Vitiligo Disease Research Articles

Assessment of changes in color and size of vitiligo lesions during treatment with narrow band ultraviolet B.

Many treatment modalities have been used to stabilize vitiligo and induce repigmentation. Several methods were used to monitor the color changes inside the treated lesions such as spectroscopes and colorimeters that measure the melanin index inside the lesion. To study whether the colorimeter and point counting technique can be used as objective methods in monitoring vitiligo lesions during treatment with Nb-UVB. Twenty randomly chosen patients with non-segmental vitiligo were enrolled in this interventional study. Vitiligo disease activity score was recorded in each patient. Patients received Nb-UVB three times per week for 6months. Two lesions were chosen in each patient, and each lesion was assessed for size using point counting technique and degree of color using the Dermacatch® at the beginning of the treatment and evaluated for changes in color and size every 4weeks till the end of the treatment. After 6months of treatment, regarding the lesion size, 90% of lesions showed variable degrees of repigmentation and 10% showed increase in size, indicating increased activity of the disease, and regarding to color changes. We noticed that after one month of Nb-UVB treatment, there is marked increase in MI measurements in many lesions before any clinical improvement appeared, while at the end of treatment, inside the lesion; 95% showed an increase in melanin index and 5% showed no elevation. While the color changes outside the lesion showed 75% of lesions increased in melanin index, 15% remained unchanged and 10% of the lesions showed decrease in melanin index. Colorimeter was able to detect change in color after only one month of treatment before it was clinically apparent which means that it can be used as a prognostic tool.

Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study.

NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity.

Vitiligo is an acquired cutaneous depigmenting disease caused by a T helper (Th) 1-cytotoxic T cells driven autoimmune attack against melanocytes, in which Th17 is also involved. Interleukin (IL)-38 belongs to the IL-1 family of cytokines and suppresses Th1 and Th17 activation. IL-38 protein and mRNA levels have been found to be elevated in various autoimmune disorders and correlated with disease severity and activity, including psoriasis, systemic sclerosis, rheumatoid arthritis, and atopic dermatitis. No previous studies have been performed to investigate the expression of IL-38 in patients with vitiligo. To evaluate IL-38serum level in patients with vitiligo compared to healthy controls (Hcs) and examine the association between IL-38level and severity and activity of vitiligo. The study comprised 21 patients with vitiligo and 21 Hcs. Vitiligo severity and activity were evaluated via Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) Score, respectively. IL-38serum level was evaluated by enzyme-linked immunosorbent assay. Vitiligo patients had significantly higher serum level of IL-38 than Hcs (p<0.001). This level was significantly higher among patients with signs of vitiligo activity (p=0.048), correlated positively with VES (p<0.001), and correlated negatively with the age of patients (p=0.001) and the age of disease onset (p=0.022). IL-38serum level was higher in patients with vitiligo than in Hcs and was related to vitiligo severity and signs of activity.

Equine vitiligo-like depigmentation in grey horses is related to genes involved in immune response and tumor metastasis

BackgroundIn horses, the autoimmune disease vitiligo is characterized by the loss of melanocytes and results in patchy depigmentation of the skin around the eyes, muzzle and the perianal region. Vitiligo-like depigmentation occurs predominantly in horses displaying the grey coat colour and is observed at a prevalence level of 26.0–67.0% in grey horses compared with only 0.8–3.5% in non-grey horses. While the polygenetic background of this complex disease is well documented in humans, the underlying candidate genes for this skin disorder in horses remain unknown. In this study we aim to perform a genome-wide association study (GWAS) for identifying putative candidate loci for vitiligo-like depigmentation in horses.MethodsIn the current study, we performed a GWAS analysis using high-density 670 k single nucleotide polymorphism (SNP) data from 152 Lipizzan and 104 Noriker horses, which were phenotyped for vitiligo-like depigmentation by visual inspection. After quality control 376,219 SNPs remained for analyses, the genome-wide Bonferroni corrected significance level was p < 1.33e-7.ResultsWe identified seven candidate genes on four chromosomes (ECA1, ECA13, ECA17, ECA20) putatively involved in vitiligo pathogenesis in grey horses. The highlighted genes PHF11, SETDB2, CARHSP1 and LITAFD, are associated with the innate immune system, while the genes RCBTB1, LITAFD, NUBPL, PTP4A1, play a role in tumor suppression and metastasis. The antagonistic pathogenesis of vitiligo in relation to cancer specific enhanced cell motility and/or metastasis on typical melanoma predilection sites underlines a plausible involvement of RCBTB1, LITAFD, NUBPL, and PTP4A1.ConclusionsThe proposed candidate genes for equine vitiligo-like depigmentation, indicate an antagonistic relation between vitiligo and tumor metastasis in a horse population with higher incidence of melanoma. Further replication and expression studies should lead to a better understanding of this skin disorder in horses.

