Objectives A CollaboraTive Initiative of worldwide Vitiligo Experts and patients to define vitiligo activity (ACTIVE) project aims to develop standardized definitions and criteria for assessing disease activity in vitiligo using a consensus-based, multi-stakeholder approach. Methods The project is divided into three main topics. Topic 1 focuses on standardizing the definition and terminology of clinical signs of disease activity, using literature reviews, iterative e-Delphi surveys, and a consensus meeting. Topic 2 aims to classify disease activity into distinct activity categories by differentiating between slowly and highly progressive vitiligo. This will involve a literature search, a patient focus group, an e-Delphi survey, and a final consensus meeting. Topic 3 addresses remaining challenges in defining and assessing disease activity in vitiligo. This will include, for instance, the definitions of stability versus activity. In addition, unresolved issues and feedback identified by working groups 1 and 2 will further contribute to working group 3 with the aim of reaching a global consensus on all other key concepts of disease activity in vitiligo. Results/Conclusion By engaging international vitiligo experts and patients/patient representatives throughout the process, the ACTIVE study is designed to enhance consistency in disease activity definitions across multiple centers. This will improve the comparability of outcomes, facilitate management, and support clinical trials evaluating new treatments with more reliable inclusion.

IntroductionPatients with active vitiligo are treated with systemic immunosuppressants to halt disease progression. However, clinical features associated with patients whose condition is more difficult to control are unknown.ObjectiveThis study aimed to identify the clinical features of patients requiring extended periods of systemic immunosuppressants and the real-world clinical course of active vitiligo patients receiving systemic treatments.MethodsThis was a single-center retrospective study. Records of actively progressing vitiligo patients from September 2017 to August 2023 were reviewed.ResultsOne hundred and fifty-nine patients with non-segmental actively progressing vitiligo were enrolled. In the six-month follow-up period, 101 (63.52%) patients required oral systemic immunosuppressants for ≤ 16 weeks without reactivation (Group 1), 51 (32.08%) patients required continuous systemic immunosuppressants for more than 16 weeks to achieve disease stabilization (Group 2), and seven (4.4%) patients achieved disease stabilization ≤16 weeks of oral immunosuppressants but recurred within nine months after stabilization (Group 3). Patients in Group 2 were significantly younger (39.69±11.51 vs. 46.47±14.91 years old; P=0.013) and had a lower proportion of facial involvement (56.86% vs. 76.24%; P=0.016) compared to Group 1. Similarly, both age (odds ratio (OR): 0.968; P=0.016) and facial involvement (OR: 0.432; P=0.023) were identified as significant factors associated with decreased risk for Group 2. At one-year follow-up, 10.89% of Group 1 patients experienced disease reactivation.ConclusionsOlder patients and patients with facial involvement were more likely to achieve disease stabilization. Careful photo documentation is essential to optimal vitiligo management as disease reactivation is common after systemic treatment, even if initial disease stabilization is achieved.

Background Progressive vitiligo lacks standardized glucocorticoid regimens, with prolonged treatments often causing adverse effects. This study evaluated a novel 5-week low-dose prednisolone strategy (0.5 mg/kg/day, tapered weekly) to balance efficacy and safety. Objective To assess the efficacy and safety of this regimen in halting disease progression and inducing repigmentation in progressive vitiligo. Methods In this single-center retrospective cohort study (January 2017 to January 2022), 319 progressive vitiligo patients (Vitiligo Disease Activity score, VIDA score ≥ +2) received the 5-week regimen. Outcomes included treatment efficacy (cessation of progression ± repigmentation), adverse events, and patient satisfaction (visual analog scale, VAS). Results The efficacy rate was 88.71% (283/319), with 63.60% (180/283) achieving repigmentation (grade 1: 56.7%, grade 2: 25.6%, grade 3: 11.1%, grade 4: 6.7%). Disease severity significantly correlated with treatment response (p = 0.013). Mild-to-moderate adverse events occurred in 14.1% (45/319), including weight gain (8.2%), insomnia (3.1%), and gastrointestinal symptoms (2.8%), all resolving post-treatment. Patient satisfaction was high (mean VAS: 8.88/10; 65% scored 10/10). Conclusion This 5-week low-dose prednisolone regimen rapidly stabilizes progressive vitiligo across ages and subtypes, with high efficacy, minimal adverse effects, and excellent patient compliance. It offers a practical alternative to prolonged steroid protocols, particularly for early intervention.

