Vitiligo Patients Research Articles

Analysis of vitamin D metabolism, thyroid and autoimmune markers in the vitiligo pathways and their possible interaction with sleep.

Vitiligo is an autoimmune skin disease that can be influenced by stress, including that resulting from sleep deprivation and sleep disturbances. Sleep is essential in the regulation of several hormonal, metabolic and autoimmune pathways that may have important roles in vitiligo. This study aimed to investigate the potential interplay between hormonal, metabolic, and autoimmune markers in vitiligo patients, and the possible influence of sleep quality in these vitiligo pathways. A cohort of 30 vitiligo patients and 26 healthy controls were assessed for various laboratory markers, including thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium, 1.25(OH)2D, 25(OH)D, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and antinuclear antibodies (ANA). The study evaluated sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Positive anti-TPO were found in the vitiligo group, but did not in the control group. Vitamin D 25(OH)D mean levels were clinically insufficient in both groups (< 30mg/dL). Reactive ANA was analyzed with 2 variables related to vitiligo: phototherapy and skin activity. No statistical correlation was found in the chi-square test on this relationship. Descriptive findings have shown that the positivity to anti-TPO and anti-TG, associated or not with reactive ANA, was higher in vitiligo group. Great part (85.7%) of vitiligo group were "poor sleepers" (PSQI > 5), which has increased (88.2%) when considering only individuals with signs of vitiligo activity. Autoimmune hypothyroidism and positive anti-TPO are expected in vitiligo, although this marker is not usually measured in the first laboratory screening to this disease. Adequate vitamin D levels may be a key adjuvant in skin pigmentation, and be related to sleep quality and immune regulation, as this vitamin can be related to better sleep and immunomodulation in autoimmune diseases. Evaluating ANA before phototherapy can be controversial, but it should be considered in cases with a poor response to this treatment, or when there is a higher risk of other autoimmune diseases. Poor sleep predominated in the vitiligo group, based on PSQI scores that reported worse subjective sleep in these patients. Worse sleep predominated in individuals with signs of skin activity and reactive autoimmune markers. Screening these components could be important in the management of vitiligo, as maintaining body homeostasis can help to improve the disease course. Sleep should be considered as a potential modulator of several multidirectional vitiligo pathways.

Conventional suspension delivery versus tattooing pen-assistedsuspension delivery in non-cultured epidermal cell suspension procedure for vitiligo: A randomized controlled trial.

Non-cultured epidermal suspension (NCES) is one of the most widely used surgical therapy for stable vitiligo patients in which recipient size preparation plays an important role in the outcome of NCES. The primary objective is to evaluate and compare the efficacy and safety of conventional suspension delivery after manual dermabrasion (CSMD) versus tattooing pen-assisted suspension delivery (TPSD) in NCES. Paired vitiligo units (VU) in 36 patients, matched with respect to size and location were divided into two groups. The VU in Group 1 underwent suspension delivery by CSMD while the VU in Group 2 underwent same by TPSD. All the VU were followed up at regular intervals until 24 weeks. At the end of 24 weeks, 31 VU (86.1%) in Group 1 achieved >75% repigmentation which was significantly higher (p = .02, chi-square test) as compared to 22 VU (61.1%) in Group 2. The color matching in both the groups VU was also comparable (p = .84, chi-square test). The patient global assessment (PGA) was significantly higher in Group 1 VU as compared to Group 2. Treatment response in terms of repigmentation and PGA was significantly better in VU treated with CSMD as compared to TPSD. Recipient site complications were seen more commonly in Group 1 VU as compared to Group 2. Perilesional halo at the recipient site was seen in none of the VU in Group 2 which was significantly lower than 6 VU in Group 1 than (p = .02, chi-square test). Better results may be possible with technical improvisations in tattooing pen needle diameter and depth of penetration.

