Depigmented Lesions Research Articles

Decreased Neutrophil-to-lymphocyte Ratio in Patients with Vitiligo: National Data Analysis.

Vitiligo is characterized by depigmented skin lesions involving melanocyte defects and immune dysregulation. Haematological markers like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been explored in various skin disorders. Given vitiligo's proposed pathogenesis, we hypothesized differences in NLR and PLR in vitiligo patients compared to controls. In a national retrospective cohort study (2005-2020) in Israel, blood count data from patients diagnosed with vitiligo (ICD-10 codes) were analysed, excluding patients with recent infections, surgeries, or malignancies. Controls matched for age and sex were selected. Sub-analyses examined age groups, treatment type, and matched controls. Children (n = 3,796) and adults (n = 38,608) with vitiligo showed significant differences in gender distribution, cell counts, and ratios. Vitiligo patients (n = 38,358) exhibited lower NLR, decreased neutrophils and platelets, and increased lymphocytes compared with controls. Non-systemically treated vitiligo patients (n = 33,871) displayed lower NLR and neutrophils compared with matched controls. Systemically treated vitiligo patients (n = 4,487) showed lower NLR, higher PLR, and reduced lymphocytes. Logistic regression identified associations between increased lymphocyte and platelet counts and being systemically treated. This study highlights significant haematological differences in vitiligo patients, emphasizing the potential utility of NLR as an accessible tool for vitiligo assessment. Further investigations are warranted to elucidate the roles of neutrophils and lymphocytes in vitiligo pathogenesis.

The many faces of autoimmune-mediated melanocyte destruction in melanoma.

Melanoma is the most severe form of skin cancer with an incidence that is increasing all over the world. Melanoma cells derive from normal melanocytes and share different melanocyte-specific antigens, the same antigens against which an immune reaction develops in vitiligo, a skin disease characterized by autoimmune-mediated melanocyte destruction. The purpose of this review is to present the autoimmune-mediated melanocyte destruction associated with melanoma development, progression and treatment. Patients with vitiligo seem to have a lower chance of developing melanoma. On the other hand, patients with melanoma can develop depigmented lesions even at distant sites from the primary tumor, defined as melanoma-associated leukoderma (MAL). Drug-associated leukoderma (DAL) was also described in melanoma patients treated with immunotherapy or targeted therapy and it seems to be a favorable prognostic factor. Clinically, MAL and DAL can be diagnosed as vitiligo and there are few differences between these three entities. In this review, the incidence of DAL in melanoma patients treated with different therapies was researched in the literature and patient outcome was recorded, with studies showing a prolonged disease-free survival in melanoma patients with DAL, treated with immune checkpoint inhibitors. Further studies are however needed to understand the dynamics of autoimmune-mediated melanocyte destruction.

Hair regrowth in alopecia areata and re-pigmentation in vitiligo in response to treatment: Commonalities and differences.

Both alopecia areata (AA) and vitiligo share common pathogenesis involving, interferon-γ (IFN-γ) and interleukin-15 (IL-15) signalling pathways that activate cytotoxic CD8+ T lymphocytes. These shared mechanisms may explain why both diseases respond to currently available treatments (e.g. topical/systemic corticosteroid) and emerging treatment modalities. As compared with the speed of re-pigmentation in vitiligo lesions, the regeneration of pigmented terminal hair follicles in AA lesions appears fast in response to treatments targeting the inhibition of the Janus kinases (JAKs) and other kinases. We summarize the commonalities and differences between AA and vitiligo focusing on the treatment modalities, followed by recent findings associated with hair follicle stem cells (HFSC) in hair bulge (HBg) and melanocyte stem cells (McSC) in HBg and hair germ (HGm). We then discuss how HFSC and HGm-McSC are involved in the initiation of anagen phase, followed by pigmented terminal hair regrowth in the recovering AA lesions in association with immunology. We also discuss how HBg-McSC contribute to the migration of fully dendritic mature melanocytes into interfollicular epidermis and the equal distribution of melanin in recovering vitiligo lesions. Finally, we present four hypotheses to elucidate the delayed distribution of melanin by mature melanocytes in depigmented vitiligo lesions from the aspects of stem cell biology, as compared with quick hair recovery in AA: (1) McSC are less abundant than HFSC. (2) McSC require a long travel, whereas HFSC reside close to hair regeneration trigger point. (3) Keratinocyte scaffold to accept melanin is not well preserved, whereas scaffold for hair regrowth is well preserved. (4) Inhibitors targeting JAKs and other kinases have less direct effects on melanocyte proliferation and differentiation in vitiligo than hair regrowth in AA. Our review provides an overview of treatment modalities and bridges the gap between scientific advancement and clinical practice in AA and vitiligo management.