Vitiligo is a common autoimmune disorder characterized by melanocyte destruction, leading to depigmented patches. It is often associated with other autoimmune diseases, including thyroid disease and systemic lupus erythematosus. Discoid lupus erythematosus (DLE) is a prevalent form of cutaneous lupus, and both conditions involve the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. However, the co-occurrence of vitiligo secondary to DLE is rare, and therapeutic approaches remain challenging. This case highlights the potential role of tofacitinib, a JAK inhibitor, in treating this dual pathology. A 49-year-old male presented with erythematous lesions on his hands, ears, and forearms, without systemic symptoms. Histopathology confirmed DLE. Despite treatment with hydroxychloroquine and tacrolimus, new white spots developed within the DLE lesions, indicating progressive vitiligo secondary to DLE. Histopathology and clinical findings, along with skin computed tomography, revealed both DLE and progressive vitiligo. The diagnosis was confirmed based on the presence of depigmented lesions within existing DLE areas. Tofacitinib (5 mg twice daily) was initiated alongside hydroxychloroquine. The patient was monitored over a 12-month period. After 1 year of continued tofacitinib treatment, the lesions continued to improve without adverse effects, demonstrating the drug's effectiveness in this complex case. This case illustrates the successful use of tofacitinib in treating vitiligo secondary to DLE, emphasizing the therapeutic potential of JAK inhibition in overlapping autoimmune skin conditions. Further studies are warranted to validate its long-term safety and efficacy in such complex cases. This is a single case report with a short follow-up duration. Lack of immunologic profiling limits broader generalizability. Controlled studies are needed to confirm these findings.

In progressive vitiligo, systemic corticosteroids as oral mini-pulse (OMP) have been successfully used, yet there is limited data regarding other immunosuppressants, such as azathioprine (AZA). We aimed to evaluate the efficacy and safety of AZA in stabilizing active vitiligo, and compare it with its combined use with narrow - band ultraviolet B (NB-UVB) and OMP combined with NB-UVB. Forty-five adult active non-segmental vitiligo (NSV) patients were randomly and equally divided into three groups. Patients received treatment for 3 months. Patients in Group A received NB-UVB with OMP, those in Group B received NB-UVB combined with oral AZA, and patients in Group C received oral AZA alone. Treatment response was evaluated at 4, 8, and 12 weeks by assessing the cessation of vitiligo activity, the onset of re-pigmentation, and its extent using vitiligo extent score (VES), VES plus, and vitiligo disease activity (VIDA) scores. Encountered side effects were also documented. Results revealed significant differences between study groups in decrease in VES and VES plus scores (incidence of re-pigmentation) after 12 weeks of treatment (Groups A and B had superior re-pigmentation than Group C). There was no significant difference among the groups in cessation of vitiligo activity (although more patients experienced a faster onset in Group A and B compared to Group C). Encountered side effects were minimal, with no significant difference. Small sample size, short duration of follow-up and not carrying out thiopurine methyl transferase activity. AZA is effective in controlling vitiligo activity, either as monotherapy or in combination with NB-UVB. However, it is inferior to the combination of OMP with NB-UVB in inducing re-pigmentation. Thus, AZA can be used as a good alternative to stop vitiligo progression when systemic steroids are contraindicated.

Serum untargeted metabolomics combined with mouse models reveals potential mechanisms of ChengShu QingChu decoction for the treatment of vitiligo.

