Unstable Vitiligo Research Articles

Immunohistochemical characterization of inflammatory infiltrates in unstable vitiligo

Objectives: Disease instability in vitiligo is a prominent step during the development or extension of disease. The presence of marked inflammatory infiltrate may be considered a diagnostic clue for disease instability. However, there is a paucity of literature regarding this. Therefore, the present study was carried out to characterize the nature of inflammatory infiltration in cases of unstable vitiligo. Materials and Methods: Thirty patients of unstable vitiligo diagnosed clinically were enrolled and two biopsies: Lesional and perilesional obtained. Histopathological examination with respect to five parameters, i.e., spongiosis, epidermal lymphocytes, basal cell vacuolation, dermal lymphocytes, and melanophages was done including histological scoring. Immunohistochemical characterization was done for T lymphocytes, Langerhans cells (LCs), macrophages, and B cells by studying their number and distribution. Statistical analysis: Statistical analysis was done using Spearman’s rank coefficient correlation test. Results: Mean T-lymphocytes, macrophages, and LC count were significantly higher in lesional skin. The three parameters correlated with vitiligo histological score. T cells were present more frequently in the dermis and stratum basale. Macrophages were found more in the dermis whereas LC was mainly located in the epidermis. Conclusions: An increase in the population of inflammatory cells, especially T lymphocytes and LC, may serve as an indicator of unstable vitiligo. The relative distribution of these cells points toward signaling between them and their role in the destruction of melanocytes and keratinocytes. A better understanding of the underlying mechanisms may lead to the development of novel targeted therapies.

The Impact of COVID-19 Pandemic on Vitiligo Patient Visits in Tertiary Hospital: A Retrospective Study

Background: Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The COVID-19 pandemic lockdown measures significantly affected the readiness of vitiligo patients to contact dermatologists. The aim of this study is to describe vitiligo patient visits during a pandemic situation.
 Methods: A retrospective descriptive study, using secondary data obtained from Dr. M. Djamil General Hospital Padang medical records during the period of 2019–2021.
 Results: During the pandemic (2020-2021), a total of 7 in 2020 and 19 in 2021 new vitiligo patient have been consulted. The ratio of male/female for two years was 16/10. The age of group 26-24 years had more frequently visited. A total 6 patients had segmental vitiligo and 16 patients had non segmental vitiligo. A total 4 patient had unstable vitiligo. During the pandemic, there were various vitiligo therapy such as oral and topical corticosteroid, topical immunomodulator, phototherapy, and punch grafting surgery. Compare to before the pandemic situation in 2019, a total 25 new vitiligo patient have been consulted in our outpatient clinic. Compared to 2019, the number of visits decrease significantly 72% in 2020 and 24% in 2021.
 Conclusion: The pandemic COVID-19 had an unprecedented impact on number of vitiligo patient visits to the tertiary hospitals. This condition may affect visits and patient compliance. There were significant reductions in the number of outpatient visits due to pandemic COVID-19.

Dermatoscopic Patterns in Vitiligo.

Vitiligo is a chronic, acquired autoimmune pigmentary skin disease, most times it can be diagnosed clinically. Dermoscopy can confirm vitiligo in a non-invasive way. It is a diagnostic technique that visualizes sub-macroscopic morphological structures which correspond with specific histological structures. It detects subtle changes in the pigment pattern, evaluates vitiligo activity, attempts of re-pigmentation, leucotrichia, and differentiates it from other hypo pigmentary disorders. Most dermatoscopic clues used to assess vitiligo activity are found at the perifollicular level in the center and edge of the lesion. Perifollicular pigmentation is present in both active lesions and treated pigmented lesions with treatment. However, perifollicular depigmentation represents poor response, in treated lesions, and poor prognosis in untreated ones. The center of the lesion has reduced and/or absent pigment network, in active and stable lesions. If on dermoscopy the center of the lesion shows islands of pigment, erythema, or telangiectasias, re-pigmentation is suggested. At the periphery of the lesion, unstable vitiligo usually shows up as a diffuse border, trichrome pattern, micro-Koebner/comet tail phenomenon, satellite lesions, or a tapioca sago pattern. In stable lesions it is more frequent to find well defined or trichromic border. Pigmented lesions commonly present sharp borders and marginal or perilesional hyperpigmentation.

