Vitiligo Group Research Articles

Association analysis of class II cytokine and receptor genes in vitiligo patients

The loss of melanocytes in vitiligo is mainly attributed to defective autoimmune mechanisms and lately autoinflammatory mediators have become more emphasized. Among these, a number of class II cytokines and their receptors have displayed altered expression patterns in vitiligo. Thus, we selected 30 SNPs from the regions of respective genes to be genotyped in Estonian case-control sample (109 and 328 individuals, respectively). For more precise analyses, patients were divided into subgroups based on vitiligo progression activity, age of onset, sex, occurrence of vitiligo among relatives, extent of depigmented areas, appearance of Köbner’s phenomenon, existence of halo nevi, occurrence of spontaneous repigmentation, and amount of thyroid peroxidase antibodies. No associations appeared in whole vitiligo group. In subgroups, several allelic and haplotype associations were found. The strongest involved SNPs rs12301088 (near IL26 gene), that was associated with familial vitiligo and existence of halo nevi, and rs2257167 (IFNAR1 gene), that was associated with female vitiligo. Additionally, haplotypes consisting of rs12301088 and rs12321603 alleles (IL26–IL22 genes), that were associated with familial vitiligo and existence of halo nevi. In conclusion, several genetic associations with vitiligo subphenotypes were revealed and functional explanations to these remain to be determined in respective studies.

Audiological and Electrophysiological Changes in Patients with Vitiligo.

The study was conducted to evaluate the audiological and electrophysiological findings in patients with Vitiligo and to compare the findings with otologically and audiologically normal controls. Study group included 50 subjects (25 Males, 25 Females) with Vitiligo (Mean age-27.4years) and control group contained 40 age-matched normal hearing subjects. Pure tone audiometry (PTA) with extended high frequency audiometry, Otoacoustic emissions (OAEs), Tympanometry, Auditory brainstem responses (ABR) and Middle latency responses (MLR) were conducted in all subjects. Comparison of the study group with the control group showed statistically significant differences (p<0.05) on PTA, in Transient otoacoustic emissions (TOAEs) at 1, 2, 3, 4kHz and in distortion product otoacoustic emissions (DPOAEs) at 357, 499, 704, 1003Hz. On ABR, statistically significant differences were observed between the groups in wave I (p<0.01) in both ears, wave V (p<0.05) in left ear and on interpeak latency of I-III (p<0.01, p<0.05), III-V (p<0.01 in left ear) and I-V (p<0.01, p<0.05) in left and right ears respectively. When patients with localized vitiligo were compared with generalized vitiligo, the SNR of TOAEs was highly significant in both ears at 2KHz (p<0.05), 3kHz (p<0.01) and 4kHz (p<0.05). PTA average of 2 KHz, 4 and 8kHz (PTA2) showed a significant difference (p<0.01) when localized vitiligo was compared to generalized vitiligo. Results support possible auditory and electrophysiological changes in Vitiligo patients along with decreased cochlear function.

Evaluation of ocular findings in patients with vitiligo.

In this study, we aimed to investigate ocular manifestations in patients with vitiligo. Sixty-one patients with vitiligo were included in the study. From the patients who referred for examination to the dermatology and ophthalmology clinic, 57 patients without any systemic disease were taken as the control group. In both groups, otorefractometry, keratometry, visual acuity test, intraocular pressure measurement, anterior segment, and fundus examinations of the eye with slit lamp, Schirmer test, and perimetry were carried out. The mean age was 24.54±11.90years and 23.03±8.72years in the patients and control group, respectively. The mean Schirmer test results were as follows: 16.74±9.11mm and 17.64±9.41mm for the right and left eyes of the patients, and 21.96±12.51mm and 23.42±12.51mm for the right and left eyes of controls, respectively. Of the patients, 36 eyes showed lenticular findings. However, only 12 eyes of the controls have some lenticular findings. Twenty-nine eyes in the vitiligo group and four in the controls showed some fundus findings. When the two groups were compared with each other, there was a statistically significant difference between them in terms of Schirmer test results, lens, and fundus findings (P<0.05 for all). However, there was no significant difference in terms of age, gender, visual acuity, refraction, keratometry, intraocular pressure, perimetry, and corneal findings (P>0.05 for all). Patients with vitiligo may have more lenticular and retinal findings than normal. They can be more prone to dry eye syndrome as well.