Clinical and dermoscopic patterns of idiopathic guttate hypomelanosis

Depigmented skin lesions are of great concern in society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically. IGH is one of the common causes of acquired leukoderma. It is also called disseminated lenticular leukoderma. The etiology is yet not clearly delineated, probably multifactorial. Various etiological factors have been proposed including ultraviolet (UV) exposure, post-phototherapy (psoralen and UVA monotherapy, narrowband-UVB), aging, genetic factors, trauma, and autoimmunity. Clinically, it is characterized by multiple, discrete porcelain-white round to oval macules of 2–5 mm average size. It most commonly occurs in the elderly. The most common sites observed are chronically sun-exposed areas such as the arm, pretibial regions, and forearm extensors. It is not easy to differentiate IGH from other hypo and depigmented conditions such as vitiligo, pityriasis versicolor, extragenital lichen sclerosus et atrophicus, guttate morphea, and post-inflammatory hypopigmentation. It poses a diagnostic challenge to dermatologists. One has to differentiate depigmented lesions from vitiligo as it carries tremendous social implications as social stigma, especially in India. Research on dermoscopic evaluation is uncommon in the literature, despite the abundance of clinic-epidemiological and histological studies of IGH. Four dermoscopic patterns, namely, petaloid, amoeboid, feathery, and nebuloid have been described. These patterns are specific to IGH and help clinicians to differentiate many depigmented skin lesions from IGH in clinical practice. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium.

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.

100 Most-Cited Articles in Vitiligo: A Bibliometric Analysis.

Vitiligo is a skin disease affecting melanocytes, characterised by the development of depigmented skin lesions. We used bibliometric analysis (BA) to identify high-quality research articles on vitiligo using criteria such as total citations, annual citations (AC) and journal impact factors. We extracted the 100 most-cited articles on vitiligo using the Web of Science database and analysed the results using Microsoft Excel 2019. Our search was limited to manuscript titles or abstracts containing the keyword 'vitiligo'. The data extracted information such as title, author, year of publication, journal of publication, total citations and research area. We also calculated the AC rate to account for bias. A total of 6,189 studies were retrieved. The 100 most-cited articles were published between 1976 and 2017. Of those, 75 were original articles, with the research foci being mainly pathogenesis (29%) and treatment (26%). The US was the most prolific publisher overall. We separately retrieved the highest cited data from 2018 to 2022 and tabled the top 10. Of those, 50% were original articles. Our BA shows that developed countries published most of the vitiligo literature. Additionally, recent research has focused on targeted treatment approaches. We also highlight the increasing paediatric vitiligo research, specifically regarding therapies.

Management of the refractory vitiligo patient: current therapeutic strategies and future options.

Vitiligo is an autoimmune disease that leads to disfiguring depigmented lesions of skin and mucosa. Although effective treatments are available for vitiligo, there are still some patients with poor responses to conventional treatment. Refractory vitiligo lesions are mostly located on exposed sites such as acral sites and lips, leading to significant life stress. Understanding the causes of refractory vitiligo and developing targeted treatments are essential to enhance vitiligo outcomes. In this review, we summarized recent treatment approaches and some potential methods for refractory vitiligo. Janus kinase inhibitors have shown efficacy in refractory vitiligo. A variety of surgical interventions and fractional carbon dioxide laser have been widely applied to combination therapies. Furthermore, melanocyte regeneration and activation therapies are potentially effective strategies. Patients with refractory vitiligo should be referred to psychological monitoring and interventions to reduce the potential pathogenic effects of chronic stress. Finally, methods for depigmentation and camouflage may be beneficial in achieving uniform skin color and improved quality of life. Our ultimate focus is to provide alternative options for refractory vitiligo and to bring inspiration to future research.