Dermatoscopic Patterns In Childhood Vitiligo And Their Association With Reflectance Confocal Microscopy Findings.

The diagnosis of vitiligo is mainly based on clinical findings. However, dermoscopy or reflectance confocal microscopy (RCM) could be useful for assessing its progression (stability, pigmentation, or depigmentation). To evaluate the correlation of dermatological findings by dermoscopy and RCM in pediatric vitiligo. We conducted a cross-sectional, descriptive, and analytical clinical study. Pediatric patients with vitiligo of both sexes, aged > 1 year and < 18 years, with all spectrums of the disease were included. Vitiligo lesions were evaluated clinically, by dermoscopy, and microscopy. A total of 40 patients with vitiligo were included. Eight dermoscopic patterns were found: reduced/absent pigment network, perifollicular pigmentation, trichromic, tapioca sago, perifollicular depigmentation, starburst, leukotrichia, and erythema. Skin with a normal pigment network showed complete dermal papillary rings and half-rings. Skin with reduced/absent pigment network also had an absence of papillary rings or only showed half-rings and was more common in unstable vitiligo. The trichrome pattern only showed half-rings. The Tapioca sago pattern showed complete papillary rings and appeared in younger patients. Perifollicular pigmentation showed half-rings and complete rings and did not show associations. The diffuse borders did not present complete papillary structures. It was found that vitiligo's duration time of fewer than 24 months (OR 4.56 CI 1.09-18.99) and absent papillary rings (OR 2.75 CI 1.01-7.51) are associated with unstable prognosis. The dermatoscopic and microscopic findings, such as the reduction/absence of the pigment network, tapioca sago pattern, and absence of papillary rings, can be used to support the evaluation of the clinical prognosis of vitiligo.

Comparative Study of Intravenous Methylprednisolone Pulse Therapy versus Oral Prednisolone Minipulse Therapy in Progressive Vitiligo

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.

Dermoscopic Features of Perilesional Skin of Unstable Vitiligo: A Cross-Sectional Study

Objectives: Dermoscopy is a very useful tool in determining stability in vitiligo. Dermoscopic features of unstable vitiligo are trichrome appearance, comet tail appearance, star burst appearance, amoeboid pattern, nebular pattern, tapioca sago pattern and perifollicular hypopigmentation. Most studies are done on determining features of vitiligo lesions; however, there is lack of studies on dermoscopy in normal appearing perilesional skin. This would give an insight into the extent of the disease process, beyond the borders of skin lesions. We conducted a study on 100 unstable lesions of vitiligo and studied dermoscopic features in its perilesional skin. The objective of this study was to observe dermoscopic features of apparently normal perilesional skin in patients of unstable vitiligo. Materials and Methods: A cross-sectional study was conducted in a tertiary care centre in New Delhi. We evaluated perilesional skin of 100 unstable vitiligo lesions over a span of 1 year. The perilesional skin has been defined as area within 5 cm of the lesion. Dermoscopy was performed using DERMLITE 4 Dermoscope at 10X magnification with inbuilt white light and polarised light. Polarised light was used to study changes in the pigmentary network and other patterns. We looked for features such as pigment network, perifollicular pigmentation, presence of leukotrichia, microkoebner phenomenon and satellite lesions in the perilesional skin. Results: The study included a total of 100 unstable lesions. Majority of patients belonged to the age group of 18−30 years. Females outnumbered males (1.8:1). All cases had progressive disease and mean duration of disease was 12.07 ± 10. 85 years. Dermoscopic features of vitiligo were observed in 56% of patients even in normal appearing perilesional skin. The most common dermoscopic finding observed was reduced pigment network which was seen in 33% of cases. Perifollicular hypopigmentation and depigmentation were observed in 23 and two sites, respectively, while leukotrichia was seen at ten sites. Eight sites showed microkoebners phenomenon. Conclusion: The perilesional apparently normal skin also shows signs of disease activity in cases of unstable vitiligo. Hence, perilesional skin should also be examined carefully with the dermoscope and topical treatment and targeted phototherapy should aim at covering the normal looking perilesional skin as well, at least within 5 cm of the borders of the skin lesions. Importantly, the perilesional skin should also be examined before surgery.