Association Between Helicobacter Pylori Infection and Vitiligo

Objective: To determine the association between Helicobacter pylori infection and vitiligo in patients visiting a tertiary care hospital of Punjab, Pakistan. Study Design: Case control study. Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Lahore Pakistan, from Oct 2021 to Mar 2022. Methodology: A total of 60 adult vitiligo patients and 60 healthy controls, of both genders, were included in the study. Their ages ranged from 18-70 years. All study participants underwent stool antigen test to detect the presence of Helicobacter pylori antigen. Results: The mean age of the cases was 43.47±8.16 years whereas it was 40.08±7.42 years in the controls. The mean duration of disease was 4.133±1.21 months. H. pylori Infection was detected in 36(60%) cases as compared to 11(18.3%) controls (p&lt;0.001, OR=6.68); which was found to be statistically significant. Conclusion: Significant association between H. pylori infection and vitiligo was demonstrated in the current study.

Cross-Sectional Descriptive Study of the Utility of Dermoscopy in Assessing the Activity and Stability of Vitiligo

Introduction: Dermoscopy is an important noninvasive tool that helps to determine the stability and activity of vitiligo. Various dermoscopic findings help classify the disease as stable or unstable. This is important for the management of the disease, as surgical management requires disease stability. Objectives: We aimed to describe the dermoscopic findings in vitiligo and to assess the frequency of various dermoscopic findings in stable and unstable vitiligo. Methods: This was a hospital-based, cross-sectional, descriptive study of 100 vitiligo patients and various dermoscopic findings. Results are expressed as percentages. Results: The most common dermoscopic findings in stable vitiligo patches were sharp border, marginal and perifollicular pigmentation, and reticulate pigment network. Findings such as polka dot appearance, starburst appearance, comet tail, and satellite lesions were seen in unstable vitiligo patches. Conclusions: Dermoscopy is extremely helpful in determining the stability of vitiligo patches.

Prevalence Of Metabolic Syndrome In Vitiligo: A Cross-sectional Study

Introduction Vitiligo is a common acquired hypomelanotic disorder of the skin and is characterized by depigmented macules and patches that can appear anywhere on the skin. In pathogenesis, the researchers have suggested an interplay of multiple factors such as genetic, neural, oxidant-antioxidant, biochemical, minerals, and autoimmune processes in the induction of vitiligo. Metabolic syndrome (MetS), also known as Syndrome X is a pathological condition typically characterized by the combination of various interrelated metabolic disorders that include abdominal obesity, impaired glucose tolerance, dyslipidemia, and hypertension. The linkage of skin diseases and MetS is due to ongoing chronic inflammation due to elevated pro-inflammatory cytokines, imbalance between reactive oxygen species and antioxidants, and hormonal abnormalities mostly insulin resistance. Methodology This cross-sectional study included patients diagnosed with vitiligo and above 16 years of age. All the patients were sent for analysis of fasting lipid profile and fasting blood glucose level. The waist circumference was measured at the mid-point between the lower border of the rib cage and the iliac crest with a flexible inch tape. The blood pressure was taken in a sitting posture after 10 minutes of rest. The data was collected using a preformed proforma. Results Of the 70 patients, the majority (N=38) were male. The mean age was 37 years with a range from 16 to 79 years. The mean age of male patients was 39.87 ± 17.24 years and female patients was 33.59 ± 13.58 years. The most common clinical type of vitiligo was generalized vitiligo (48.6%) followed by focal (18.6%) and segmental (15.7%). The metabolic syndrome was present in 26 patients (37.1%). The patient with generalized vitiligo had maximum prevalence (n=10) followed by acrofacial vitiligo (n=6). Conclusion This study found a high prevalence of metabolic syndrome and its components in patients with vitiligo. Therefore, vitiligo patients need to be screened for metabolic syndrome to prevent unforeseen complications.

