Therapy For Vitiligo Research Articles

Identification of the role of autophagy-related TNFSF10/ hsa-let-7a-5p axis in vitiligo development and potential herbs exploring based on a bioinformatics analysis

BackgroundVitiligo is a common clinical disorder caused by the destruction of epidermal melanocytes, which is often associated with autoimmune mechanisms. Autophagy plays a crucial role in maintaining cellular homeostasis and exhibits close associations with various autoimmune disorders. While dysautophagy of melanocytes is associated with vitiligo pathogenesis, there is a lack of studies on autophagy-related genes (ARGs) in blood samples from individuals with vitiligo. MethodsBlood samples from individuals with vitiligo and healthy controls were compared to identify differentially expressed genes (DEGs), which were subsequently subjected to further analysis. Then, miRNAs correlated with core genes were predicted by five distinct online tools, and those miRNAs that appeared in three or more tools at the same time were chosen for further enrichment analysis. Furthermore, in vitro experiments of targeting core genes were conducted. ResultsThe results showed that there were a total of 30 ARGs among DEGs, with 13 up-regulated genes and 17 down-regulated genes. Based on the functional enrichment analysis of DEGs and projected miRNAs, we hypothesized that autophagy and apoptosis may synergistically contribute to the progression of vitiligo, with the TNFSF10/hsa-let-7a-5p axis potentially playing an important role that should not be ignored. In addition, epigallocatechin-3-gallate (EGCG) was found to be the common component in BAI GUO, CHA YE, and MEI ZHOU JIN LV MEI, which were discovered to be potential in vitiligo treatment by inducing cell autophagy and apoptosis targeting TNFSF10. ConclusionIt was the first time that TNFSF/hsa-let-7a-5p was discovered to be involved in the development of vitiligo through autophagy and apoptosis. Meanwhile, we observed that BAI GUO, CHA YE, and MEI ZHOU JIN LV MEI were promising to treat vitiligo by regulating autophagy and apoptosis via TNFSF10. These findings could lead to new directions for investigating the pathogenesis and therapy of vitiligo.

Exploring the Efficacy of Fractional Carbon Dioxide Laser as an Add-on Combination to Conventional Therapies for Treatment-Resistant Vitiligo (A Review Article).

Introduction: Vitiligo, a dermatological disorder that leads to depigmented skin patches, presents a significant challenge, particularly in resistant areas such as acral regions. Fractional CO2 laser therapy holds promise as an adjunct to conventional treatment, enhancing repigmentation. This review comprehensively explores its efficacy and safety in resistant-to-treatment vitiligo. Methods: We conducted extensive database searches in PubMed, Embase, and Cochrane, focusing on English-language literature published between 2012 and 2023. We included comparative studies that met the following criteria: (1) Participants had non-segmental vitiligo, with resistant-to-treatment localization engagement; (2) The treatment involved the use of fractional CO2 laser in combination with conventional therapies; and (3) Outcomes were assessed based on the repigmentation ratio or significant difference. We excluded studies from which data from published results could not be extracted. Results: After extensive screening of 52 articles, we finally selected five studies. The results showed that fractional CO2 laser therapy, when combined with other treatments, often shows promise in vitiligo treatment in refractory cases. Although individual responses varied, overall efficacy and safety were promising, with minimal adverse effects and no severe complications. Conclusion: The fractional CO2 laser, when used in conjunction with conventional therapies, emerges as a promising option for treating refractory vitiligo. Large-scale randomized trials and a deeper understanding of the underlying mechanisms are vital for future progress in optimizing treatment protocols, case selection, and safety.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm.

The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.

Two Methods with Less Donor Site Complications of Epidermal Cellular Grafting in Cell Therapy of Vitiligo.

The Article Abstract is not available.