Macrophage Migration Inhibitory Factor and Gene Polymorphism (rs755622G&gt;C) in Unstable Vitiligo Patients

Vitiligo pathogenesis is related to the macrophage migration inhibitory factor (MIF) protein. This study aimed to assess the lesional MIF levels and gene polymorphisms (rs755622G&gt;C) in patients with vitiligo. To assess the consequences of combining narrow‐band ultraviolet B with oral minipulse prednisolone as opposed to a combination with oral methotrexate on MIF levels in vitiligo patients, 50 unstable vitiligo patients and 50 controls were randomly chosen for comparison. MIF levels in skin homogenates and MIF (rs755622G&gt;C) single nucleotide polymorphisms were assessed using the ELISA and the polymerase chain reaction restriction fragment length polymorphism (RFLP‐PCR) techniques. We found significantly higher lesional MIF levels, a higher frequency of both (GC) and (CC) genotypes, and a significantly more frequent mutant allele (C) in patients than in controls. In addition, there was a significantly lower frequency of the allele (C) among patients who exhibited moderate to marked therapeutic improvement than among those who showed minimal to mild improvement. In conclusion, tissue MIF and gene polymorphisms were associated with vitiligo. In addition, oral corticosteroids, narrow‐band ultraviolet B, methotrexate‐targeted tissue MIF, and gene polymorphisms can improve unstable vitiligo.

The use of Janus kinase inhibitors and narrowband ultraviolet Bcombination therapy in non-segmental vitiligo.

Vitiligo is a depigmentation disorder of the skin that occurs secondary to the destruction of melanocytes by an immune-mediated process. Vitiligo clinically presents with depigmented macules and patches, most commonly on the face, acral sites, and genitalia. It can be characterized as generalized or localized based on distribution. The localized form can be further divided into segmental (linear, band-like, or Blaschkoid) and non-segmental vitiligo. The classical treatment of vitiligo includes topical steroids, pulsed oral steroids in unstable vitiligo, phototherapy, a combination of steroid therapy and phototherapy, surgical grafting, as well as intentional depigmentation therapy in severe cases. However, recent advances in understanding the immune mechanisms implicated in the pathogenesis of vitiligo have led to the use of an FDA-approved topical Janus kinase (JAK) inhibitors for vitiligo. Despite this novel therapy advancement, we recommend the addition of narrowband ultraviolet B (NB-UVB) to JAK inhibitors in patients with extensive and progressive lesions, or those not fully responsive to JAK inhibitor monotherapy.

Study to evaluate effect of oral mini pulse corticosteroid therapy for unstable vitiligo on hypothalamic pituitary adrenal axis suppression

BackgroundThe treatment of vitiligo is difficult and usually requires prolonged therapy. All exogenous glucocorticoid therapies can lead to the hypothalamic–pituitary–adrenal axis (HPA) suppression. Steroid therapy in the form of an intermittent pulse therapy is a much safer option than daily administration. Very few studies have been carried out to evaluate the effect of oral minipulse prednisolone (OMP) on HPA axis, and there are no concrete guidelines regarding the tapering of steroids after OMP, if needed at all. This study is a pilot study to evaluate the effect of use of OMP on HPA axis suppression in unstable vitiligo. MethodsIt is an observational prospective study approved by the Institutional Ethics Committee (IEC) of institution carried out on 30 patients with unstable vitiligo being initiated on OMP between the ages of 20–50 yrs carried out at a tertiary care hospital of Western Maharashtra for a period of one year. Inclusion criteria was all new cases of unstable vitiligo attending dermatology OPD with patients in the age group 20–50 years. Patients treated with systemic corticosteroids in the last six months, on prolonged topical steroid therapy, patients on any other immunosuppressive therapy, patients having contraindications for exhibiting systemic steroids were excluded from the study. ResultsThirty steroid-naive patients (11 women, 19 men) with a median duration of vitiligo of 10.67 months duration were evaluated. A total of 19 (63.3%) were males and 11 (36.6%) were females with mean age 29.13 years. Serum cortisol levels at baseline, one week, and the end of therapy were 291.1 nmol/L, 288.7 nmol/L, and 304 nmol/L, respectively. Acton Prolongatum (ACTH) stimulated serum cortisol levels at baseline, one week, and the end of therapy were 658.3 nmol/L, 626.1 nmol/L, and 630.1 nmol/L, respectively. Time taken to achieve stability was a mean of 4.41 months post-initiation of OMP in 22/25(73.3%) patients. In 4/30 (13.3%) patients, no stability was achieved at six months of follow-up. ConclusionsThis pilot study has shown that there is no suppression of serum cortisol levels by OMP prednisolone if taken in a weekly dose. OMP steroid therapy is not very effective to achieve a decent level of repigmentation alone; hence, they should be used in combination with other modalities like topical steroids or phototherapy to achieve better repigmentation. The patients did not develop any systemic or cutaneous side effects due to the drug; hence, prednisolone can be considered a safe drug for pulse therapy.