Insights into the gut microbiome of vitiligo patients from India

BackgroundVitiligo is an autoimmune disease characterized by loss of pigmentation in the skin. It affects 0.4 to 2% of the global population, but the factors that trigger autoimmunity remain elusive. Previous work on several immune-mediated dermatological disorders has illuminated the substantial roles of the gut microbiome in disease pathogenesis. Here, we examined the gut microbiome composition in a cohort of vitiligo patients and healthy controls from India, including patients with a family history of the disease.ResultsOur results show significant alterations in the gut microbiome of vitiligo patients compared to healthy controls, affecting taxonomic and functional profiles as well as community structure. We observed a reduction in the abundance of several bacterial taxa commonly associated with a healthy gut microbiome and noted a decrease in the abundance of SCFA (Short Chain Fatty Acids) producing taxa in the vitiligo group. Observation of a higher abundance of genes linked to bacteria-mediated degradation of intestinal mucus suggested a potential compromise of the gut mucus barrier in vitiligo. Functional analysis also revealed a higher abundance of fatty acid and lipid metabolism-related genes in the vitiligo group. Combined analysis with data from a French cohort of vitiligo also led to the identification of common genera differentiating healthy and gut microbiome across populations.ConclusionOur observations, together with available data, strengthen the role of gut microbiome dysbiosis in symptom exacerbation and possibly pathogenesis in vitiligo. The reported microbiome changes also showed similarities with other autoimmune disorders, suggesting common gut microbiome-mediated mechanisms in autoimmune diseases. Further investigation can lead to the exploration of dietary interventions and probiotics for the management of these conditions.

Dermatology life quality index in vitiligo patients: A systematic review and meta-analysis of observational studies

Background &amp; Aim: Vitiligo is a chronic and unpredictable condition. The absence of effective treatments, coupled with fears of rejection and stigma, can adversely affect patients' coping abilities and their social and psychological adjustment. This study aimed to assess the overall quality of life score of vitiligo patients using DLQI to evaluate the disease's impact on their quality of life. Methods &amp; Materials: This meta-analysis adhered to PRISMA 2020 guidelines and thoroughly searched the PubMed, EMBASE, Web of Science/ISI, and Scopus databases from their inception to January 2023. All observational studies reporting the quality of life score based on the DLQI were included in the analysis. Heterogeneity among the studies was assessed using the I2 index and Cochrane’s Q-statistic. Data were analyzed using the random effects model using STATA software version 12. Results: Our analysis included a total of 58 studies involving 9277 individuals. The pooled DLQI score was 8.07 (95% CI: 7.22-8.91). The lowest and highest scores were observed in Europe (5.52, 95% CI: 4.18-6.87) and Africa (10.95, 95% CI: 7.77-14.15), respectively. The DLQI score was 7.17 (95% CI: 6.04-8.31) in men and 8.63 (95% CI: 7.44-9.82) in women. No significant correlation was found between the DLQI score and the publication year of the articles (p=0.219), patients’ age (p=0.119), and disease duration (p=0.203). Conclusion: Vitiligo moderately impacts patients' quality of life. Therefore, it seems necessary to provide psychological and social training for these patients

Evaluation of auditory system in vitiligo patients: A case-control study

BackgroundVitiligo is a common acquired pigmentary disorder characterized by well-defined areas of depigmentation due to loss of melanocytes. Vitiligo can affect melanocytes in the auditory system and potentially hearing. ObjectiveThe aim of this study was to investigate hearing changes in vitiligo patients. MethodsTwenty-six with vitiligo patients and 26 demographically matched healthy controls were included in this study. Audiological function was evaluated using pure tone audiometry (PTA), speech audiometry and tympanometry tests in all subjects. ResultsThe mean hearing threshold of the left ear at frequencies of 250 and 8000 Hz in vitiligo patients was significantly higher than the control group. Sensorineural hearing loss (SNHL) was seen in 14 (53.8 %) vitiligo patients and 5(19.2 %) control group (p < 0.05). Most affected patients (10/14; 71 %) had bilateral hearing loss especially in high frequency (8000 Hz). A significant association was identified between vitiligo and SNHL (OR 4.9; 95 % CI, 1.41–16.98, P = 0.01). There was a statistically significant correlation between hearing impairment and age in both groups. Gender, severity, activity and duration of vitiligo had no a significant effect on the results of audiometric tests. ConclusionThis study confirmed that the auditory system was affected in vitiligo patients. Vitiligo patients might be at a higher risk for auditory abnormalities at a younger age than control subjects. Auditory evaluation of vitiligo patients should be considered for early detection of hearing loss.