The Effect of Free Radicals on Vitiligo

Vitiligo is a depigmentation disorder that is commonly found in the community. The causes of vitiligo are multifactorial such as genetic and environmental factors accompanied by the presence of non-specific and specific immune system factors. Melanocytes are the main target exposed by reactive oxygen species (ROS) during the process of melanogenesis. Such exposure can cause loss of homeostasis and cell death and has implications for vitiligo. Clinical manifestations of vitiligo are generally white depigmented macular lesions that are well demarcated. Based on its distribution, vitiligo can be divided into segmental and non-segmental vitiligo different in terms of prognosis, treatment and resolution of vitiligo.

A clinico-epidemiological study of hypopigmented and depigmented lesions in paediatric age group

Hypopigmentary and depigmentary lesions are very commonly encountered group of dermatosis in pediatric age group.: To evaluate the epidemiology and clinical characteristics of various hypopigmented and depigmented lesions in patient of paediatric age group. : A total number of 124 children between age group 0-18 years who presented to dermatology OPD with hypopigmented and depigmented lesions were assessed and evaluated.: In this study, most common causes of hypopigmented disorders among the children are Pityriasis Alba (25.7%) followed by Pityriasis versicolor(21.96), Polymorphous light eruption & vitiligo. Pigmentary disorders are very commonly encountered group of dermatoses in paediatric age group. Among pigmentary disorders, hypopigmented lesions are more common and are frequent cause of consultation. In this study most common causes of hypopigmented disorders among the children are Pityriasis Alba followed by Pityriasis versicolor, Polymorphous light eruption & vitiligo.

Taking a “U-TURN” on the Road to Treating a Difficult Depigmented Lesion

Taking a “U-TURN” on the Road to Treating a Difficult Depigmented Lesion

Coexistence of Genital and Extragenital LSA with Dermoscopic Features

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis, primarily involving the anogenital region, and sometimes extragenital sites (15–20%). Rarely, patients can present with only extragenital lesions (2.5%). A 50-year-old female presented with depigmented lesions on vulva, bilateral knees and legs for 1½ years. Dermoscopy showed patchy white structureless areas with follicular plugs and histopathological examination revealed focal vacuolar degeneration of the basal layer and hyalinisation in the papillary dermis, with mild perivascular lymphohistiocytic inflammation, helping confirm the diagnosis of genital and extragenital LSA. Thus, the authors elaborate the rarity of coexistence of genital and extragenital LSA in a single patient and the use of dermoscopy as a tool in its diagnosis.

Platelet-Rich Plasma Injection Versus Combined Fractional Carbon Dioxide Laser with Platelet-Rich Plasma in Treatment of Vitiligo: A Comparative Study

Vitiligo is an acquired skin disorder characterized by depigmented macules and patches due to the loss of functioning melanocytes in the skin, with a global prevalence around 1%. Vitiligo does not produce direct physical impairment; however, it has a negative social and psychological impact on the afflicted patients when the depigmented lesions occur in exposed areas, such as face, neck, and extremities.

Burden of vitiligo on Chinese patients: an online survey.

Burden of vitiligo on Chinese patients: an online survey.

Clinicodermoscopic Study of Idiopathic Guttate Hypomelanosis at a Tertiary Care Hospital in Central India

Introduction: Depigmented skin lesions are commonly encountered in day-to-day practice and can cause significant social stigma. They are challenging to diagnose clinically and histopathologically. Idiopathic Guttate Hypomelanosis (IGH), a pigmentary condition commonly affecting older individuals, can lead to cosmetic deformity and have a significant psychological impact. Dermoscopic evaluation offers a quick and easy way to resolve diagnostic confusion and prevent unnecessary biopsies. Aim: To study the clinical and dermoscopic features of IGH. Materials and Methods: This cross-sectional observational study was conducted in the Department of Dermatology, Venereology, and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh (MP), India from July 2021 to June 2022. A total of 180 patients with IGH lesions underwent a detailed clinical history, dermatological and systemic examinations, followed by dermoscopic examination. The collected data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the results were tabulated in terms of distribution, frequency, and mean±Standard Deviation (±SD). Results: Among the 180 patients, the most affected age group was 51-60 years. A total of 108 (60%) were females and 72 (40%) were males. The most common site of involvement was the distal part of the lower extremity in 152 (84.4%) cases, followed by the distal part of the upper extremity in 115 (63.8%) cases. A total of 46 (25.5%) patients had a history of excessive sun exposure. Additionally, 21 (11.6%) patients had other associated features of photoaging, such as xerosis, solar lentigo, seborrhoeic keratosis, freckles, and actinic keratosis. The most common dermoscopic pattern observed was amoeboid in 103 (57.2%) patients, followed by feathery in 41 (22.7%), petaloid in 23 (12.7%), nebuloid in 13 (7.2%), and a combination of patterns in six percent of patients. Conclusion: The IGH was more common in females and older age groups, with the distal parts of the lower extremity being the most frequently involved site. Excessive sun exposure was a common risk factor for IGH, and several patients may have associated signs of photoaging. The most common dermoscopic pattern observed was amoeboid. Therefore, clinical dermoscopic examination can be helpful in identifying IGH and differentiating it from other depigmented lesions.