Evaluation between Association of Psoriasis and Vitiligo.

Although the occurrence of psoriasis and vitiligo is reported in a few studies, no proper relationship has been found between these two diseases. The aim of this study was to identify the frequency of the coincidence of these two diseases. A descriptive and cross-sectional study was conducted on 6,200 patients referred to dermatology clinics from September 2004 to June 2005. Among these patients, 219 and 154 patients suffered from psoriasis (3.53%) and vitiligo (2.48%), respectively, and 12 patients (0.19%) had psoriasis and vitiligo simultaneously. The coincidence in the psoriasis group was 5.48% and in the vitiligo group was 7.79%, so the coincidence of both diseases was greater than the incidence of each alone. This association was significant (p = .004). Coincidence of these two diseases was seen, but more studies should be done to find common genetic and immunologic factors.

Pediatric Patients with Vitiligo in Eastern China: Abnormalities in 145 Cases Based on Thyroid Function Tests and Immunological Findings.

BackgroundThe aim of this study was to evaluate abnormalities in thyroid function according to tests and the humoral immune systems of patients from Eastern China with pediatric vitiligo.Material/MethodsA total of 145 pediatric patients with vitiligo were investigated in this study, along with 59 children without autoimmune diseases as controls. Laboratory tests of thyroid function were conducted, and these tests examined free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), thyroid peroxidase antibody (TPO-Ab), antinuclear antibodies (ANAs), immunoglobulins (IgA, IgM, and IgG), and complements (C3 and C4).ResultsA total of 63 patients (43.4%), including 39 boys (44.3%) and 24 girls (42.1%), displayed abnormalities in thyroid function according to the tests. This finding indicated that patients with vitiligo differed significantly from those in the control group (P<0.001), particularly in terms of FT3 and TSH abnormalities (P<0.05). However, these groups did not deviate significantly with respect to FT4, Tg-Ab, and TPO-Ab abnormalities (P>0.05). Thirteen patients (8.9%) and 1 (1.7%) control were positive for ANA. All 12 specific antibodies were detected in 8 patients. Anti-SSA/Ro-60 and anti-SSA/Ro-52 were the most prevalent antibodies, followed by anti-dsDNA and then by anti-SmD1 and CENB-P. The serum levels of IgA and IgG decreased more significantly in the vitiligo group than in the control group (P<0.001). However, no significant difference was observed in terms of IgM levels (P>0.05). C4 serum levels also decreased more significantly in the vitiligo group than in the control group (P=0.035).ConclusionsResults suggest that the incidence of abnormalities in the thyroid functions of children and adolescents is significantly higher in those with vitiligo than that in those in the control group. In addition, immunological dysfunction is common in the vitiligo group.

Study of serum levels of Vitamin B12, folic acid, and homocysteine in vitiligo

Background: Vitiligo has a complex etiopathogenesis. The role of nutritional factors (including Vitamin B12and folic acid) has been recently proposed in its causation, which needs to be confirmed further. Aims: The study was conducted: (1) To estimate the serum levels of Vitamin B12, folic acid, and homocysteine in patients of vitiligo and control group. (2) To determine the relationship between serum levels of Vitamin B12, folic acid, homocysteine and the extent and activity of vitiligo. Methods: A cross-sectional, observational study consisting of 50 patients with vitiligo, and 35 age and sex matched controls was conducted. Serum homocysteine was estimated by Diazyme homocysteine enzymatic assay kit, and serum Vitamin B12and folic acid levels were estimated by chemiluminescence using the Access Immunoassay System. Results: The mean serum Vitamin B12and folate levels were found to be significantly lower in vitiligo patients than controls (157.18 ± 68.95 pg/mL vs. 306.6 ± 169.73 pg/mL and 4.18 ± 3.55 ng/mL vs. 7.3 ± 3.67 ng/mL, respectively), while serum homocysteine levels were significantly higher in cases (15.39 ± 7.2 μmol/L) as compared to controls (11.88 ± 4.81 μmol/L) (P < 0.05). There was a significant positive correlation of serum homocysteine levels with the duration of disease, Vitiligo Area Scoring Index (score), and type of vitiligo (higher levels in patients with universal vitiligo). Conclusions: Long standing vitiligo (especially universal and generalized variants) may show deranged serum homocysteine, Vitamin B12, and folic acid levels. Supplementation with Vitamin B12/folic acid may have a therapeutic role in improving the treatment outcome.