AI fusion of multisource data identifies key features of vitiligo

Vitiligo is a skin disorder that is associated with a decreased risk of skin cancer, but it can lead to increased susceptibility to sunburn, psychological distress, and disruptions in daily life, consists of two primary subtypes: segmental and nonsegmental vitiligo, each with distinct underlying mechanisms. However, the reliable identification of diagnostic markers and the ability to differentiate between these subtypes have remained elusive challenges. This study aims to pioneer predictive algorithms for vitiligo diagnosis, harnessing the capabilities of AI (Artificial Intelligence) to amalgamate multisource data and uncover essential features for distinguishing vitiligo subtypes.An ensemble algorithm was thoughtfully developed for vitiligo diagnosis, utilizing a spectrum of machine learning techniques to evaluate the likelihood of vitiligo, whether segmental or nonsegmental. Diverse machine learning methodologies were applied to distinguish between healthy individuals and vitiligo patients, as well as to differentiate segmental from nonsegmental vitiligo. The ensemble algorithm achieved a remarkable AUC (Area Under the Curve) of 0.99 and an accuracy of 0.98 for diagnosing vitiligo. Furthermore, in predicting the development of segmental or nonsegmental vitiligo, the model exhibited an AUC of 0.79 and an accuracy of 0.73. Key parameters for vitiligo identification encompassed factors such as age, FBC (full blood count)-neutrophils, FBC-lymphocytes, LKF(liver and kidney function)-direct bilirubin, LKF-total bilirubin, and LKF-total protein levels. In contrast, vital indicators for monitoring the progression of segmental and nonsegmental vitiligo included FBC-B lymphocyte count, FBC-NK (Natural Killer) cell count, and LKF-alkaline phosphatase levels. This retrospective study underscores the potential of AI-driven analysis in identifying significant risk factors for vitiligo and predicting its subtypes at an early stage. These findings offer great promise for the development of effective diagnostic tools and the implementation of personalized treatment approaches in managing this challenging skin disorder.

Decreased Neutrophil-to-lymphocyte Ratio in Patients with Vitiligo: National Data Analysis.

Vitiligo is characterized by depigmented skin lesions involving melanocyte defects and immune dysregulation. Haematological markers like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been explored in various skin disorders. Given vitiligo's proposed pathogenesis, we hypothesized differences in NLR and PLR in vitiligo patients compared to controls. In a national retrospective cohort study (2005-2020) in Israel, blood count data from patients diagnosed with vitiligo (ICD-10 codes) were analysed, excluding patients with recent infections, surgeries, or malignancies. Controls matched for age and sex were selected. Sub-analyses examined age groups, treatment type, and matched controls. Children (n = 3,796) and adults (n = 38,608) with vitiligo showed significant differences in gender distribution, cell counts, and ratios. Vitiligo patients (n = 38,358) exhibited lower NLR, decreased neutrophils and platelets, and increased lymphocytes compared with controls. Non-systemically treated vitiligo patients (n = 33,871) displayed lower NLR and neutrophils compared with matched controls. Systemically treated vitiligo patients (n = 4,487) showed lower NLR, higher PLR, and reduced lymphocytes. Logistic regression identified associations between increased lymphocyte and platelet counts and being systemically treated. This study highlights significant haematological differences in vitiligo patients, emphasizing the potential utility of NLR as an accessible tool for vitiligo assessment. Further investigations are warranted to elucidate the roles of neutrophils and lymphocytes in vitiligo pathogenesis.