Efficacy and Safety of Diphenylcyclopropenone (DPCP) as a Depigmenting Therapy in Extensive Vitiligo

Abstract Background Patients with extensive vitiligo who have residual pigmentation affecting exposed areas especially acral sites or patients with vitiligo universalis often seek depigmentation. At present, there is no ideal depigmenting therapy available. Possible options include; monobenzyl ether of hydroquinone (MBEH) cream, phenol, cryotherapy and Q-switched lasers. Diphenylcyclopropenone (DPCP) has been reported to rarely cause vitiligo as a side effect during the treatment of alopecia areata. Aim The aim of the present work is to evaluate the efficacy and safety of DPCP as a depigmenting therapy in extensive Vitiligo. Patients and Methods This is a pilot single arm clinical trial study. Twenty patients with extensive vitiligo were recruited from the vitiligo outpatient clinic of Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. We used DPCP applied topically to residual pigmented patches (sensitization session then therapeutic sessions). Results Depigmentation occurred among 5 patients (25% of cases). Depigmentation occurred in different tested sites including the scalp, forearm and back. Itching and blister formation were the main side effects leading to intolerability to the DPCP treatment. Conclusion Cosmetic result of DPCP depigmentation was acceptable with no skin atrophy. Further studies could be done following other protocols using sensitization dose with less concentrations of DPCP to avoid patients' intolerance to the therapy.

A randomized prospective study to assess the role of topical tacrolimus as preventive therapy in unstable acral vitiligo.

Acral vitiligo is a significantly distressing condition and tends to be treatment-resistant. The occurrence of new lesions on acral areas further causes greater psychological trauma. Topical tacrolimus has been widely used in the management of vitiligo and its role in preventing flares in other dermatoses such as atopic dermatitis has been well documented. To assess the role of topical tacrolimus as preventive therapy in unstable acral vitiligo. In this single-center randomized prospective study, 60 patients aged 16-60 years having unstable acral vitiligo with symmetrical lesions were enrolled and randomized (1:1) into two groups. Patients in group A were instructed to apply topical tacrolimus 0.1% ointment on both vitiliginous and normal skin while patients in group B were instructed to apply topical tacrolimus 0.1% ointment only on vitiliginous skin for 6-months. Only the distal hand till the wrist joint was chosen for observation. Vitiliginous patches were assessed monthly for 6 months for a change in the number of lesions and total area involved, extension of preexisting lesions, and adverse effects if any. A reduction in the number of lesions was observed in both groups. The decrease in the number of lesions in group A was 5.6% as compared to 2.3% in group B (p-0.001). The decrease in depigmented area in group A was 10.5% as compared to 4.6% in group B (p-0.048). Treatment failure was seen in 11/60 (18.3%) patients. Tacrolimus 0.1% ointment application showed effectiveness in preventing the appearance of new lesions in unstable acral vitiligo and hastening the repigmentation when applied on both lesional and perilesional skin in vitiligo.

Combining network pharmacology, molecular docking, molecular dynamics simulation, and experimental verification to examine the efficacy and immunoregulation mechanism of FHB granules on vitiligo.

Fufang Honghua Buji (FHB) granules, have proven efficacy against vitiligo in long-term clinical practice. However, its major active chemical components and molecular mechanisms of action remain unknown. The purpose of this study was to confirm the molecular mechanism of FHB's therapeutic effect on vitiligo utilizing network pharmacology, molecular docking, and molecular dynamics simulation prediction, as well as experimental verification. Traditional Chinese Medicine Systems Pharmacology (TCMSP) and HERB databases were used to obtain the chemical composition and action targets of FHB. Online Mendelian Inheritance in Man (OMIM), DrugBank, DisGeNET, GeneCards, and Therapeutic Target Database (TTD) databases were applied to screen for vitiligo-related targets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed through the Matascape database. Molecular docking and dynamics simulation methods were for the analysis of the binding sites and binding energies between the FHB's active components and the targets. Finally, a vitiligo mouse model was created, and the therapeutic effect and molecular mechanism of action of FHB were validated using enzyme linked immunosorbent assay (ELISA), western blot (WB), and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Additionally, hematoxylin-eosin staining (HE) and blood biochemical assays were conducted to assess the biosafety of FHB. The screening of chemical composition and targets suggested that 94 genetic targets of FHB were associated with vitiligo. The bioinformatics analysis suggested that luteolin, quercetin, and wogonin may be major active components, and nuclear factor-kappa B p65 subunit (RELA), signal transducer, and activator of transcription (STAT) 3 and RAC-alpha serine/threonine-protein kinase (AKT) 1 may be potential targets of FHB-vitiligo therapy. Molecular docking and dynamics simulation further demonstrated that luteolin, quercetin, and wogonin all bound best to STAT3. Through experimental verification, FHB has been demonstrated to alleviate the pathogenic characteristics of vitiligo mice, suppress the JAK-STAT signaling pathway, reduce inflammation, and increase melanogenesis. The in vivo safety evaluation experiments also demonstrated the non-toxicity of FHB. FHB exerts anti-inflammatory and melanogenesis-promoting effects via the effect of multi-component on multi-target, among which the JAK-STAT pathway is a validated FHB-vitiligo target, providing new ideas and clues for the development of vitiligo therapy.

