Vitiligo Research Articles

P-019 Semen analysis results are negatively affected in patients with vitiligo:a cross-sectional study

Abstract Study question Does vitiligo affect the results of semen analysis? Summary answer Semen analysis results are negatively affected in patients with vitiligo. What is known already Vitiligo is a multifactorial disorder characterized by the loss of functional melanocytes, and both genetic and non-genetic factors play a pathogenic role.Male infertility is also a common problem, contributing to almost 50% of all infertility problems.It was reported that skin-derived cytokines triggered in diseases with inflammation in the skin negatively affect spermatogenesis and sperm viability.Although vitiligo is a common skin disorder, the pathogenesis remains unknown. It was shown that inflammation and oxidative stress was accepted as a trigger factor in melanocyte degeneration.It was emphasized that the increase in inflammation in the body might be indirectly related to male infertility. Study design, size, duration This cross-sectional study was conducted between January 2015 and January 2021 by retrospectively evaluating patients who underwent sperm analysis at an university hospital. All patients aged between 25-45 years who underwent semen analysis at the relevant dates were evaluated in terms of the study (N = 5167).76 patients with vitiligo and 71 healthy controls were included in our study. The diagnosis of vitiligo was made clinically and using Wood's lamp. Participants/materials, setting, methods The control group was selected from among age and BMI-matched patients who underwent semen analysis (n = 71).The parameters examined in the study were as follows: Characteristics of cases (age, BMI, family history), Disease features (duration of disease, clinical type, Koebner phenomenon, halo naevi)The level of hormones [follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroxine (FT4), thyroid-stimulating hormone (TSH), testosterone, prolactin], and blood glucose, Semen analysis (volume, sperm concentration, total motility, A + B motility, morphology). Main results and the role of chance Seventy-six patients with vitiligo and 71 healthy controls were included in our study. The mean age was 30.29 ± 4.18 (range, 25-45) years. The mean age at onset was 23.66 ± 3.96 (range, 15-35) years, and the mean duration of disease was 6.36 ± 2.80 (range, 2-20) years in the vitiligo group. Sixty-seven (88.16%) patients had non-segmental vitiligo and nine (11.84%) had segmental vitiligo. Seven (9.21%) patients had a family history, three (3.95%) had Koebner phenomenon, and one (1.32%) patient had halo naevi.Free T4 levels were significantly lower in the vitiligo group than in the control group (P < 0.001) There were no significant differences between the groups regarding age, BMI, FSH, LH, TSH, testosterone, prolactin, and blood glucose levels. When we evaluated the semen analysis results, we found that sperm concentrations A+B motility and morphology were significantly higher in the controls than in the patients with vitiligo (P < 0.001,p<0.01,and P < 0.001) )There were no significant differences between the groups concerning volume and total motility. We divided patients with vitiligo into three groups according to their sperm concentrations.There were no significant differences between groups regarding age and BMI Free T4 levels were significantly higher in the control group than in the other groups. (p < 0.001). Limitations, reasons for caution The retrospective design of the study is an important limitation. Although the relationship between vitiligo and sperm parameters has been examined, the direction and cause of this relationship could not be determined due to the study design. Wider implications of the findings Inflammation and oxidative stress may affect sperm quality.One of the reasons for the more negative results in sperm analysis parameters in patients with vitiligo in our study might be due to increased inflammation level.Oxidative stress may be the trigger factor in the destruction of melanocytes as well as semen parameters. Trial registration number not applicable

Circulating Exosomal miR-493-3p Affects Melanocyte Survival and Function by Regulating Epidermal Dopamine Concentration in Segmental Vitiligo

