Vitiligo Extent Research Articles

Prognostic value and clinical significance of halo naevi regarding vitiligo

Vitiligo and halo naevi can present together or separately. Whether they are different entities remains unclear. To assess the clinical significance of halo naevi, both with respect to the future development of vitiligo, and to the clinical profile and course of vitiligo. In total, 291 patients were included in this study: patients with only halo naevi (group 1; n=40), patients with generalized vitiligo without halo naevi (group 2; n=173) and patients with generalized vitiligo with halo naevi (group 3; n=78). Patients with only halo naevi (group 1) reported significantly less associated autoimmune disease (P=0·001), were less likely to have a family history of vitiligo (P=0·013) and were less likely to have presence of Koebner phenomenon (P<0·001) compared with patients with generalized vitiligo (groups 2+3). Multiple halo naevi (≥3) were significantly more frequently observed (P=0·002) in patients from group 1 compared with patients from group 3. In group 3, halo naevi were reported prior to the development of vitiligo in 61% (mean±SD time interval of 33·7±5·17months). No significant correlation was observed between the presence of halo naevi and the extent, activity or subtype of vitiligo. However, halo naevi in patients with vitiligo significantly reduced the risk for associated autoimmune diseases, and age at onset of vitiligo was significantly lower compared with patients with vitiligo without halo naevi (P<0·001). Our results support the hypothesis that halo naevi can represent a distinct condition. In a subset of patients, the occurrence of halo naevi may be an initiating factor in the pathogenesis of vitiligo.