Psychological Morbidity in Vitiligo-A Case Control Study

Background: Vitiligo is associated with various psychiatric comorbidities. Various studies have showed prevalence ranging from 34% to 75%. Vitiligo can greatly affect the quality of life of patients and psychiatric comorbidities can further worsen it. Thus there is need to recognise psychiatric comorbidities and treat them in these patients. Aims: The aims of our study were to determine the psychiatric morbidity and the Quality of Life (QOL) in patients suffering from vitiligo and to determine the factors related with psychiatric morbidity and those affecting the QOL in these patients. Methods: 50 patients of age range 18 – 65 years with disease duration of 1-26 years attending the vitiligo clinic in dermatology outpatient department of a tertiary care hospital were included and 50 persons with no dermatological or diagnosed psychiatric illness accompanying them served as control group. They were diagnosed for psychiatric disorders as per DSM-IV TR, if present. Scales used were Body Surface Area (BSA), WHO-Quality of Life (WHO-QOL) scale, General Health Questionnaire (GHQ), Hamilton rating scales for Anxiety and Depression (HAM-A and HAM-D). Results: 30% patients in vitiligo group suffered from psychiatric disorder, depression was present in 20% of patients and 8% had anxiety disorders. QOL scores had negative correlation with BSA, GHQ, HAM-A and HAM-D scores and they were statistically significant. Conclusions: Thus it was found that vitiligo patients had more psychiatric comorbidities as compared to control group and it had bearing on their quality of life too.

Reduced serum brain-derived neurotrophic factor in patients with first onset vitiligo.

PurposeVitiligo is an acquired pigmentary skin disease that can cause serious cosmetic problems. There have been numerous and well established studies that have demonstrated the comorbidity of various psychiatric disorders in patients with vitiligo. However, to our knowledge, there have been no studies investigating whether a psychiatric biomarker, such as brain-derived neurotrophic factor (BDNF), is associated with vitiligo.Patients and methodsThis study was conducted in Namık Kemal University Medical Faculty, Departments of Dermatology and Psychiatry between January 2013 and September 2014. After meeting inclusion and exclusion criteria, serum BDNF levels were assayed in 57 patients with first onset vitiligo and no known current or past psychiatric disorder and compared with BDNF levels in 58 age and sex matched healthy subjects.ResultsThe age and female/male ratios were similar between groups. The mean values of serum BDNF were 1.57±0.97 ng/dL and 2.37±1.73 ng/dL in the vitiligo group and in the healthy control group, respectively. The mean BDNF level was significantly higher in the healthy control group compared with the vitiligo group (t=2.76, P=0.007).ConclusionThis is the first study to compare serum BDNF levels between patients with vitiligo and healthy subjects. The reduced level of serum BDNF in patients with vitiligo may be directly related to the etiology of vitiligo or associated with the high percentage of psychiatric disorders in that patient population. Further studies are needed to support our preliminary results.

Regulatory T cells from active non-segmental vitiligo exhibit lower suppressive ability on CD8+CLA+ T cells.