Contribution of HLA class II genes, DRB4*01:01, DRB1*07:01, and DQB1*03:03:2 to clinical features of Vitiligo disease in Iranian population.

Vitiligo is a multifactorial depigmentation condition, which is due to skin melanocyte destruction. Increased expression of HLA class II genes in patients with pre-lesions of Vitiligo suggests a crucial role for the participation of immune response in Vitiligo development. Recent studies progressively focused on HLA-DRB1 and DQB1 genes. In this study, we have evaluated the association and role of HLA-DRB4*01:01, -DRB1*07:01, and -DQB1*03:03:2 genes in different clinical subtypes of Vitiligo in the Iranian population. First, Genomic DNA from peripheral blood of 125 unrelated Vitiligo patients and 100 unrelated healthy controls were extracted through the salting-out method. Then, HLA class II genotyping was performed using the sequence-specific primer PCR method. Finally, the clinical relevance of the testing for these genotypes was evaluated by applying the PcPPV (prevalence-corrected positive predictive value) formula. Our results indicated the positive associations of DRB4*01:01 and DRB1*07:01 allelic genes with early-onset Vitiligo (p = 0.024 and 0.022, respectively). DRB4*01:01 also showed strong protection against late-onset Vitiligo (p = 0.0016, RR = 0.360). Moreover, our data revealed that the DRB1*07:01 increases the susceptibility to Sporadic Vitiligo (p = 0.030, RR = 1.702). Furthermore, our findings proposed that elevated vulnerability of Vitiligo patients due to DRB4*01:01 and DRB1*07:01 alleles maybe is correlated with the presence of amino acid Arginine at position 71 at pocket 4 on the antigen-binding site of the HLA-DRB1 receptor. Our findings on different subtypes of Vitiligo suggest that, despite a more apparent autoimmune involvement, a non-autoimmune nature for the etiology of Vitiligo should also be considered.

Role of Interleukin 33 in Immune Response Process of Vitiligo Disease

Background: When melanocytes cease to operate, vitiligo develops. It is a skin and mucosa depigmentation condition. Any area of the body can develop well-circumscribed white macules or patches in this disease. Approximately 1-2 percent of the population is affected by Vitiligo. Suppression of tumorigenicity 2 (ST2), a newly discovered member of the interleukin-1 (IL-1) family, acts as a receptor for the IL-1 receptor-like 1 protein (also known as IL-1RL1) while also acting as a ligand for the interleukin-1 receptor-like 1 protein (also known as IL-1RL1) and suppressing tumorigenicity 2. Objective: To study Interleukin 33 (IL-33) in generalized and localized vitiligo patients and to assess their relationship with disease activity. Conclusion: Vitiligo could be associated with increased serum levels of IL-33, which could help as predictor marker of disease activity in vitiligo.

The effect of oxidative stress on vitiligo patients

The purpose of the study to shed light on one of the hypotheses keys in causing disease vitiligo is thestress hypothesis of oxidative, stable of vitiligo have been identified active stages or on the basis of thedevelopment or the emergence of new spots in the past three months and the absence of new or patchesdevelopment in the past six months, the in a row, this study included three groups, all of them were male.The first group included the active group, patients with vitiligo of the active type30 the second person, thedormant group, includes static type vitiligo patients 25One person, the third, the control group (apparentlyhealthy) included20People. We have examined the serum levels of Superoxide Dismutase enzyme, catalaseenzyme, and Malondi- aldehyde, our results revealed that the level of higher than Malondi- aldehyde at thelevel of probability (P &lt;0.05) In the serum of the disease group compared to the control group, a significantincrease in the activity of superoxide dismutase was observed in the serum of the disease group at the level ofprobability(P &lt;0.05)Compared to the control group, the catalase activity decreased at the probability level(P &lt;0.05) In the pathological group compared with the control group, our study shows that stress Oxidativehas a role in the physiology pathogenesis of vitiligo active and static. An imbalance of antioxidants wasobserved in the blood of active Vitiligo patients.