N-Acetyltransferase 2 gene polymorphism and its serum levels in vitiligo patients.

Although numerous mechanisms are involved in vitiligo pathogenesis, few studies correlate N-acetyltransferase 2 to this disease. To assess the N-acetyltransferase 2 (rs1799929) gene and its serum levels in vitiligo patients. In this case-control study, 65 vitiligo cases were compared to 65 age- and sex-matched healthy controls. Serum NAT2 levels and the NAT2 gene polymorphism (rs1799929) were evaluated using ELISA and real-time PCR, respectively. Serum N-acetyltransferase 2 levels were significantly lower in cases than in controls, 1.24 ± 0.31 vs. 2.01 ± 0.46 (p = 0.001). CC genotype was more dominant in controls (58.5%) than in cases (20%). TT and CT genotypes were more dominant in cases (30.8% and 49.2%) than in controls (13.8% and 27.7%), respectively (p = 0.001). The C allele was more prominent in controls (72.3%) than in cases (44.6%) while the T allele was more dominant in cases (55.4%) than in controls (27.7%) (p = 0.001). N-acetyltransferase 2 slow acetylator phenotype (TT genotype) was higher in cases (30.8%) than in controls (13.8%) and rapid acetylator phenotypes (CC and CT genotypes) were higher in controls (86.2%) than in cases (69.2%) (p = 0.035). Slow acetylator genotype (TT) of NAT2 gene (rs1799929) and low serum levels of NAT2 enzyme might play a role in the susceptibility and pathogenesis of vitiligo.

Zinc, copper, and selenium levels in vitiligo: a systematic review and meta-analysis

Vitiligo is a dermatological disease characterized by loss of melanocytes, causing non-scaly white macules on the skin. Zinc, copper, and selenium are important micronutrients that play a role in the normal functioning of the body and have been found to potentially aid in vitiligo treatment, although the relationship between their serum levels and vitiligo is not yet fully understood. This is a systematic review aimed at assessing the levels of serum zinc, copper, and selenium and their association with vitiligo. This review was performed following the Preferred Reporting Items of the systematic Review and Meta-Analysis (PRISMA) checklist and Cochrane guidelines. A comprehensive literature search was conducted on PubMed, Google Scholar and 41 studies published between 1970 and 2022 including 3353 vitiligo cases and 10,638 controls were included in the meta-analysis conducted from August 2022 till September 2023. The quality of the studies was assessed using the National Heart Lung and Blood Institute Study Quality Assessment tool, and the risk of bias was represented using the RobVis tool. The statistical analysis was performed using Review Manager (RevMan) Version 5.4. This meta-analysis indicate a significant decline in serum zinc levels (Z = 4.97; P < 0.0001; SMD = − 0.86; 95% CI − 1.19 to − 0.52) in vitiligo group with high statistical heterogeneity (Tau2 = 0.74; Chi2 = 513.95, d.f. = 26 [P < 0.00001]; I2 = 95%). Similarly for serum copper levels there was decline (Z = 2.43; P < 0.0001; SMD = − 0.50; 95% confidence interval [CI] − 0.91 to − 0.10) in vitiligo group and high statistical heterogeneity (Tau2 = 0.92; Chi2 = 475.10, d.f. = 22 [P < 0.00001]; I2 = 95%). On the other hand, there was a increase of serum selenium levels in the vitiligo group (Z = 0.56; P < 0.0001; SMD = 0.23; 95% confidence interval [CI], 0.58 to 1.04) and the results reveals high statistical heterogeneity among studies (Tau2 = 1.93; Chi2 = 406.44, d.f. = 11 [P < 0.00001]; I2 = 97%) in vitiligo patients compared to healthy controls. Publication bias was not found for the studies analysed. This study analyses the association of serum micronutrient levels and vitiligo among patients and controls from published research along with sub-group analysis specific to Asian populations using a meta-analysis. Low serum levels of Zinc and copper and high selenium levels are associated with Vitiligo.