Childhood vitiligo, distinct from its adult counterpart, presents unique treatment challenges. Glycyrrhizin inhibits the release of high-mobility group box1 (HMGB1) protein from keratinocytes, preventing melanocyte apoptosis and autophagy. Furthermore, the orally administered compound glycyrrhizin (OCG) effectively treats various autoimmune disorders, demonstrating long-term efficacy, safety, and tolerability. This study compared the efficacy of OCG and oral prednisone (OP), followed by phototherapy, in patients with progressive childhood vitiligo at 52 weeks' follow-up. Fifty children with vitiligo were randomized into two groups according to treatment: OCG (50-150 mg/day) followed by phototherapy (n = 25) and OP (5-10 mg/day) followed by phototherapy (n = 25). At Week 24, a halt in disease progression (HDP) was observed in 20 (80%) patients in the OCG group and 21 (84%) in the OP group, with no significant difference (p > 0.99). However, the mean time to achieve HDP was significantly shorter in the OP group than in the OCG group (14.73 ± 4.84 vs. 19.13 ± 4.82 weeks; p < 0.01). In addition, serum HMGB1 concentrations were significantly reduced after treatment with OCG at Week 24 (3.02 ± 0.83 vs. 0.95 ± 0.36 ng/mL [p < 0.01]; OP, 2.79 ± 0.16 vs. 1.03 ± 0.34 ng/mL [p < 0.01]). The decline in Vitiligo Area Scoring Index (VASI) score at the end of follow-up (i.e., Week 52) did not show a statistically significant difference between the OCG and OP groups (52.31% ± 14.86% vs. 55.71% ± 21.23%; p = 0.55). The therapeutic response of the clinical markers of progression was good and comparable between the OCG and OP groups. OCG demonstrated similar efficacy to OP followed by phototherapy in controlling disease activity and promoting repigmentation in children with vitiligo at 52 weeks of follow-up. Trial Registration: ChiCTR2400086844.

Background Handheld narrowband ultraviolet B (NB-UVB) device is a portable, home-based, patient-friendly equipment used in vitiligo. It is a newer promising treatment that lacks generalised consensus due to heterogenicity among studies. Objective To determine the clinical efficacy and safety profile of handheld NB-UVB devices in the treatment of vitiligo. Methods Following the PRISMA guidelines and using appropriate keywords, the Embase, PubMed and Scopus databases were searched on 28 November 2023. Data on the proportion of patients with a percentage of re-pigmentation and toxicity were extracted from the included studies. Random effects and fixed model were utilised to generate pooled estimates via meta-analysis. Results Out of 250 articles, 13 studies (557 patients) were included. The extent of repigmentation achieved over a median duration of 6 months (range 3-12 months) was quantified to be > 25%, > 50%, and >75 % in 63.6% (95% CI: 51.0-75.3%), 40.8% (95% CI: 30.4-51.6%) and 15.4% (95% CI: 7.6-25.3%) of patients respectively. After 12 weeks of treatment, the proportions of patients achieving > 25%, > 50%, and >75% re-pigmentation were 31.1% (95% CI: 9.6-58.3%), 12.9% (95% CI: 3.1-28.1%) and 6.5% (95% CI: 1.7-14.1%), respectively. Similarly, at 24 weeks, these proportions were 53.2% (95% CI: 24.5-80.7%), 36.7% (95% CI: 15.8-60.5%), and 11.1% (95% CI: 2.9-23.7%). Minimal erythema dose (MED) calculation-based therapy was not significantly better than therapy given without MED calculation (p = 0.43). The studies with only stable vitiligo patients did not achieve significantly greater > 25% (p = 0.06), > 50% (p = 0.80), and > 75% (p = 0.25) re-pigmentation compared to the studies that also included active or slowly progressive vitiligo. Three sessions per week resulted in significantly higher > 50% (p < 0.01) and > 75% (p = 0.01) re-pigmentation. Totally, 11.3% (38/334) of patients showed no response to therapy. The most commonly reported adverse event was erythema in 33.4% (95% CI: 19.3-49.2%) of patients, with grade 3 and 4 erythema in 27 and 15 patients, respectively. Other adverse events included pruritus, burning, hyperpigmentation, dryness, and blister formation observed in 22.1%, 16.4%, 19.1%, 9.8%, and 9.7% of patients, respectively. Conclusion Handheld NB-UVB portable home-based devices are an efficacious and safe treatment option in vitiligo patients even without MED calculation, when the treatment frequency is three to four sessions per week.

