Vitiligo Disease Activity Score Research Articles

Unlocking vitiligo’s metal code: an analytical cross-sectional study of serum levels of trace elements in vitiligo patients

Background: Vitiligo is an acquired depigmenting skin disorder often associated with social stigma and having a significant psychological impact on patients. The study aimed to determine the correlation between serum levels of copper (Cu), zinc (Zn), selenium (Se), lead (Pb), mercury (Hg), cadmium (Cd), and Cu/Pb, Cu/Hg, Cu/Cd, Se/Hg, Se/Pb, Se/Cd, Zn/Hg, Zn/Pb, and Zn/Cd ratios in vitiligo patients. Materials and methods: In this analytical cross-sectional study, we enrolled 110 vitiligo patients as cases and 110 normal adults as controls. VIDA (Vitiligo Disease Activity Score) and VASI (Vitiligo Area Severity Index) were used to assess the activity and severity of vitiligo in patients. Venous blood samples of all study participants (aged >12 years) were examined for serum levels of Zn, Cu, Se, Pb, Hg, and Cd using inductively coupled plasma mass spectrometry. SPSS.21 version software was used for the analysis of the data. Results: We noted a statistically significant (p-value < 0.05, student’s t-test) difference in mean serum levels of Cu, Zn, and Se (microgram/liter) between cases and controls, denoted as 1370.67 ± 484.36 versus 2887.30 ± 3744.15, 1324.50 ± 555.02 versus 1603.81 ± 551.03, 248.95 ± 120.06 versus 287.15 ± 117.37, respectively. A significantly low serum level of Se was observed in female vitiligo patients, unlike controls. Vegetarian patients had low levels of Pb (p-value <0.05) in comparison to non-vegetarian patients. Significantly low Zn/Hg and Cu/Hg ratios were observed in cases compared to controls. Limitations: Our study was limited by a small sample size. Being an observational study done from a single center, chances of inclusion of patients from a limited geographical area cannot be ruled out. Conclusion: Low levels of Zn, Cu, and Se could play a crucial role in the etiopathogenesis of vitiligo, which can vary based on the gender and diet pattern of the patient.

Clinical study of Wnt inhibitory factor-1 expression and its association with disease severity in non-segmental vitiligo

BackgroundVitiligo is classified as an acquired chronic depigmentation disorder that includes the destruction of epidermal melanocytes. It affects 0.5–1% of the population all over the world. Wnt signaling pathway is vital in melanocytes differentiation and development. WIF-1 is an antagonist of the Wnt signaling pathway; it hinders Wnt from binding its receptors. The present study aims to detect WIF-1 expression in vitiligo skin and if it relates to the disease's severity.ResultsThis case–control study included 70 subjects: 35 vitiligo patients and 35 healthy controls. Skin WIF-1 expression was estimated using quantitative real-time PCR. Assessment of the vitiligo disease activity score and vitiligo area severity index score was determined. WIF-1 expression showed significant elevation in the skin of vitiligo patients compared to the healthy control group.ConclusionOverexpression of WIF-1 may participate in the pathogenesis of vitiligo; hence, it should be a future therapeutic target.

Serum Calprotectin Levels in Vitiligo Patients and Disease Relation.

Vitiligo is characterized as melanocyte loss in skin and mucous membranes, the pathogenesis of which has not yet been clarified. Calprotectin is a protein secreted from neutrophils, monocytes, and dendritic cells which has an effect on cytokine receptor regulation and the production of reactive oxygen radicals. It has been the subject of research in various inflammatory and autoimmune diseases, yet not investigated in vitiligo. The aim of our study was to investigate the role of calprotectin in the etiopathogenesis of vitiligo and its relationship with clinical subtypes and disease scores. Forty-four vitiligo patients with lack of autoimmune disease and 36 age- and sex-matched healthy controls were involved in the study. Serum calprotectin levels were measured by ELISA. The results were compared with the control group, and the relationship between patients' demographic characteristics, skin phototypes, disease type, disease scores (Vitiligo Area Scoring Index and Vitiligo Disease Activity Score), disease duration, and age at onset were evaluated. The median serum calprotectin level was 454.08 pg/ml (41.19-873.41) in the patient group, and the median serum calprotectin level was 223.17 pg/ml (44.88-1044.43) in the control group. Serum calprotectin level was significantly higher in the patient group than in the control group (P = 0.016). No correlation was found between serum calprotectin level and disease scores, disease duration, age, or age of onset of disease (P > 0.05). In our study, serum calprotectin levels in the patient group were found to be significantly higher than in the control group. Our findings and the existing literature on calprotectin suggest its potential involvement in the pathogenesis of vitiligo, independent of disease progression and patient characteristics.