Serum homocysteine as a biomarker of vitiligo vulgaris severity: A pilot study

To the Editor: Vitiligo is an autoimmune depigmenting disorder. Vitamin B12 (B12) and folic acid (FA) supplementation can benefit vitiligo patients.1Don P. Iuga A. Dacko A. Hardick K. Treatment of vitiligo with broadband ultraviolet B and vitamins.Int J Dermatol. 2006; 45: 63-65Crossref PubMed Scopus (21) Google Scholar B12/FA deficiencies cause homocysteine (HC) elevations; supplementation reduces homocysteine. Homocysteine may mediate melanocyte destruction via increased oxidative damage, interleukin 6 production and nuclear factor κB (NFKB) activation. We examined the association between HC and vitiligo. Institutional review board (IRB)–approved chart review was conducted of patients with new-onset vitiligo (January 2003-July 2006) at St. Luke’s-Roosevelt Hospital. Complete blood cell count, B12, FA, and HC were collected. Body surface area (BSA) was estimated by using palm size, approximately 2 inches,2Shaker O.G. El-Tahlawi S.M. Is there a relationship between homocysteine and vitiligo? A pilot study.Br J Dermatol. 2008; 159: 720-724PubMed Google Scholar to estimate 1% BSA. Distribution and number of body parts involved were recorded. Categorical variables were examined by chi-square tests. All continuous variables were not normally distributed and were analyzed by non-parametric Mann-Whitney U or Kruskal-Wallis tests. Linear and logistic regression was performed for continuous and binary dependent variables, respectively. Log transformation was used for nonlinear data. Data were analyzed with SAS 9.2 Software (SAS Institute Inc., Cary, NC). HC levels were available for 56 patients; 46 also had B12 and FA. No vegetarians, or B12 (<300 pg/mL)/ FA deficiencies (<5.4 ng/mL) were noted. Linear regression models, controlling for age, gender, and ethnicity, found significant associations between HC and B12 (b = -0.01, P = .0003) (Fig 1), log vitiligo BSA (b = 0.16, exponentiated b = 1.17, P = .003) and number of vitiligo-affected body parts (b = 0.41, P = .004) (Fig 2).Fig 2Association between vitiligo extent and serum homocysteine levels. A, Body surface area, (B) number of body parts involved, (C) bilaterality of lesions, but not (D) distribution of lesions (dependent variables) are associated with serum homocysteine levels (independent variables). Linear regression models were constructed both as parsimonious models and as confounding models including age, gender, ethnicity, serum vitamin B12 levels, and supplementation with oral vitamin B12 and folic acid. Outliers were excluded from statistical analysis and are indicated as open circles. Regression coefficients for confounding models and P values are presented above, except for panel C, where results of parsimonious model are presented.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Logistic regression models, controlling for age, gender, ethnicity, B12, and oral B12/FA supplementation, found significant associations between HC and face and body (generalized) vitiligo lesions, compared with face or body alone (odds ratio [OR] = 12.00; 95% confidence interval [CI], 1.43-100.78; P = .02). Parsimonious logistic regression models found significant associations between HC and lesion bilaterality (OR = 1.21; 95% CI, 1.10-1.33; P < .0001) (Fig 2, C), but were no longer significant when age, gender, ethnicity, serum B12 levels, and B12/ FA supplementation were included in the model (P = .81). HC was not associated with type of generalized vitiligo (Wilcoxon signed-rank test, P = .16) (Fig 2, D). B12 and FA levels were not associated with BSA, distribution, body part number, or bilaterality of lesions (P = 0.43-0.89) nor supplementation of B12 and FA (P = 0.29-0.97). We demonstrate an association between serum HC and extent of vitiligo, suggesting HC as a new biomarker of vitiligo extent. Prior published studies of the association between vitiligo and HC found conflicting results. An age-matched case-controlled study of Egyptian patients demonstrated elevations of HC.2Shaker O.G. El-Tahlawi S.M. Is there a relationship between homocysteine and vitiligo? A pilot study.Br J Dermatol. 2008; 159: 720-724PubMed Google Scholar Validity of parametric tests for between-group comparisons was not assessed; groups were compared by using Pearson correlation, limiting the utility of the statistics and did not control for B12/FA. Extraordinarily elevated HC in cases and controls were not consistent with our population levels. Balci et al3Balci D.D. Yonden Z. Yenin J.Z. Okumus N. Serum homocysteine, folic acid and vitamin B12 levels in vitiligo.Eur J Dermatol. 2009; 19: 382-383PubMed Google Scholar performed a Turkish age/gender-matched case-control study, finding no association between HC, B12/FA, and vitiligo. Their study did not control for vitiligo duration, age, or gender. Differences between HC and vitamin levels may represent regional or ethnic variation. Nevertheless, the results of the present study demonstrate elevated serum HC levels in extensive vitiligo. We strongly recommend the inclusion of HC as a severity marker on initial examination for patients with vitiligo.

Role of interleukin-17 in the pathogenesis of vitiligo

Skewing of the immune response towards T helper (Th)1 or Th17 and away from regulatory T cells (Tregs) and Th2 cells may be responsible for the development and progression of autoimmune disease. An autoimmune theory has been proposed in the pathogenesis of vitiligo. No previous reports have investigated alterations in IL-17 produced by Th17 cells in lesional skin in vitiligo. To investigate the role of IL-17 in the pathogenesis of vitiligo by assessing its levels in lesional skin and serum of patients with vitiligo compared with controls. In total, 30 patients with vitiligo and 20 controls matched for age and gender were enrolled in the study. Serum and tissue IL-17 levels were measured by ELISA and compared between both groups for correlations with age, gender, family history, disease duration, activity of vitiligo and percentage of involved body surface area. A significant difference between patients and healthy controls was found for both serum and tissue IL-17 levels (P<0.001 for both). Significant positive correlations were found between disease duration and IL-17 level in both serum (r=0.42, P=0.02) and lesional skin (r=0.45, P<0.015); between extent of vitiligo and IL-17 levels in both serum (r=0.65, P<0.001) and skin (r=0.48, P<0.05); and between the serum and the tissue IL-17 levels in patients with vitiligo (r=0.54, P=0.002). Multiple factors have been implicated in the pathogenesis of vitiligo. The increased levels of IL-17 we found in serum and lesional skin suggest an important role for this cytokine in the pathogenesis of vitiligo.