Exploring the natural and treatment history of vitiligo: patient and healthcare professional perceptions from the global VALIANT study.

Vitiligo is a chronic autoimmune disease affecting melanocytes, resulting in depigmentation of skin. Patients with vitiligo often have reduced quality of life and comorbid autoimmune conditions and have reported a lack of available treatments for their vitiligo. The Vitiligo and Life Impact Among International Communities (VALIANT) study is the first global survey to explore the natural history and management of vitiligo from the perspectives of patients and healthcare professionals (HCPs). The survey recruited adults (≥18 years) diagnosed with vitiligo and HCPs treating patients with vitiligo via an online panel in 17 countries. Patients were queried regarding clinical characteristics and vitiligo treatment. HCPs were queried regarding diagnosis and management of patients with vitiligo. Included in the analysis were 3541 patients and 1203 HCPs. Nearly half (45.2%) of patients had >5% affected body surface area; 57.1% reported family history. Patients obtained formal diagnosis after a mean (SD) of 2.4 (4.1) years; 44.9% reported previous misdiagnosis. Many patients (56.7%) reported being told that vitiligo could not be treated; 53.9% of HCPs believed patients who never treated their vitiligo were told that vitiligo could not be treated. One-quarter of HCPs (26.3%) did not believe an effective therapy for vitiligo exists; 44.6% of patients reported giving up on finding an effective therapy. Top treatment goals for patients and HCPs, respectively, were reduction/cessation of spread (24.7%/18.5%) and repigmentation (22.5%/37.2%). Patient perception of effective care was similar for treatment by dermatologists (66.9%) and primary care HCPs (67.0%). Patients with vitiligo and HCPs reported similar treatment goals and expressed frustration with lack of effective therapies. Patients reported high rates of initial misdiagnosis; many ceased seeking healthcare because they perceived that vitiligo could not be treated. Findings highlight the need for earlier diagnosis and improved disease management for vitiligo.

Is The Glycerol, Petroleum Jelly and Liquid Paraffin Mixture (Dexeryl®) an Adjunctive Therapy for Vitiligo of Autoimmune Origin? Toward a Novel Therapeutic Indication. About a Case

