Depigmented Lesions Research Articles

Expression of Melan-A in Depigmented Skin of Vitiligo Patients

Background: Vitiligo is an acquired and commonly found pigmentation disorder characterized by milky-white patches on the skin, hair, and mucosa due to melanocyte damage. The cause of vitiligo is still unclear. A study proves that cell-mediated immunity plays a role in the pathogenesis of vitiligo. Melan-A is a melanoma-related antigen that is recognized by autologous cytotoxic T cells and one of the critical markers for detecting melanocytes. Objective: To evaluate the expression of Melan-A in depigmented lesions of vitiligo patients. Methods: A descriptive study aimed to describe the expression of Melan-A in the depigmented skin of vitiligo patients at the Dermatovenerology Outpatient Clinic Cosmetic Division of Academic General Hospital Dr. Soetomo Surabaya. Eleven study subjects were selected through a sequence of selection. Results: Melan-A expression in the depigmented skin of vitiligo patients was lower than the average. This result was found in 6 (54.55%) out of 11 patients. Conclusion: Melan-A expressions on depigmented skins of vitiligo patients are generally below the average value; therefore, adequate intervention is needed to increase the Melan-A expression.

Dermoscopic approach to hypopigmentary or depigmentary lesions in skin of color

Introduction: Hypopigmented or depigmented lesions are considered as important dermatoses in daily practice. Their accurate diagnosis is very much crucial because of social stigma attached to these diseases in Indian subcontinent. Authors have proposed basic guidelines for dermoscopic assessment in terms of approach to a given hypopigmented/depigmented lesion. The following conditions are dermoscopically described here, they are vitiligo, idiopathic guttate hypomelanosis, lichen sclerosus, pityriasis alba, leprosy, pityriasis versicolor and nevus depigmentosus. Aim: To propose basic dermoscopic guidelines in terms of approach of a hypopigmented/ depigmented lesion in skin of color. Summary: Dermoscopic patterns highly depend on melanin skin layers and thus analysis of dermoscopic patterns in hypopigmented/depigmented lesions is difficult owing to the reduction or absent melanin in the epidermis. All hypopigmented/depigmentary conditions are described based on the 5 dermoscopic parameters which include; i) background colour, ii) vessels, iii) scales, iv) follicular findings and v) specific clues. Glowing white color in vitiligo and pale or dull white color in IGH and white with little brownish color in PA and PV are the different shades of color in the background in dermoscopy. In leprosy, PMH and ND, background color is brownish-white rather white. LSEA, color is white with bluish or pinkish hue is observed. Furthermore, dermoscopic diagnosis should be based on every parameter visible in a given lesion and not in isolation as each pattern or parameter is immensely contributory to the final diagnosis. Conclusion: Thus, dermoscopy aids in the distinction of hypopigmented/depigmentary lesions by demonstrating characteristic and definitive patterns.

Clinical evaluation of the effectiveness of Switra Nashak Churna and Lepa in the management of Switra (vitiligo): A pilot study

Background: All the skin diseases in Ayurveda have been described under the heading of Kushtha. Pigmentation disorder Switra is also considered under Kushtha, as it fulfills the general criteria of Kustha, by causing cosmetic problems. The description of Switra found in Ayurveda texts is very much similar to that of vitiligo mentioned in modern contemporary medicine. According to modern medical science, vitiligo is the most common pigmentation disorder that is characterized by a progressive loss of melanocytes from the epidermis; it manifests as white macules and/ or patches on the skin and/ or mucosa with or without whitening of hair. Though many treatment modalities are available in the modern contemporary system of medicine, most of those treatment modalities are expensive, having serious adverse effects; apart from this, many a time, the output of the treatment is not satisfactory. In Ayurveda, many formulations for internal as well as external use have been mentioned for this condition. So to achieve an effective, safe, and affordable treatment, this study was planned with the drugs that are considered the best in the treatment of Switra. Objective: The objective of the study was to evaluate the effectiveness of Switra Nashak Churna and Lepa in the management of Switra (vitiligo). Materials and Methods: In this clinical study, 25 patients suffering from Switra were given Switra Nashak Churna (Bakuchi beeja and Khadir sara) with Haridra swaras anupana and Switra Nashak Lepa (Bakuchi beeja, Mulaka beeja, and Gomutra) as external application followed by a sun exposer. Out of the 25 patients, 20 completed the treatment for 60 days. Assessment was done before starting the treatment and on the 60th day based on the size and number of depigmented skin lesions. Result: Statistically significant improvement was observed in the patients in terms of the size and number of the skin lesions. Conclusion: It can be concluded that Switra Nashak Churna and Switra Nashak Lepa have been found to be effective in the management of vitiligo. After the assessment on the 60th day, the improvement was found to be significant.

