Vitiligo Area Severity Index Score Research Articles

Impact of Vitiligo on Quality of Life in Patients of Skin of Color and Its Correlation With Clinical Severity Assessment Scores Utilizing Disease Specific Scores: A Cross-Sectional Study.

Assessment of disease severity of vitiligo is exigent as it is a psychosomatic ailment. VIDA (vitiligo disease activity score) and VASI (vitiligo area severity index) were previously used for this evaluation. Recently, the introduction of two vitiligo specific tools, vitiligo impact scale (VIS)-22 and Vitiligo Quality of Life Index (VitiQoL) has aided in assessing the quality of life (QOL) in a pertinent manner. To measure the QOL in vitiligo using disease specific indices (VitiQoL and VIS-22), to assess their relationship with disease severity (VASI and VIDA) and to determine the correlation between QOL scores (VIS-22 and VitiQoL). This observational cross-sectional study included 195 patients with vitiligo, and their disease severity was calculated using VASI and VIDA scoring. Patients were asked to fill questionnaires for assessing the QOL using validated tools i.e. VIS-22 and VitiQoL. Significant correlation was demonstrated between both QOL scores and VASI score (P value 0.001) with slightly higher values for VitiQoL (r = 0.824) than with VIS 22 (r = 0.693). Both scores exhibited a significant association with VIDA score (P value < 0.001). Moreover, statistically significant correlation was found between VIS-22 and VitiQoL, thereby proving the concordance between these scores. The study infers that QOL seemed to be remarkably dependent on the clinical severity scores and that higher disease activity corresponds to poorer QOL. It is imperative to precisely assess burden of vitiligo and the impairments caused by it in order to aid multi-modality management and allow more standardized research.

To study the role of tofacitinib and betamethasone pulse in the treatment of vitiligo at a tertiary care centre: an observational comparative study

Background: According to recent updates, both genetic and non-genetic factors play a role in the pathogenesis of vitiligo, and CD8T lymphocytes and interferon γ are also known to result in vitiligo. The new oral biologic tofacitinib, which is a Janus kinase inhibitor, is a new addition to the armamentarium of immunosuppressive therapy to halt disease progression in vitiligo. Tofacitinib is also known to inhibit IFN-γ mediated inflammation, which is an important step in the development of vitiligo lesions. Aims and objectives: The aim of this study was to compare tofacitinib with betamethasone pulse in reducing the disease activity with respect to reduction in VASI (vitiligo area severity index) and BSA (body surface area) in patients with vitiligo. The primary objective was to see the efficacy of tofacitinib over betamethasone in the treatment of vitiligo, and the secondary objective was to assess its safety in treating vitiligo patients. Methodology: All the patients with vitiligo of age &gt;12 years attending the dermatology clinic of our institute and willing to give written informed consent were included in the study. Group A patients were prescribed betamethasone 4 mg twice weekly, and group B patients were given tofacitinib 5 mg twice daily, followed by sun exposure in both groups, and photography was done at each monthly visit. Results: The mean change in VASI and BSA in the tofacitinib group was better at each visit than in the betamethasone group. The mean VASI scores at baseline, 1st, 2nd, and 3rd visits were 13.64, 12.79, 11.57, and 10.57, respectively, and the mean BSA at baseline, 1st, 2nd, and 3rd visits were 10.80, 9.75, 8.30, and 7.75 respectively, in the betamethasone group. Similarly, in the tofacitinib group, mean BSA values from baseline to the 3rd visit were consecutively 11.47, 9.50, 7.50, and 5.25, and mean VASIs were 14.92, 12.46, 9.46, and 7.08, respectively. Further, mean changes in BSA and VASI from baseline at each visit. as depicted in graphs 1 and 2, were more in tofacitinib group. There was no side effect in either group at any of the visits. Conclusion: Tofacitinib, along with sun exposure, can cause faster repigmentation and faster control of disease activity, as evident from mean changes at each visit, than oral betamethasone pulse in vitiligo patients.

Serum Inflammatory and Oxidative Stress Markers in Patients with Vitiligo.

