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Farag AGA, Badr EAE, Ibrahim AF. Circadian clock gene expression and polymorphism in non-segmental vitiligo. Mol Biol Rep 2024; 51:142. [PMID: 38236441 PMCID: PMC10796645 DOI: 10.1007/s11033-023-09109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Vitiligo is an acquired and progressive mucocutaneous disease with the damage of functioning epidermal melanocytes. Metabolic syndrome is associated with inflammatory skin diseases incorporating vitiligo. The circadian dysfunction triggers the pathogenesis of metabolic diseases, so our study aimed to determine the relationship between aryl hydrocarbon receptor nuclear translocator-like gene, a ligand-activated transcription factor and sensor of environmental chemicals, expression and polymorphism with non-segmental vitiligo, as well as its effect on lipid profile. METHODS This case-control study was handled on 50 non-segmental vitiligo patients (generalized (12) and localized type (focal; 24 and acrofacial; 14)) and 50 matched controls. Each subject was proposed for full history taking, clinical examinations, serum lipid profile, and measurement of BMAL1 gene expression in the blood, and BMAL1 rs2279287 polymorphism of DNA extract from whole blood by real time-PCR. RESULTS We identified that total cholesterol, triglyceride, and low-density lipoprotein were significantly higher, but high-density lipoprotein was significantly lower in non-segmental vitiligo patients than in the control group. A significant increase in circadian gene expression in non-segmental vitiligo patients was observed, with more detection of the BMAL1 T/C genotype (92%) than the T/T genotype. There was a significant positive relationship between the level of the circadian gene and the vitiligo patient's age, age of onset, and VIDA Score. The level of the circadian gene at Cutoff ≥ 1.16 can predict the prognosis of vitiligo with a sensitivity of 78%, specificity of 84%, and accuracy of 81%. CONCLUSION The circadian gene has an active role in the progress of non-segmental vitiligo and targeting this gene could have a significant impact on its management.
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Affiliation(s)
| | - Eman A E Badr
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Shebin AlKom, Egypt
| | - Asmaa Fahmy Ibrahim
- Department of Clinical and Molecular Parasitology, National Liver Institute, Menoufia University, Shebin AlKom, Egypt.
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2
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Farajzadeh S, Khalili M, Mirmohammadkhani M, Paknazar F, Rastegarnasab F, Abtahi-Naeini B. Global clinicoepidemiological pattern of childhood vitiligo: a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001839. [PMID: 37616066 PMCID: PMC10083860 DOI: 10.1136/bmjpo-2022-001839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/05/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Childhood vitiligo differs from adult vitiligo in many aspects. To the best of the authors' knowledge, there is no systematic review of different clinicoepidemiological patterns of vitiligo in children. This study aimed to review the characteristics of vitiligo among the paediatric population. METHODS In June 2022, a comprehensive search was conducted using MeSh-based keywords on online databases including PubMed, Scopus and Web of Sciences. The papers were assessed, and the eligible articles were selected. The selection of articles followed three distinct steps. The extracted clinicoepidemiological data were then imported into the STATA software for meta-analysis. RESULTS The meta-analysis of 17 studies with 4365 subjects yielded 2475 women (estimated=56.8%, 95% CI 54.45 to 59.22). The female-to-male ratio was determined to be 1.3:1. Meta-regression demonstrated a significant relationship between continents and gender (p=0.03). The most prevalent types of non-segmental vitiligo were vulgaris (42.49%), focal (27.21%) and acrofacial (17.8%). The pooled ratio of non-segmental to segmental was 4.6:1. The highest and lowest ratios were found in Africa with one study (estimated=11.56%, 95% CI -0.98 to 24.10) and America with two studies (estimated=3.02%, 95% CI 1.54 to 4.50), respectively. Using meta-regression, the relationship between continents and vitiligo type was found to be insignificant (p=0.47). Positive family history was recorded in 657 patients (estimated = 16.88%, 95% CI 13.37 to 20.39). Positive family history varied by country of study from 13.91% (Asia with 11 studies) to 27.01% (Europe with two studies) (p=0.11). Kobner phenomena and leukotrichia were noted in 687 (25.47%) and 461 (18.52%) patients, respectively. CONCLUSION The review indicated that childhood vitiligo is more prevalent in women. Non-segmental forms of childhood vitiligo were the most common, including vulgaris, focal and acrofacial. The clinicoepidemiological pattern of childhood vitiligo is variable in different geographic areas.
