stem cells in IFE may provide an additional reservoir needed for repigmentation.

Study of vitiligo repigmentation with systemic and topical unani formulations – an open label clinical study

Vitiligo affects about 0.1–8% of the world population [1]; being a cosmetic problem needs more attention as it leads to social isolation and psychological discomfort [2]. The efficacy of compound Unani formulation UNIM 004 and UNIM 005 (coded) both systemic and topical was studied in an open label study. 2020 patients were treated and evaluated for their regimentation pattern in relation to different clinical types of Vitiligo as non dermatomal, acrofacial and mixed Vitiligo (Generalized), segmental, mucosal and focal Vitiligo (localized) and were evaluated initially after 3 months and subsequently once in 2 months for total period of 9 months. Response to the treatment was recorded as follicular and peri-lesional repigmentation in relation to age, duration of disease, extention and distribution of lesions. The Mixed and nondermatomal Vitiligo has responded well 41.11±19.65 and 39.50±18.69 mean percent of repigmentation respectively (p<0.001) than acrofacial Vitiligo 35.17±19.50 among generalized type, whereas focal and segmental Vitiligo had responded better i.e. 42.72±23.26 and 36.20±18.93 mean percent of repigmentation respectively which is better than mucosal Vitiligo 34.55±19.15 among localized type (p<0.05).

Study of Vitiligo Repigmentation with Systemic and Topical Unani Formulations - An Open Label Clinical Study

Vitiligo affects about 0.1–8% of the world population [1]. Because of cosmetic problems, Vitiligo needs more attention because it leads to social isolation and psychological discomfort [2]. The efficacy of compound Unani formulations UNIM 004 and UNIM 005 (coded) both systemic and topical effects were studied in an open label study. 2020 patients were treated and evaluated for their regimentation pattern in relation to different clinical types of Vitiligo as non dermatomal, acrofacial and mixed Vitiligo (Generalized), segmental, mucosal and focal Vitiligo (localized) and were evaluated initially after 3 months and subsequently once every 2 months for a total period of 9 months. Response to the treatment was recorded as follicular and peri-lesional repigmentation in relation to age, duration of disease, extension and distribution of lesions. The mixed and nondermatomal Vitiligo responded well 41±19 and 39±18 mean percent of re-pigmentation respectively (p<0.001) than acrofacial Vitiligo 35±19 among generalized type, whereas focal and segmental Vitiligo responded better i.e. 42±23 and 36±18 mean percent of re-pigmentation respectively which is better than mucosal Vitiligo 34±19 among localized types (p<0.05). Acknowledgments: Thanks to the clinical Research Team of the Central Research Institute of Unani medicine, Hyderabad for conducting clinical trials on Unani Medicines for Vitiligo management. Reference: [1] Alikhan A, Felsten LM, et al. (2011)J Am Acad Dermatol 65(3): 473–91. [2] Ongenae K, Beelaert L, et al. (2006)J Eur Acad Dermatol Venereol 20(1): 1–8.

Direct Melanocytes Transplant from Normal Donor Area into Vitiliginous Recipient Area by Dermabrasion Technique

Background: Vitiligo is an autoimmune pigmentory disorder, that affects all age group that is treated by many medical treatments but some of them might need surgical therapy. Objective: To evaluate the dermabrasion technique in the treatment of vitiligo by direct transfer of melanocytes from the dermabraded normal donor area to the vitiliginous recipient area. Patients and Methods: This is a case interventional study was done in Department of Dermatology/Baghdad Teaching Hospital from February 2011-March 2012. Nine Patients with vitiligo were enrolled in this study with different clinical types of vitiligo including 5 segmental, 2 generalized and 2 localized. The donor and recipient areas were anesthetized at the same time with xylocain alone. Dermabrasion of recipient area was done first by manual abrader and left for few minutes until the oozing was stopped. Then the donor area was similarly dermabraded and the dermabraded tissue including the epidermis and superficial epidermis was immediately transferred into the recipient area and dressing was applied. Removal of the dressing was done after 10 - 14 days from the operative time. Follow up was done every 2 weeks in the first month then monthly for six months to record the result of implantation and repigmentation. Results: The re-pigmentation started one month after the operation as small macules and this increased gradually over time: the mean rate of re-pigmentation was 13% at 2 months, 27.8% at 4 months and 36.78% at 6 months. In addition, sun light exposure was applied to enhance re-pigmentation. The pigmentation was diffuse and not follicular in shape. Conclusion: Direct transfer of melanocytes from normal donor area into vitiliginous recipient area by dermabrasion technique was easy, rapid and non-costly and gave 36.78% mean rate of pigmentation at 6 months follow up and without complications.