Vitiligo is a clinically prevalent acquired skin disorder characterized by depigmentation. Currently, the therapeutic options for vitiligo are restricted, and numerous issues exist, such as a prolonged treatment course, unsatisfactory therapeutic efficacy, adverse reactions and a high propensity for recurrence after treatment cessation. To assess the safety and efficacy of combined treatment involving oral tofacitinib citrate (TC) and a 308-nm excimer laser (EL), with the aim of discovering a rapid and effective treatment approach to minimize the side-effects of various drugs. In total, 63 patients with progressive vitiligo and a Vitiligo Disease Activity Score of 4 from January 2022 to January 2024 were enrolled and divided into three groups. The three groups were: the TC combined with 308-nm EL and methylprednisolone treatment group (group 1); the TC and 308-nm EL treatment group (group 2); and the methylprednisolone alone treatment group (group 3). The treatment was continued for 24 weeks, and an assessment of therapy outcomes was performed. When TC was combined with 308-nm EL and methylprednisolone treatment (group 1), the effect was more rapid than in the other two groups. When TC was combined with 308-nm EL (group 2), it had a more favourable treatment effect than that of methylprednisolone alone (group 3), despite having a slower onset of effect. After 24 weeks of treatment, there was no significant difference between group 1 and group 2 in terms of the total response rate or significant response. However, when only methylprednisolone treatment was applied, the effect was relatively slow and ineffective. This study confirmed a rapid and effective treatment of vitiligo was achieved through a combination of TC and 308-nm EL. No serious adverse reactions were reported, and therefore this could potentially offer an optimal treatment plan for patients with vitiligo.

Abstract Background Pigmentation disorders are rather common in dark skin. In India, 11% of patients presenting to the dermatology outpatient department in Western India have pigmentary disorders. Recently, dermoscopy has been involved as an important tool in the diagnosis of various dermatological diseases. Aim of the Work The aim of this study was to describe the Dermoscopic features of some hypopigmented skin disorders that may be clinically overlapping in order to facilitate differentiation between these skin disorders. Patients and Methods This Cross section descriptive study included 104 patients who complained of patchy or macular hypopigmented lesions. Results The most common dermoscopic features of progressive vitiligo were; Perifollicular hyperpigmentation, diffuse white glowing areas, white vellus and terminal hairs. The most common dermoscopic features of repigmenting vitiligo were; perifollicular pigmentation, marginal hyperpigmentation and interfollicular pigmentation. The most common dermoscopic features of stable vitiligo were; starburst appearance and altered pigmentation, marginal hyperpigmentation and perifollicular pigmentation. The most common dermoscopic features of idiopathic guttate hypomelanosis were; multiple, shiny and porceilin like macules, most of the lesions were well- defined (amoeboid pattern), few lesions were ill-defined with irregular cloudy whitish pattern (nebuloid pattern) and hyperpigmented networks were seen on the surrounding skin of some lesions giving the appearance of the cloudy-sky pattern. The most common Dermoscopic features of nevus depigmentosus were; hypopigmented patch with irregular and serrated borders, faint reticular network in some patches, borders showed pseudopods pattern protruding into the normal skin, the surrounding skin was scaly on some lesions and hair was pigmented with no peri-follicular hyperpigmentation. The most common dermoscopic features of pityriasis alba were; fairly demarcated hypopigmented macules, fine scales and hair inside patches of normal color. Conclusion Dermoscopy can aid in the diagnosis of hypopigmented skin disorders and can help in assessing the activity of vitiligo, however in sometimes the condition may be challenging and difficult to differentiate even by dermoscopy and in such cases histopathological examination may be helpful.