Vitiligo is a common chronic hypomelanotic skin disorder. An intricate pool of markers associated with a complex combination of biological and environmental factors is thought to be implicated in etiology. This study aims to investigate the most important markers associated with vitiligo pathogenesis, including redox status, inflammation, and immune profile, in patients with vitiligo. The study included a total of 96 subjects: 30 patients with active non-segmental vitiligo, 30 patients with stable non-segmental vitiligo, and 36 controls. The vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were determined. The following serum parameters were assessed: antioxidant status (TAS), superoxide dismutase activity (SOD), catalase activity (CAT), glutathione peroxidase activity (GPx), glutathione-S-transferase activity (GST), malondialdehyde (MDA), advanced oxidation protein products (AOPP), C reactive protein (CRP), interleukin-15 (IL-15), and chemokines (CXCL9, CXCL10). The VASI score was not significantly different between active and stable vitiligo patients, as it was approximately 0.1. TAS, CAT, GPx, and GST were significantly lower in vitiligo patients compared to controls (p < 0.05). They were also significantly lower in active vitiligo when compared to stable vitiligo (p < 0.05). However, SOD levels were significantly higher in vitiligo patients than in controls and in the active vitiligo group than in the stable vitiligo group (p < 0.05). MDA and AOPP levels were significantly higher in patients with active and stable vitiligo compared to controls (p < 0.05). However, they did not significantly differ between active and stable vitiligo patients (p < 0.05). In both active and stable vitiligo, CRP and IL-15 were significantly higher than controls (p < 0.05). Whereas CRP was significantly higher in active (range = 2.0-7.2, mean = 4.46 ± 1.09) than in stable vitiligo (range = 1.6-6.7, mean = 3.75 ± 1.08) (p < 0.05). There was no significant difference in IL-15 levels between active and stable vitiligo. In both active and stable vitiligo, CXCL9 and CXCL10 were significantly higher than controls (p < 0.05), and they were significantly higher in active than stable vitiligo (p < 0.05). In vitiligo, oxidative damage induces an increase in pro-inflammatory IL-15, which in turn promotes IFN-γ-inducible chemokines such as CXCL9 and CXCL10. Further, there seems to be a link between the VASI score and IL-15 levels. These data imply that inhibiting IL-15 could be a promising method for developing a potentially targeted treatment that suppresses the early interplay between oxidant stress and IL-15 keratinocyte production, as well as between resident and recirculating memory T cells.

Comparison of Oral Azathioprine and Oral Mini Pulse Steroid in the Treatment of Vitiligo: An Open-Label Randomized Controlled Trial.

Vitiligo is a common acquired depigmentory skin disorder supposed to be of autoimmune aetiology. Different immunosuppressants have been tried with varying success. Azathioprine has been less studied in vitiligo. To study the efficacy of oral azathioprine and compare with systemic steroid in the treatment of vitiligo. It was an interventional study with multi-armed (three), parallel group, an open-label, randomized controlled trial with allocation ratio of 1:1:1. Patients of vitiligo aged between 18 and 60 years having more than 5% body surface involvement were included in the study. Patients were divided into three groups. Group A-patients received oral azathioprine 50 mg OD daily, group B-patients received combination of oral azathioprine 50 mg OD and PUVASOL and group C-patients received combination of betamethasone oral mini pulse (OMP) and PUVASOL. All the groups were treated for 1 year. Repigmentation was evaluated by vitiligo area severity index (VASI), and stabilization was evaluated by vitiligo disease activity (VIDA). Group A, group B and group C showed 24.24%, 53.24% and 47.28% improvement in VASI score, respectively, at the end of 1 year. Group B and group C showed statistically significant superior repigmentation as compared to azathioprine monotherapy. Though azathioprine and betamethasone showed equivalent efficacy, azathioprine has a better safety profile. Side effects were minimal in azathioprine groups, whereas 50% patients developed various side effects in group C. Azathioprine is safe and effective option in the treatment of vitiligo.