Introduction: Vitiligo, considered to have an autoimmune basis, is an acquired, non-contagious disorder characterized by progressive, patchy loss of pigmentation from skin, overlying hair, and oral mucosa. The treatment of vitiligo includes medicines or medicated skin creams, such as corticosteroids or a calcineurin inhibitor, phototherapy, Depigmentation, or removing color from dark areas, surgical techniques. The results from treatments can vary from one part of the body to another, and new patches may appear in the meantime Here, we report a case with complete remission of vitiligo of autoimmune origin under DMARDs and the glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®), of which we hypothesize that the glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) would have played a role in rapid and complete vitiligo lesion regression. Clinical Observation: An 18-year-old Malian female presented to the internal medicine outpatient clinic with 3-months history of pruritic achromic skin patches. Concomitantly, this was associated with Gottron's papules, polyarthralgia with arthritis and exertional dyspnea for which the diagnosis of mixed connective tissue disease (MTCD) based on the EULAR/ACR 2019 criteria for systemic lupus erythematosus, EULAR/ACR 2010 criteria for rheumatoid arthritis with subcutaneous rheumatoid nodule, EULAR/ ACR 2013 criteria for systemic scleroderma, Bohan and Peter 1975 criteria for probable dermato-polymyositis and Kasukawa’s criteria 1988 for MTCD itself; and autoimmune hemolytic anemia (AHA) with positivity of the direct coombs test and the context of hemolysis were made. Vitiligo of autoimmune origin was considered because of the clinical context and the immunological disorder in this case. She was treated only with Disease-Modifying Anti-rheumatic Drugs (DMARDs) and glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®). The vitiligo lesion had completely resolved on 1-year follow-up visit in our case without specific vitiligo treatment. Discussion: The glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) in our case was indicated for dry skin presentation. But we observed a rapid and complete vitiligo regression under this mixture associated with DMARDs. This is why, beside a controlled inflammation process by DMARDs, we suspected a role of glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) in melanocyte regeneration. Conclusion: This case would highlight a potential novel indication of glycerol, petroleum jelly and liquid paraffin mixtures (dexeryl®) in vitiligo of autoimmune origin. A clinical trial will be necessary to deeply appreciation this novel therapeutic property of glycerol, petroleum jelly and liquid paraffin mixtures (dexeryl®).

Clinical effect of stem cell transplantation combined with 308-nm excimer laser therapy for 56 cases of vitiligo.

To probe the clinical effect of stem cell transplantation in combination with 308-nm excimer laser therapy for vitiligo and to analyze its value in clinical application. A total of 56 patients with stable non-segmental vitiligo in different parts who were not cured by other therapies visiting our hospital from March 2019 to December 2021 were enrolled as study subjects. They were treated by stem cell transplantation combined with 308-nm excimer laser therapy. The treatment efficacy was observed and analyzed. Among the 56 patients, 38 (67.85%) and 49 (87.5%) patients were cured at 6 and 12 months after treatment, respectively. Stem cell transplantation combined with 308-nm excimer laser therapy for vitiligo achieves significant efficacy, with the cure rate far superior to that of other therapies for vitiligo. The therapy is worthy of popularization in the clinic.

New trends in the regenerative therapy of vitiligo. Literature review

Vitiligo is the most common acquired skin depigmentation disorder characterized by progressive loss of pigmentation caused by the destruction of functional melanocytes in the epidermis. The pathogenesis consists in the interaction of genetic components, metabolic factors associated with cellular oxidative stress, adhesion of melanocytes to the epithelium and autoimmunity, which culminate in aggression against melanocytes. To date, the treatment of vitiligo, according to Russian and European clinical guidelines, consists in the appointment of various drug and non-drug methods: the use of topical and systemic glucocorticosteroids, calcineurin inhibitors, azathioprine, phototherapy, both in the form of monotherapy and their combination.
 In recent years, in connection with the development of cellular technologies, alternative methods of therapy based on the transplantation of autologous cultured and non-cultured melanocytes have become widespread in the treatment of vitiligo. The most promising options for vitiligo cell therapy are methods based not only on the transplantation of ready-made cellular structures, but also on the replacement of damaged cells with a transplant of pluropotent progenitor stem cells or their immature committed structures.
 This article is of an overview nature. The aim of the review is to update information on promising new treatments for vitiligo. A literature review was conducted using the PubMed, Cochrane Library, CyberLeninka and Internet databases to study clinical and preclinical data on the possibility of using innovative methods of regenerative medicine in patients with vitiligo.
 This review is addressed to medical researchers interested in the treatment of vitiligo.

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas

Characteristics and decreased Vitiligo Area Scoring Index of vitiligo patients with narrowband-UVB phototherapy in Yogyakarta, Indonesia.