Piebaldism with Neurofibromatosis-1 with Skeletal Anomalies in Two Successive Generations

Piebaldism is a rare autosomal dominant disorder characterized by the congenital absence of melanocytes in affected areas of the skin and hair due to mutations of the c-KIT gene on chromosome 4q12. Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder. We present a case report of three siblings with piebaldism with neurofibromatosis-1. They presented with depigmented lesions over the abdomen and knees since birth. Two of them had white forelock of hair. The oldest sibling had gait abnormality, scoliosis, and reported repigmentation over the forehead lesion. Along with that, multiple café-au-lait macules were present in all the three siblings of size more than 5 mm in diameter and more than 6 in number. Their father had a history of similar depigmented macules over both shins and he also developed freckles over the axilla, palms, and feet. Diagnosis of piebaldism and NF1 was based on clinical features, and the National Institute of Health Consensus Conference in 1987 has given seven diagnostic criteria.

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

522 T cell tissue responses and spatial profiling of vitiligo skin

Vitiligo is an inflammatory disease that presents as well-demarcated, depigmented skin lesions. While different mechanisms are implicated in the development and maintenance of vitiligo lesions, immune-mediated destruction of melanocytes has been ascribed the major mechanism of depigmentation. We have previously observed enrichment of cytotoxic resident CD49a+ CD103+ T-cells in the skin of vitiligo patients and recent single cell data highlights crosstalk between CD8+ effector and Treg cells within the lesion, as well as a subclinical state of activation in the non-lesional skin.

503 Decreased non-melanoma skin cancer prevalence in vitiligo patients: A protective role for the P53 pathway?

Non-melanoma skin cancer (NMSC) represents the most frequent type of cancers among Caucasians. Consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which both develop in the epidermis of the skin. The incidence of NMSC has increased by 33% over the past 10 years. The steadily increasing number of cases continue to cause burden to society and health care. Vitiligo is an autoimmune disease characterized by white depigmented skin lesions due to local loss of melanocytes. We showed the protective effect of vitiligo against melanoma and clinical and epidemiological data suggest that vitiligo may also suppress NMSC.

34612 Exploring the natural history of vitiligo in the United States: Findings from the VALIANT study

Vitiligo is a chronic autoimmune disease characterized by the destruction of melanocytes, resulting in depigmented skin lesions. Epidemiology studies in vitiligo are often limited to smaller sample sizes and rely on dermatology clinics as the source population. The population-based Vitiligo and Life Impact Among International Communities (VALIANT) study sought to understand the natural history of vitiligo among patients around the world. Here, data from US participants are presented. Participants were recruited via an online panel.

Efficacy of adjuvant therapy gingko biloba extract on vitiligo treated by topical desoximetasone to melanin index and vasi score

Ginkgo biloba (GB) has anxiolytic properties, which can help to prevent the spread of vitiligo lesions. The purpose of this study was to examine the efficacy of adding orally and placebo GB extract as adjuvant therapy in treating depigmented lesions in vitiligo patients. This research is an experimental study with samples of vitiligo patients at the Dermatology and Venereology Polyclinic, RSUD Dr. Moewardi, Surakarta, Central Java, Indonesia. This study involved 23 patients aged 18-60 years. The sample met the inclusion criteria: routine control patients with stable non-segmental vitiligo with less than 20% lesions and not receiving therapy for the past four weeks. Research subjects were divided into two groups using a capsule containing 60 mg of GB extract and a placebo. The data were processed by statistical analysis using the SPSS and the Mann-Whitney test with a significance P-value <0.05. The results showed that the administration of GB was able to significantly reduce the melanin index in vitiligo patients at week 12 (p = 0.003 < 0.05).