Circulating exosomal microRNAs have been used as potential biomarkers for various disorders. However, to date, the microRNA expression profile of circulating exosomes in patients with segmental vitiligo (SV) has not been identified. Thus, we aimed to identify the expression profile of circulating exosomal microRNAs and investigate their role in the pathogenesis of SV. Our study identified the expression profile of circulating exosomal microRNAs in SV and selected miR-493-3p as a candidate biomarker whose expression is significantly increased in circulating exosomes and perilesions in patients with SV. Circulating exosomes were internalized by human primary keratinocytes and increased dopamine secretion invitro. Furthermore, miR-493-3p overexpression in keratinocytes increased dopamine concentration in the culture supernatant, which led to a significant increase in ROS and melanocyte apoptosis as well as a decrease in melanocyte proliferation and melanin synthesis in the coculture system by targeting HNRNPU. We also confirmed that HNRNPU could bind to and regulate COMT, a major degradative enzyme of dopamine. Hence, circulating exosomal miR-493-3p is a biomarker for SV, and the miR-493-3p/HNRNPU/COMT/dopamine axis may contribute to melanocyte dysregulation in the pathogenesis of SV.

Clinicoepidemiological Features of Childhood and Adult Vitiligo - A Cross- Sectional Observational Study

BACKGROUND
 Vitiligo is an acquired primary, usually progressive, melanocytopenia of unknown aetiology clinically manifested by circumscribed achromic macules and histologically by degeneration and disappearance of melanocytes in involved skin. Childhood vitiligo deserves special attention as it has unique epidemiological features. We wanted to determine, compare and analyze the clinical and epidemiological features and autoimmune disease associations in childhood vitiligo and adult vitiligo.
 METHODS
 It was a prospective cross-sectional observational hospital-based clinical study conducted in a suburban medical college hospital over 20 months which involved 120 patients with vitiligo who were assessed using detailed history and clinical examination for demographic and clinical data. Relevant history and family history were noted. Investigations including complete hemogram, serum biochemistry profile, thyroid profile and fasting plasma glucose examination were performed in all patients. Data were collected, tabulated, and all statistical analysis was done by using SPSS trial version 25 and in MS Excel 2007.
 RESULTS
 The majority of patients were in the age group of 16-30 years. Among 60 patients, female preponderance was noted in the study with a percentage of 53.3 % followed by 46 % males in the childhood group. The prevalence of segmental vitiligo was more in children (30 %) than in adults (5 %) which was statistically significant (P= 0.000). In adults, there was a statistically significant higher prevalence (P=0.000) of mucosal vitiligo (30 %) than in children (3.35 %). On performing statistical analysis, thyroid dysfunction (P=0.00) and diabetes mellitus (P=0.01) were found to be significantly more prevalent in adults than in children.
 CONCLUSIONS
 This study provides clinical evidence that vitiligo at different ages has different characteristics mainly regarding an increased incidence of segmental vitiligo and a more common positive family history among children than adults. A higher prevalence of thyroid dysfunction and diabetes mellitus in adult vitiligo patients compared to children warrants prompt treatment in all detected cases to prevent long-term morbidity and complications.

Epidemiological and clinical profile of childhood vitiligo in Abidjan

Background Vitiligo is an acquired and visible leucoderma that can lead to social stigmatization. The aim of this study was to establish the epidemiological and clinical profile of childhood vitiligo in Abidjan. In fact, very little data is available on this chronic child disease in sub-Saharan Africa, particularly in Côte d’Ivoire. Methods We carried out a cross-sectional study at University Teaching Hospital of Treichville from June 2017 to June 2018. All children under 16 years old with vitiligo who meet our selection criteria were included. CSPRO 7.2 and SPSS 23 software were used for data analysis and the significance threshold was set at 0.05. Results The prevalence of childhood vitiligo was 1.78%. Our series consisted of 19 boys and 21 girls (sex ratio M/F: 0.9). Children aged between 9 and 15 years old were the most affected (45%). The main family history were diabetes (37.5%), early canitis (30%) and vitiligo (17.5%). Atopic dermatitis was the main dermatosis associated with the childhood vitiligo (17.5%). The main clinical form of vitiligo was the non-segmental form (47.5%). The segmental and mixed forms had rates of 42.5% and 10% respectively. The vitiligo lesions were mainly located in sun-exposed areas (52.5%) and the segmental vitiligo significantly reached the face (P=0.04). Segmental vitiligo was also more common in children aged 0 to 3 years (P=0.03). The Koebner phenomenon was present in 5 children and was statistically associated with non-segmental vitiligo (P=0.04). Conclusion The prevalence of vitiligo in our series was 1.78%. This pathology occurs mainly in older children. The main clinical form was the non-segmental form. The affection was most often located on the sun-exposed areas.

Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article.

Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. A total of thirty-four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band-ultraviolet B (NB-UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium-neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt-thickness skin graft (STSG), and cultured/non-cultured-melanocytes-keratinocytes transplantation (MKTP)]. There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first-line of treatment in refractory cases, long-standing disease, or presence of leukotrichia in depigmented patches.

The Current Status of Antioxidants in the Treatment of Vitiligo in China.

Little is known about the use of antioxidants in the clinical treatment of vitiligo. To investigate the specific use of antioxidants in the treatment of vitiligo and the possible reasons behind its use in China, we conducted a prospective questionnaire-based study using an online questionnaire comprising 26 questions in 5 areas. A total of 323 clinical frontline dermatologists participated in this study. Differences among groups were compared using Pearson's chi-square test. Ordinal logistic regression was used to develop knowledge–use multiple regression models. Among the 323 dermatologists, 293 (90.7%) approved the oxidative stress theory of vitiligo, and 182 (56.3%) encouraged the use of antioxidants for treating vitiligo; nonetheless, only 11.8% frequently treated vitiligo with antioxidants. Insufficient knowledge of antioxidants was a significant predictor of lower frequency of antioxidant usage (adjusted odds ratio, 0.401 [95% confidence interval, 0.256-0.629]; P < .001). The predictors associated with higher antioxidant efficacy included advanced or rapid progression, moderate or moderate-to-severe vitiligo, age of 0–2 years or 13–18 years, segmental vitiligo, oral and topical combination therapy, and course duration of <1 month. The use of antioxidants for treating vitiligo is highly encouraged; however, the rates of their clinical use are considerably low. Insufficient knowledge of antioxidants is associated with a lower frequency of antioxidant usage. The synergistic curative efficacy of antioxidants could be affected by the stage, type, severity, age of patients with vitiligo, and method of using antioxidants.

Surgical procedures and innovative approaches for vitiligo regenerative treatment and melanocytorrhagy.

Surgical treatments for vitiligo are a safe and effective treatment modality for select patients with vitiligo. Many techniques of vitiligo surgery exist, each with unique advantages and disadvantages. We reviewed the various surgical therapies and innovative approaches for vitiligo regenerative treatment reported in the literature. Surgical therapies can be subdivided into tissue grafting methods and cellular grafting methods. Tissue grafting methods mainly include mini punch grafts, suction blister roof grafts, and hair follicle grafts. Cellular grafting methods include cultured and non-cultured treatments. The efficacy needs to be improved largely due to the poor proliferation and quality of the autologous melanocytes. Rho-associated protein kinase inhibitor enhances primary melanocyte culture proliferation from vitiligo patients to prevent apoptosis. Innovative approaches using stem cell methods could prove invaluable in developing a novel cell therapy for patients suffering from vitiligo. We succeeded in inducing melanin pigmentation in mice skin in vivo using our human induced pluripotent stem cell-derived melanocytes. In addition, we reviewed melanocytorrhagy, detachment and transepidermal loss of melanocytes, and melanocyte-related adhesion molecules. These adhesion molecules include epithelial cadherin, discoidin domain receptor tyrosine kinase 1, glycoprotein non-metastatic melanoma protein B, macrophage migration inhibiting factor, 17β-hydroxysteroid dehydrogenase 1, and E26 transformation-specific 1.

Clinicodemographic features of mixed vitiligo: a case-control study.