Narrowband ultraviolet-B (NB-UVB) phototherapy is the mainstay of vitiligo therapy. The response can be evaluated using the vitiligo area scoring index (VASI) and repigmentation grade. However, few studies used VASI to evaluate phototherapy response and there are no definitive data on the reduction of VASI. This retrospective descriptive study aimed to determine the characteristics and decrease of VASI in patients with vitiligo after 36 and 48 sessions of NB-UVB phototherapy, conducted at Dr. Sardjito General Hospital, Yogyakarta, from December 2021-June 2022. The most common predilection was on the face (71.43%) and acral (61.90%). The most common responses after 36 and 48 phototherapy sessions were minimally improved (decrease in VASI<10%) and improved (reduction in VASI 10-25%). The mean decrease in VASI was 18% and 22% after 36 and 48 phototherapy sessions, respectively. 9.52% and 6.67% of patients experienced a reduction in VASI >50% after 36 and 48 phototherapy sessions, respectively. VASI assessment can be used to evaluate the response to phototherapy in vitiligo. However, VASI cannot show a reduction in vitiligo with slight repigmentation in slow-response patients.

Retrospective analysis of ultrathin skin grafting over carbon dioxide ablated lesions supplemented with excimer lamp (308 nm) therapy in stable vitiligo.

Background Of all the tissue or cellular grafting techniques used in the treatment of vitiligo, melanocyte transplant/transfer through ultrathin skin grafting (UTSG) provides rapid onset of regimentation. The regimentation process is further accelerated with a combination of psoralen and ultraviolet A radiation, or psoralen and ultraviolet A obtained by sunlight or narrowband ultraviolet light B, or excimer laser/lamp (308 nm). Aims We assessed the efficacy of carbon dioxide laser ablation followed by melanocyte transplant/transfer through ultrathin skin graft sheet/sheets and further treated by excimer lamp therapy in patients with stable vitiligo. Methods One hundred ninety-two patients with stable vitiligo were treated with UTSG following carbon dioxide laser ablation and patients were then put on excimer lamp therapy. Primary efficacy was determined in terms of grades of regimentation and colour match at the end of 1-year. Results A total of 192 stable vitiligo patients with a mean age of 32.71 ± 8.55 years were recruited. Of the total 410 lesions, 394 showed excellent regimentation indicating a success rate of 96.1% at 1-year follow-up, whereas 16 (3.9%) lesions present on fingertips and toe tips showed poor or no regimentation at 3-month and 1-year follow-up. With regards to colour match, 394 (96.1%) lesions had achieved excellent colour match, and 16 lesions (3.9%) had poor or no colour match at 1-year follow-up. Limitations This was a single-center study with a small sample size. Conclusion The effectiveness of carbon dioxide laser ablation followed by melanocyte transfer/transplant through ultra-thin skin graft sheet/sheets when combined with excimer lamp therapy provides favourable cosmetic outcomes with rapid onset of regimentation in stable vitiligo.

Implementation of the vitiligo area scoring index in clinical studies of patients with vitiligo: a scoping review.

The vitiligo area scoring index (VASI) is a validated, reliable clinician-reported outcome measure widely used to assess the extent of skin depigmentation seen in patients with vitiligo and to measure patient responses to therapies for vitiligo in clinical trials. However, its implementation in studies is inconsistent and makes comparing results across different studies difficult. The aim of this scoping review is to summarize interventional clinical studies that applied the VASI to measure vitiligo and identify variability in VASI implementation. A systematic search of Ovid Medline, Embase, Web of Science, Cochrane, and ClinicalTrials.gov was performed. Interventional studies published between January 1946 and October 2020 that used the VASI as an outcome measure for assessing vitiligo response were reviewed for methodological approach. Great heterogeneity was found within the 55 included interventional studies that used VASI as an outcome measure. A total of 9 VASI subtypes were described by the authors within 10 intervention categories. VASI determined study eligibility in one study. Body surface area was most frequently established using inconsistent methods. We found unclear or ambiguously scaled assessments of depigmentation. Most VASI outcomes were reported as mean absolute difference, percentage VASI improvement, and percentage of patients who achieved the VASI endpoint. The VASI score was over 100 in one study. Our scoping review revealed many VASI methodology variations in interventional clinical studies of vitiligo. While VASI is a standard method to measure vitiligo changes, substantial heterogeneity in methodology limits reliable comparison and interpretation of findings from different clinical trials. Our findings may be used as a foundation to standardize the VASI outcome measure methodology, allowing for improved clinician training and rigorous data analysis across vitiligo research groups worldwide.