Role of Serum IFN-γ and IL-10 as Predictive Biomarkers of Vitiligo Disease Activity: A Case-Control Study

Abstract Background and Objectives: IFNγ is a pleiotropic cytokine and through the regulation of immunologically relevant genes, they coordinate a wide range of cellular programs.[1] As a potent pro-inflammatory cytokine, it plays a pivotal role to induce depigmentation in vitiligo. In this study, we aim to assess the role of IFNγ in the activity, duration and extent of the disease and the antagonistic action of IL-10 is also assessed in vitiligo. Materials and Methods: A case-control study was conducted with 100 study participants with 50 cases clinically diagnosed as Vitiligo and 50 controls. All patients underwent complete evaluation with detailed demographic parameters, history and physical examination. The severity of the disease was assessed clinically by Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA). And blood investigations done were IFN-γ and IL-10. Results: We observed significantly higher levels of serum IFNγ levels in the patient group when compared with those of the normal controls (p=0.002) and showed a positive correlation with the activity and severity of the disease with a significant VASI (p=0.05) and VIDA score (p=<0.001). The mean serum IL-10 (p<0.001) in patients with vitiligo was significantly lower than that in the control group. Conclusion: This study showed significantly high serum levels of IFN-γ and correspondingly low levels of IL-10. New strategies, such as the combination of IFNγ blockade with inhibition of other signalling pathways, may further improve IFNγ targeted immunotherapy of the disease.

Prevalence of Metabolic Syndrome in Vitiligo Patients and its Relation to Vitiligo Severity - A Cross-Sectional Study.

In vitiligo, there is a significant decrease in melanocytes and melanin. The decrease in melanin causes oxidative stress, with a chance of causing metabolic syndrome. Hence, there is a need to look for metabolic syndrome in vitiligo. To estimate the prevalence of metabolic syndrome in vitiligo patients and to evaluate the relationship between the severity and progression of vitiligo and metabolic syndrome. A hospital-based cross-sectional study was conducted on 178 vitiligo cases and 178 controls who were age- and sex-matched. The type of vitiligo, stability by vitiligo disease activity score (VIDA), and severity by vitiligo area severity index (VASI) were noted. The waist circumference, blood pressure, fasting lipid profile, and fasting blood sugar were measured for cases and controls. Metabolic syndrome was diagnosed based on Harmonization Asian criteria. The mean age in cases was 34.38 years, and in controls, it was 35.67 years. The majority were females in both cases (52.2%) and controls (55.6%). Most have a VIDA score of 2+ (41.6%). The mean VASI score was 2.54. The percentage of metabolic syndrome was higher in cases (36%) compared to controls (24.2%) (P = 0.015). The mean age was lower in vitiligo cases with metabolic syndrome (38.83 years) compared to controls with metabolic syndrome (43.14 years). Metabolic syndrome was more frequent in the vitiligo vulgaris type (48.9%) than in acral and segmental vitiligo. Metabolic syndrome was more common in patients with high VIDA (45%) and VASI (52.3%) scores compared to patients with low VIDA (25%) and VASI (27.3%) scores. It is a hospital-based study, so controls were not from the general population. The prevalence of metabolic syndrome was higher in vitiligo patients compared to controls, and it was higher in patients with active and severe disease. Screening and close monitoring of vitiligo patients help in the early diagnosis of metabolic syndrome and reduce the risk of cardiovascular disease.

Exploring the Severity Strata of Disease Activity and Repigmentation in Vitiligo Based on Validated Physician Global Assessment (PGA) Scores.

