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Awad SS. Depigmentation during vitiligo activity spares epithelial grafted areas. J Cosmet Dermatol 2016; 15:383-386. [PMID: 27369365 DOI: 10.1111/jocd.12243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo is a depigmenting disease characterized by episodes of stability and activity without a fixed sequence, and active phases demonstrate immune attacks toward vulnerable melanocytes. Epithelial grafts were introduced to treat recalcitrant vitiligo patches aiming to provide new generations of melanocytes. AIMS The aim of study was to evaluate the possible permanency of succeeded epithelial grafts during a coming activity episode. METHODS This study included 20 nonsegmental vitiligo cases. They were epithelial grafted, success was maintained with the use of UV sessions for a year, and further follow-up was allowed until new phases of activity developed. RESULTS The grafted areas, in all cases, were spared during the activity episodes in spite of the development of new depigmented lesions in other parts of skin neighboring the grafted areas or in remote sites. CONCLUSION The permanency of epithelial grafts in spite of disease reactivity is a good sign and magnifies the value of surgical approaches in management of vitiligo. New genetically different melanocytes should have been provided and were able to resist the new immune attacks in spite of the yielding of other skin melanocytes.
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Affiliation(s)
- Sherif Shoukry Awad
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
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2
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Kovacevic M, Stanimirovic A, Vucic M, Goren A, Situm M, Lukinovic Skudar V, Lotti T. Mixed vitiligo of Blaschko lines: a newly discovered presentation of vitiligo responsive to combination treatment. Dermatol Ther 2016; 29:240-3. [PMID: 26970077 DOI: 10.1111/dth.12345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vitiligo, depigmenting disorder of the skin and mucous membranes, affects up to 1% of the population worldwide. It is classified into four major types: segmental, non-segmental, mixed, and unclassified type. Non-segmental vitiligo refers to non-dermatomal distribution of lesions, while dermatomal distribution of lesions is present in patients with segmental vitiligo. Segmental vitiligo can also follow Blaschko lines - pathways of epidermal cell migration and proliferation during the development of the fetus. Here, we present patient with segmental and non-segmental vitiligo following Blaschko lines with excellent therapeutic response to combined therapy. Prior to our report, a case of segmental and non-segmental vitiligo followed by Blaschko lines was never described, therefore we suggest the term "mixed vitiligo of Blaschko lines" to describe this entity. This is also a rare case in which 90% repigmentation was achieved in patient with segmental and nonsegmental vitiligo following Blaschko lines in only 2 months of combined therapy.
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Affiliation(s)
- Maja Kovacevic
- Croatian Vitiligo Association, Huga Badalica 26, Zagreb, Croatia.,Dermatology and Venereology Division, Guglielmo Marconi University, Via Plinio, 44, 00193, Roma, Italy
| | - Andrija Stanimirovic
- Croatian Vitiligo Association, Huga Badalica 26, Zagreb, Croatia.,Department of Clinical Medicine, University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Majda Vucic
- Department of Pathology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, Zagreb, Croatia
| | - Andy Goren
- Dermatology and Venereology Division, Guglielmo Marconi University, Via Plinio, 44, 00193, Roma, Italy.,Applied Biology, Inc., Irvine, California
| | - Mirna Situm
- Department of Dermatology and Venereology, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, Zagreb, Croatia
| | | | - Torello Lotti
- Dermatology and Venereology Division, Guglielmo Marconi University, Via Plinio, 44, 00193, Roma, Italy
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Schallreuter KU, Salem MAEL, Holtz S, Panske A. Basic evidence for epidermal H2O2/ONOO(-)-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS. FASEB J 2013; 27:3113-22. [PMID: 23629861 DOI: 10.1096/fj.12-226779] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nonsegmental vitiligo (NSV) is characterized by loss of inherited skin color. The cause of the disease is still unknown despite accumulating in vivo and in vitro evidence of massive epidermal oxidative stress via H2O2 and peroxynitrite (ONOO(-)) in affected individuals. The most favored hypothesis is based on autoimmune mechanisms. Strictly segmental vitiligo (SSV) with dermatomal distribution is a rare entity, often associated with stable outcome. Recently, it was documented that this form can be associated with NSV (mixed vitiligo). We here asked the question whether ROS and possibly ONOO(-) could be players in the pathogenesis of SSV. Our in situ results demonstrate for the first time epidermal biopterin accumulation together with significantly decreased epidermal catalase, thioredoxin/thioreoxin reductase, and MSRA/MSRB expression. Moreover, we show epidermal ONOO(-) accumulation. In vivo FT-Raman spectroscopy reveals the presence of H2O2, methionine sulfoxide, and tryptophan metabolites; i.e., N-formylkynurenine and kynurenine, implying Fenton chemistry in the cascade (n=10). Validation of the basic data stems from successful repigmentation of skin and eyelashes in affected individuals, regardless of SSV or segmental vitiligo in association with NSV after reduction of epidermal H2O2 (n=5). Taken together, our contribution strongly supports H2O2/ONOO-mediated stress in the pathogenesis of SSV. Our findings offer new treatment intervention for lost skin and hair color.
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Affiliation(s)
- Karin U Schallreuter
- Institute for Pigmentary Disorders, E. M. Arndt University, Greifswald, Germany.