COVID-19 Pandemic and Vitiligo: Changing Paradigms.

Dear editor, The COVID-19 pandemic has now grown to colossal proportions, affecting nearly 233 million cases, with 4.7 million deaths (WHO dashboard 1-10-2021). How vitiligo management has changed during the pandemic has not been explored.[12] A cross-sectional Google form (Google LLC) based questionnaire was developed by a group of 4 consultants of our institutional pigmentary clinic (later updated by Delphi group of 15 members) [Annexure 1] and disseminated, via email to a few national and international experts who had five or more years in managing vitiligo and had been the first or corresponding authors of articles published on the same. Totally 103 participants responded to the survey. Most worked in private clinics (35; 33.9%), followed by university hospitals (30; 29.1%), public hospitals (21; 20.4%), and corporate hospitals’ centers of excellence (17; 16.5%). All questions were answered by the participants. The approximate number of both stable (80.2 ± 26.4/month to 10.4 ± 8.6/month, P < 0.05) and unstable vitiligo cases (60.4 ± 32.8/month to 7.5 ± 7.2/month, P < 0.05) seen by study participants decreased during the lockdown [Figure 1]. A gross decrease in number of face-to-face consultations during the lockdown (74.7% to 13.5%; P < 0.05) was noted [Figure 1].Figure 1: Consultation trends by physiciansThose who presented during the pandemic phase predominantly had unstable disease and nearly 10% presented with an unstable disease for the first time during the pandemic. There was a gross reduction in the usage of almost all scoring systems [Table 1].Table 1: Use of scoring systemsThirty-five percent of respondents had been posted in care of COVID-19 patients, of them 14 (40%) agreed that these assignments had negatively impacted the care of their vitiligo patients due to unavailability and less time. A few (1.9%) of the participants had vitiligo patients who were COVID-19 positive [Table 2].Table 2: Characterization of the vitiligo patients with COVID-19 positiveThe majority of participants (65; 63.1%) felt pandemic had a negative impact on the quality of life of vitiligo patients (VITIQoL and by physician perception). Twenty participants (19.4%) advocated switch over from previous systemic treatment to topical therapies, and disfavored the use of systemic immunosuppressants, phototherapy, and immunomodulators [Table 3].Table 3: Comparison of the initiation of systemic immunosuppressants and immunomodulators during the COVID-19 lockdownFor patients affected with COVID-19, 60 (58.25%) wished to continue only oral mini pulse with dexamethasone at the same dose, whereas 70 (67.9%) felt that the dose of agents like oral cyclosporine, azathioprine, and mycophenolate mofetil should be reduced by 25%–50%. The majority (78; 75.7%) felt that phototherapy can be continued at the same dose and frequency, if feasible. There was hesitation in the initiation of systemic immunosuppressive therapy. The highest level of safety so far appears to be with low dose mini pulse of dexamethasone and with apremilast. The risk is moderate with methotrexate, and high with mycophenolate mofetil and JAK inhibitors.[2] Xu et al.[3] had found that delay in initiation of systemic immunosuppressants was the most significant risk factor for recurrence of vitiligo during the pandemic. Now even though there is a lesser number of cases, the unstable cases constitute a higher proportion. We had observed a trend of hesitancy in the initiation of immunosuppression. Steps need to be taken by the vitiligo task force to regularize the role of adequate immunosuppressive treatment, especially in patients with unstable vitiligo. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Role of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo

Background: There are several medical and surgical interventions for vitiligo but still the search for a definite cure is going on. The first goal of the therapy is to make the disease stable by preventing the appearance of new lesions. Drugs like oral corticosteroids, methotrexate, and azathioprine have been found effective in this phase. Objective: To compare the efficacy of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo. Materials and Methods: It was a retrospective data analysis of 319 vitiligo patients, out of which 52 patients with unstable vitiligo who have received treatment in the form of 0.5 mg/kg oral corticosteroids on 2 consecutive days per week, 0.3 mg/kg methotrexate per week, and 1 to 1.5 mg/kg azathioprine daily were selected and were evaluated for the effect of drug for 12weeks. Results: There was no statistically significant difference in the appearance of new lesions in all 3 groups; however, methotrexate showed the early effect which plateaus after a few weeks whereas steroids as well as azathioprine showed a gradual and consistent effect. Conclusion: Methotrexate, steroids, and azathioprine all arrest the disease activity in vitiligo. Methotrexate can be used to arrest disease activity in fast-spreading vitiligo. Azathioprine can be used in patients with active vitiligo, wherever steroids are contraindicated.

26966 Tofacitinib treats unresponsive vitiligo and elevated thyroid peroxidase antibodies

A 56-year-old female presented with expanding vitiligo to 35% total body surface area (TBSA) despite treatment with alpha lipoic acid, vitamin C, vitamin E, polypodium leucotomus, topical pimecrolimus, narrowband ultraviolet B, and excimer laser for 2 months. Past medical history was pertinent for Hashimoto thyroiditis treated with levothyroxine with normal levels of thyroid stimulating hormone (TSH) and free thyroxine (FT4), psoriatic arthritis, alopecia, and localized psoriasis on the elbows. Notably, lab tests confirmed normal levels of serum TSH and FT4 but elevated thyroid peroxidase antibodies (TPO) of 795 and elevated thyroglobulin antibodies (TG) of 3. Her endocrinologist denied necessity of treating patients for elevated TPO but stated that patients were only treated with increased dosages of levothyroxine. Because of reported case reports of success in treating vitiligo and FDA-approval for psoriatic arthritis, tofacitinib 5 mg (Tofa) twice daily (BID) was added to the treatment regimen. Serum levels of TPO and TG normalized within 1 month, with simultaneous improvement in vitiligo. Because of gastrointestinal side effects after BID dosing for 5 months, Tofa was decreased to once daily, with continued vitiligo repigmentation. By then, vitiligo had decreased to 12% TBSA, with accompanying improvement in alopecia, psoriatic arthritis, and psoriasis. This case suggests that unstable vitiligo may be associated with elevated TPO and TG, because of a disregard of endocrinologists to treat elevated antibodies, and should be tested in patients with unresponsive vitiligo. Tofacitinib may ameliorate vitiligo not only as a Janus kinase inhibitor but also through an effect on TPO and TG.

Reciprocal regulation of interleukin-17A and interleukin-22 secretion through aryl hydrocarbon receptor activation in CD4+ T cells of patients with vitiligo.

Previous studies have shown the participation of the cytokines interleukin (IL) 17A and IL22 in the development of vitiligo. The aryl hydrocarbon receptor (AhR) functions in the pathogenesis of vitiligo and can modulate cytokine production. The aim of the present study was to determine the relationship between AhR activation and the secretion of IL17A and IL22 in CD4+ T cells in vitiligo. A total of 20 newly diagnosed patients with progressive, unstable vitiligo and 20 healthy controls were recruited. CD4+ T cells and skin samples were collected. Immunohistochemistry, ELISA, reverse transcription-quantitative PCR, western blotting and RNA interference experiments were performed. The expression of AhR was significantly lower in the CD4+ T cells and skin, both lesional and nonlesional, of patients with vitiligo compared with healthy subjects. AhR expression was markedly lower in nonlesional compared with lesional skin of patients with vitiligo. The expression levels of IL17A and IL22 were significantly higher in patients with vitiligo compared with healthy subjects. Knockdown of AhR significantly increased the production of IL17A and markedly decreased IL22 levels in the CD4+ T cells of patients with vitiligo. Ginkgo biloba extract EGb 761 activated AhR, inhibited IL17A secretion and enhanced IL22 release in the CD4+ T cells of patients with vitiligo. In conclusion, reduced AhR expression is associated with progressive, unstable vitiligo. Activation of AhR with G. biloba extract EGb 761 may have therapeutic potential for decreasing IL17A levels and increasing IL22 levels in patients with vitiligo.