Outcome of Repeated Use of Donor Site for Noncultured Epidermal Cellular Grafting in Stable Vitiligo: A Retrospective Study.

Background Noncultured epidermal suspension (NCES) is a surgical technique which employs cellular grafting onto depigmented lesions. However, scarring and dyschromia at the donor site often occurs. Objective To assess the outcome of reusing the same donor site in subsequent sessions of NCES procedures. Methods Electronic records of vitiligo patients who had undergone two sessions of NCES procedures were retrospectively reviewed. Information on the first and second NCES was retrieved for analyses. Results A total of 30 patients (female 19 and male 11) were included. The majority of patients had nonsegmental vitiligo (66.7%). The median donor-to-recipient ratios were 1 : 3 (1 : 1–1 : 20) for the first session and 1 : 3 (1 : 1–1 : 13.5) for the second session (p=0.661). The mean melanocyte count was 220.7 ± 65.5 cells/mm2 vs. 242.4 ± 55.3 cells/mm2 on the first and second sessions, respectively (p=0.440). The mean repigmentation rate was 84.2% (±21.1%) and 82.3 (±22.1%) for the first and second NCESs, respectively (p=0.645). The frequency of color mismatch and pigment loss were similar between both sessions (p=0.706 and p=1.000). Conclusions Repeated use of donor sites in subsequent NCES sessions gave comparable repigmentation.

An Investigation of the Relationship between Involvement Sites in Vitiligo Patients and Autoimmune Diseases and Hematological Parameters

Aim-Objectives: Vitiligo is an acquired idiopathic disease which progresses with melanocyte destruction and is clinically characterized by depigmented lesions of unknown etiology. Vitiligo may be coexistence with a autoimmune and endocrine disorders. This study examined the sT3, fT4, TSH, Anti-TPO, Anti-Tg, Vitamin B12 and fasting blood glucose (FBG) values, and thrombocyte-to-lymphocyte ratio(TLR), neutrophil-to-lymphocyte ratio(NLR), the mean platelet volume(MPV) the correlation of depigmented lesions with the extent of body involvement sites(IS). Materials and Method: The study enrolled 67 patients aged 0‒65 who were diagnosed with non-segmental generalized vitiligo and in whom an increase in lesions had been observed in the last six months. The IS of the lesions in the patients were evaluated as IS ˂10%(1st group), 10%‒20% (2nd group), 20% - 30%(3rd group), 30% - 40%(4th group), 40% ‒50 %(5th group), and ˃50%(6th group). The control group consisted of patients who had presented to the outpatient clinic having had no history of vitiligo detected in themselves nor in their families. Results: No significant correlation was found between IS and sT3, fT4, TSH, Anti-TPO, Anti-Tg, Vit. B12, PBG or MPV. A moderately positive correlation was found between IS and duration (p <0.05) and a mildly positive correlation between IS and NLR and TLR (p <0.05). Conclusion: This study show that every patient diagnosed with vitiligo, independent of the IS, should undergo examination for autoimmune disease. A mild positive correlation between VTA and NLO-TLO was found to be an indicator of increased inflammation in vitiligo patients as the extent of lesions increased.

Goltz-Gorlin syndrome: a rare cause of ectrodactyly

A 1-year-old female child presented with depigmented lesions on her trunk and extremities since birth. Examination revealed multiple, depigmented, atrophic macules in a blashkoidal pattern involving both halves of the...