The Effect of Ginkgo Biloba Extract on Oxidative Stress, Anti-Inflammatory and Antiapoptotic in Vitiligo Treated with Topical Desoxymethasone

Vitiligo is a progressive and multifactorial condition of skin, mucosa, and hair depigmentation. Loss of functional melanocytes leads to the appearance of white macules on the skin, often affecting the lips and genitalia. The impact extends to psychological stress, decreased quality of life, and risk of psychiatric morbidity. Various therapeutic strategies have been designed to inhibit the immune response in vitiligo to reduce melanocyte damage while increasing melanocyte repopulation. There is no standardized method of evaluating treatment outcomes in vitiligo patients. Herbal medicines several studies have shown that GB also has many benefits for health and healing skin diseases, one of which is used in treating vitiligo. Therefore, this study aimed to evaluate the potential of Ginkgo biloba extract as a therapeutic supplement in enhancing the positive effects of desoxymethasone on vitiligo. Using a double-blind randomized control trial clinical trial research design, 26 subjects were divided into treatment and control groups. The control group received standard vitiligo therapy with topical desoxymethasone and placebo, while the treatment group received topical desoxymethasone plus Ginkgo biloba extract. Melanin index, VASI score, MDA, TNF-α, CD8 expression, and caspase 3 were measured before and after treatment. The results showed that the administration of Ginkgo biloba extract had a significant effect in reducing MDA, TNF-α, CD8 expression, and caspase 3 levels, and improving melanin index and erythema in vitiligo patients who received topical desoxymethasone therapy. These findings demonstrate the positive potential of Ginkgo biloba extract as an adjunct to vitiligo therapy, resulting in favorable clinical and molecular impacts in patients undergoing combination treatments.

Determining the Mean Dermatology Life Quality Index of Skin of Color (SOC) Patients With Vitiligo: A South Asian Perspective.

Vitiligo has a special significance to the skin of colour (SOC) population because depigmentation is more obvious in the SOC population. As a result, vitiligo exerts a huge stigma on the affected individuals. The literature so far has reported on the health-related quality of life (QOL), including the dermatology life quality index (DLQI), and has demonstrated the profound effect of vitiligo on a patient's QOL. Those affected by vitiligo are found to have lower self-esteem when compared to the non-affected individuals. The impact on the SOC population is even graver and underrepresented. Thus, the objective of this study was to report the mean DLQI in vitiligo in SOC individuals. This descriptive, cross-sectional study was performed in the dermatology outpatient department of a tertiary healthcare setup in Rawalpindi Pakistan. A total of 113 patients suffering from vitiligo, aged 15 to 65 years, both male and female, were included in the study. In all the cases, the DLQI score was noted. With the age ranging from 15 to 65 years and a mean age of 34.96 ± 9.59 years, 70% (n=77) of the patients were between 15 to 40 years of age. The male-to-female ratio was 1:1.3, with male patients comprising 38.21% (n=47) and females being 61.79% (n=66). The mean DLQI score of the vitiligo patients in our cohort was 9.39 ± 6.35. This study concluded that the mean DLQI score was higher in female patients and in vitiligo universalis patients, compared to other variants of vitiligo. The SOC population affected with vitiligo is at a higher risk of having a decreased QOL and hence may need special attention with regard to quality health delivery services.

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 &gt;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 &lt; 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 &lt;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.