Mixed vitiligo (MV) is the coexistence of segmental vitiligo (SV) and non-segmental vitiligo (NSV). The literature on MV is sparse. To assess the clinicodemographic and treatment parameters in MV and compare them with SV. Clinical data of MV and SV patients enrolled in our pigmentary clinic from July 2015 to December 2019 were reviewed retrospectively and compared. Out of a total of 4,371 vitiligo patients, 293 (6.7%) were SV while 74 (1.69%) were MV. As compared to SV, MV had significantly lower mean age of onset of segmental component (SC) (13.33 ± 9.01 vs. 15.70 ± 8.60 years, P = 0.03) and significantly higher proportion of patients with more than 1% body surface involvement by SC (66.2% vs. 51.5%, P = 0.03) and presence of leukotrichia in the SC (66.2% vs. 51.5%, P = 0.03). Topical agents and systemic immunosuppressive agents were significantly more effective in non-segmental component (NSC) as compared to SC of MV. Surgical modalities were the only effective treatment modality for SC. Retrospective design, heterogeneity of treatment regimens. Early age of onset, larger (>1%) body surface area involvement, and leukotrichia in SV predict its progression into MV with time. Treatment response to different modalities varies significantly between SC and NSC of MV.

Assessment of CXCL10 Before and After Narrow Band UVB Phototherapy in Non-Segmental Vitiligo Patients.

Vitiligo is a common depigmenting skin disorder characterized by white macules and patches accompanied by local melanocyte loss, caused by autoimmune destruction. Vitiligo is classified into two major forms: segmental vitiligo (SV) and non-segmental vitiligo (NSV). It was also found that the IFN-ȣ/CXCL10 axis is functionally required for both progression and maintenance of the disease. Chemokine 10 (CXCL10) is a pro-inflammatory chemokine which was found to be elevated in the serum of vitiligo patients. UVB has been found to be a useful therapy that results in rapid repigmentation in NSV patients. To evaluate CXCL10 in vitiligo patients before and after narrow band UVB (NB-UVB) phototherapy, which if targeted could provide new insights for therapeutic intervention for vitiligo. The study included 25 active NSV patients who were able to comply with the study protocol in the Center of Excellence, Dermatology Outpatient Clinic, National Research Center, Egypt (February 2020-2021). All recruited patients were subjected to documentation of complete history. Dermatological assessment of vitiligo lesions, including vitiligo area score index (VASI) score, CXCL10 and extent of the disease were performed. A 3 mm punch biopsy from active vitiligo lesion (site of biopsy) was taken before and after treatment by NB-UVB, and then immunohistochemical staining was performed to evaluate expression of CXCL10. After treatment by NB-UVB there was a significant decrease in VASI score, extent of the disease and CXCL10 expression. The decrease in CXCL10 levels could be attributed to the effect of NB-UVB which leads to decrease in IFN-γ level, necessary to release CXCL10 through its pathway resulting in repigmentation and decrease in the extent of the disease and VASI scores.

A report of stable segmental vitiligo with exacerbations following Oxford–AstraZeneca and MVC-COV1901 COVID-19 vaccinations

A report of stable segmental vitiligo with exacerbations following Oxford–AstraZeneca and MVC-COV1901 COVID-19 vaccinations

A celiac disease marker: Serum immunoglobulin a anti-tissue transglutaminase in vitiligo cases and controls in a hospital in South-West Nigeria

Background: Vitiligo is an autoimmune disorder resulting from the destruction of melanocytes of affected patients. Celiac disease (CD) is characterised by autoimmune inflammation of small intestinal mucosa specifically triggered by the gluten consumption in susceptible individuals. Immunoglobulin A (IgA) anti-tissue transglutaminase (anti-tTG) serology is recommended as an initial test for the diagnosis of CD prior to confirmation with intestinal biopsy. Aim: We aimed to compare the serum IgA anti-tTG levels in vitiligo patients and controls without vitiligo in a hospital in South-West Nigeria. Materials and Methods: The study was a case–control study of 33 vitiligo cases and 33 controls. IgA anti-tTG was assayed in participants’ sera using an enzyme-linked immunosorbent assay protocol employing recombinant human tTG. Results: A total of 66 participants were recruited into the study; 33 cases with vitiligo and 33 controls. The median age for cases was 50 years (range: 4–82). The median age for the controls was 55 years (range: 23–76). Generalised vitiligo accounted for 13 (40%) of vitiligo cases with the others consisting of various forms of segmental vitiligo. Anti-tTG levels were higher in cases at 6.1U/ml (8.8, 0.6–20.0) (med [interquartile range (IQR), min-max]), compared to controls 5.2 U/ml (3.7, 0.7–22.4). Difference between groups estimated using the Mann-Whitney U-test was not significant, u = 408.0, P = 0.08 (α = 0.05). Conclusion: There was no significant difference in serum IgA anti-tTG in vitiligo cases and controls in this study. Further studies are required to clarify the nature of the association between vitiligo and CD.