Recent studies have shown that vitiligo is a T-cell mediated autoimmune disease. Skin-homing cytotoxic T lymphocytes expressing cutaneous lymphocyte-associated antigen (CLA) have been suggested to be responsible for the destruction of melanocytes in vitiligo. An aberration in the suppressive function of regulatory T cells (Tregs) has been reported in vitiligo patients. However, whether the weakened suppressive ability of the Tregs contributes to hyper-activated skin homing CD8(+)CLA(+) T cells remains to be determined. To investigate the inhibition of circulating Tregs on the proliferation of autologous CD8(+)CLA(+) T cells in non-segmental vitiligo patients. CD8(+)CLA(+) T cells and Tregs were obtained from the peripheral blood of 13 non-segmental vitiligo patients and 7 controls. The proliferative responses of CD8(+)CLA(+) T cells were assessed in the absence or presence of autologous Tregs, and the levels of Transforming Growth Factor β1(TGF-β1) and IL-10 in culture supernatants were detected by enzyme-linked immunosorbent assay. The proliferative responses of circulating CD8(+)CLA(+) T cells in the presence of Tregs were significantly higher in the active vitiligo than in the stable vitiligo and control groups. Tregs from active vitiligo patients exhibited a lower inhibitory effect on proliferation of CD8(+)CLA(+) T cells. The levels of TGF-β1 produced by Tregs were significantly lower in active vitiligo than other groups and anti-TGF-β1 antibodies could abrogate the suppressive function of Tregs. The functional activity of Tregs is compromised in active vitiligo patients. TGF-β1 plays an important role in the autoimmune mechanism of the disease.

The combination of tumour necrosis factor-α -308A and interleukin-10 -1082G gene polymorphisms and increased serum levels of related cytokines: susceptibility to vitiligo.

The aetiopathogenesis of vitiligo is still under investigation. To assess the role of single nucleotide polymorphisms (SNPs) of the genes for tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, as well as the serum levels of these three cytokines in the pathogenesis of vitiligo. The study enrolled 105 patients with vitiligo, and 211 age- and sex-matched controls. TNF-α (-308), IL-6 (-174) and IL-10 (-1082) promoter polymorphisms were investigated by LightSNiP assay and analysed by χ(2) test. Subsequently, the serum cytokine levels were assessed by ELISA and evaluated by Mann-Whitney U-test and Kruskal-Wallis test. The frequency of the GG genotype of the IL-10 -1082 polymorphism was significantly higher in the vitiligo group compared with the healthy control group (P=0.02). Further investigations using combinations of these variant alleles detected a significant risk for vitiligo for individuals carrying both the IL-10 -1082G and TNF-α -308A alleles (OR=12.57, 95% CI 1.44-110.0, P<0.01). Serum IL-10 and TNF-α levels were higher in the vitiligo group (P=0.001). In addition, TNF-α levels in patients with active disease were significantly higher than in patients with stable disease (P<0.02). The concomitant presence of IL-10 -1082G and TNF-α -308A alleles significantly raises the risk for vitiligo. Furthermore, in accordance with these findings, serum IL-10 and TNF-α were also increased in this study, confirming the role of these cytokines in the pathogenesis of vitiligo.

ASSESSMENT OF OXIDATIVE STRESS DURING NARROW BAND UVB PHOTOTHERAPY IN VITILIGO PATIENTS OF NORTH INDIA

Vitiligo is an acquired epidermal pigment loss which occurs anywhere in the body. The disease occurs worldwide with an estimated overall prevalence of less than 0.5%. The biological basis of vitiligo has been an intractable problem to confront. Among several therapies for the disease, narrow band UVB phototherapy is preferred modality and is effective. Recently, oxidative stress has been speculated to be the primary event in the pathogenesis of vitiligo. The ability of free radicals to destroy melanocytes is considered as missing link. This study is aimed to assess the oxidative stress and antioxidant status in vitiligo patients with and without NB-UVB phototherapy for 4 weeks. 30 Vitiligo patients were recruited for study from OPD of Department of Dermatology, Era’s Lucknow Medical College & Hospital, Lucknow. Blood of all subjects was investigated for anti-oxidant parameters such as Superoxide dismutase (SOD), Catalase (CAT), Glutathione peroxidase (GPx) and Lipid peroxides (LPO). Results indicated significant increase in the CAT and SOD activity in stable vitiligo patients after NB-UVB phototherapy as compared to its baseline activity. However, in active vitiligo patients, the increase in the CAT and SOD activity were found non-significant. GPx activity was found statistically non-significant in active vitiligo group after NB-UVB phototherapy compared to its baseline value, however in stable vitiligo patients the GPx activity was statistically significant. Following the NB-UVB phototherapy the LPO levels increased significantly in both active and stable vitiligo patients as compared to their baseline values.