The positive correlation between serum malondialdehyde levels with vitiligo severity and activity

Background: There are several theories that suggest melanocyte death in vitiligo, one example is oxidative stress theory. Oxidative stress primarily manifested by lipid peroxidation ultimately produce malondialdehyde. Malondialdehyde is a stable marker to assess an oxidative stress event. The correlation between serum malondialdehyde levels and vitiligo severity and activity remained controversial in previous studies.&#x0D; Objective: This study aimed to verify whether or not the serum MDA levels are positively correlated with vitiligo severity and activity.&#x0D; Methods: This study was an analytical cross-sectional study. which involved 64 subjects with vitiligo and 20 subjects without vitiligo. Serum MDA levels were measured to mark an oxidative stress event, whereas the severity and activity of vitiligo were clinically assessed with vitiligo area severity index (VASI) and vitiligo disease activity (VIDA) scoring system.&#x0D; Results: Total 64 subjects with vitiligo and 20 subjects without vitiligo participated in this study. Serum MDA mean levels of vitiligo subjects were significantly higher compared to subjects without vitiligo (p&lt;0.05). Serum MDA levels had a strong positive correlation with VASI score (r=0.761; p&lt;0.01). The strong positive correlation found between serum MDA levels with vitiligo activity assessed by VASI score in vitiligo subjects (r=0.609; p&lt;0.01), and high serum MDA levels increased the risk for developing vitiligo (PR=7.62; 95% CI: 2.49-23.30; p&lt;0.01). Serum MDA levels influenced vitiligo as much as 10.1%, meanwhile the remaining 89.9% were influenced by other variables apart from high serum MDA levels out of this study (R2=0.101; p&lt;0.05).&#x0D; Conclusion: Serum MDA levels were positively correlated with vitiligo severity and activity, and high serum MDA levels increased the risk of developing vitiligo.

A Cross Sectional Study of Psychiatric Morbidity and Quality of Life in Vitiligo Patients

Introduction: Vitiligo is a chronic disorder of skin pigmentation caused by the selective destruction of melanocytes. It causes psychological distress and affects quality of life. Materials and method: An institution based case control study with 55 cases and 55 controls with vitiligo and without vitiligo was undertaken. They were assessed using the Vitiligo area severity index (VASI), Vitiligo Disease Activity Scoring (VDAS), Hamilton Depression Scale (HAMD) and Dermatology life quality index (DLQI). Results: In our study sample 29.1 % had vulgaris, 27.3 % had focal type of vitiligo, and 32.7 % had acro-facial vitiligo, 5.5 % mixed and 5.5 % segmental type of vitiligo was respectively seen. 76.4 % of the cases scored for mild depression and 16.4 % of the cases scored for moderate degree of depression. 23 (41.8 %) of the cases had mild degree of anxiety and 2 (3.6 %) had moderate degree of anxiety. Acro- facial and vulgaris group scored more for anxiety. Significant difference between two groups on WHO Quality of Life scale BREF and DLQI scores. Discussion: Psychiatric morbidity and Quality of Life was found to be significant in patient group with vitiligo than normal controls. There was a higher positive correlation between QOL and VASI scores, denoting the poor quality of life in patients attributable to the severity of the lesions. Conclusion: Psycho-dermatological services will help to mitigate the sufferings and improve the quality of life of patients with vitiligo.

A case control study on the role of interleukin 17 in the pathogenesis of vitiligo