Association of metabolic syndrome in patients of vitiligo

The metabolic syndrome is the term used to describe a constellations of metabolic derangements that includes insulin resistance, hypertension, Dyslipidemia, central or visceral obesity, type 2 DM &amp; accelerated cardiovascular disease. An oxidative imbalance is responsible for the development of both metabolic syndrome &amp; vitiligo. In the present study we have evaluated the association of metabolic syndrome with Vitiligo.In this observational cross-sectional study we selected 40 subjects attending skin OPD with age matched 40 controls and assessed the waist circumference, blood pressure, serum triglyceride level, cholesterol and high-density cholesterol along with Fasting blood glucose level at tertiary care Hospital. A detailed history including age, gender, diabetes mellitus, hypertension, smoking and onset of vitiligo was taken. The MetS criteria were defined by National Cholesterol Education Program Adult Treatment Panel III 2005 (ATP III) guidelines.We identified metabolic syndrome in 15 subjects with vitiligo and 6 subjects without vitiligo. The P value came 0.022 which is statistically significant. Active vitiligo, segmental vitiligo and increased duration of vitiligo were determined to be independent predictors of metabolic syndrome.The risk of developing metabolic syndrome is increased in patients of vitiligo. Screening and the close follow up of the patients of vitiligo with clinical feature such as in unstable, segmental vitiligo with increased duration is necessary for the early diagnosis of the metabolic syndrome to reduce the morbidity &amp; mortality of the patients

New insights into segmental vitiligo: A clinical and immunological comparison with nonsegmental vitiligo.

The overlaps between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) suggest the underlying features of SV, which may be helpful for treating SV. In this study, 379 vitiligo patients were recruited and divided into SV (33.2%), mild-to-moderate NSV (M-NSV, affected body affected area [BSA] ≤10%, 34.0%), and severe NSV (S-NSV, affected BSA >10%, 32.7%) groups. Demographics and clinical data were collected through in-person interviews. The disease activity, progression, and prognosis were assessed through 6months' follow-up. Serum cytokines profile and tissue-infiltrating immune cells were measured by ELISA assay and immunofluorescence, respectively. The SV exhibited lower rates of autoimmune comorbidities and recurrence than the S-NSV, but performed similar to the M-NSV. Moreover, the disease activity, progression, serum cytokines profile, and tissue-infiltratingTh/c1 cells in the active SV and M-NSV were comparable, but differed significantly from those of the active S-NSV. The clinical and immunological similarities between SV and M-NSV presented a deeper autoimmune understanding of SV. Additionally, a classification of active vitiligo according to disease extent may be more clinically meaningful than subtypes for guiding immunomodulatory treatment.