Relationship between Helicobacter pylori infection and vitiligo: a prospective study.

Helicobacter pylori is a worldwide bacteria that may affect several extra-gastric systems, including the endocrine, hematologic, vascular, respiratory, immune, and skin. Several skin diseases, including chronic urticaria, alopecia areata, psoriasis, and systemic lupus erythematosis have been found to be associated with H. pylori infection. To our knowledge, there are no data showing an association between H. pylori and vitiligo. Therefore, in this study, we wanted to evaluate the relationship between H. pylori and vitiligo. This study is a prospective study carried out in our Gastroenterology and Dermatology and Venereology departments of the Ankara Education and Research Hospital (Ankara, Turkey) between July 2013 and December 2013. Seventy-nine consecutive patients with vitiligo and 72 patients with telogen effluvium (TE) were recruited from the dermatology outpatient clinic. A total of 133 patients with vitiligo (n=68) and TE (n=65) [excluding 18 patients who had suspicious urea breath test (UBT) results] were included in the study. All individuals were tested for H. pylori IgG and CagA. Also, a UBT was performed to detect the presence of H. pylori infection. There were significantly higher rates of H. pylori positivity, H. pylori CagA, and IgG in serum in the vitiligo group than in the TE group (p<0.05). The number of patients with dyspepsia was significantly higher in the vitiligo group than in the TE group. No statistically significant relationship was seen between H. pylori positivity, CagA, H. pylori IgG, dyspepsia, and the Vitiligo Disease Activity score (p>0.05). Also, when patients with vitiligo were divided into localized and generalized types of vitiligo, there was no association between vitiligo involvement pattern and H. pylori positivity, CagA, H. pylori IgG, and dyspepsia (p>0.05). Additional studies are necessary to evaluate the effect of H. pylori eradication on the clinical course of vitiligo. Further studies are also needed to explain the relationship between H. pylori and the pathogenesis of vitiligo.

The effects of galangin on a mouse model of vitiligo induced by hydroquinone.

Galangin, the main active component of Alpinia officinarum Hance, was tested in a mouse model of vitiligo induced in C57BL/6 mice by the topical application of 2 mL of 2.5% hydroquinone daily to shaved areas (2 × 2 cm) of dorsal skin for 60 days. Thirty days after the final application of hydroquinone, galangin (0.425, and 4.25 mg/kg) was administered orally for 30 days. The hair colour darkened when it grew back after treatment, and histological analysis showed that the number of melanin-containing hair follicles had increased after treatment with all doses of galangin groups and 8-methoxypsoralen (8-MOP, the positive control) compared with the untreated vitiligo group (p < 0.05). The number of skin basal layer melanocytes and melanin-containing epidermal cells had also increased significantly with the application of 4.25 mg/kg of galangin. The concentration of tyrosinase (TYR) in serum was found to have increased, whereas the content of malondialdehyde and the activity of cholinesterase had decreased after treatment with all doses of galangin and 8-MOP, compared with control (p < 0.05). The expression of TYR protein in treated areas of skin also increased with the application of 4.25 mg/kg galangin and 8-MOP. In conclusion, the results showed that galangin was able to improve vitiligo induced by hydroquinone in mice, with the activity related to concentrations of TYR, expression of TYR protein, activity of malondialdehyde and content of cholinesterase. Galangin may therefore be a potential candidate for the treatment of vitiligo, subject to further investigation.