Efficacy of 308-nm monochromatic excimer light in the management of halo nevi: An open label, pilot study

Introduction:Halo nevus (HN) affects approximately 1% of the population. Presence of hypo- or depigmented lesion carries tremendous psychosocial disturbance in the mind-set of population in the Indian subcontinent. Hence, HN requires intervention by any modalities. Here authors attempted to evaluate the efficacy of monochromatic excimer light (MEL) in treating HN.Materials and Methods:A total of 29 patients with HN were included in the study. A xenon chloride lamp emitting noncoherent, monochromatic 308-nm light that represents the natural evolution of the excimer laser was used. The initial dose was 100 mJ/cm2, which was increased by 100 mJ/cm2 per session. All the patients were followed up for 6 months.Results:A total of 29 patients with 10 males and 19 females (male to female ratio of 1:1.9) completed the study. The age of onset of HN ranged from 5 to 47 years and the mean age of the patients was 23 years. HN was seen on the face, back, neck, chest, trunk, and extremities in 5 (17.2%), 6 (20.7%), 4 (13.7%), and 6 (20.7%) patients, respectively. Outstanding response was noticed in 14 patients (48.2%), whereas 6 (20.6%) patients showed excellent improvement. Only 2 (6.8%) patients showed no response after 10 consecutive sessions.Conclusion:HN causes apprehension in the Indian population because of the social stigma associated with depigmented patches on the body. Mere observation and only counseling in the treatment protocol are not sufficient. MEL is a noninvasive procedure, which results in excellent repigmentation of HN without scarring.

Low-grade \u201cbenign\u201d birdshot retinochoroiditis: prevalence and characteristics

PurposeTo establish the prevalence, morphologic and functional characteristics and evolution of mild birdshot retinochoroiditis (BRC).MethodsRetrospective review of all BRC cases treated at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland, with at least 3 years of follow-up since the initial symptoms. Sub-Tenon’s injection of triamcinolone was the first line of treatment if visual field changes were unilateral, with no additional treatment if visual field returned to normal. The percentage of patients who did not need systemic therapy was established, and the following parameters were evaluated: demographic characteristics, best-corrected visual acuity (BCVA), fundus photographs, fluorescein angiography (FA) and indocyanine green (ICGA) angiography frames and perimetry evaluation from initial visit to last follow-up.ResultsTwenty cases of BRC were included in this study. Three of these patients (15%) received only local periocular therapy and qualified as mild BRC, with a mean follow-up of 9.3 years. The BCVA was 0.89 ± 0.25 at presentation and 1.0 ± 0.39 at last follow-up. Average visual field mean defect was 5.05 ± 3.27 at presentation and 1.78 ± 0.95 at last follow-up. Depigmented fundus lesions remained stable from presentation to last follow-up. Choroidal inflammatory activity monitored by ICGA decreased from 11.66 ± 3.44 at presentation to 4.25 ± 2.87 at last follow-up. FA revealed mild retinal vasculitis (2.25 ± 3.20) which remained stable (2.00 ± 4.00).ConclusionsIn our setting, 15% of BRC cases had a benign course, controlled with periocular treatment. It is important to identify such cases in order not to overtreat, exposing patients needlessly to potential side effects of aggressive and prolonged immunosuppressive treatment.

Spontaneous Posterior Segment Vascular Disease Phenotype of a Mouse Model, rnv3, Is Dependent on the Crb1rd8 Allele.

PurposeTo determine the molecular basis of lesion development in a murine model of spontaneous retinal vascularization, rnv3 (retinal vascularization 3, aka JR5558).MethodsDisease progression of rnv3 was examined in longitudinal studies by clinical evaluation, electroretinography (ERG) and light microscopy analyses. The chromosomal position for the recessive rnv3 mutation was determined by DNA pooling and genome-wide linkage analysis. The causative mutation was discovered by comparison of whole exome sequences of rnv3 mutant and wild-type (WT) controls. In order to confirm the causative mutation, transcription activator-like effector nuclease (TALEN)-mediated oligonucleotide directed repair (ODR) was utilized to correct the mutant allele. Phenotypic correction was assessed by fundus imaging and optical coherence tomography of live mice.Resultsrnv3 exhibits early-onset, multifocal depigmented retinal lesions observable by fundus examination starting at 18 days of age. The retinal lesions are associated with fluorescein leakage around 25 days of age, with peak leakage at about 4 weeks of age. ERG responses deteriorate as rnv3 mutants age, concomitant with progressive photoreceptor disruption and loss that is observable by histology. Genetic analysis localized rnv3 to mouse chromosome (Chr) 1. By high throughput sequencing of a whole exome capture library of a rnv3/rnv3 mutant and subsequent sequence analysis, a single base deletion (del) in the Crb1 [crumbs family member 1] gene, which was previously reported to cause retinal degeneration 8, was identified. The TALEN-mediated ODR rescued the posterior segment vascularization phenotype; heterozygous Crb1rd8+em1Boc/Crb1rd8 and homozygous Crb1rd8+em1Boc/Crb1rd8+em1Boc mice showed a normal retinal phenotype. Additionally, six novel disruptions of Crb1 that were generated through aberrant non-homologous end joining induced by TALEN exhibited variable levels of vascularization, suggesting allelic effects.ConclusionsThe rnv3 model and the models of six novel disruptions of Crb1 are all reliable, novel mouse models for the study of both early and late events associated with posterior segment vascularization and can also be used to test the effects of pharmacological targets for treating human ocular vascular disorders. Further study of these models may provide a greater understanding about how different Crb1 alleles result in aberrant angiogenesis.