Background: Interleukin 17 (IL-17) has recently been implicated in the pathogenesis of vitiligo by many studies but it is unclear whether it has any definitive role in causing depigmentation. IL-17 inhibitors have already been used in other inflammatory disorders with good results and may prove to be a valuable therapeutic modality in vitiligo. Thus, this study aims at adding to the existing data on the role of IL-17 in the pathogenesis of vitiligo. Objectives: (1) To determine the correlation between IL-17 and the extent of body surface area involvement. (2) To determine the correlation between IL-17 and the severity of disease activity. (3) To determine the correlation between IL-17 and serum vitamin D levels. Methodology: Thirty-two clinically diagnosed patients with vitiligo and 26 age- and sex-matched controls who fulfill the inclusion criteria were enrolled in the study. After obtaining a detailed history, a complete dermatologic examination was performed and vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were assigned. The baseline serum IL-17 level was measured using Raybiotech serum IL-17 enzyme-linked immunosorbent assay kit. Serum vitamin D was measured for all cases and controls. Results: In our study, the mean VASI score of all the patients was 6.32 ± 10.14 and the mean VIDA score was 1.97 ± 0.999. The mean serum IL-17 levels were 155.72 ± 79.412 pg/mL in patients with vitiligo compared to 102.73 ± 56.478 pg/mL of the controls, with a mean difference of 52.99 pg/mL and the difference was statistically significant (P = 0.008). Although, there is no significant correlation between the serum IL-17 levels with the VASI score, our study noticed slightly higher levels of IL-17 in generalized vitiligo and lowest levels were noticed in localized vitiligo. Limitations: Our study was limited by the small sample size of 32. Conclusion: Although, serum IL-17 levels were significantly higher in the patient group than the controls, there was no correlation with the disease extent or activity. Thus, it is difficult to establish a causal role of serum IL-17 in vitiligo.

A comparative study of efficacy and safety of topical 10% phenylalanine gel versus 0.1% mometasone furoate cream in limited nonsegmental vitiligo

Background: Among various therapeutic options for treating vitiligo, the search for an effective agent to minimize disease progression and achieve repigmentation continues. Topical phenylalanine 10% gel has shown promising results, and hence this study was carried out in patients with limited vitiligo. Aim: To compare the efficacy and safety of topical 10% phenylalanine gel versus topical 0.1% mometasone furoate cream in patients with limited nonsegmental vitiligo. Materials and methods: This study included 74 participants diagnosed as limited nonsegmental vitiligo (≤5 skin lesions). Group A received topical 10% phenylalanine gel (twice daily application), whereas Group B received topical 0.1% mometasone furoate cream (once daily application) for a period of 16 weeks. Clinical improvement based on vitiligo area severity index (VASI) scoring was assessed at intervals of 4 weeks until the end of the study duration. Physician’s global improvement assessment was calculated at the end of the study based on VASI scores. Results: Group A participants showed improvement of 24% when compared with 30.7% in group B at end of 16 weeks. Reduction in VASI scores and clinically visible improvement were noted in both groups after 8 weeks. Adverse events were not noted in any of the groups. Lesions over hands and feet were 11.3 times less likely to show response to treatment when compared with other sites. Conclusion: Both phenylalanine and mometasone were able to achieve significant repigmentation in the participants without any adverse effects. Mometasone achieved marked to excellent response in a higher percentage of participants. The overall efficacy of topical mometasone cream was better than topical phenylalanine gel.

303 Maintenance of Repigmentation After Discontinuation of Ruxolitinib Cream in Patients With Vitiligo

Treatment with ruxolitinib cream (Janus kinase [JAK] 1/JAK2 inhibitor) in adult patients with vitiligo resulted in substantial repigmentation over 52 weeks in a phase 2 dose-ranging study (NCT03099304). We assessed maintenance of repigmentation among responders from the phase 2 study following ruxolitinib discontinuation after 104 weeks of treatment. Patients initially randomized to ruxolitinib cream (1.5% twice daily [BID], 1.5% once daily [QD], 0.5% QD, or 0.15% QD) with evidence of facial repigmentation at Week 24 who completed ≥1 follow-up visit 1, 3, or 6 months after an additional 52 weeks of 1.5% ruxolitinib cream BID (Weeks 52–104) were analyzed. Loss of repigmentation was defined as an increase in Vitiligo Area Severity Index score during the last follow-up visit vs Week 104 on ruxolitinib cream. The analysis included 16 patients (1.5% BID, n=3; 1.5% QD, n=5; 0.5% QD, n=3; 0.15% QD, n=5 [including 2 patients rerandomized to 1.5% BID/0.5% QD after Week 24]). Twelve patients (75.0%) maintained total body repigmentation and 13 (81.3%) maintained facial repigmentation during follow-up of 1–6 months; no patients from the 1.5% ruxolitinib BID treatment group (with 2 years’ exposure) experienced repigmentation loss. There were no significant differences in baseline serum levels of chemokine (C-X-C motif) ligand (CXCL) 9, CXCL10, or interleukin-15 in patients who experienced loss vs maintenance of repigmentation after ruxolitinib cream discontinuation. This exploratory analysis suggests that some repigmentation with ruxolitinib cream may be maintained post-discontinuation; larger follow-up studies are required to confirm these findings.