Predicting Depression and Anxiety in Vitiligo Patients by Considering Forgiveness, Perfectionism, Anger, and Alexithymia

Background: Vitiligo, a chronic dermatological disorder, is characterized by depigmented patches. Depression and anxiety are considered two major problems in patients with skin disorders, requiring special attention. Various factors can influence the onset of anxiety and depression in these patients. Objectives: The present study aimed to predict depression and anxiety in vitiligo patients by considering forgiveness, perfectionism, anger, and alexithymia. Methods: This cross-sectional study was conducted at the Dermatology Department of Shahid Yahyanejad Hospital in Babol from May to September 2023. The study population consisted of 119 vitiligo patients whose anxiety, depression, forgiveness, perfectionism, anger, and alexithymia were evaluated using relevant questionnaires. The data were analyzed using statistical tests, including the Mann-Whitney, Kruskal-Wallis, Spearman Correlation, and Generalized Linear Model, in SPSS-22. Results: The mean age of the vitiligo patients was 34.17 ± 12.32 years. Their mean scores for depression and anxiety were 4.24 ± 4.90 and 11.50 ± 9.04, respectively. Among the vitiligo patients, 43.6% displayed mild to severe degrees of depression, and 61.3% displayed mild to severe degrees of anxiety. The mean scores for depression and anxiety were significantly higher in women than in men (P &lt; 0.05). There were significant correlations between the mean scores for depression and anxiety (r = 0.58), forgiveness (r = -0.25), perfectionism (r = 0.29), anger (r = 0.30), and alexithymia (r = 0.40). Additionally, the mean scores for anxiety were correlated with forgiveness (r = -0.36), perfectionism (r = 0.36), anger (r = 0.44), and alexithymia (r = 0.53). The results of the Generalized Linear Model analysis revealed that anxiety was the only predictive factor of depression among the subjects. Furthermore, depression, anger, and alexithymia were identified as positive predictors of anxiety, while forgiveness was identified as a negative predictor of anxiety in these patients. Conclusions: The study underscores the importance of addressing psychological factors in the management and treatment of vitiligo patients to improve their overall well-being and quality of life. Further research and interventions targeting these factors may enhance our understanding of the mental health challenges faced by individuals living with vitiligo and aid in developing strategies to better address these challenges.

The Effect of Monobenzone Cream on Oxidative Stress and Its Relationship With Serum Levels of IL-1β and IL-18 in Vitiligo Patients.

Monobenzyl ether hydroquinone (MEBHQ) is a cream that promotes the spread and evenness of skin patches in vitiligo. Our aim was to investigate the oxidative and inflammatory effects of this cream on vitiligo patients consuming MEBHQ. A case-control study was conducted with three groups of 30 people from the control group, vitiligo patients before and after treatment. The percentage of vitiligo spots was determined by a specialist doctor. The levels of biochemical factors, oxidative stress profile and inflammatory factors were measured by enzymatic, colorimetric and ELISA methods, respectively. Vitiligo patients showed a high level of inflammation and oxidative stress compared to healthy people. Although after 3 months of using MBEHQ cream, the percentage of skin spots in vitiligo patients increased from an average of 63%-91% and the skin color became almost uniform, but it still increased the level of oxidative stress and inflammation in these patients. Although the level of oxidative stress increased significantly in these patients, there was no significant increase in the level of malondialdehyde. The lack of significant differences in the levels of biochemical factors between healthy people and vitiligo patients before and after using the treatment shows the absence of side effects. The use of MBEHQ increased the size of skin spots and uneven skin color in vitiligo patients. Although MBEHQ did not show side effects such as diabetes, liver and kidney diseases, it increased the levels of oxidative stress and inflammatory cytokines, which needs further study.

Markers of Metabolic Abnormalities in Vitiligo Patients.