Transplantation of melanocytes in vitiligo.

We report the results of a study on 100 patients (aged 12-68) with vitiligo, who were treated by transplantation of cultured autologous melanocytes to the depigmented areas, after removal of the epidermis at the recipient site by dermabrasion. The melanocytes were cultured from a 2 x 3 cm2 superficial shave biopsy taken from pigmented buttock skin. After 2-3 weeks in culture, 700-1000 cells per mm2 were applied on 60-500 cm2 dermabraded areas, and occluded for 1 week. The repigmented portion of the total treated area amounted to 95-100% in 40 patients, 65-94% in 32, 20-64% in 22, and 0-19% in six. It was more difficult to achieve complete pigmentation on the fingers, elbows and knees. In the first few months following the procedure, the treated areas were often hypo- or hyperpigmented, but after 6-8 months they had acquired the same colour as the surrounding skin. No scarring or other side-effects occurred. The donor site had repigmented after 3-6 months in all but two patients, who also showed poor pigmentation in the transplanted areas. At follow-up after 1 and 2 years in 50 and 10 patients, respectively, the repigmented areas remained unchanged. The method is time-consuming, but the results obtained indicate that the procedure can be valuable in motivated patients, when the extent of vitiligo does not exceed 30% of the total body area, and when the areas to be treated are not actively extending.

Anti-thyroid peroxidase antibody and vitiligo: a controlled study

BackgroundVitiligo is an acquired depigmenting disorder due to destruction of melanocytes. Although many theories have been suggested for its pathogenesis, the role of autoimmunity is the most popular one. The association of vitiligo with autoimmune thyroid diseases and the increased prevalence of autoantibodies including thyroid autoantibodies in vitiligo favor this role. Our objective was to compare the frequency of thyroid peroxidase antibody (anti-TPO) in vitiligo patients with healthy subjects in Iran.MethodsNinety-four cases of vitiligo (46 female and 48 male) and 96 control subjects (49 female and 47 male) were enrolled in this controlled study. Patients with known thyroid disease, history of thyroid surgery and those receiving thyroid medications were not included. The two groups were matched regarding gender and age. The demographic data, symptoms related to thyroid diseases and results of skin and thyroid examinations were recorded in a questionnaire for each subject. Thyroid function tests including free T3, free T4 and TSH-IRMA were performed. Anti-TPO levels were assessed as well. The collected data were analyzed by SPSS version-11 in vitiligo patients and subgroups according to gender, age, extent, and duration of the disease compared with the control group.ResultsAnti-TPO was detected in 17 (18.1%) of patients affected by vitiligo, while this figure was 7 (7.3%) in the control group; the difference was significant with p-value < 0.025 (Phi & Cramer's V = 0.162). When analyzing subgroups, the difference in the frequency of anti-TPO remained significant only in females (p-value < 0.044) (Phi & Cramer's V = 0.207) and in patients in the age ranges of 18–25 (p-value < 0.05) (Phi & Cramer's V = 0.28) and 26–35 year-old (p-value < 0.042) (Phi & Cramer's V = 0.304).The difference of the frequency of anti-TPO was not significant regarding the duration and extent of vitiligo. In addition, there was no significant difference in the levels of free T3, free T4, and TSH in vitiligo patients compared with the control group.ConclusionAccording to our study, anti-TPO was shown to be significantly more common in vitiligo patients especially in young women, compared with control group. As this antibody is a relatively sensitive and specific marker of autoimmune thyroid disorders including Hashimoto thyroiditis and Graves' disease, and considering the fact that vitiligo usually precedes the onset of thyroid dysfunction, periodic follow-up of vitiligo patients for detecting thyroid diseases is further emphasized especially in young women with increased level of anti-TPO.