Granzyme B gene polymorphism in vitiligo: does it have an association?

Objectives To study the role of granzyme B (GZMB) gene polymorphism (rs8192917) in patients with nonsegmental vitiligo and to correlate the results with the available clinical information. Background Vitiligo is considered the most common acquired disease of depigmented skin characterized by depigmented patches of the skin, hair, and mucous membranes owing to destruction of melanocytes. Vitiligo is a multifactorial polygenic condition with a multifaceted pathogenesis, linked to both genetic and nongenetic aspects, such as autoimmune, cytotoxic, oxidant–antioxidant, and neural therories working in performance. Patients and methods GZMB gene polymorphism (rs8192917) was identified using real-time PCR technique in 40 patients having nonsegmental vitiligo and 40 age-matched and sex-matched healthy controls. Assessment of disease severity was done using Vitiligo Area Severity Index score, and disease activity was assessed using Vitiligo Disease Activity score. Results CC and TC genotypes were significantly higher in the patients' group [P = 0.005; odds ratio (OR) = 7.2, 95% confidence interval (CI) = 1.61–32.2 for CC and OR = 1.86, 95% CI = 0.42–8.15 for TC], with significant statistical preponderance of C allele in cases (P = 0.001; OR = 3.05, 95% CI = 1.55–6.01). Conclusion GZMB gene polymorphism (rs8192917) is associated with the susceptibility to nonsegmental vitiligo in a sample of Egyptian population.

Effectiveness of dermabrasion plus 5-fluorouracil vs suction blister in treating vitiligo: A comparative study.

Vitiligo is a prevalent destructive melanocyte skin disease that negatively affects the patients' life in terms of self-esteem. Suction blister and dermabrasion plus 5-fluorouracil are effective treatments for vitiligo. The present study was conducted to compare the outcomes of these two techniques. The present clinical trial was conducted on 36 patients with persistent refractory vitiligo which defined as the lack of any new or progressed lesion during the previous year as well as no responding to conventional therapies of vitiligo including topical treatments and phototherapy. Individuals with two vitiligo patches, with similar baseline Vitiligo Area Severity Index (VASI) scores were randomly allocated to dermabrasion plus 5-fluorouracil or suction blister treatments. VASI and repigmentation scores were measured and compared at the baseline, four, and 12 weeks after performing the procedures. Both of the approaches accompanied with significant improvement in both entities of VASI and repigmentation scores (P value < .05) at the end of the study, besides the trend of VASI and repigmentation scores between the two groups revealed insignificant difference (P > .05). The short-term follow-up of the patients was the limitation of this study. The present findings suggested that both surgical techniques of dermabrasion plus 5-fluorouracil and suction blister posed acceptable outcomes within 12-week follow-up.

Quality of life impairment amongst persons living with vitiligo using disease specific vitiligo quality of life index: A Nigerian perspective.

Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. This condition can affect the patients' psychology, leading to an impairment of quality of life (QOL). Recently, much attention is been given to the emotional and psychological issues in the affected subjects. This was to assess the QOL impairment among Nigerian patients with vitiligo using a disease-specific quality of life index questionnaire (VitiQoL). Seventy seven adults aged 18 years and above with vitiligo attending the Dermatology Clinic of a tertiary health center were included in this cross-sectional study. The QOL was assessed using the vitiligo quality of life questionnaire (VitiQoL). Disease severity was assessed using Vitiligo Area Severity Index (VASI). The mean age of the study participants was 38.97 ± 13.2 years, comprising of 32 (41.6%) and 45 (58.4%) females. Almost half of the vitiligo patients belong to the lower socioeconomic class, 37 (48.1%). The mean age of first onset of vitiligo was 33.5 ± 14.84 years, with 32 (41.6%) of the participants having age of first onset between 24 and 42 years. The mean VitiQoL score was 30.51 ± 15.74 (range 3-64). There was a significant relationship between VASI score and VitiQoL (P = 0.036, r = 0.517). Other factors such as age, gender, socioeconomic status, disease activity, family history of vitiligo, duration of the disease and educational attainment were significantly associated with VitiQoL score (P < 0.05). QOL is impaired significantly in Nigerian patients with vitiligo. Focusing on patient's QOL is an essential aspect in the management of patients with vitiligo.

Serum paraoxonase-1 levels as an indicator of oxidative stress in patients with vitiligo

ObjectiveTo evaluate the use of serum paraoxonase-1 (PON1) activity as an indicator of oxidative stress in patients with active generalized vitiligo.BackgroundVitiligo is an acquired cutaneous disorder of pigmentation, characterized by destruction of melanocytes. One of the major hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis. In patients with vitiligo, lower levels of PON1 prevent lipoprotein peroxidation and oxidation of low-density lipoprotein and cholesterol.Patients and methodsA case–control study was conducted on 40 patients: 20 patients with recent active generalized vitiligo and 20 age-matched and sex-matched healthy volunteers served as controls. All the included patients underwent full history taking, full examination, routine laboratory investigations, and assessment of serum PON1.ResultsThe serum PON1 level in patient group A (101.64 ± 25.48) was significantly lower than that in the control group B (181.88 ± 95.12) (P < 0.001). There was a significant negative correlation between serum PON1 level and vitiligo area severity index score (r = −0.780, P < 0.001).ConclusionVitiligo is probably mediated through a process of oxidative stress and imbalance of oxidant–antioxidant system. Oxidative stress present in vitiligo disease can be determined by measurement of serum PON1 in these patients.

Serum interleukin 15 as a marker of activity in patients with vitiligo

Background Interleukin 15 (IL15) is a proinflammatory cytokine that is involved in the pathogenesis of several autoimmune and inflammatory diseases. The stability of vitiligo represents the periods of no activity of the disease, and it is crucial in determining the line of treatment of the patient.Objective To assess serum IL15 in patients with vitiligo and to evaluate its predictive capacity as a marker of vitiligo activity.Patients and methods A total of 40 patients with nonsegmental vitiligo were included, in addition to 30 age-matched and sex-matched healthy individuals as a control. The severity of vitiligo was assessed using vitiligo area severity index score, whereas the activity of disease in patients was assessed using vitiligo disease activity score. Serum levels of IL15 were measured using the ELISA technique.Results The mean serum level of IL15 was significantly higher in patients with vitiligo (201.14±115.41 ng/l) than in control (136.13±22.57 ng/l). Moreover, the mean serum level of IL15 was significantly higher in patients with unstable/active vitiligo (243.12±136.64 ng/l) than in patients with stable vitiligo (144.35±28.82 ng/l). Patients with serum level of less than or equal to 150.90 ng/l can be diagnosed as stable vitiligo, with 76.47% sensitivity and 73.91% specificity.Conclusion IL15 is a good and reliable marker for the detection of activity in patients with vitiligo, but further studies are needed to follow the progression of disease and to correlate this with the serum level of IL15. Targeting IL15 could be a novel treatment approach for patients with vitiligo.

Serum level of S100B in vitiligo patients: Is it a marker of disease activity?