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Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CCE, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25:E1-13. [PMID: 22417114 PMCID: PMC3511780 DOI: 10.1111/j.1755-148x.2012.00997.x] [Citation(s) in RCA: 364] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner's phenomenon (KP); and 'autoimmune vitiligo'. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term 'vitiligo' be used as an umbrella term for all non-segmental forms of vitiligo, including 'mixed vitiligo' in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that 'autoimmune vitiligo' should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin Disorders, Hôpital Pellegrin, Bordeaux, France.
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5
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Ezzedine K, Diallo A, Léauté-Labrèze C, Séneschal J, Prey S, Ballanger F, Alghamdi K, Cario-André M, Jouary T, Gauthier Y, Taieb A. Halo naevi and leukotrichia are strong predictors of the passage to mixed vitiligo in a subgroup of segmental vitiligo. Br J Dermatol 2012; 166:539-44. [PMID: 22032627 DOI: 10.1111/j.1365-2133.2011.10709.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Until now, segmental vitiligo has been considered as a stable entity and mixed vitiligo, the association of segmental and nonsegmental vitiligo, has been reported rarely. OBJECTIVES The aim of this study was to search for factors associated with the generalization of vitiligo in patients with segmental vitiligo. PATIENTS AND METHODS This was a prospective observational study conducted in the vitiligo clinic of the Department of Dermatology of Bordeaux, France. The Vitiligo European Task Force questionnaire was completed for each patient attending the clinic with a confirmed diagnosis of segmental vitiligo after exclusion of other forms of vitiligo (focal, mucosal, not classifiable.) Thyroid function and antithyroid antibodies were screened if not obtained in the previous year. RESULTS One hundred and twenty-seven patients were recruited: 101 had segmental vitiligo and 26 had segmental vitiligo that evolved into mixed vitiligo; 56 were male and 71 were female. Most patients had onset of segmental vitiligo before the age of 18. When conducting multivariate analysis, we found the following to be independent factors associated with the evolution of patients' disease from segmental vitiligo to mixed vitiligo: initial percentage of body surface involvement of the segment >1% [odds ratio (OR) 15·14, P=0·002], the presence of halo naevi (OR 24·82, P=0·0001) and leukotrichia (OR 25·73, P=0·0009). CONCLUSIONS Halo naevi association and leukotrichia at first consultation in segmental vitiligo are risk factors for the progression of segmental vitiligo to mixed vitiligo. In addition, this progression of segmental vitiligo to mixed vitiligo carries a stronger link if initial segmental involvement is situated on the trunk.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France.
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Ezzedine K, Gauthier Y, Léauté-Labrèze C, Marquez S, Bouchtnei S, Jouary T, Taieb A. Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): a retrospective case series of 19 patients. J Am Acad Dermatol 2011; 65:965-71. [PMID: 21616559 DOI: 10.1016/j.jaad.2010.08.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/30/2010] [Accepted: 08/30/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mixed vitiligo (MV), the association of segmental vitiligo (SV) and nonsegmental vitiligo, has been rarely reported. OBJECTIVE The aim of this study was to delineate the clinical spectrum of MV through a case series of patients with typical SV associated with patchy bilateral vitiligo. METHODS This was a cross-sectional evaluation in the setting of a prospective observational study conducted in the vitiligo clinic of the department of dermatology in Bordeaux, France. RESULTS Nineteen patients with MV were identified. Four were male and 15 were female. Most patients had an onset of SV before the age of 18 years (18 of 19). In all patients, SV preceded nonsegmental vitiligo with a delay ranging from 6 months to more than 24 months. LIMITATIONS This study was cross-sectional and based on a single-center experience. CONCLUSION MV is not yet part of a conventional classification. However, this entity may have been neglected until now and should be included in the classification of vitiligo in addition to SV and nonsegmental vitiligo. Moreover, MV may be essential to the understanding of the pathogenesis of vitiligo as a primary skin disorder.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and National Centre for Rare Skin Disorders, CHU St-André, Bordeaux, France.
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van Geel N, De Lille S, Vandenhaute S, Gauthier Y, Mollet I, Brochez L, Lambert J. Different phenotypes of segmental vitiligo based on a clinical observational study. J Eur Acad Dermatol Venereol 2010; 25:673-8. [DOI: 10.1111/j.1468-3083.2010.03847.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taïeb A, Morice-Picard F, Jouary T, Ezzedine K, Cario-André M, Gauthier Y. Segmental vitiligo as the possible expression of cutaneous somatic mosaicism: implications for common non-segmental vitiligo. Pigment Cell Melanoma Res 2008; 21:646-52. [DOI: 10.1111/j.1755-148x.2008.00511.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Interface dermatitis can be classified based upon the cell type that dominates the infiltrate (ie, neutrophilic, lymphocytic, or lymphohistiocytic) or by the intensity of the interface inflammation. Regarding lymphocytic interface dermatitis, there are 2 broad categories: cell-poor interface dermatitis, when only a sparse infiltrate of inflammatory cells is present along the dermoepidermal junction, or cell rich, which typically occurs as a heavy bandlike infiltrate that obscures the basal layers of the epidermis. In the case of lymphocytic interface dermatitis, the latter is often termed a lichenoid interface dermatitis. This review focuses upon the mononuclear cell-predominant forms of interface dermatitis.
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Affiliation(s)
- A Neil Crowson
- Department of Dermatology, University of Oklahoma and Regional Medical Laboratories, St John Medical Center, 1923 S Utica Ave, Tulsa, OK 74104, USA.
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