Abstract Introduction &amp; Objectives Vitiligo is the most common skin pigmentary condition in humans. Its etiology is attributed to an autoimmune attack on the melanocytes which results in achromic lesions. There is a deregulated autoimmune attack against melanocytes, activation of free radicals and proinflammatory cytokines with a preference for certain skin areas.The principal ABCB5 isoform is a transmembrane transporter located in cytoplasmic membrane melanocytes that eliminates intracellular toxic metabolites, it also protects against chemotherapeutic agents in normal melanocytes and melanoma cells.It has been seen that ABCB5 is expressed in the mesenchymal stem cells of the dermis, in addition to having immunoregulatory properties co-expressed with the programmed death ligand PD-1, and as a regulator of pro-inflammatory chemokines produced by macrophages, neutrophil overstimulation, and promoter of Treg lymphocyte activity. This work suggests that decreasing or altering the immunological regulation of mesenchymal cells can facilitate the immunological attack of CD8+ T lymphocytes in the epidermis, affecting the viability of melanocytes, resulting in skin depigmentation. Materials &amp; Methods This research aims to include 15 biopsy samples and 5 control samples. At present, we have gathered 5 biopsy samples from patients with non-segmental progressive vitiligo diagnosis through punch technique of 4mm from a public dermatology center, and 2 control samples that were donated from discarded materials at a private practice. Two probes were designed to detect messenger RNAs of the tyrosinase and ABCB5 genes in skin biopsies of patients and healthy controls, one for the tyrosinase messenger RNA (labeled with fluorescein) and other for ABCB5 messenger RNA (labeled with Cy5). Confocal microscopy was used to evaluate the emissions from these fluorophores. It’s planned to perform immunohistochemistry with antiABCB5 monoclonal antibodies to enhance the gene detection to afford quantitative and comparative results between the transition zone and controls. Results A, B. Confocal microscopy view of normal skin sample, image of melanocytes displaying green fluorescence indicative of tyrosine (Tyr) presence within in the basal epidermis. C. The presence of red (Cy5) in the transitional zone of epidermis, some parts of the dermis and blood vessels, but it is absent in the intracellular space and melanocytes. D, E. Vitiligo-affected basal epidermis exhibits reduced fluorescence as compared to controls, F. suggesting diminished tyrosinase activity and the presence of Cy5 red fluorochrome in a few dermis cells. Additionally, fewer differences were observed between vitiligo perilesional skin and healthy skin expression of ABCB5, which warrants further quantification and comparison with the rest of the sample. Conclusion Previous studies conducted in melanoma skin report an overexpression of the protein related to the cell capacity of detoxification and tumor differentiation, normal skin present much less expression compared to melanoma samples and at the moment, our observations allow us to think that ABCB5 expression in vitiligo skin is lightly minor than in normal skin, what can be related to its immunoregulatory role in mesenchymal cells and the depletion of the regulatory response of local inflammatory environment.

Background Vitiligo is an acquired disorder of pigmentation with an elusive pathogenesis, though various theories have been proposed. The presence of peri-lesional autoreactive CD8+ T cell infiltrate suggests the involvement of abnormal immune responses and autoimmunity in vitiligo. Recent studies have identified the IFN-γ-CXCL9/CXCL-10 axis as a key component of the autoimmune response that perpetuates disease activity in vitiligo. Objectives The primary objective was to estimate serum CXCL9 and CXCL10 levels in vitiligo patients compared to age- and sex-matched controls. Additionally, the study aimed to find correlations between CXCL9 and CXCL10 levels and disease severity and stability. Secondary objectives included comparing levels in segmental/nonsegmental vitiligo and stable/progressive vitiligo and assessing the impact of age and gender. Methods A hospital-based cross-sectional study included 60 vitiligo patients and 30 age- and sex-matched controls. Serum levels of CXCL9 and CXCL10 were assessed using Enzyme-linked immunosorbent assay (ELISA). Cases were clinically evaluated for the type of vitiligo (segmental or non-segmental), disease severity (VASI score), and disease stability (VIDA score). Statistical analysis included t-tests, chi-square tests, and correlation coefficients. P value less than 0.5 was taken as significant. Results Serum CXCL9 and CXCL10, both, were significantly raised in vitiligo patients as compared to controls (p-value = 0.001* & 0.001* respectively) and correlated positively with both VASI score (p-value = 0.001* & 0.001* respectively) and with VIDA score (p-value = 0.032* & 0.001* respectively). Serum CXCL10 showed significant elevation in progressive vitiligo, and CXCL9 exhibited a non-significant trend. No significant difference was observed between segmental and non-segmental vitiligo. Both chemokines positively correlated with disease severity and stability, while age and gender did not significantly impact chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlated positively with disease severity & instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. Both serum CXCL9 and CXCL10 were significantly elevated in vitiligo patients compared to controls and they can be used as potential serum biomarkers for assessing the disease activity. Limitations Small sample size of control population. The voluntary sampling technique led to an unequal number of patients in progressive and stable vitiligo groups, as well as in segmental and non-segmental groups. The current study did not include blister fluid analysis and the effect of therapy on the chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlates positively with disease severity and instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. *represents statistically significant results.