Background/Objectives: There is currently no guidance on how to interpret the global degrees of activity (worsening) and repigmentation (improvement) in vitiligo. Stratification into global degrees can be completed for static evaluations (e.g., visible disease activity signs) and dynamic assessments (e.g., evolution over time). For the latter, the Vitiligo Disease Activity Score (VDAS15&60) and Vitiligo Disease Improvement Score (VDIS15&60) were recently validated. Methods: In the current study, a Physician Global Assessment (PGA) for disease activity (worsening) and repigmentation (improvement) was evaluated for validity (construct) and reliability (inter- and intrarater) based on a photo set of 66 patients. Subsequently, the PGA activity (worsening) and repigmentation (improvement) were used to stratify the Vitiligo Extent Score plus (VESplus), VDAS15&60 or VDIS15&60 into three global categories (slightly, moderately and much worse/improved), based on ROC analysis. Results: For the VESplus, cut-off values for the categories 'slightly, moderately and much worse' were >0.3%, >27.71% and >128.75% BSA (relative changes in the affected total BSA), respectively. For the categories 'slightly, moderately and much improved', they were >0%, >4.87% and >36.88% BSA (relative changes in the affected total BSA), respectively. The optimal cut-off values of the number of active (VDAS15) body areas were >0 areas for slightly worse, >2 areas for moderately worse and >7 for much worse. For VDIS15, the cut-off values for slightly improved and moderately improved were >0 and >1. For VDAS60 and VDIS60, the cut-off points were >0.5, >3, >9.5 and >0.5 and >1.5, respectively. The results should be interpreted with caution in patients with extensive vitiligo due to the rather limited disease extent of the included patient population (VESplus (median: 3.2%)). Conclusions: This research will aid in the development of more detailed international definitions.

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.

Exploring the spectrum of vitiligo: Clinical and demographic perspectives – A cross-sectional study

Objectives: Vitiligo is an acquired depigmentation skin disorder caused by the progressive loss of melanocytes and melanin, characterized by white macules on the skin. This study aimed to understand a specific population’s demographic and clinical characteristic factors associated with vitiligo. Materials and Methods: This cross-sectional study consists of 50 patients undergoing treatment for vitiligo at the RSV Clinic, Chennai, for a period of six months. Our study included comprehensive sociodemographic, clinical, and vitiligo profile examinations. Vitiligo disease activity score and vitiligo area scoring index were assessed in all patients, and their treatment approaches were noted. Results: The results showed that vitiligo was most common in adolescents and young adults (66%), followed by children under 10 (18%) and adults over 50 (20%). There was a nearly equal gender distribution, with 52% females and 48% males. Education levels varied, and no specific association with vitiligo was found. The onset of symptoms ranged widely, with lips (28%) and face other than lips (24%) as common initial sites. Coexisting conditions included premature canities (10%) and psoriasis (6%). Treatment approaches varied, with 26% undergoing topical steroids and other therapies. Various triggers were identified, such as trauma (10%) and stress (6%). Clinical manifestations included leukotrichia (18%) and trichrome lesions (10%). Conclusion: This study confirms vitiligo’s prevalence in adolescents and young adults, emphasizing its link to autoimmune disorders. It also underscores complex triggering factors and diverse clinical manifestations among those with vitiligo, enhancing our understanding of its demographics and clinical characteristics in this population.

Epidermal Biophysical Characteristics in Patients with Vitiligo and the Association with Thyroid Auto-immunity and Itch.

Vitiligo is characterized by depigmentation due to melanocyte destruction. Itch is an under-recognized symptom; its pathophysiology is unclear. To compare epidermal biophysical characteristics of the vitiligous skin and normal skin and to determine the association with thyroid auto-immunity and itch. A cross-sectional study involving vitiligo patients was conducted. Hydration, pH, and trans-epidermal water loss (TEWL) at the vitiligous skin and normal adjacent skin were measured. The Vitiligo Disease Activity Score (VIDA) and Vitiligo Area Scoring Index (VASI) were assessed. Itch severity and thyroid auto-antibodies were determined. Thirty-nine (62.9%) females and 23 (37.1%) males participated. Twenty-six (41.9%) had stable vitiligo, and 36 (58.1%) had active disease with a median VASI was 0.8 (2.2). Hydration was lower [93 (83) to 125.5 (111) vs 104 (73) to 156 (100), P < 0.01] and TEWL [7.13 (6.18) to 8.86 (6.93) vs 5.54 (5.90) to 6.88 (6.37), P < 0.01] was higher at the vitiligous skin compared to the normal skin. A non-significant higher pH trend was observed in the vitiligous skin. Thyroid antibody was detected in 19.7% patients. There were no significant differences in biophysical characteristics between patients with and without thyroid antibodies, with hydration of 88 (159) to 129.5 (120) vs 91.5 (81) to 116 (101) and TEWL of 7.08 (2.03) to 9.97 (6.38) vs 7.65 (7.54) to 8.22 (6.52). Itch was reported by 14 (22.6%). Patients with itch had lower hydration and higher TEWL but were not significantly different from patients without itch. The vitiligous skin has reduced hydration and increased TEWL, suggesting a defective epidermal barrier. Thyroid antibody positivity was not associated with biophysical characteristics or itch. Itch was not associated with hydration, pH, and TEWL. An impaired epidermal barrier and itch need to be addressed in vitiligo management.

