Depigmentation In Patients Research Articles

Hair depigmentation in a patient treated with pazopanib: A case report and a comprehensive analysis

Pazopanib is a multitargeted tyrosine kinase inhibitor used for the treatment of various solid tumor malignancies. Hair color change, particularly hair depigmentation, is a common side effect of pazopanib therapy. However, it usually develops gradually over a span of few months. This article will provide a comprehensive analysis of hair depigmentation in patients treated with pazopanib, focusing on the various aspects of this phenomenon, including its onset, possible causes, and potential implications for therapy success. Multitargeted tyrosine kinase inhibitors (MKIs) including pazopanib are recommended for various malignancies. Hair color changes are known side effects of MKIs. The exact mechanisms behind hair depigmentation due to pazopanib therapy are not yet fully understood. However, researchers believe that several factors may contribute to this phenomenon. We presented a case of a patient with relapse Ewings sarcoma who experienced rapid hair depigmentation during pazopanib therapy.

Objective evaluation of choroidal melanin loss in patients with Vogt\u2013Koyanagi\u2013Harada disease using polarization-sensitive optical coherence tomography

In this study, sunset glow fundus was evaluated in patients with Vogt–Koyanagi–Harada (VKH) disease using polarization-sensitive optical coherence tomography (PS-OCT). We evaluated 40 VKH eyes (20 patients) and 59 healthy eyes (59 age-matched controls). VKH eyes were divided into three groups according to color fundus images: sunset (17 eyes), potential sunset (13 eyes), and non-sunset (10 eyes). Choroidal melanin thickness (ChMeT) and the choroidal melanin thickness ratio (ChMeTratio) were calculated based on the degree of polarization uniformity from PS-OCT. ChMeT was significantly lower in sunset eyes than in non-sunset or control eyes (P = 0.003). The ChMeTratios of sunset or potential sunset eyes were significantly lower than those of non-sunset or control eyes (P = 0.04). Regional evaluation of ChMeT and the ChMeTratio showed that choroidal depigmentation predominantly occurred in the macula’s outer ring area (P = 0.002). The areas under receiver operating characteristic curves discriminating combined sunset (sunset and potential sunset) from non-sunset eyes were 0.983 and 0.997 for ChMeT and the ChMeTratio, respectively. Time course evaluation of 12 eyes from disease onset showed that ChMeT and the ChMeTratio significantly decreased over time. PS-OCT may be useful for objectively evaluating choroidal depigmentation in patients with VKH disease.

Immune-Related Adverse Events and Outcomes in Patients with Advanced Non–Small Cell Lung Cancer: A Predictive Marker of Efficacy?

Immune-Related Adverse Events and Outcomes in Patients with Advanced Non–Small Cell Lung Cancer: A Predictive Marker of Efficacy?

Vitiligo-Like Depigmentation in Patients With Stage III-IV Melanoma Receiving Immunotherapy and Its Association With Survival: A Systematic Review and Meta-Analysis

Vitiligo-like depigmentation in patients with melanoma may be associated with more favorable clinical outcome. We conducted a systematic review of patients with stage III to IV melanoma treated with immunotherapy to determine the cumulative incidence of vitiligo-like depigmentation and the prognostic value of vitiligo development on survival. We systemically searched and selected all studies on melanoma immunotherapy that reported on autoimmune toxicity and/or vitiligo between 1995 and 2013. Methodologic quality of each study was appraised using adapted criteria for systematic reviews in prognostic studies. Random-effect models were used to calculate summary estimates of the cumulative incidence of vitiligo-like depigmentation across studies. The prognostic value of vitiligo-like depigmentation on survival outcome was assessed using random-effects Cox regression survival analyses. One hundred thirty-seven studies were identified comprising 139 treatment arms (11 general immune stimulation, 84 vaccine, 28 antibody-based, and 16 adoptive transfer) including a total of 5,737 patients. The overall cumulative incidence of vitiligo was 3.4% (95% CI, 2.5% to 4.5%). In 27 studies reporting individual patient data, vitiligo development was significantly associated with both progression-free-survival (hazard ratio [HR], 0.51; 95% CI, 0.32 to 0.82; P < .005) and overall survival (HR, 0.25; 95% CI, 0.10 to 0.61; P < .003), indicating that these patients have two to four times less risk of disease progression and death, respectively, compared with patients without vitiligo development. Although vitiligo occurs only in a low percentage of patients with melanoma treated with immunotherapy, our findings suggest clear survival benefit in these patients. Awareness of vitiligo induction in patients with melanoma is important as an indicator of robust antimelanoma immunity and associated improved survival.

Metastatic malignant melanoma associated with vitiligo-like depigmentation

Vitiligo-like depigmentation in patients with malignant melanoma is a poorly understood phenomenon. We report a patient who presented with a 4-month history of vitiligo-like depigmentation of the face, trunk and limbs. Physical examination revealed an enlarged left inguinal lymph node. A needle biopsy taken from the lymph nodes revealed metastatic malignant melanoma. One small nodule on the left sole was found subsequently. Despite the absence of junctional activity, it was considered to be a primary tumour with regression of the epidermal lesion. The patient died from sepsis, the main complication of immunosuppressive therapy, without evidence of distant metastasis. We report this case to highlight the importance of careful physical examination of patients with skin hypomelanoses. We also propose that, due to the favourable prognosis in patients with malignant melanomas and vitiligo-like depigmentation, the treatment plan may be more conservative to minimize the adverse effects of chemotherapy.

Accumulation of low-avidity anti-melanocortin receptor 1 (anti-MC1R) CD8+ T cells in the lesional skin of a patient with melanoma-related depigmentation

Spontaneous or therapy-induced depigmentation in patients with melanoma has long been considered a favourable prognostic indicator. In this report, we isolated T cells infiltrating the depigmented skin of an HLA-A2+/DR4+ patient with melanoma, and detected a very high frequency of CD8+ T cells specific for melanocortin receptor 1 (MC1R), a hormone receptor involved in cutaneous pigmentation. In particular, tissue-infiltrating CD8+ T cells dominantly recognized the novel MC1R52-60 peptide epitope in an HLA-A2-restricted manner, and peptide-reactive CD8+ T cells were also detected in freshly isolated peripheral blood from this patient. Although type 1 CD4+ T-cell responses against MC1R were not detected in fresh tissue isolates, short-term in-vitro stimulation of peripheral blood lymphocytes resulted in the rapid expansion of CD4+ T cells reactive against novel HLA-DR4-presented epitopes derived from the MC1R protein (i.e. MC1R82-95, MC1R105-118 and MC1R149-161). MC1R peptide-specific CD8+ T-cell clones isolated from the depigmented skin of this patient were characterized by comparatively low functional avidity for specific major histocompatibility complex-peptide complexes and were poorly lytic; however, these effector cells were capable of secreting both interferon-gamma and granzyme B against relevant target cells in vitro, and may have played an important role in the induction of leucoderma in situ in this patient.