Significance of dermoscopy in vitiligo

Vitiligo: An autoimmune disorder of pigmentation characterised by loss of functional melanocytes and melanin in epidermis. The disease has incidence of 0.5%–2% with no ethnic/sex predilection. Morphological dermoscopic patterns in vitiligo and its correlation with stability. An observational study conducted on patients attending C. R. Gardi Hospital, Ujjain during January’19-December’19. Dermoscopic examination was done after taking consent in 50 clinically diagnosed cases of vitiligo including stable vitiligo and unstable vitiligo.Fisher's Exact Test Sig.On dermoscopy, patterns like perifollicular pigmentation (44%), perilesional/marginal hyperpigmentation (50%), intra/perilesional erythema with telangiectasia (86%), perifollicular depigmentation (64%), trichrome pattern (50%), leukotrichia (46%), starburst appearance (24%), comet tail appearance (48%), micro-koebner’s phenomenon (42%), tapioca sago appearance (28%) were observed. Perilesional/marginal hyperpigmentation was observed more frequently in stable disease. Perifollicular depigmentation, trichrome pattern, comet tail appearance, micro koebner’s phenomenon and tapioca sago appearance are the findings significant in unstable disease. Perifollicular pigmentation and intra/perilesional erythema with telangiectasia though are findings of stable disease, were observed in both stable and unstable disease in similar numbers. Leukotrichia and starburst appearance were present in both stable and unstable disease despite being the findings of unstable disease. Dermoscopy serves as an auxiliary tool in confirming the diagnosis and assessing stability of the disease. Dermoscopy allows appreciation of subtle features invisible to naked eye. This is the first ever study to find out the statistically significant findings in stable and unstable vitiligo. We conclude that dermoscopic study in cases of vitiligo can be used as an additional aid in confirming the diagnosis of vitiligo apart from other modalities.

A CROSS SECTIONAL STUDY OF DERMASCOPIC PATTERNS IN VITILIGO: A STUDY FROM CENTRAL INDIA

Background: Vitiligo is an acquired skin condition characterised by enlarging and becoming more numerous over time by white and depigmented patches. It is attributed to the absence and depletion of melanin in the epidermis of healthy melanocytes. The disease can be cosmetically disfigured and the skin is also more vulnerable to sunburns. It affects 0.1-2 percent of the world 's population, and its aetiology is uncertain regardless of gender and ethnicity.&#x0D; Aim: Analysis of morphological dermascopic trends in cases of vitiligo and access to the operation of the disorder, prognosis and as a diagnostic method in the choice of modality of care.&#x0D; Materials and Methods: In 200 diagnosed cases of vitiligo, which contains stable vitiligo, unstable vilitigo, guttate vitiligo and vitiligo treatment cases, white light dermascopy is used in imaging patterns.&#x0D; Result: Trichrom, marginal hyperpigmentation, marginal reticular pigmentation, perifollicular hyperpigmentation in stable vitiligo and salt pepper pattern, starburst pattern in unstable vitiligo is seen on inspection with dermascopy, erythema, perifollicular pigmentation, reticular pigmentation seen in stable viiligo, comet tail pattern seen in Koebner phenomenon.&#x0D; Conclusion: Bad prognosis was demonstrated by erythema, telangectasis, perifollicular pigmentation, reticular pigmentation patterns: marginal hyperpigmentation, perifollicular hyperpigmentation, leucotrichia, marginal reticular pigmentation, comet tail. Dermascopy is therefore used to track treatment activity and disease prognosis, and certain trends can also recommend adjusting the modality of treatment.&#x0D; Keywords: Dermascopy, Stable vitiligo, Unstable vitiligo.