Background: The treatment landscape for vitiligo has witnessed diverse approaches yielding variable outcomes. Objective: To discern the optimal approach in terms of both tolerability and efficacy by comparing Narrow Band Ultraviolet B (NB-UVB) phototherapy with adjunctive oral mini pulse (OMP) prednisolone tablets. Patients and Methods: A total of eighty-seven individuals with progressive vitiligo were enrolled in a one-year study, with participants allocated randomly across three study groups through a continuous selection method. Group 1 received a combination of NB-UVB and OMP prednisolone tablets, group 2 underwent NB-UVB treatment only, and group 3 received OMP prednisolone tablets alone. Clinical assessments were conducted at three- and six-month intervals, and statistical analyses were performed utilizing descriptive and bivariate techniques, including the chi-square test, to gauge the significance of differences between the various groups. Results: In Group 1 (NB-UVB + OMP), substantial improvement was observed in 41.4%, accompanied by moderate improvement in 44.8% of patients. Group 2 (NB-UVB) demonstrated marked improvement in 31.0% and moderate improvement in 38.0%. In Group 3 (OMP), a lower proportion experienced marked (13.8%) or moderate (3.4%) improvement. Chi-square test findings indicated that the combination of NB-UVB and OMP correlated significantly with marked and moderate improvement in contrast to OMP alone, with respective values of χ² = 6.434 (p = 0.001) and χ² = 7.831 (p = 0.015) after a six-month follow-up. Conclusion: Through a comprehensive evaluation of three treatment modalities in vitiligo patients, it was established that the sole application of oral mini pulse steroids (OMP) held an adjunctive value, lacking substantial efficacy on its own. Remarkably, the amalgamation of Narrow Band UVB and OMP presented a clear advantage over either treatment administered independently.

Background: The treatment landscape for vitiligo has witnessed diverse approaches yielding variable outcomes. Objective: To discern the optimal approach in terms of both tolerability and efficacy by comparing Narrow Band Ultraviolet B (NB-UVB) phototherapy with adjunctive oral mini pulse (OMP) prednisolone tablets. Patients and Methods: A total of eighty-seven individuals with progressive vitiligo were enrolled in a one-year study, with participants allocated randomly across three study groups through a continuous selection method. Group 1 received a combination of NB-UVB and OMP prednisolone tablets, group 2 underwent NB-UVB treatment only, and group 3 received OMP prednisolone tablets alone. Clinical assessments were conducted at three- and six-month intervals, and statistical analyses were performed utilizing descriptive and bivariate techniques, including the chi-square test, to gauge the significance of differences between the various groups. Results: In Group 1 (NB-UVB + OMP), substantial improvement was observed in 41.4%, accompanied by moderate improvement in 44.8% of patients. Group 2 (NB-UVB) demonstrated marked improvement in 31.0% and moderate improvement in 38.0%. In Group 3 (OMP), a lower proportion experienced marked (13.8%) or moderate (3.4%) improvement. Chi-square test findings indicated that the combination of NB-UVB and OMP correlated significantly with marked and moderate improvement in contrast to OMP alone, with respective values of χ² = 6.434 (p = 0.001) and χ² = 7.831 (p = 0.015) after a six-month follow-up. Conclusion: Through a comprehensive evaluation of three treatment modalities in vitiligo patients, it was established that the sole application of oral mini pulse steroids (OMP) held an adjunctive value, lacking substantial efficacy on its own. Remarkably, the amalgamation of Narrow Band UVB and OMP presented a clear advantage over either treatment administered independently. Keywords: Vitiligo, NB-UVB, OMP, Prednisolone.