In-depth study of Wood's lamp examination combined with reflective confocal laser scanning microscopy for the guidance of vitiligo staging and treatment.

Both Wood's lamp and reflective confidential laser scanning microcopy are helpful for the diagnosis and treatment of vitiligo. However, there is few research that contains large samples and consistent observations. To analyze the characteristics of Wood's lamp images and reflectance confocal microscopy (RCM) images of vitiligo lesions and to evaluate their significance in vitiligo staging. We analyzed the characteristics of RCM images, Wood's lamp images, the vitiligo disease activity (VIDA) score, and clinical features to guide vitiligo staging and treatment. The expert consensus based on the clinical features, VIDA score, Wood's lamp findings, and isomorphic response was consistent with the Wood's lamp findings (χ2 = 3.63, p > 0.05) and RCM findings (χ2 = 3.60, p > 0.05) in diagnosing vitiligo and assessing the disease stage. There was a correlation between the three lesion grades based on the Wood's lamp findings and the stage of vitiligo (p < 0.01). Lesions that appeared porcelain white under the Wood's lamp were in the slowly progressive stage; lesions that appeared gray-white or trichromatic under the Wood's lamp were in the rapidly progressive stage; lesions with clear borders under the Wood's lamp needed further analysis by RCM for the stage to be determined; lesions with blurred borders under the Wood's lamp were in the rapidly progressive stage; lesions that were visible under the naked eye and under the Wood's lamp were in the rapidly progressive stage. The study demonstrates a reliable correlation between the findings of RCM (a sophisticated expensive tool) and Wood's lamp examination (a simple, readily available, inexpensive tool) in the assessment of the disease activity of vitiligo lesions.

A New Assessment Method of Vitiligo by Combination of Dermoscopy and Reflectance Confocal Microscopy.

The aim is to investigate the application value of dermoscopy combined with reflectance confocal microscopy (RCM) in assessing vitiligo disease activity and treatment response. We enrolled 279 patients with vitiligo and evaluated the disease activity by Vitiligo Disease Activity (VIDA) score, dermoscopy, RCM and dermoscopy combined with RCM respectively. The sensitivity and specificity of different assessment techniques were compared with VIDA score by the differences and consistency. The different characteristics of dermoscopy and RCM with different treatment responses were also analyzed. The results showed that the sensitivity and specificity of dermoscopy combined RCM were higher than RCM or dermoscopy alone (P values less than 0.05). In the repigmentation process, leukotrichia, pigment network absent and perilesional hyperpigmentation under dermoscopy at the baseline suggested a poor treatment response, while the incompletely disappearing pigment rings under RCM and perifollicular hyperpigmentation under dermoscopy indicated a good treatment response. We also found the proportion of patients with telangiectasia, increased pigment at the lesions and around the hair follicles was significantly higher in the good treatment response group than that in the poor one by dermoscopy (χ2 = 4.423, 32.471, 4.348, P = 0.035 0.000, 0.037) and by RCM the proportion of patients with both increased pigment granules and dendritic melanocytes in the good treatment response group was higher than that in the poor one (χ2 = 38.215, 5.283, P = 0.000, 0.022, respectively). With the higher sensitivity and specificity than dermoscopy or RCM alone, a combination of dermoscopy and RCM may be a new more accurate measure to assess the vitiligo disease activity and the treatment response.

Clinician-reported outcome measures for the assessment of vitiligo: A scoping review.