Therapeutic management of vitiligo.

Affecting 0.5% of the world's population, vitiligo is an acquired skin disorder that poses major challenges in terms of dermatological care. Characterized by patchy depigmentation, the disease is frequently associated with cosmetic disfigurement and considerable psychological distress. The primary pathophysiological causes for the loss of functional melanocytes are thought to include genetic predisposition, autoimmune mechanisms, and oxidative stress. The present article highlights treatment recommendations contained in the European guidelines as well as those provided by recent reviews on vitiligo. Current therapeutic options are based on three approaches: (1) Regulation of the autoimmune response using topical and systemic immunomodulatory agents (corticosteroids and calcineurin inhibitors); (2) decrease in oxidative stress in melanocytes by means of topical and systemic antioxidants; and (3) activation of melanocyte regeneration using phototherapy (UVB in particular) and transplantation of pigment cells. In addition, patients should be educated in techniques for cosmetic camouflage. Following successful repigmentation, application of calcineurin inhibitors is recommended to prevent recurrences. Combination therapies of the aforementioned approaches are generally considered to be more successful than monotherapies. Early initiation of treatment is associated with a more favorable prognosis. Using the above treatment options, it may be possible to halt disease progression, stabilize depigmented lesions, and achieve repigmentation. Only in exceptional cases should permanent depigmentation be considered as a possible option. New insights into the pathogenesis of vitiligo will likely give rise to novel therapeutic approaches.

Decreased SUMOylation of the retinoblastoma protein in keratinocytes during the pathogenesis of vitiligo.

The role of SUMOylation in the pathogenesis of vitiligo has not been reported previously. The present study aimed to reveal abnormalities in small ubiquitin‑like modifier (SUMO) conjugation in keratinocytes from depigmented lesions of patients with vitiligo and confirm the role of SUMOylation in keratinocytes from patients with vitiligo. Skin samples used for immunohistochemistry were obtained by punch biopsy from the depigmented lesions of 6 patients. Blisters were produced by vacuum and the roofs were collected for keratinocyte culture. HaCaT cells were transduced with SUMO1 knockdown vectors. The protein expression of SUMO1, SUMO‑specific peptidase1 (SENP1), ubiquitin‑conjugating enzyme E2 I (Ubc9), SUMO‑activating enzyme subunit1 (SAE1), cyclin‑dependent kinase (CDK)2, CDK6, proliferating cell nuclear antigen (PCNA), retinoblastoma protein (Rb), phosphorylated Rb (pRb) and β‑actin was assessed by western blotting. The SUMOylation status of proteins was assessed by immunoprecipitation. Cell cycle analysis was performed by flow cytometry and cell proliferation rate was investigated using a Cell Counting Kit‑8. The results demonstrated that the levels of SUMO1‑conjugated proteins were decreased in vitiligo lesions and vitiligo keratinocytes compared with normal controls. The protein expression of Ubc9 was decreased and SENP1 was increased in vitiligo keratinocytes compared with normal keratinocytes, with no alterations in SAE1 expression. Following knockdown of SUMO1 in HaCaT cells, the proliferation of HaCaT cells was reduced and the cell cycle was arrested in G1 phase. Furthermore, the protein expression levels of PCNA, CDK2, CDK6 and pRb were reduced in SUMO1‑knockdown HaCaT cells, and SUMOylated Rb was also decreased markedly in keratinocytes from lesions of patients with vitiligo compared with normal keratinocytes. In conclusion, vitiligo lesions in the present study exhibited dysregulated SUMOylation and deSUMOylation balance and dysregulation of cell cycle progression may be present in SUMO1 knockdown HaCaT cells. These results indicate that deSUMOylation of Rb of keratinocytes may serve an important role in vitiligo, providing a novel direction for the study into the mechanism of vitiligo.