Vitiligo is a chronic depigmentary skin disorder, characterised clinically by the development of white macules and or patches caused by loss of epidermal melanocytes. S100B is a dual function protein released from epidermal melanocytes in response to injury. It considered a possible marker of disease activity in both malignant melanoma and vitiligo. To estimate the serum level of S100B level in vitiligo patients and correlate its level with disease activity and various disease parameters. Sixty vitiligo patients and 60 healthy volunteers as controls were included in the study. Vitiligo Area Severity Index (VASI) and Vitiligo Disease Activity (VIDA) scores were estimated for each patient. Quantitative assessment of S100B level using ELISA technique was done for all participants. S100B level was significantly correlated with the presence of vitiligo (P=0.01), while it showed no correlation with the disease activity using VASI or VIDA scores. As regards the receiver operating characteristic (ROC) curve analysis of S100B for diagnosis and discrimination of vitiligo, serum S100B showed area under the curve (AUC) of 0.781 with 73.3% sensitivity and 80% specificity. The serum level of S100B was related to the presence of vitiligo, but its level did not show any relation to the disease activity using either VASI and VIDA scores or various disease parameters.

Correlation between serum vitamin D levels and severity of vitiligo

Objective To correlate between serum vitamin D levels and severity of vitiligo. Background Vitiligo is an acquired depigmentary disorder that affects more than 0.5–1% of the worldwide population. Vitamin D has been implicated in the pathogenesis of various autoimmune diseases. The correlation between vitiligo and vitamin D is discussed in this study. Patients and methods This case–control study was conducted on 60 patients with vitiligo and 60 age-matched and sex-matched healthy individuals. All patients were recruited from the Outpatient Clinic of Dermatology and Andrology Department of Shebeen El-Kom University Hospital between 1 May 2018 and 31 August 2018. Blood samples were taken, and serum levels of vitamin D were measured by enzyme-linked immunosorbent assay technique. Serum levels of vitamin D were statistically analyzed in relation to Vitiligo Area Severity Index (VASI) score using Spearman coefficient test. Results The patients had higher serum vitamin D levels than the controls with highly significant difference (P Conclusion There was no significant correlation between vitamin D levels and VASI score. Future larger controlled studies are required to obtain a wider assessment of the relationship between vitamin D level and vitiligo disease severity.

他克莫司治疗白癜风一年的临床疗效观察

Objective To evaluate the efficacy of long-term treatment with tacrolimus ointment in patients with vitiligo. Methods A total of 156 patients with vitiligo (70 males and 86 females) were enrolled into this study, who were firstly diagnosed with vitiligo and continuously followed up in Department of Dermatology, Yiwu Dermatology Hospital and the Third People′s Hospital of Hangzhou between January 2016 and February 2018. Of the 156 patients, 114 were adults, and 42 were children aged 6 - 18 years. All the patients received 6-month treatment with tacrolimus ointment twice a day. They were followed up once a month, the time to initial repigmentation and vitiligo area severity index (VASI) were recorded, and VASI improvement rate was calculated. After 6-month treatment, the patients achieving marked improvement were divided into conventional treatment group and interval treatment group to be treated with tacrolimus ointment twice a day and once every 3 days respectively for another 6 months, and final efficacy of the 2 protocols was compared. Mauchly′s test of sphericity, randomized block analysis of variance and Bonferroni method were used to analyze differences among pre-treatment VASI scores, and 1- to 6-month post-treatment VASI scores. Results Among the 156 patients, the pre-treatment, and 1-, 2-, 3-, 4-, 5- and 6-month post-treatment VASI scores[M (P25, P75) ] were 2 (0.6, 5) , 2 (2, 5) , 1.6 (0.575, 4.5) , 1.2 (0.5, 4.0) , 0.4 (1.15, 3.5) , 0.75 (0.3, 2.575) , 0.6 (0.2, 2.2) respectively. Additionally, there was a significant difference in the VASI score among the above time points (F = 6.14, P 0.05) . Conclusions The initial 6-month topical tacrolimus therapy showed marked efficacy for vitiligo. After the marked improvement of skin lesions, good efficacy can be maintained by long-term treatment with topical tacrolimus once every 3 days or twice a day. Key words: Vitiligo; Therapy; Tacrolimus; Long-term treatment

The positive correlation between serum malondialdehyde levels with vitiligo severity and activity