The possible role of Wnt/β-catenin signalling in vitiligo treatment.

Vitiligo is a common chronic skin disease which has an adverse impact on patients' life. Its pathogenesis is complex, involving autoimmunity and oxidative stress (OS). Autoimmunity leads to the loss of epidermal melanocytes and the formation of the depigmented patches of the disease. Treatment of vitiligo should control the exaggerated immune response to arrest the progress of active disease, and then promote melanocytes to repigmentation. Wnt/β-catenin signalling pathway has been of recent interest in vitiligo. Wnt/β-catenin signalling pathway is downregulated in vitiligo. Upregulation of Wnt/β-catenin signalling possibly control vitiligo autoimmune response by protecting melanocyte from OS damage, inhibiting CD8+ T cell effector cell differentiation and enhancing Treg. Wnt/β-catenin signalling plays a critical role in the melanocyte regeneration by driving the differentiation of melanocyte stem cells (McSCs) into melanocytes. Promoting Wnt/β-catenin signalling can not only arrest the progress of active disease of vitiligo but also promote repigmentation. Some of the main effective therapies for vitiligo are likely to work by activating Wnt/β-catenin signalling. Agents that can enhance the effect of Wnt/β-catenin signalling may become potential candidates for the development of new drugs for vitiligo treatment.

Vitiligo: Prevalence, Clinical Patterns, and Efficacy of Narrow Band Ultraviolet B Phototherapy

Background: Vitiligo denotes an acquired primary, usually progressive, melanocytopenia of unknown etiology, and clinically manifested by circumscribed achromic macules often associated with leukotrichia. Objective: The objective was to assess the prevalence and various clinical patterns of vitiligo and to study the efficacy of narrow-band ultraviolet B (NB-UVB) radiation. Materials and Methods: A prospective case series study was carried out at dermatology outpatient department (OPD), of tertiary care center in Central India on 50 patients of Vitiligo, who were diagnosed clinically, age ranging from 5 to 70 years of age. A thorough history and clinical examination as per institutional protocol was done for all the patients included in the study. Patients were exposed to NB-UVB rays in a phototherapy unit (Dermaindia Spiegel Series) with a standard protocol. Two scores designed for the assessment of vitiligo are Vitiligo Area Severity Index and Wallace Rule of Nines. Results: During the period of two years, 6638 patients were seen in dermatology OPD, out of which 129 patients were having vitiligo clinically. Thus, the prevalence of vitiligo was 1.9% in our study. The mean age in male was 40.4 years and that of female was 30.85 years. The female-to-male ratio was 2:3. 6% had a positive family history of vitiligo. The most common site affected was leg (pretibial region) (48%). Two patients (4%) were in Category– 0, 12 patients (24%) were in Category– I, 24 patients (48%) were in Category-II, and 12 patients (24%) were in Category– III, when graded according to their improvement. Forty-five patients (90%) had vitiligo vulgaris, two patients (4%) had segmental vitiligo, and one patient (2%) each of acrofacial vitiligo, lip-tip vitiligo, and focal vitiligo. On comparing the level of significance before treatment and after 2 months of treatment, after 4 and 6 months of treatment, and before treatment and at the end of treatment, it was found that the results were statistically highly significant. Thus, indicating that the improvement in the disease after NB-UVB therapy is statically significant. Conclusion: Our study found 1.9% prevalence of vitiligo among patients attending OPD. On comparing the level of significance, before treatment and at the end of treatment, it was found that the results were statistically highly significant with respect to improvement. Side effects were minimal in our participants. Thus, our study concludes that NB-UVB radiation is an effective and safe therapy for vitiligo.