Validation and discovery of mechanisms that promote vitiligo pathogenesis using single-cell RNA-sequencing of cells isolated from skin interstitial fluid

Abstract Vitiligo is an autoimmune disease in which CD8+ T cells destroy melanocytes, leading to patchy, depigmented lesions of the skin. To investigate possible immune processes in the skin that could explain the patchy appearance of vitiligo inflammation, we performed single-cell RNA-sequencing on cells isolated from the skin using a modified suction blistering technique. We compared the transcriptomes of cells isolated from lesional and non-lesional skin of six vitiligo subjects with active, spreading lesions as well as normal skin from six healthy subjects. Using differential gene analysis to cluster more than 18,000 cell transcriptomes in an unbiased fashion, we were able to identify the cellular components of the skin: melanocytes, keratinocytes, and Langerhans cells, as well as subgroups of immune cells. Consistent with previous findings by our group and others, this approach revealed an IFNγ signature in vitiligo lesions. This method identified 87 ligand-receptor pairs that may promote vitiligo pathogenesis, including CXCR6 and CXCL16 that were just recently implicated in vitiligo. The data set also revealed that Langerhans cells actively express many genes which have known risk alleles for vitiligo, highlighting a potential pivotal role in the development of vitiligo. Overall, single-cell RNA-sequencing of the skin infiltrate in vitiligo lesions is providing robust data that confirms many previous findings, but adds additional layers of nuance missed by conventional studies of bulk material. This level of resolution will yield powerful insight into the identification of novel drug targets in previously unknown signaling pathways in vitiligo and other diseases of the skin.

Impact on Quality of Life in Vitiligo Patients Treated with Narrowband Ultraviolet B Phototherapy.

Context:Vitiligo is a psychosocial problem which significantly affects quality of life in Indian scenario.Aims:The purpose of this study was to compare the changes in quality of life in patients of vitiligo before and after treatment with narrowband ultraviolet B (NBUVB) phototherapy.Subjects and Methods:A total of 54 patients had completed the study. The age ranged between 16 and 70 years with a mean age of 26.77±14.2 years. The initial dose of NBUVB was 300 mJ/cm2 in adults and 150 mJ/cm2 in children twice weekly with 20% dose increment on subsequent visits. It was given for a maximum period of 6 months and was followed up for another 6 months to determine stability of repigmentation.Results:The average number of exposure given to the patients was 45.63±12.74 while the mean irradiation cumulative dose was 39.8 J/cm2. Mean Dermatology Life Quality Index (DLQI) of the vitiligo patients was 8.64±4.32 while those patients with acrofacial vitiligo had a mean DLQI of 11.78±5.61. After treatment with NBUVB, mean DLQI of all vitiligo patients was significantly reduced to 5.86±2.15 (P<0.01).Conclusions:This study showed that phototherapy had a positive therapeutic outcome in vitiligo, especially in younger patients. Even a small, depigmented lesion in a child could be psychosocially devastating.