Fatty acid-binding protein 4 circulating levels in non-segmental vitiligo

BackgroundVitiligo is an acquired and progressive mucocutaneous disease resulting from the loss of active epidermal melanocytes. Metabolic syndrome (MetS) affects about 25% of the world’s population and is linked to inflammatory skin diseases including vitiligo. Fatty Acid-Binding Protein 4 (FABP4) is an intracellular lipid chaperone. FABP4 is closely associated with MetS. ObjectivesTo evaluate the serum level of FABP4 in vitiligo patients and its relation to MetS in the investigated cases. MethodsThis case control study was conducted on 45 patients having non segmental vitiligo and 45 matched controls. Their lipid profile, blood glucose and serum FABP4 levels were measured. ResultsThere were significant elevations in FABP4 (p < 0.001), cholesterol (p < 0.001), triglycerides (p = 0.005), and glucose (fasting [p = 0.001] and 2 hours post prandial [p < 0.001]) levels in patients in comparison with controls. MetS was significantly more prevalent among vitiligo patients (p < 0.001) and associated with high FABP4 serum levels (p = 0.037). In vitiligo patients, there were significant positive correlations between FABP4 serum levels and triglycerides (p = 0.047), cholesterol (p = 0.001) and LDL (p = 0.001) levels and negative correlation regarding HDL level (p = 0.009). FABP4 level was a significantly good diagnostic test for early detection of vitiligo (p < 0.001). Study limitationsThe small number of studied subjects. ConclusionsFABP4 may play an active role in the disease process of vitiligo that could be mediated through associated dyslipidemia and hyperglycemia. FABP4 may be a marker of vitiligo helping in its early diagnosis, but it does not appear to be useful for determining vitiligo severity, activity or associated MetS.

Prevalence of Vitiligo Among Adults in the United States

Vitiligo can have profound effects on patients and is often associated with other autoimmune comorbid conditions. It is important to understand the current prevalence of vitiligo, including diagnosed, undiagnosed, and subtypes (nonsegmental and segmental). To estimate the point prevalence of vitiligo in the US. For this population-based study of adults in the US, a cross-sectional online survey was administered between December 2019 and March 2020 to obtain participant self-reported vitiligo status. A representative sample of the US adult general population, aged 18 to 85 years, was recruited using a stratified proportional, sampling design from general population research panels. Additionally, 3 expert dermatologists adjudicated participants' self-reported vitiligo diagnosis by reviewing photographs uploaded by the participants using a teledermatology app designed and tested specifically for this study. The main outcomes were the point prevalence estimates of overall vitiligo, as well as diagnosed, undiagnosed, nonsegmental, and segmental vitiligo. Among the 40 888 eligible adult participants, the mean (SD) age was 44.9 (17.4) years, 23 170 (56.7%) were female, 30 428 (74.4%) were White, and 4225 (10.3%) were of Hispanic, Latino, or Spanish origin. Self-reported vitiligo prevalence was 1.38% (95% CI, 1.26%-1.49%), with 0.77% (95% CI, 0.68%-0.85%) for diagnosed and 0.61% (95% CI, 0.54%-0.69%) for undiagnosed. Based on expert dermatologist review of 113 photographs of participants with self-reported vitiligo, clinician-adjudicated vitiligo prevalence (sensitivity bounds) was 0.76% (0.76%-1.11%), with 0.46% (0.46%-0.61%) for diagnosed and 0.29% (0.29%-0.50%) for undiagnosed. Self-reported nonsegmental vitiligo prevalence was 0.77% (95% CI, 0.68%-0.85%), with 0.48% (95% CI, 0.41%-0.55%) for diagnosed and 0.29% (95% CI, 0.23%-0.34%) for undiagnosed. Clinician-adjudicated nonsegmental vitiligo prevalence (sensitivity bounds) was 0.58% (0.57%-0.84%), with 0.37% (0.37%-0.49%) for diagnosed and 0.21% (0.20%-0.36%) for undiagnosed. Self-reported segmental vitiligo prevalence was 0.61% (95% CI, 0.53%-0.69%), with 0.28% (95% CI, 0.23%-0.33%) for diagnosed and 0.33% (95% CI, 0.27%-0.38%) for undiagnosed. Clinician-adjudicated segmental vitiligo prevalence (sensitivity bounds) was 0.18% (0.18%-0.27%), with 0.09% (0.09%-0.12%) for diagnosed and 0.08% (0.08%-0.15%) for undiagnosed. Results of this survey study demonstrated that the current US population-based prevalence estimate of overall (diagnosed and undiagnosed combined) vitiligo in adults is between 0.76% (1.9 million cases in 2020) and 1.11% (2.8 million cases in 2020). Additionally, this study suggests that approximately 40% of adult vitiligo in the US may be undiagnosed. Future studies should be performed to confirm these findings.

Efficacy and safety of automated epidermal micrograft in patients with stable segmental and nonsegmental vitiligo.