604 Clinical efficacy and safety of using minocycline in the treatment of unstable vitiligo

604 Clinical efficacy and safety of using minocycline in the treatment of unstable vitiligo

A Study on Stability of Acrofacial Vitiligo

Introduction: Acrofacial vitiligo being cosmetically disfiguring, can affect patients self-esteem, employability and interaction with society. The resistant nature if this form of vitiligo adds to angerand disillusionment in the affected individual. The defiant form in addition to its unstable nature necessitates the further study on acrofacial vitiligo. Objectives: To determine the clinical morphology with respect to stability of Vitiligo. Materials and Methods: A cross sectional study was done over a period of one year comprising of patients with acro-facial vitiligo. Relevant investigations including histopathology and patch test were done wherever necessary. Results: A total of 191 cases of acrofacial vitiligo were included in the study. Among stable acral vitiligo (59.48%), ill-defined margins were seen in 84.61% and dorsum was the commonestsite (23.57%). Among unstable Vitiligo, joint was predominantly involved (27.03%). Conclusion: Being prone for injuries, acrofacial areas are unstable. Well defined margins do not strike to the stability of acral vitiligo and signs of activity can be seen even in stable vitiligo. Hence unlike vitiligo of other areas, where well defined margins can be a marker of stable Vitiligo, margins may not be a scale for defining the stability of acral Vitiligo. Involvement of bony prominences could indicate unstable course and least involvement of proximal area of the phalanges may indicate its unstable nature.

A comparative study of psychosocial morbidity in stable versus unstable vitiligo

A comparative study of psychosocial morbidity in stable versus unstable vitiligo

Vitiligo - An Indian Perspective

The prevalence of vitiligo in India is high. It affects DLQI. Exact aetiology is not clear. Melanocytorrhagy hypothesis is important. Classification into segmental and non segmental vitiligo is satisfactory from prognosis and treatment point of view. Onset of vitiligo after the age of 30 years is defined as late onset vitiligo: separate subset with strong genetic background and presence of precipitating environmental factors. Mucosal vitiligo is a distinct subset. Koebner type 2 A phenomenon needs redefining. Oral minipulse and minocycline are effective in progressive unstable vitiligo. Narrowband UVB phototherapy is effective in both children and adults: it has an edge over PUVA. NCECS is the most common surgical technique used in treatment. Suspension in patient's serum gives better results. NCECS is better than SEBG. Camouflaging and depigmentation are required in some cases.

A Randomized Comparative Study of Oral Corticosteroid Minipulse and Low-Dose Oral Methotrexate in the Treatment of Unstable Vitiligo

Background: Despite continued progress towards elucidation of the biochemical, genetic and immunopathological pathways in vitiligo, a definitive cure remains elusive. The initial therapy must be directed to arrest disease progression. Oral minipulse therapy (OMP) with betamethasone/dexamethasone has been tried and shown to be an effective modality to arrest the disease progression in vitiligo. Objectives: Methotrexate (MTX) is a time-tested effective treatment extensively used in various autoimmune disorders with good efficacy, safety and tolerability on a long-term basis. We intended to compare the efficacy of MTX with that of OMP in patients with unstable vitiligo vulgaris. Patients and Methods: In a prospective randomized open label study, 52 patients with vitiligo were divided into two groups. Patients in group 1 received 10 mg methotrexate weekly. Group 2 patients received corticosteroid OMP which comprised tablets of dexamethasone 2.5 mg (5 tablets), taken on 2 consecutive days in a week (total weekly dose of 5 mg dexamethasone). Results: In the MTX group, among 25 patients analyzed, during the course of treatment for 24 weeks, overall 6 patients developed new vitiliginous lesions. In the OMP group, 7/25 patients developed new lesions. Statistical correlation between the two groups showed no significance in the number of patients who developed new lesions (increasing disease activity) in either of the groups. At the end of the study, it was demonstrated that patients in both groups had a similar reduction in the vitiligo disease activity score. Conclusion: Our study demonstrated that both drugs are equally effective in controlling the disease activity of vitiligo. MTX can be used in patients with active vitiligo, wherever corticosteroids are contraindicated.