Aural Plaques in Crossbred Working Horses

Background: The aural plaque is a papillomatosis variant that occurs in the inner surface of the auricular pavilion of equine. The disease is associated with economic losses in the equine sector, since it reduces the commercial value of the severely affected animals. However, there are few studies evaluating the occurrence of aural plaques in different breeds and equine populations in Brazil and in other countries. The aim of the present study was to evaluate the frequency, clinical and histological characteristics of the aural plaques in working horses from Lages, SC, Brazil.Materials, Methods &amp; Results: Seventy-three crossbreed equines were used, including 48 males and 25 females between 1 and 25 years old, and that were used as working horses (traction) in the urban perimeter in the city of Lages, SC. The findings related to breed, age, sex, presence or absence of compatible lesions with aural plaques, anatomical location and lesion characteristics were evaluated and annotated. The lesions were photographed and drawn on paper to determine the size and distribution in the ear and were reevaluated for a period of two months with an interval of 30 days between each evaluation. The number of aural plaques was determined by manual counting in each auricular pavilion, which were divided into four quadrants (left and right upper, right and left lower). When the plaque was located in the median region of the quadrants, it was described in the region of the greatest location. To evaluate the histopathologic features, three equines that bearer typical lesions of aural plate were submitted to a biopsy. The statistical analysis of the data was performed through the descriptive analysis, and the chi-square test was used to identify the relationship between sex, presence or not of aural plaque and anatomical location of the lesions, and Analysis of Variance (ANOVA) followed by the Tukey’s test to determine the most affected quadrant, being accepted a level of significance of 5%. The frequency of affected animals by aural plaques was 56.16% (41/73), being 68% (17/25) females and 50% (24/48) males, with no predilection for sex. The superficial, depigmented and punctate lesions frequently were the most observed, being unilaterals in 63.41% (26/41) and bilaterals in 36.59% (15/41) of the animals. There was a difference for the distribution of the unilateral or bilateral lesions and the upper quadrants of the inner face of the ear frequently were the most affected. The regression of the size or number of plaques was not observed during the period of clinical follow-up. Besides, it was not observed significant increase in lesion size or appearance of new aural plaques during the evaluation period. Pain or itching were not associated with the lesions. The histopathological characteristics consisted in pronounced hyperplasia of the epidermis, deepening to the dermis, diffuse moderate orthokeratotic hyperkeratinization and acanthosis.Discussion: The high frequency of aural plaques in the study may be related to the work environment and breeding of these animals. However, more studies are needed to evaluate the epidemiological characteristics of this disease in raised and used for traction horses in the urban environment. The arrangement of the plaques on the surface of the ear was higher in the regions of the upper quadrants, suggesting that this distribution may be related to the greater exposure and access of the region to the viral transmission through insects and arthropods implicated as vectors. No regression and no increase in size or appearance of the new aural plaques were also described in previous studies. Besides, the absence of pain or itching associated with the lesions confirm which the lesions are asymptomatic. Clinical and histopathological characteristics were similar to those previously described in horses of the other breeds.

Phototherapy for vitiligo, what's new?

Vitiligo is a disorder characterized by the development of depigmented macules and patches. Existing treatments include topical and systemic immunosuppressants, topical vitamin D analogues in monotherapy or in association with phototherapy, phototherapy and surgical techniques, which together may serve to halt disease progression, stabilize depigmented lesions, and encourage repigmentation. Narrow-band UVB (NB-UVB 310-315 nm) radiation is now considered as the "gold standard" for the treatment of diffuse vitiligo. This article provides a brief overview of the different phototherapy based treatments in vitiligo.

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

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

Late onset atopic dermatitis and vitiligo: A case report

Dear Editor, Adult-onset atopic dermatitis (AOAD) (onset >18 years) is a subgroup of atopic dermatitis (AD). This subgroup has been mentioned by Bannister and Freeman from Australia 1 . It may have different morphologic variants. Apart from the most typical flexural localization and eczematous pattern in adults, patients may also have a nonflexural distribution and other morphologic variants such as nummular or prurigo-like pattern 2 . The Hannifin and Rajka criteria can be used to diagnose AOAD 3 . AD is occasionally associated with vitiligo, and patients with vitiligo, especially early onset may appear to have increased risk of AD 4 . We present a rare case with late onset atopic dermatitis and vitiligo. A 16 year old boy suffering from itchy lesions and dryness on his whole body, especially on flexural distributions for 6 months admitted to our out-patient policlinic. He also complained depigmented lesions. No personal history of atopy. His mother has an allergic rhinitis for many years. Dermatologic examination of the patient revealed pruritic dry skin, pilar keratosis, and symmetric lichenified flexural eczema. He has a facial erythema, orbital darkness and Dennie-Morgan folds (Figure 1). Potassium hydroxide preperations were negative. Histopathologic examination of the lesions showed the findings of chronic dermatitis. The diagnosis of atopic dermatitis was made based on Hanifin-Rajka criteria. He has also symmetric depigmented lesions on the popliteal skin area. Wood lamp examination of these lesions revealed blue-white light areas with sharp margins. Haematologic and urine analysis, including IgE, ANA and antithyroid antibodies were in normal range. Atopic dermatitis is a chronic or chronic relapsing, the classic morphology and location of which differs depending on age, and which is usually as sociated with severe pruritus. A D is a common skin disease, both in childhood and adolescence and in adults 5 . The term AO AD (onset >18 years) was introduced by Bannister and Freeman 1 . The onset age of the disease in our case was 16. Because of that, our case is not an AOAD . However, his diagnosis may be accepted as a late-onset atopic dermatitis. There is lack of diagnostic criteria useful in both children and adults. Therefore understanding the natural history of AD is complicated. The UK working party criteria may not perform well among adults 6 . Ozkaya 1 reported that there is no problem in detecting early-onset AD according to The UK working criteria, but approximately one fourth of patients could not be given the diagnosis of AO AD according to this in its current form. The criteria of Hanifin and Rajka have been considered as a gold standard for AD diagnosis for the last 20 years, and this criteria was used in the diagnosis of our case. A diagnostic difficulty may arise when the onset occurs after the adolescence or later, as in these cases the clinical pattern may be atypical. However it may still present with flexural dermatitis 3 . Our case had a typical typical flexural distribution and lichenified eczematous pattern. A D may be associated with specific subsets of vitiligo, and may indicate poor prognostic value for vitiligo. The mechanisms of association between AD and vitiligo are yet unknown. Patients with vitiligo, especially early onset, appear to have increased risk of AD 4 . The onset time was almost the same for both diseases in our case. However, while our case has a late onset time for AD , but early onset for vitiligo. Further studies are needed to explain the association between atopic dermatitis and vitiligo, and common disease mechanisms for both diseases.