Mitochondria-Melanocyte cellular interactions: An emerging mechanism of vitiligo pathogenesis.

Mitochondria has emerged as a potential modulator of melanocyte function other than just meeting its cellular ATP demands. Mitochondrial DNA defects are now an established cause of maternal inheritance diseases. Recent cellular studies have highlighted the mitochondrial interaction with other cellular organelles that lead to disease conditions such as in Duchenne muscular dystrophy, where defective mitochondria was found in melanocytes of these patients. Vitiligo, a depigmentory ailment of the skin, is another such disorder whose pathogenesis is now found to be associated with mitochondria. The complete absence of melanocytes at the lesioned site in vitiligo is a fact; however, the precise mechanism of this destruction is still undefined. In this review we have tried to discuss and link the emerging facts of mitochondrial function or its inter- and intra-organellar communications in vitiligo pathogenesis. Mitochondrial close association with melanosomes, molecular involvement in melanocyte-keratinocyte communication and melanocyte survival are new paradigm of melanogenesis that could ultimately account for vitiligo. This definitely adds the new dimensions to our understanding of vitiligo, its management and designing of future mitochondrial targeted therapy for vitiligo.

Psychosocial and quality-of-life factors associated with depigmentation therapy for vitiligo.

There is a paucity of data examining the psychosocial factors relevant to depigmentation therapy, an irreversible treatment for vitiligo. This study explores patients' perspective and experience while undergoing depigmentation therapy and quality-of-life effects of such therapy. An online instrument assessing the impact of depigmentation therapy on various psychosocial variables and including the validated Dermatology Life Quality Index (DLQI) were administered to two groups of participants with vitiligo: (1) those who are currently undergoing or have completed depigmentation therapy and (2) those with vitiligo who have not undergone depigmentation therapy but had considered it. Data were collected on psychosocial factors such as length of time until depigmentation therapy was offered, duration, financial burden, level of satisfaction, impact on life activities, and challenges faced during and after depigmentation therapy. DLQI scores were also measured. Thirty-five vitiligo patients who did not undergo depigmentation and 42 patients who did undergo depigmentation therapy were included in the study. Baseline characteristics were comparable between groups. Mean DLQI was higher for patients who did not undergo depigmentation than for those who underwent depigmentation (10.2 versus 5.3, p = 0.002), indicating worse quality-of-life in those not depigmenting. Patients who underwent depigmentation reported significantly less discomfort in various social situations after undergoing depigmentation therapy compared to how they felt before undergoing therapy and reported significantly less discomfort in these situations than patients who did not undergo depigmentation therapy. Despite potential challenges, depigmentation therapy appears to augment quality-of-life across various domains in individuals with vitiligo.

Multi-Modality Ayurveda Regime in the Management of Childhood Vitiligo w.s.r.to Shwitra: A Case Report.

Patients of vitiligo are hated and neglected lot in the society. Great researches in the world have done lot of studies and experiments but no medicine has proved satisfactory in total eradication of the disease. Objective: To see the effect of multi-modality Ayurveda regime in the management of Childhood vitiligo/Shwitra. Methodology: Female patient 07yrs old had been experiencing symptoms of white Patches around the b/l eye and elbow since 5months. Ayurvedic medicines were used in the study for one year and six months. Discussion: The major goal of the multi-modality regime is to help to eliminate white patches. Bakuchi Ghanvati, Mahamanjishtadi kadha, Panchtikta ghruta guggul, Krumikuthar rasa were given orally. Bakuchi tail for local application and daily Hanuman chalisa path advised to patient. This treatment for one half year continued which showed excellent result in the patient. Conclusion: The effect of Dravya and Adravya shaman chikitsa has shown encouraging results in the repigmentation of the affected skin. Not many complications were observed in the patients at the end of the study. Ayurveda has distinctive concepts with all disease called as Chikitsa siddhanta, which work and stand for a long period of time. Since the therapy for Vitiligo has limitation in other pathies, Ayurvedic management of vitiligo is one of the most effective therapy and which have less chances of recurrence.