Clinician-reported outcome measures (ClinROMs) are essential for assessment of vitiligo in clinical trials and daily practice. Several instruments have been developed and tested to measure, for example, vitiligo extent, repigmentation and activity. The goal of this review was to identify all introductory publications of ClinROMs for vitiligo that include at least some aspects of validation and to describe the instruments' characteristics, intention for use and practical strengths and limitations. A search strategy was conducted in PubMed, Embase and Cochrane Library (CENTRAL) from inception to July 2022. Based on the literature search (n = 2860), 10 articles were identified, describing 14 different ClinROMs. Six ClinRoms measured disease extent and/or repigmentation, seven evaluated disease activity and one was a composite score. The Vitiligo Area Scoring Index (VASI), and Vitiligo Extent Score (VES and VESplus) measure overall disease extent and/or repigmentation. The VASI relies on hand units (1% body surface area), whereas the VES and VESplus use a picture-based scoring technique. The Vitiligo Extent Score for a Target Area (VESTA) measures repigmentation percentage for target lesions. One global assessment score for extent has been validated. Vitiligo disease activity scores included a static measure of clinical activity signs (Vitiligo Signs of Activity Score [VSAS]) and two measures assessing dynamic evolution (Vitiligo Disease Activity Score [VDAS] and Vitiligo Disease Improvement Score [VDIS]). The Vitiligo European Task Force assessment tool (VETFa) is a composite score. Depending on the practical strengths and limitations as well as the research question and setting (clinical trials vs. daily practice), the choice of an appropriate ClinROM may differ. Fourteen ClinROMs in vitiligo were identified to measure vitiligo extent, repigmentation, and activity. Further research evaluating the validity, reliability, and responsiveness of each instrument and worldwide consensus on which instrument to use for a specific outcome (domain) is greatly needed.

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.

Evaluation of Serum Level of Interleukin 15 in Active Vitiligo Compared to Stable Disease and Healthy Control

Abstract Background Vitiligo is a common acquired disorder of depigmentation. Its pathogenesis entails a T helper (TH) 1-cytotoxic T (CT) lymphocytes mediated autoimmune melanocyte destruction. Interleukin (IL)-15 is one of the IL-2 family of cytokines and shares several actions with IL-2. IL-15 enhances survival, maturation, and functional activity of natural killer, neutrophils, and dendritic cells. Furthermore, it potentiates survival, maturation, and cytotoxicity of memory CT cells. IL-15 has been shown to play a crucial role in the pathogenesis of several autoimmune diseases but was poorly investigated in patients with vitiligo. Aims To investigate the role of IL-15 in the pathogenesis of vitiligo. Patients and Methods In total, 40 Patients with vitiligo and 20 controls matched for age and gender were enrolled in the study. Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) score were used to assess vitiligo severity and activity, respectively. Serum level of IL-15 was assessed by enzyme-linked immune-sorbent assay. Results Serum IL-15 level, in patients with vitiligo, was significantly higher in comparison with the control group (P =. 001). A significant positive correlation was found between serum IL-15 level and VES score (P =. 001) Conclusion IL-15 level was elevated in the sera of patients with vitiligo. IL-15 may therefore have a significant impact on vitiligo autoimmune pathogenesis, and further identification of its molecular roles may highlight new therapeutic strategies for vitiligo.

Serum interleukin-6 and high sensitivity c-reactive protein levels and their correlation with the vitiligo disease activity and extent: A cross-sectional study of 58 patients