Role of oxidative stress in the pathogenesis of vitiligo with special emphasis on the antioxidant action of narrowband ultraviolet B phototherapy

To evaluate the role of oxidative stress in the pathogenesis of vitiligo and the effect of narrowband (NB) ultraviolet (UV) B phototherapy on oxidative stress markers. Patients with vitiligo and healthy control subjects were included in the study. Patients in the vitiligo group were treated with an NB-UVB regimen (3 × weekly for 6 months). Erythrocyte superoxide dismutase activity (SOD), erythrocyte malonyldialdehyde (MDA) and erythrocyte glutathione peroxidase activity (GSH-Px) levels were assessed in all participants at baseline, and after NB-UVB phototherapy in patients with vitiligo. A total of 24 patients with vitiligo and 27 control subjects were included in the study. Before treatment, erythrocyte MDA levels were significantly higher, and SOD and GSH-Px levels were significantly lower, in patients with vitiligo compared with controls. NB-UVB phototherapy was associated with a significant reduction in MDA levels and a significant increase in GSH-Px levels, compared with baseline, in patients with vitiligo. NB-UVB phototherapy may relieve oxidative stress in patients with vitiligo by reversing the oxidant-antioxidant imbalance that is considered to play a role in the pathogenesis of this disease.

Association between an HLA-G 14 bp insertion/deletion polymorphism and non-segmental vitiligo in the Korean population

Vitiligo is a pigmentary skin disorder characterized by the chronic and progressive loss of melanocytes. Although the etiology of vitiligo is still unknown, several theories have been proposed to explain the pathogenesis of vitiligo including autoimmune, neural, self-destruction, oxidative stress, and genetic theories. Human leukocyte antigen (HLA)-G is a nonclassic, major histocompatibility complex class I molecule that plays an important role in suppression of the immune response. Several recent studies have provided evidence that a 14 bp insertion (INS)/deletion (DEL) polymorphism in the HLA-G gene might be associated with autoimmune disease. Our aim in this study was to determine whether the 14 bp INS/DEL polymorphism in the HLA-G gene contributes to the risk of developing non-segmental vitiligo (NSV) in the Korean population. We conducted a case-control association study of 192 NSV patients and 491 matched, unaffected controls. The HLA-G 14bp INS/DEL polymorphism was analyzed by gene scan after amplification using the polymerase chain reaction. Genotype frequencies for the 14bpINS/DEL were different between the vitiligo group and Korean control group. The proportion of subjects with a homozygote 14bpINS/14bpINS genotype was significantly higher in the vitiligo group compared with the control group (7.1 vs. 3.5 %, OR 2.25, 95 % CI 1.06-4.76, p = 0.039 in the recessive model). Our results suggest that the HLA-G 14bpINS/DEL polymorphism is associated with the development of NSV in the Korean population.

Immunohistochemical expression of heat shock protein 70 in vitiligo

Heat shock proteins (HSPs) are proteins that are expressed under variety of stresses including pathologic conditions. How stresses affect vitiligo is not fully understood and little is known about the role of HSPs generally and Hsp70 specifically in vitiligo. The current study investigated the expression of Hsp70 in vitiliginous (32) and normal skin (10) by immunohistochemistry together with correlating this expression with the clinicopathologic parameters in the studied vitiligo group. Hsp70 was expressed in the cytoplasm of epidermis in all normal skin compared with its localization to the cytoplasm in 35.5% and to the nuclei in 64.5% of epidermis in vitiligo lesions. Intense (P < .001) and diffuse (P < .001) expression of Hsp70 was in favor of vitiligo skin compared with normal skin. Nuclear form of Hsp70 tended to be expressed in progressive forms of the disease. The percentage of Hsp70 expression tended to be decreased with the duration of the disease. From the present study, up-regulation of HSP 70, in the form of its intense and diffuse expression, may be blamed in pathogenesis of vitiligo. Nuclear localization of HSP 70 may be more important than its presence or absence, beside it may be related to progression of the disease.

Immunohistochemical Expression of c-kit Receptor (CD117) in Two Pigmentary Disorders