Depigmented lesions of pityriasis versicolor: A diagnostic dilemma with review of literature

Depigmented lesions of pityriasis versicolor: A diagnostic dilemma with review of literature

Therapeutic efficacy of autologous cultured melanocyte transplantation in the treatment of vitiligo among patients with isomorphic response at donor sites and its relevant factors

Objective To evaluate the therapeutic efficacy of transplantation of autologous cultured pure melanocytes (TACM) in the treatment of vitiligo among patients with isomorphic response at donor sites, and to analyze its relevant factors. Methods A total of 1 685 patients with vitiligo were subjected to TACM. After 6-month follow-up, correlations were evaluated between isomorphic response at donor sites and the therapeutic efficacy of TACM, and factors associated with the therapeutic efficacy were analyzed. Results Of the 1 685 patients subjected to TACM, 75 (4.5%) had isomorphic response at the donor site. Among 75 patients with isomorphic response, 13 (17.3%) achieved 90%-100% repigmentation, and 23 (30.7%) achieved 50%-90% repigmentation. However, among the 1 610 patients without isomorphic response, 865 (53.7%) achieved 90%-100% repigmentation, and 1 376 (85.5%) achieved 50%-90% repigmentation. Fisher's exact probability test showed that the recovery rate and response rate were both significantly lower in the patients with isomorphic response than those without (P 48 months than in those with the duration of stable phase being 12-48 months, in patients aged ≤ 12 years than in those aged ≥ 18 years, in patients with segmental vitiligo than in those with non-segmental vitiligo, in patients with the recipient site on the face and trunk than in those with the recipient site on the limb, as well as in patients with total area of depigmented lesions ≤ 100 cm2 than in those with total area of depigmented lesions > 100 cm2 (all P < 0.05) . Conclusion Patients with isomorphic response show poor response to TACM, which may be associated with the duration of stable phase, patients' age, types of vitiligo, recipient sites and total area of depigmented lesions. Key words: Vitiligo; Cell transplantation; Melanocytes; Koebner phenomenon

A clinico-epidemiological study of hypopigmented and depigmented lesions in children and adolescent age group in Hadoti region (South East Rajasthan)

Background: Hypopigmentory and depigmented lesions are common among children and adolescent group. The parents are very much concerned about the condition and they seek dermatologist advice without fail. Aims and Objectives: To evaluate the Epidemiology and clinical characteristics of Hypopigmented and Depigmented Lesion in patients of Children and Adolescent age group in Hadoti region in Rajasthan. Materials and Methods: The study was conducted for the period one year from April 2015 to March 2016. This planned study is to be undertaken in children age 0-19 yr with hypopigmented and depigmented lesions irrespective of sex. Results: The most common disorder was Pityriasis alba, seen in 27.33%, followed by Pityriasis versicolor in 21%, Vitiligo 19.33%, Post inflammatory hypopigmentation in 14%, Primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33%, and miscellaneous conditions in 4% of the cases. Conclusion: The most common hypopigmentary disorders are seen in our study is Pityriasis alba and other causes of hypopigmentary and depigmentory disorders are in decreasing order are Pityriasis versicolor, Vitiligo, Postinflammatory hypopigmentation, Primary causes of hypopigmentation and less common are Leprosy.