AbstractBackground:Vitiligo is an acquired depigmenting disorder due to the destructive loss of melanocytes, clinically presenting as hypopigmented or depigmented macules and/or patches. Many theories have been proposed to explain its etiopathogenesis among which cell-mediated immunity is one of the crucial links. Estimation of vitiligo activity and extent in a patient is important in tailoring an optimal treatment regimen. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HsCRP) are sensitive indicators for systemic inflammation and are found to be relevant in determining vitiligo disease activity.Objective:This study was conducted to estimate serum levels of IL-6 and HsCRP in vitiligo patients and to correlate them with the disease activity and extent in order to assess if these serum markers serve as objective indicators of vitiligo disease activity.Materials and Methods:This was a hospital-based cross-sectional study of 58 vitiligo patients diagnosed clinically irrespective of age, gender, and any ongoing or past treatment. Disease activity and extent were calculated using the vitiligo disease activity (VIDA) score and vitiligo area severity index (VASI), respectively. Serum levels of IL-6 and HsCRP were obtained and their correlation with VIDA and VASI values were statistically analyzed.Results:A weak negative statistically insignificant correlation was found between IL-6 and VIDA (P= 0.092). No correlation was found between VIDA and HsCRP (P= 0.998). A weak positive, statistically insignificant correlation was found between VASI and IL-6 as well as between VASI and HsCRP (P= 0.175 andP= 0.238, respectively). Although statistically insignificant, the patients who were not on immunosuppressive therapy showed higher mean values of IL-6 and HsCRP compared to those who were on immunosuppressive therapy.Conclusion:In contrast to the findings of previous studies, our study found a weak negative correlation between VIDA and IL-6 levels possibly attributable to the difference between the mean levels of IL-6 among the subgroups of patients who were, and were not on immunosuppressive therapy. The VIDA score and HsCRP levels did not show any statistical correlation. However, patients who were not on immunosuppressive therapy showed a higher albeit statistically insignificant mean value of HsCRP. Our observations suggest that any ongoing and/or treatment in the recent past, especially immunosuppressive therapy, and any co-morbidities should be essentially considered while investigating for sensitive serum markers of inflammation as determinants of vitiligo disease activity.

Comparative Analysis of the Most Used Versus the Recently Developed Vitiligo Activity and Extent Scores and Their Change with Treatment.

There are diverse assessment tools for vitiligo, with no standardized approach that helps unify treatment outcome measures. Thus, comparing different treatment modalities and developing evidence-based recommendations for vitiligo management has been quite challenging. We compared the most commonly used tools assessing both vitiligo activity and extent, namely, Vitiligo Disease Activity Score (VIDA) and Vitiligo Area and Severity Index (VASI) score to their newly developed counterparts, namely, Vitiligo Extent Score Plus (VES plus) and Vitiligo Signs of Activity score (VSAS), to provide insights that would help set recommendations for a unified outcome assessment protocol for vitiligo patients. Thirty-six active non-segmental vitiligo cases were recruited, 30 of whom completed 48 sessions of narrow band ultraviolet B (NB-UVB). Patients were assessed for both extent and activity both before and after treatment with NB-UVB. Scores were correlated. Additionally, VES plus was assessed for its reliability in comparison to VASI score. Both extent (VASI and VES plus) and activity scores (VIDA and VSAS) showed significant improvement following treatment. Additionally, VES plus and VASI were positively correlating both before and after treatment as well as their percent change. Furthermore, VES plus proved as reliable as VASI. Regarding activity scores, total, hypochromic and Koebner VSAS only correlated with VIDA following treatment. Confetti VSAS neither correlated with VIDA before nor after treatment. VES plus and VASI scores have proven of comparable reliability. While examination-based VSAS score comes as an additive tool to the history-based VIDA score.

Assessment of serum interleukin-13 level in vitiligo patients and its correlation to disease severity

Background Vitiligo is a chronic depigmenting skin disease that has a prevalence of 0.5–2% of the population worldwide. Cytokines have a regulatory role in the immune response and depigmentation process in vitiligo. There is an imbalance of various types of cytokines in vitiligo patients. Interleukin-13 (IL-13) plays a role in many autoimmune diseases. Objective To measure the serum level of IL-13 in vitiligo patients and detect its correlation with disease severity. Patients and methods This is a case–control study including 20 randomly chosen patients with nonsegmental vitiligo and 20 healthy controls. Vitiligo disease activity score was assessed in all patients. Serum level of IL-13 was measured by enzyme-linked immunosorbent assay. Results This study revealed that the mean serum level of IL-13 was significantly higher in vitiligo patients, and there was negative correlation between serum level of IL-13 and vitiligo extent score but not statistically significant. Conclusion IL-13 might have a role in the pathogenesis of vitiligo and might play a protective role in the disease. Further large-scale studies are needed to confirm the definite role of IL-13 in vitiligo pathogenesis.

Vitiligo: Correlation with Cytokine Profiles and its Role in Novel Therapeutic Strategies: A Case-Control Study.