A prospective observational study of oral abrocitinib and narrow-band ultraviolet-B in refractory progressive vitiligo

BACKGROUND: Vitiligo is a chronic disease of unknown etiology, characterized by the appearance of depigmented spots on various areas of the skin, rarely on mucous membranes, and discolored hair due to destruction and reduction of melanocytes. While not life-threatening, vitiligo significantly impacts the psychoemotional aspect. Studies assessing the quality of life of vitiligo patients reveal the presence of depression in these individuals. In addition to depression, a high susceptibility to anxiety, stigmatization, sleep disturbances, adaptation, and problems in personal relationships have been identified. The prevalence of depression and anxiety among vitiligo patients is comparable to other dermatological conditions such as atopic dermatitis, acne, psoriasis, and urticaria. This underscores the need to seek new means and methods for treating this condition. AIM: Clinical assessment of the effectiveness of using cyclosporine in combination with UVB 311 nm and monotherapy with UVB 311 nm for vitiligo. MATERIALS AND METHODS: The study involved 40 patients with progressive vitiligo. All patients were randomly divided into two groups. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. The duration of the treatment was 6 months. The extent of the affected area relative to the body surface area was evaluated using the VES index (Vitiligo extent score) on a vitiligo calculator. The impact of the disease on the quality of life was assessed using the VitiQoL scale (vitiligo-specific quality-of-life instrument). RESULTS: All patients included in the study completed the full course of treatment. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. Patients in the combined therapy group experienced earlier stabilization of the skin process compared to those receiving monotherapy with UVB 311 nm. Additionally, Group 1 demonstrated more pronounced repigmentation of vitiligo lesions and significant improvement in quality of life compared to Group 2. CONCLUSION: Cyclosporine in combination with narrowband phototherapy at 311 nm demonstrated good clinical efficacy and significant improvement in quality of life for non-segmental vitiligo patients. Cyclosporine is well-tolerated, has a low spectrum of side effects, and can be used long-term for patients with active vitiligo.

Treatment of progressive vitiligo aims to halt the spread of the disease and facilitate repigmentation of lesions. JAK inhibitor has been shown some therapeutic effects on vitiligo, but the data for the progressive vitiligo are limited. This retrospective study was performed to evaluate the efficacy and safety of oral tofacitinib in 25 refractory progressive vitiligo patients who experienced failure to previous steroid treatments. 16 (64%) of the 25 patients noted stopping disease progression, and nearly half of the 16 cases halted progression within one month. 10 (40%) patients had repigmentation in varying degrees. Combination with phototherapy was a key factor affecting the rate of repigmentation. Oral tofacitinib might be a potentially effective treatment for intractable progressive vitiligo. The limitations of the study include the retrospective, single‐centre study with small sample size and lack of comparison with other systemic therapies.

Dermoscopic and ultrastructural features of vitiligo-associated leukotrichia (VAL) have not been well studied. This study is aimed at the dermoscopic and ultrastructural features of VAL. We present a cross-sectional study of VAL-related dermoscopic signs and their relationship with disease stages and duration of leukotrichia. Characteristics of hair surface and finer details including melanosomes, macrofibrils, and remnant nucleus were observed under Electron Microscopy (EM). One hundred and forty samples on distinct sites from 100 patients were collected. Among 75 VAL from the scalp, the prevalence of diameter diversity of leukotrichia (52.6% vs 8.1%), Pohl-Pinkus constrictions (34.2% vs 0), and depigmented hair roots signs (34.2% vs 8.1%) in patients with progressive vitiligo was much higher than that in patients with stable vitiligo (all P<0.05). The EM result of VAL showed that melanosomes were smaller with vesicles formation, reduced counts, and incomplete shape, and macrofibrils were irregularly arranged with widened spaces and vesicles formation. No conclusions about the histopathologic characteristics or dermoscopic-histopathologic correlation of the VAL. The dermoscopic signs of diameter diversity of leukotrichia, Pohl-Pinkus constrictions, and depigmented hair roots are related to progressive vitiligo. The process of melanin synthesis and formation of VAL are impaired at the early stage of VAL under Electron microscopy.