Vitiligo is a common, psychologically devastating pigmentary disorder. Surgical graftings are used to treat stable vitiligo when medical treatment fails. An automated epidermal micrograft harvesting (AEMH) system was first designated to treat wounds, and very few studies investigated the application of AEMH in vitiligo. In this study, we investigated the efficacy and safety of the AEMH system in patients with stable segmental and nonsegmental vitiligo. The rate of repigmentation and adverse events was recorded bimonthly for at least 12months. We analyzed the efficacy based on patient characteristics, vitiligo subtypes, and different anatomical locations. A total of 56 depigmented lesions from 34 patients were included. 95.50% of the automated epidermal micrografts were successfully grafted at the recipient sites. There was a significant improvement in Vitiligo Area Scoring Index (VASI) and Dermatologic Life Quality Index (DLQI) in patients treated with AEMH (p<0.001). The rate of repigmentation by VASI score improves from 96.25±8.59 to 48.30±28.16 after the treatment (p<0.001). Treatment outcomes were comparable between the patients of segmental and stable nonsegmental vitiligo. The face and neck region achieved a better outcome, followed by the trunk (chest, abdomen, back, and axilla), limbs, and the worse outcome was found in the acral region (p<0.014). Conclusively, AEMH is an effective treatment procedure with limited adverse events in patients with stable vitiligo. This harvesting method may be a feasible option for vitiligo surgical treatment.

Peculiarities of Adverse Events Manifested by Injury of Skin and Skin Derivatives and Associated with Beta-blockers Use

More than 50 years after Propranolol was introduced to the pharmaceutical market as a drug that can lower the heart rate, beta-blockers (BAB) are still widely used in the pharmacotherapy of cardiovascular diseases. However, the use of BAB has a number of limitations, first of all, due to adverse drug events (AE) that develop during their use. The purpose of our review was to study the features of the BAB AE manifested by injuries of the skin and its appendages. The clinical manifestations of them are the development or exacerbation of psoriasis, lichen planus, contact dermatitis, acrocyanosis, Raynaud's disease, alopecia, hyperhidrosis, vitiligo, anaphylaxis, and allergic skin reactions. True medicinal psoriasis occurs in patients taking BAB with no family or previous history and most often mimics erythrodermic psoriasis and palmar-plantar pustular psoriasis. Systemic use of BAB can also be accompanied by exacerbation of vitiligo. In patients with segmental vitiligo, the results of Doppler flowmetry and iontophoresis showed increased blood flow in vitiligo foci compared with normal skin. The development of anaphylactic reactions against the background of BAB therapy may be due to the modulation of adenylate cyclase, which can affect the release of anaphylactogenic mediators, as well as a decrease in the severity of cardiovascular compensatory changes. The peculiarities of the development of such reactions may be the resistance of patients to traditional treatment, which is due to the development of paradoxical reflex vagotonic effects when using adrenaline. Some of the mentioned AE may pose a potential threat to the life and health of the patient and therefore require additional discussion.

Possible enigmatic link between serum leptin and vitiligo with its metabolic derangements: A comparative controlled study.

Serum leptin, an adipocytokine of interleukin-6 family, has been linked to vitiligo-associated metabolic derangements. Additionally, it has been proposed as an inflammatory mediator with possible influence on vitiligo pathogenesis. This study aimed at assessing serum leptin in vitiligo patients compared to controls and whether different vitiligo characteristics have an influence on serum leptin levels. In this hospital-based, cross-sectional case-control study, 70 vitiligo (35segmental vitiligo (SV) and 35Non-segmental vitiligo (NSV)) and 70 age- and sex-matched controls were assessed for different anthropometric measurements including waist circumference (WC), index of central obesity (ICO), and body mass index (BMI) as well as serum leptin levels. Central obesity as per ICO showed no significant difference between patients and controls. Additionally, patients of SV and NSV collectively showed significant higher incidence of +ve serum leptin than their controls (41.4% vs. 22.9%%, P: 0.019). Mere presence of vitiligo and ICO >0.5 were highlighted as independent predictors of +ve serum leptin (P: 0.009 and <0.001, respectively). Inability to determine a cause/effect relationship based on a cross-sectional study. Larger scale studies are needed to affirm our findings. Mere presence of vitiligo being an independent predictor for high serum leptin could be either a contributor to pathogenesis of vitiligo or a sequel to accumulating evidence of metabolic nature of vitiligo. This is likely to influence the investigative panel and treatment protocol for vitiligo patients.