While vitiligo is primarily caused by melanocyte deficiency or dysfunction, recent studies have revealed a notable prevalence of metabolic syndrome (MetS) among patients with vitiligo. This suggests shared pathogenic features between the two conditions. Individuals with vitiligo often exhibit variations in triglyceride levels, cholesterol, and blood pressure, which are also affected in MetS. Given the similarities in their underlying mechanisms, genetic factors, pro-inflammatory signalling pathways, and increased oxidative stress, this study aims to highlight the common traits between vitiligo and metabolic systemic disorders. Serum analyses confirmed increased low-density lipoprotein (LDL) levels in patients with vitiligo, compared to physiological values. In addition, we reported significant decreases in folate and vitamin D (Vit D) levels. Oxidative stress is one of the underlying causes of the development of metabolic syndromes and is related to the advancement of skin diseases. This study found high levels of inflammatory cytokines, such as interleukin-6 (IL-6) and chemokine 10 (CXCL10), which are markers of inflammation and disease progression. The accumulation of insulin growth factor binding proteins 5 (IGFBP5) and advanced glycation end products (AGEs) entailed in atherosclerosis and diabetes onset, respectively, were also disclosed in vitiligo. In addition, the blood-associated activity of the antioxidant enzymes catalase (Cat) and superoxide dismutase (SOD) was impaired. Moreover, the plasma fatty acid (FAs) profile analysis showed an alteration in composition and specific estimated activities of FAs biosynthetic enzymes resembling MetS development, resulting in an imbalance towards pro-inflammatory n6-series FAs. These results revealed a systemic metabolic alteration in vitiligo patients that could be considered a new target for developing a more effective therapeutic approach.

Updates on the Association Between Vitiligo and Thyroid Diseases: A Systematic Review.

The main objective of this study is to estimate the prevalence of thyroid diseases in patients with vitiligo and investigate the potential shared autoimmune mechanisms underlying the co-occurrence of vitiligo and thyroid diseases. To locate research that met the inclusion criteria, a thorough computerized search of relevant databases was carried out. A comprehensive search was carried out on PubMed, SCOPUS, Science Direct, and Web of Science to locate relevant material. Our data included 13 trials with 82,230 participants, and 40,116 (48.8%) of them were males. The prevalence of thyroid disorders ranged from 3.2% to 32.1%, with a total prevalence of 2,906 (3.5%). Vitiligo patients are more likely to have a number of immunological comorbidities, underscoring the serious effects of the illness on overall health, especially thyroid disorders. The correlation between vitiligo and positive thyroid peroxidase antibodies, hypothyroidism, and autoimmune thyroiditis is notably high. We found a strong association between vitiligo and the incidence of thyroid disorders, particularly autoimmune thyroid disorders. The findings emphasize the necessity of identifying and treating thyroid dysfunction in vitiligo patients, as it might affect the clinical course of the skin condition and overall patient health. Future research is required to standardize study methodology, investigate underlying mechanisms, and create integrated therapy and screening regimens.

Serum and Tissue CXCL9 Levels in Patients with Vitiligo Before and After Phototherapy: A Case-Control Study

Background: Vitiligo is a common pigmentation disease that affects 1–2% of the global population. It is a genetic disease that is triggered by an environmental factor resulting in an autoimmune disease. The predominance of the T-helper 1 (Th1) pattern favors the development of vitiligo. Interferon-gamma (IFN-γ) is the most important cytokine that is associated with the Th1 immune response. IFN-γ induces the release of chemokine which is called CXCL9. Objectives: Evaluation of the effects of narrow band ultraviolet B (nbUVB) phototherapy on the serum and tissue levels of CXCL9 among vitiligo patients. Patients and methods: We recruited in our study two groups; one group of twenty patients complaining of nonsegmental vitiligo and the other is a control group composed of another age and sex-matched twenty healthy controls, we assessed the serum level of CXCL9 in all subjects before the study and the patient group was reassessed after treatment with nbUVB for 12 weeks. We also determined tissue level of CXCL9 in patients before and after the phototherapy for 12 weeks from suction blister fluid. Results: We detected that serum levels of CXCL9 were higher in patients with vitiligo compared to healthy matched controls. nbUVB sessions for twelve weeks were done, and we found that serum and tissue levels of CXCL9 after treatment were decreased. Conclusion: Serum and tissue CXCL9 can be used as a marker for disease activity and potentiality for the response to treatment. Therefore, targeting the inhibition of the Interferon-γ-chemokine axis may help in treating the disease activity.