Background: There are several theories that suggest melanocyte death in vitiligo, one example is oxidative stress theory. Oxidative stress primarily manifested by lipid peroxidation ultimately produce malondialdehyde. Malondialdehyde is a stable marker to assess an oxidative stress event. The correlation between serum malondialdehyde levels and vitiligo severity and activity remained controversial in previous studies.Objective: This study aimed to verify whether or not the serum MDA levels are positively correlated with vitiligo severity and activity.Methods: This study was an analytical cross-sectional study. which involved 64 subjects with vitiligo and 20 subjects without vitiligo. Serum MDA levels were measured to mark an oxidative stress event, whereas the severity and activity of vitiligo were clinically assessed with vitiligo area severity index (VASI) and vitiligo disease activity (VIDA) scoring system.Results: Total 64 subjects with vitiligo and 20 subjects without vitiligo participated in this study. Serum MDA mean levels of vitiligo subjects were significantly higher compared to subjects without vitiligo (p&lt;0.05). Serum MDA levels had a strong positive correlation with VASI score (r=0.761; p&lt;0.01). The strong positive correlation found between serum MDA levels with vitiligo activity assessed by VASI score in vitiligo subjects (r=0.609; p&lt;0.01), and high serum MDA levels increased the risk for developing vitiligo (PR=7.62; 95% CI: 2.49-23.30; p&lt;0.01). Serum MDA levels influenced vitiligo as much as 10.1%, meanwhile the remaining 89.9% were influenced by other variables apart from high serum MDA levels out of this study (R2=0.101; p&lt;0.05).Conclusion: Serum MDA levels were positively correlated with vitiligo severity and activity, and high serum MDA levels increased the risk of developing vitiligo.

Can we consider silymarin as a treatment option for vitiligo? A double-blind controlled randomized clinical trial of phototherapy plus oral Silybum marianum product versus phototherapy alone

Introduction: Vitiligo is a chronic skin disorder caused by destruction of the skin melanocytes, which presents as a depigmented area in the skin. This study examined the effect of Phototherapy plus oral Silybummarianum on the treatment of skin lesions of Vitiligo.Materials and methods: In this randomized controlled clinical trial, 34 patients with vitiligo who were referred to Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Iran, were randomly divided into two groups. The first group was treated with phototherapy plus Narrowband UVB plus oral silymarin and the other group was treated with phototherapy with placebo. The patients in both groups were evaluated with vitiligo area severity index (VASI) at the beginning and end of the study. SPSS software version 23 was used for statistical analyses.Results: The mean of the VASI score showed a statistically significant decrease in both groups at the end of the study (p < .05), but the decrease in the VASI score in patients who received Silybum marianum was more in comparison with the other group.Conclusion: This study showed that probably Silybum marianum is a good choice for patients with vitiligo; however, further studies are recommended to be conducted to confirm our result.

Effect of intralesional platelet rich plasma in chronic localized vitiligo

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vitiligo is a disease caused by destruction of melanocytes in lesional skin. It occurs worldwide in occurance of 0.1 to 2.0 percent. It is a multifactorial polygenic disease with complex pathogenesis. Several treatments, old and new are advocated for such patients. The first line of treatment includes topical corticosteroids and calcineurin inhibitors, and phototherapy (NBUVB, PUVA). The second line of treatment includes systemic corticosteroids, topical calcipotriol 0.005%, lasers such as excimer laser (308 nm). The aim of the study was to evaluate the efficacy of platelet rich plasma in 40 cases of stable vitiligo with less than or equal to 1% body surface area involvement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 40 cases of stable vitiligo not responding to adequate topical therapy for more than 1 year were included in the study. They were subjected to intralesional injections of freshly prepared autologous platelet rich plasma (PRP) by double spin technique. Each patient was given injections every 2 weekly interwals for a total of 6 injections. Results were evaluated using the vitiligo area severity index (VASI) score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 40 patients15 Patients showed good response, 12 patients showed Average response and13 patients showed no response to treatment according to VASI score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PRP may be considered as an additional therapy in patients not responding adequately to traditional therapies. Our patients were not subjected to histopathology. It was also felt that patients might require more than 6 sittings for complete repigmentation.&lt;/p&gt;