26957 A study of dermoscopic features in relation to vitiligo activity

Background: Evaluating vitiligo disease activity is an essential in vitiligo patient management and vitiligo surgery. Conventionally, it takes about a year of period for evaluating vitiligo activity. Recently, utility of dermoscopy as a tool for evaluation of vitiligo activity is reported.

English

BACKGROUND Vitiligo is a hypopigmentary disease of the skin which is associated with impaired quality of life and depression. In our present study, we evaluated the serum levels of homocysteine, vitamin B12, and folic acid in patients with vitiligo and controls in a tertiary care centre and also their association with the extent and activity of vitiligo. METHODS An analytical cross-sectional study was conducted on 40 patients with vitiligo and 40 controls visiting a tertiary care centre for a period of one year. Detailed history regarding demographic data, history of disease, family history, duration of the disease etc. was recorded. Vitiligo Disease Activity Score (VIDA SCORE) and vitiligo area scoring index (VASI) of each body region was calculated. After explaining the procedure, fasting (5 ml) blood sample was drawn and the levels of homocysteine, vitamin B12, and folic acid were measured. Data was analysed using SPSS software and P value less than 0.05 was considered statistically significant. RESULTS There was statistical significance between vitiligo patients and controls of serum vitamin B12, homocysteine and folic acid (P &lt; 0.05) and there was significant association for males in cases and controls (P &lt; 0.05). CONCLUSIONS Vitiligo is associated with elevated levels of serum homocysteine and decreased levels of vitamin B12 and folic acid. KEY WORDS Vitiligo, Homocysteine, Vitamin B12, Folic Acid, Depigmentation

Feasibility of oral tranexamic acid for vitiligo patients with melasma.

Melasma and vitiligo are both common pigmentary disorders, and the treatment is challenging. Oral tranexamic acid (TA) is effective for refractory melasma; however, the feasibility of TA in vitiligo patients with melasma was not studied. To evaluate the treatment outcomes and adverse effects of oral TA in vitiligo patients with melasma. We conducted a retrospective analysis of vitiligo patients who received oral TA for melasma in a tertiary dermatologic center from January 2017 to August 2020. We enrolled 32 patients with concomitant vitiligo and melasma on the face. The mean duration of the improvement of melasma that patients reported is around 1.64 months of treatment. The first sign of repigmentation of the vitiligo lesions occurred at 1 month of treatment. 84.38% of the patients achieved a mild to good degree of improvement of melasma (0%-75% improvement), whereas 81.25% of the patients achieved a moderate to excellent degree of improvement of vitiligo (25%-100% improvement) via physician global assessments. No significant adverse event was noted. No patients experience vitiligo disease deterioration during TA treatment. Oral TA may be a feasible option for melasma in vitiligo patients.

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.

Oral cyclosporine is effective in stabilizing active vitiligo: Results of a randomized controlled trial.

Oral dexamethasone mini pulse (OMP) is an established treatment modality for active vitiligo. Cyclosporine may have therapeutic role in active vitiligo but current evidence supporting its role is scarce. The objective of study was to compare the efficacy and safety of oral cyclosporine with OMP in patients of active vitiligo. Fifty patients with active vitiligo were randomized into two groups of 25 patients. Group 1 was treated with OMP (2.5mg dexamethasone) on two consecutive days/week for 4months while group 2 was treated with cyclosporine (3mg/kg/day) for 4months. Laboratory monitoring was performed as per the prevalent protocol. The patients were followed up for another 2months after stopping treatment. Arrest of disease progression (ADP) was defined as change of vitiligo disease activity score from 4+ to 3+ (time elapsed since last disease activity being more than 6 weeks upto 3months) during the study period (6months). ADP was attained in 21 patients in group 1 and 22 patients in group 2 (84% vs. 88%, p=1.00) at the end of 6months. However, mean time to achieve ADP was significantly lower in group 2 as compared to group 1 (10.92 [4.12] weeks vs. 13.90 [3.92] weeks, p=0.01). Extent of repigmentation, improvement in patient assessment score, vitiligo quality of life and clinical markers of disease activity were marginal and comparable in both groups. Cyclosporine leads to earlier disease stabilization in active vitiligo as compared to OMP. Although considered a rescue drug in dermatology, low dose cyclosporine can be an effective therapeutic alternative in vitiligo patients.