Acetylcholine esterase levels in different clinical types of vitiligo in Baroda, Gujarat

Vitiligo is an acquired depigmentary disorder involving a progressive loss of melanocytes from the epidermis and hair follicles. Gujarat has a high prevalence of vitiligo. One of the major hypotheses in the pathogenesis of vitiligo is the neurochemical hypothesis. According to the neural hypothesis neurochemical mediator/s such as acetylcholine secreted by the nerve endings cause the destruction of melanocytes. Acetylcholine esterase (AChE) activity has been found to be lowered in vitiligo patients during the process of depigmentation. We have earlier reported impairment of systemic antioxidant status in Baroda vitiligo patients, and we now show analysis of blood AChE activity in these patients. The study consisted of 121 vitiligo patients and 126 age and sex-matched healthy controls. Acetylcholine esterase activity showed significant decrease in vitiligo patients. However, there is no significant difference in AChE activity in segmental and non-segmental types as well as in active and stable types of vitiligo. The age group 16-25 showed a significant decrease in AChE activity. This study suggests that AChE may be inactivated due to high systemic oxidative stress in these patients. This is the first report showing that AChE may be playing a role in the pathogenesis of vitiligo in Baroda patients.

Increased prevalence of chronic autoimmune (Hashimoto's) thyroiditis in children and adolescents with vitiligo

An increased prevalence of autoimmune (Hashimoto's) thyroiditis in adult patients with vitiligo has been described. This association has scarcely been studied in children. We sought to assess children and adolescents with vitiligo for autoimmune thyroid disorder and to identify any predisposing factors of this association. In all, 54 children and adolescents (23 boys, 31 girls; mean age 11.4 years) with known vitiligo were studied by physical examination and laboratory studies. Four patients with vitiligo were already known to have Hashimoto's thyroiditis. In 9 of the remaining 50 patients, autoimmune thyroiditis was revealed at the time of the investigation. Of the 54 patients with vitiligo, 13 (24.1%) had autoimmune thyroiditis as compared with 9.6% of school-aged children from an iodine-replete area of Greece ( P = .002). There was no association between thyroiditis and clinical type of vitiligo, age at onset, mean duration of vitiligo, or sex. Hashimoto's thyroiditis is 2.5 times more frequent among children and adolescents with vitiligo than in a healthy age- and sex-matched population. It usually follows the onset of vitiligo. We propose that children and adolescents with vitiligo should be screened annually for thyroid dysfunction, particularly autoimmune thyroiditis.

Clinical profiles of vitiligo in China: an analysis of 3742 patients

Very few articles have aimed to illuminate the clinical profiles of vitiligo in China. We conducted this retrospective survey involving 4118 outpatients with vitiligo in order to identify the differences among various clinical types of vitiligo and their associated disorders. Completed questionnaires (3742) were validated and analysed. Of this large cohort, 1565 (41.8%) individuals presented vitiligo vulgaris, followed by focal, segmental, acrofacial, and universal, in that order. The mean age of vitiligo onset was 18.88 years. More than 60% of the patients were affected before 20 years of age. Patients with segmental vitiligo were affected earlier than those with other types of vitiligo (15.55 years; (P < 0.001). More than 74% of the patients presented with focal vitiligo at onset. After 3-5 years, 99% of active vitiligo was worse and shifted from one clinical type to another. However, there was no transformation between acrofacial vitiligo and segmental vitiligo. Compared with the general population, the patients with vitiligo were more likely to be affected by rheumatoid arthritis (P < 0.01), ichthyosis (P < 0.01), chronic urticaria (P < 0.01), or alopecia areata (P < 0.01).

Oral trimethylpsoralen in the treatment of vitiligo

One hundred and 18 children with various clinical types of vitiligo, were treated with oral trimethylpsoralen (Trisoralen, P. B. Elder Co.) followed by exposure to sunlight or an artificial ultraviolet radiation source. In 61 of the adult patients, more than 80% of the vitiliginous areas became repigmented, 18 patients re-pigmented 50-80%, 13 repigmented less than 50% and 8 patients failed to repigment at all. In all of the children, more than 80% of the treated vitiliginous patches became repigmented. No side effects were observed. A follow-up study of the retention of the new pigment revealed that 72 adults (out of 76 followed-up) and 10 children (out of 11) without any treatment had retained 95% or more of the new pigment, 18 months after the completion of treatment. Oral trimethylpsoralen is therefore suggested for the treatment of vitiligo.

Oral trimethylpsoralen in vitiligo in children: a preliminary report.

Summary.— Oral trimethylpsoralen was given to 12 children with different clinical types of vitiligo in a dosage of 5–10 mg daily, followed by exposure to sunlight. The response to this therapy was favourable. Vitiligo areata responded the best as compared to the other types. No cutaneous or systemic side effects were seen. Trimethylpsoralen is therefore recommended for the treatment of vitiligo in children.