The inflammatory and immune factors play a key role in the pathogenesis of vitiligo, and there are very few studies that have investigated the levels of major cytokines produced by T helper (Th) 1, Th2, and Th17 cells. This can enable better understanding of the, pathogenesis, and severity of vitiligo. To evaluate the serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-1β, interferon (IFN)-γ, and IL-10 in patients with vitiligo and to correlate them with the disease severity and activity and to compare them with normal healthy controls. A case-control study was conducted with 100 study participants: 50 cases clinically diagnosed as vitiligo and 50 controls. All patients underwent complete evaluation with detailed demographic parameters, history, and physical examination. The severity of the disease was assessed clinically by Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA). Blood investigations performed were IL-6, TNF-α, IL-1β, IFN-γ, and IL-10. We observed significantly higher levels of serum IFN-γ levels in the patient group when compared with those of the normal controls (P = 0.002) and showed a positive correlation with the activity and severity of the disease with a significant VASI (P = 0.05) and VIDA score (P = < 0.001). The mean serum IL-10 (p < 0.001) in patients with vitiligo was significantly lower than that in the control group. There was no significant difference in the serum level of TNF-α level (P = 0.347), IL-6 (P = 0.365), and IL-1β (P = 0.362) between vitiligo and healthy controls. This study proved that high serum level of IFN-γ may be a risk factor for vitiligo progression and significantly low levels of IL-10, which has an anti-inflammatory role, suggesting that they could be used as a marker for assessing vitiligo activity and may open the way for further therapeutic approaches for vitiligo.

A Retrospective Statistical Analysis of Vitiligo Exacerbation after COVID‐19 Vaccination in China

At present, COVID‐19 vaccination is an effective method to stop the spread of the epidemic and reduce disease severity and mortality. It has been reported that COVID‐19 vaccine can activate several autoimmune diseases. However, whether it can affect development of vitiligo remains elusive. In this study, we aimed to evaluate the possible risk factors of vitiligo disease activity or recurrence after COVID‐19 vaccination. We recruited 383 vitiligo patients, of whom 126 were not vaccinated and 257 had received the COVID‐19 vaccine. Vitiligo disease activity (VIDA) score was used to analyze key risk factors of vitiligo in patients who underwent COVID‐19 vaccination. Multivariate logistic regression models were used to explore the risk factors associated with VIDA. Compared with patients without history of undergoing vaccination, the VIDA score of vaccinated patients increased significantly (3(2, 4) vs. 3(2, 3) scores, P &lt; 0.01). Logistic regression analysis identified COVID‐19 vaccination (odds ratio (OR): 3.040, 95% confidence interval (CI): 1.649–5.603) as an independent risk factor for VIDA. The data showed that COVID‐19 vaccination aggravated the development of vitiligo, which is a key risk factor for recurrence.

Simvastatin and non-segmental vitiligo: A new potential treatment option?

There is a paucity of data about the impact of systemic statins on vitiliginous lesions in non-segmental vitiligo (NSV) patients. To the best of our knowledge, no other studies have considered the correlation between lipid disturbances in vitiligo and vitiligo disease activity (VIDA) score. We sought in this study to evaluate the influence of simvastatin on vitiliginous lesions in NSV patients with dyslipidemia and study the correlation between VIDA score and lipid profile. This clinical trial started with 120 patients with NSV, 79 patients had dyslipidemia and received simvastatin 80 mg daily (till normalization of lipid profile or for 4months, which came first) and only 63 patients continued till the end of the study. Lipid profile, vitiligo area severity index and VIDA were assessed before and 6months after the end of simvastatin use. Serum total cholesterol (TC), triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein, and LDL/HDL ratio showed statistically significant increases in the NSV than in the control group (p˂0.001). There was a statistically significant positive correlation between VIDA and serum levels of TC and LDL and with LDL/HDL ratio. Simvastatin significantly improved the lipid profile and significantly decreased VIDA (p < 0.011). Negative moderate correlation was found between the decrease in VIDA and duration of disease (r=-0.562, p < 0.001). Simvastatin 80 mg daily could be a helpful treatment for NSV patients with dyslipidemia, controlling the vitiligo activity and protecting against the hazardous effects of dyslipidemia. Better results can be obtained in patients with short duration of the disease.