Impact of cytotoxic T‐lymphocyte‐associated protein 4 codon 17 variant and expression on vitiligo risk

BackgroundCytotoxic T‐lymphocyte‐associated protein 4 (CTLA‐4) is one of the essential brakes expressed on T cells that prevent T‐cell hyperactivation‐associated autoimmune disorders. Several CTLA4 polymorphisms were implicated in the regulation of gene expression. We aimed to explore the association of CTLA4 expression and rs231775 (c.49A>G) variant with vitiligo risk and severity of the disease in a sample of the Middle Eastern population.MethodsThe CTLA4 gene expression and genotyping for rs231775 (A/G) variant were assessed in 161 vitiligo patients and 165 controls using a real‐time polymerase chain reaction. Vitiligo Area Severity Index (VASI) and Vitiligo Disease Activity score (VIDA) were evaluated.ResultsA higher frequency of rs231775 G allele was observed in vitiligo cases than controls (45% vs. 33%, p = 0.002). After adjustment of age, sex, family history of vitiligo, and CTLA expression level, using multivariate analysis, G/G carriers were associated with a higher risk of vitiligo under recessive (OR = 2.94, 95% CI = 1.61–5.35, p < 0.001), dominant (OR = 1.87, 95% CI = 1.14–3.06, p = 0.013), and homozygote comparison (OR = 3.34, 95% CI = 1.73–6.42, p = 0.001) models. Although the CTLA4 relative expression levels were comparable to that of controls, G/G carriers exhibited a significantly lower expression profile (median = 0.63, IQR = 0.34–1.75) than A/A (median = 1.43, IQR = 0.39–4.25, p = 0.018) and A/G carriers (median = 1.68, IQR = 0.49–3.92, p = 0.007). No significant associations of CTLA4 variant/expression with disease severity and/or activity were observed.ConclusionThe CTLA4 rs231775 variant was associated with vitiligo susceptibility and gene expression; the risky genotype (GG) was associated with lower CTLA4 relative expression levels than the other genotypes. Further large‐scale studies in different populations are warranted.

547 Regulatory T cell production of IFN-γ in vitiligo

Vitiligo is a common autoimmune skin disease that affects 1-2% of the population. In vitiligo, CD8+ effector T cells (Teffs) target melanocytes, the pigment producing cells. Over time, this targeted destruction leads to patchy skin depigmentation, which can result in social stigma and emotional distress to affected individuals. Regulatory T cells (Tregs) help maintain tolerance in peripheral tissues by suppressing Teffs that target self-antigens and thus limit vitiligo disease severity. We performed single cell RNA sequencing on cells isolated from vitiligo patients and determined that Tregs adopt a type 1 cytokine expression profile in lesions, but not nonlesional skin. Consistent with this profile, human lesional Tregs produce IFN-γ, which we confirmed in our mouse model of vitiligo. IFN-γ production by Tregs could indicate reduced function with conversion to effector status, or in contrast, improved function by adopting a similar profile to their effector targets. Additional studies will determine what role IFN-γ plays in Treg function during the progression, maintenance, and stabilization of vitiligo.

Efficacy and safety of i.v. methylprednisolone pulse therapy for vitiligo: A retrospective study of 58 therapy experiences for 33 vitiligo patients.