307 Looking at vitiligo from the skin barrier point of view

Vitiligo (VTG) is increasingly regarded as affecting the entire skin. Recently, keratinocytes have been indicated as key players in VTG being able to produce pro-inflammatory mediators involved in the immune response. Moreover, alterations in stratum corneum (SC) thickness as well as in the expression of genes participating in keratinocyte differentiation and cornification, have been observed in VTG lesional skin. To evaluate possible abnormalities of the skin barrier in non-lesional VTG skin, SC was collected from the forearm of 50 healthy subjects (HS) and 57 VTG patients. SC lipid signature was obtained by a lipidomic approach combining GC-MS and LC-MS profiles of the different lipid classes such as cholesterol (CH) and cholesterol sulfate (CHS), free fatty acids (FFAs), and ceramides (CERs). Heatmaps were employed to display the individual profiles as well as the VTG and HS mediated data. Score and loadings plots generated by ASCA analysis were utilized to evaluate significant differences in SC lipid composition. The data obtained demonstrated a higher content of FFAs in VTG in comparison to HS. Moreover, the FFAs relative composition highlighted the increase in the unsaturated fraction and the decrease of C26:0, a fatty acid with Ultra Long Chain length (ULC). VTG showed a general content reduction of CERs statistically significant for CER[NP], CER[AP], CER[AS], and CER[NDS] subclasses. Furthermore, we observed a relevant different distribution of fatty acids contained in CERs with ULC fatty acids significantly reduced in VTG patients. CH and CHS amounts resulted higher in VTG compared with HS. Overall, the data revealed remarkable differences in VTG SC lipid composition as demonstrated by the PCA plot, which allowed to separate HS from VTG. The altered ratio between CERs, FFAs, CH, and CHS may represent an index of the impairment to develop a fully-competent skin barrier in VTG, thus creating a local pro-inflammatory milieu potentially able to trigger the immune response.

214 Increased cutaneous activation of innate immunity and pro-apoptotic CXCR3B in patients with segmental vitiligo

Segmental vitiligo (SV) is a rare form of vitiligo, characterized by white patchy skin due to destruction of melanocytes affecting only one side of the body. The mechanisms are poorly understood. Recently we have demonstrated the importance of innate immunity and a newly discovered melanocytic chemokine receptor CXCR3B in triggering early anti-melanocytic response in non-segmental or generalized vitiligo. The role of innate immunity or CXCR3B in SV has not been studied. To do this, we obtained 2x4-mm skin biopsies from normal-appearing skin of SV patients (n=5), one from a non-depigmented skin of the affected side of the body (L) and the second from the contralateral non-effected side of the same patient (NL) and results were compared to healthy controls matched from age and biopsy location (n=5). Biopsies were cut in 2 for PCR and immunofluorescent staining. Our results have shown increased expression of vitiligo signature cytokines (IFNg) and chemokines (CXCL9 and CXCL10) as well as markers of ECM disruption (increased MMP-9 and decreased E-cadherin) in both L and NL sites. The targets of cellular stress (CXCL16, iHSP70) and cellular damage (mito-DNA) were only increased in L but not in NL sites. We found a significant increase in CXCR3B mRNA at both sites and a significantly increased number of CXCR3B+ melanocytes at L sites only, which may explain their increased responses to chemokines. In conclusion, our results suggest that SV patients, as has been described for NSV, have increased innate immunity throughout their skin which precedes depigmentation. Increased CXCR3B expression in SV suggests strategies fighting against the local stress or specifically targeting CXCR3B activation could provide effective approaches for halting the progression of this disabling disease.