Stem Cell Factor (SCF) is generally thought to be an important regulator of melanocyte and mast cell survival, migration and proliferation. The c-kit receptor (CD117) may play a role in many skin disorders with dyspigmentation. The aim of this study was to assess the immunohistochemical expression of CD117 in some pigmentary disorders such as melasma and vitiligo. The study included a total of 40 patients were divided into two groups; melasma group: included (20) patients and vitiligo group: included (20) patients, in addition to a control group which included (20) healthy skin specimens were obtained during plastic operations. The severity of melasma and vitiligo skin lesions was measured by modified melasma and area severity index (MASI) and vitiligo area severity index (VASI) scores respectively. Tissue biopsies were taken from all the participant and stained by haematoxylin and eosin (H and E) and immunohistochemical staining for c-kit antibody. Normal skin: The intensity of c-kit expression was mild to moderate positivity Melasma: The intensity of c-kit expression showed significant increase when its expression was compared with control group. There was statistically significant positive correlation between the intensity of c-kit expression in both melasma groups when compared with modified MASI score Vitiligo: c-kit expression was negative in the epidermis. There was significant decrease in the intensity of c-kit expression in vitiligo when compared with control group. There was statistically significant negative correlation between the intensity of c-kit expression in both vitiligo groups when compared with VASI score we concluded that c-kit may play a role in the pathogenesis of some dyspigmentary disorders as melasma and vitiligo. It could be used as a marker for melasma severity. So, c-kit is may be considered the main target in the treatment of these diseases.

Comparison of the Psychological Impacts of Asymptomatic and Symptomatic Cutaneous Diseases: Vitiligo and Atopic Dermatitis

BackgroundVitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients.ObjectiveWe evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs).MethodsA total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used.ResultsThe vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL.ConclusionVitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.

Impression cytology of the ocular surface and tear function in patients with periocular vitiligo

We evaluated the ocular surface and tear function in patients with periocular vitiligo in this prospective, case-control study. Sixty eyes of 30 vitiligo patients with periocular involvement and 100 eyes of 50 control subjects were included in the study. Patients and control subjects were compared for Schirmer test and tear film break-up time (BUT) results and impression cytology findings graded according to Nelson's classification. The mean BUT value was 9.5 ± 4.1 seconds in patients with periocular vitiligo and 13.1 ± 4.2 seconds in the control group. The difference was statistically significant (p=0.005). Thirty-seven eyes (61.7%) in the vitiligo group and 28 eyes (28.0%) in the control group had BUT values less than 10 seconds (p<0.001). The mean Schirmer test value was 14.6 ± 4.3 mm in patients with periocular vitiligo and 15.1 ± 4.4 mm in the control group (p>0.05). Nineteen eyes (31.7%) in patients with periocular vitiligo and 8 eyes (8.0%) in the control group had grade 2-3 changes according to Nelson's classification (p<0.001). Three eyes (5.0%) in the periocular vitiligo group and none of the eyes in the control group had inflammation signs in the impression cytology analysis. In patients with periocular vitiligo, ocular surface and tear function alterations may occur. Further studies on ocular surface involvement in periocular vitiligo patients may help to increase understanding of the pathophysiology of vitiligo.

Association of halo nevus/i and vitiligo in childhood: a retrospective observational study

Although halo nevus (HN) is frequently observed, the relationship between vitiligo and HN in children has rarely been investigated. To investigate the association between HN and vitiligo in children and understand if HN/HNi might be a risk factor for vitiligo. Ninety-eight patients with only HN/HNi and 27 with HN/HNi and vitiligo were investigated for number and localization of HN/HNi, family history for HN/HNi and vitiligo and personal and family history for autoimmune or other diseases. A follow-up telephone interview was performed to investigate the evolution of HN/HNi and the possible onset of vitiligo and/or other diseases. In the HN/HNi and vitiligo group, HN/HNi and vitiligo had started almost simultaneously in 11 children; in nine, the onset of HN/HNi was followed by vitiligo after 6 months to 5 years; seven patients presented vitiligo first and HN/HNi after 3-9 years. Patients with associated vitiligo had, significantly more often, multiple HNi and a positive personal and/or family history of autoimmune thyroiditis compared with those with only HN/HNi. Follow-up longer than 5 years was available in 54/98 patients with only HN/HNi; two of them, both with multiple HNi, developed vitiligo. After follow-up, multiple HNi were noticed in 18/52 patients without vitiligo and in 9/11 of those in whom HN/HNi heralded vitiligo (s.s.). In patients with multiple HNi, the risk of vitiligo and other autoimmune diseases seems to be higher than in pediatric patients with a single HN; clinicians should pay particular attention to children with multiple HNi and personal or family history of autoimmune diseases.