Abstract Background: Vitiligo is an idiopathic acquired illness characterized by limited depigmented macules and patches. We aim to compare intravenous (IV) methylprednisolone pulse therapy with oral prednisolone minipulse therapy in the treatment of progressive vitiligo. Objective: The assessment of the efficacy of both treatment methods in the arrest of the progression of vitiligo and repigmentation of the existing lesions. Materials and Methods: A total of 60 patients, 30 in each group, were enrolled for the study. Each patient underwent a detailed clinical, general physical, systemic, and thorough dermatological examination. A set of routine investigations, consisting of hemoglobin%, total leukocyte count, differential leukocyte count, urine routine examination, blood sugar (fasting and postprandial), liver function tests, renal function test, serum electrolytes, Montoux test, chest X-ray posteroanterior view, and thyroid profile were carried out before the analysis. Clinical photographs were taken before the start of therapy and after each month thereafter were used for the analysis after taking written consent. Results: The age of vitiligo patients considered for the study ranged from 13 to 70 years. The ratio of male-to-female patients considered for the study was 22:38 (36.6%: 63.3%). The duration of instability in vitiligo cases studied varied from 6 months to 2 years. In both Group A and Group B, the maximum number of patients (66.7% and 86.7%, respectively) had unstable vitiligo for 6 months to 1 year. Percentage repigmentation was better in Group A (IV) than Group B (OMP). In Group A, 17 out of 20 (85%) patients had shown different degrees of repigmentation, while 20 out of 30 (66.7%) patients of Group B had shown the same. This was statistically insignificant. Types of repigmentation observed in patients were of the following types: perifollicular, marginal, and combined. In both groups, all patients showed perifollicular regimentation. Conclusions: In progressive vitiligo, it was observed that oral mini pulse with prednisolone is superior to IV methylprednisolone pulse therapy for the arrest of progression. Considering the cost, mode of administration, hospital admission, loss of man-hours, and patients’ compliance, OMP was considered simpler and cost-effective.

Vitiligo is an acquired chronic autoimmune skin disorder with an estimated prevalence of 1% worldwide. The CD8+ T-cell-mediated chemokines such as CXCR3, CXCL9 and CXCL10 are the non-specific action immunomodulators that are responsible for the depigmentation and progression in vitiligo. This study aimed to explore the expression levels of serum CXCL9-11 in vitiligo patients who received the transplantation of cultured autologous melanocytes (TCAMs) before and after the operation and correlate their expressions with clinical stage, subtype and course of the vitiligo disease. The expression levels of serum CXCL9-11 were measured in the peripheral blood of 26 progressive vitiligo patients, 24 stable vitiligo, 13 TCAM patients and 30 healthy control (HC) cases using enzyme-linked immunosorbent assay (ELISA). The potential correlations between their expressions and disease features such as stage, type and surgical treatment were evaluated using Student's t-test. The expression levels of serum CXCL9-11 increased by ~1.4, ~1.6 and ~2.3-fold in vitiligo patients compared with HCs (P < 0.01). The expression levels of all chemokines were significantly higher in progressive vitiligo patients than in stable vitiligo (P < 0.01). The increasing expression levels of serum CXCL9, CXCL10 and CXCL11 were significantly related to the different types of vitiligo patients (P < 0.05). Preoperative expression levels of serum CXCL9-11 were significantly higher than the post-operative expression levels (P < 0.01). Our results demonstrate that increasing expression levels of the CXC family play a key role in the immunopathogenesis of vitiligo. The abnormal expression of the CXC family may be considered an effective and therapeutic target for TCAM treatment.