Systemic corticosteroid is indicated for vitiligo, especially for generalized and progressive vitiligo. However, no consensus exists yet for the dosages and modalities of systemic corticosteroid treatments for vitiligo. The purpose of this study is to validate the efficacy and safety of i.v. methylprednisolone pulse therapy (IVMP) for patients with progressive generalized vitiligo. We retrospectively reviewed the medical records of vitiligo patients treated in our institute for 10years between January 2010 and December 2019. Among 525 vitiligo patients treated in 10years, 33 vitiligo patients (aged, 8-78years; 18 female and 15 males) received IVMP, a single course of daily 500mg methylprednisolone application (8mg/kg/day for children) for 3 consecutive days. We observed that 14 of 25 (56%) achieved stable condition without lesion progression, and 12 of 19 (63%) had more than 25% repigmentation at 6months after IVMP. A group of Vitiligo Area Scoring Index over 10 included more patients with Vitiligo Disease Activity Score of +3 and +4 disease progression at 6months after the IVMP. We did not observe any severe adverse events relating to the IVMP procedures. In conclusion, IVMP is a safe and effective treatment for progressive generalized vitiligo.

Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort

Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort

Microbial Community of Human Skin and its Role Vitiligo Disease

Microbial Community of Human Skin and its Role Vitiligo Disease

Dendritic cells sub-sets are associated with inflammatory cytokine production in progressive vitiligo disease.

In autoimmune onset of vitiligo, perilesional area shows inflammatory cells including T cytotoxic, helper cells and macrophages. Dendritic Cells (DCs) regulate immune activities by antigen presentation to T cells or cytokine production. It is evident that pro- and anti-inflammatory DCs are responsible for their respective cytokines release. However, role of DCs in vitiligo is enigmatic. In the present study, we assessed DCs markers (CD11b and CD11c) along with pro- and anti-inflammatory cytokines (IL-17A, IL-10 and IL-12p70) in stable and active vitiligo patients. Our results revealed a significant augmented expression of CD11b+CD11c+ (pro-inflammatory DC) in peripheral blood mononuclear cells (PBMCs) and skin tissues of active vitiligo patients versus control and stable vitiligo group. Unlikely, CD11b+ (anti-inflammatory DC) levels were significantly impeded in active vitiligo group as compared to another two groups. CD11c (T helper 1 stimulating DC) presented no significant alterations in any group. Furthermore, we perceived significantly up-regulated IL-17A (pro-inflammatory cytokine) and down-regulated IL-10 (anti-inflammatory cytokine) expressions in active vitiligo group as compared to control and stable group (in sera, PBMCs and skin tissue). Also, a significant positive correlation was observed between CD11b+CD11c+ and IL-17A; and CD11b+ and IL-10. Contrarily, CD11b+CD11c+ and CD11b+ were negatively correlated with IL-10 and IL-17A, respectively. In conclusion, modulation of pro- and anti-inflammatory DCs in active vitiligo patients may affect cytokines production and thereby, lead to further depigmentation of skin.

Psychiatric comorbidity and quality of life in patients with dermatological diseases

ObjectiveThe aim of the study was to compare the psychiatric comorbidities in patients with vitiligo with control group considering the burden in their life quality.BackgroundSeveral studies reported high rates of depression and anxiety particularly for specific dermatological diseases such as vitiligo, affecting their life quality.Patients and methodsA total of 30 patients with vitiligo as well as 30 participants as a control group were included. The study was conducted in Neuropsychiatry Department, Menoufia University. Arabic version of the Structured Clinical Interview for psychiatric Disorders 1 based on the Diagnostic and Statistical Manual of Mental Health Disorders, fourth ed., was used for psychiatric diagnosis. Dermatology life quality index was used to assess life quality in patients with vitiligo. Arabic version of the Holmes and Rahe Stress Scale was used to determine stressful life events that might increase risk for illnesses.ResultsA statistically significant difference between the patients with vitiligo and controls was found regarding psychiatric comorbidities (P < 0.001). Only seven (23.3%) patients of vitiligo group were free of psychiatric disorders. Overall, 23 patients of vitiligo group had psychiatric comorbidities versus control group (76.7 vs. 16.7%). Quality of life (QOL) affection was at moderate effect in 16.7%, very large effect in 30%, and extreme large effect in 10%.ConclusionPatients with vitiligo disease were associated with high rates of psychiatric comorbidity. A significant disruption was found in QOL. Screening may be helpful for early diagnosis, improving their QOL.

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.