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Affiliation(s)
- Saeedeh Farajzadeh
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Chivu AM, Bălășescu E, Pandia LD, Nedelcu RI, Brînzea A, Turcu G, Antohe M, Ion DA. Vitiligo-Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review. J Pers Med 2022; 12:jpm12122048. [PMID: 36556267 PMCID: PMC9785784 DOI: 10.3390/jpm12122048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
In most dermatological pathologies, the phenomena observed on the skin are a reflection of internal disorders. In patients with associated acral involvement on the dorsal sides of the hands, this "vitiligo phenotype" may lead to the investigation of certain associated pathologies that sometimes have no obvious clinical impact. To assess the link between skin depigmentation and autoimmune pathologies, we conducted a systematic review involving article selection from the PubMed database. Patients with coexisting thyroid pathologies were found to have a predisposition for developing acral vitiligo and depigmentation of the wrists, and autoimmune thyroid pathologies appeared to be the only coexisting autoimmune or inflammatory diseases in vitiligo patients to show a pattern of distribution. The association of concomitant thyroid dysfunction with depigmentation of the hands was found to be so strong that the absence of depigmented macules on the hands may exclude the coexistence of an autoimmune thyroid pathology. Although the frequency of acral involvement in patients with vitiligo and autoimmune pathologies is higher, the mechanism by which thyroid dysfunction influences this distribution pattern remains incompletely elucidated and requires future studies.
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Affiliation(s)
- Ana Maria Chivu
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
| | - Elena Bălășescu
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
- SanacareVital Clinic, 010161 Bucharest, Romania
- Correspondence:
| | - Larisa Diana Pandia
- Astera Diamed Diabetes & Nutrition and Endocrinology Clinic, 010161 Bucharest, Romania
| | - Roxana Ioana Nedelcu
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
- Derma 360 Clinic, 11273 Bucharest, Romania
| | - Alice Brînzea
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
- Institutul Național de Boli Infecțioase (INBI) Matei Bals, 021105 Bucharest, Romania
| | - Gabriela Turcu
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
- Department of Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Mihaela Antohe
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
- Derma 360 Clinic, 11273 Bucharest, Romania
| | - Daniela Adriana Ion
- 2nd Pathophysiology Department, Laboratory of Experimental Medicine and Fundamental Research, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania
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4
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Lim JH, Lew BL, Sim WY, Kwon SH. Incidence of childhood-onset vitiligo and increased risk of atopic dermatitis, autoimmune diseases, and psoriasis: A nationwide population-based study. J Am Acad Dermatol 2022; 87:1196-1198. [PMID: 35276286 DOI: 10.1016/j.jaad.2022.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Ji-Hoon Lim
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Woo-Young Sim
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon-Hyo Kwon
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
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Chaudhary A, Patel M, Singh S. Current Debates on Etiopathogenesis and Treatment Strategies for Vitiligo. Curr Drug Targets 2022; 23:1219-1238. [PMID: 35388753 DOI: 10.2174/1389450123666220406125645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 01/25/2023]
Abstract
Vitiligo is an acquired, chronic, and progressive depigmentation or hypopigmentation characterized by the destruction of melanocytes and the occurrence of white patches or macules in the skin, mucosal surface of eyes, and ears. Melanocytes are the melanin pigment-producing cells of the skin which are destroyed in pathological conditions called vitiligo. Approximately 0.5 - 2.0% of the population is suffering from vitiligo, and a higher prevalence rate of up to 8.8% has been reported in India. It is caused by various pathogenic factors like genetic predisposition, hyperimmune activation, increased oxidative stress, and alteration in neuropeptides level. Genetic research has revealed a multi- genetic inheritance that exhibits an overlap with other autoimmune disorders. However, melanocytes specific genes are also affected (such as DDR1, XBP1, NLRP1, PTPN22, COMT, FOXP3, ACE, APE, GSTP1, TLR, SOD, and CTLA-4). A number of therapeutic options are employed for the treatment of vitiligo. The topical corticosteroids and immunomodulators are currently in practice for the management of vitiligo. Phototherapies alone and in combinations with other approaches are used in those patients who do not respond to the topical treatment. The main focus of this review is on the etiopathological factors, pharmacological management (phototherapy, topical, systemic, and surgical therapy), and herbal drugs used to treat vitiligo.
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Affiliation(s)
- Ankit Chaudhary
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Mayank Patel
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Shamsher Singh
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
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Liu X, Yao Z, Wang Y, Chai L, Zhou X. Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies. Int Immunopharmacol 2022; 109:108789. [DOI: 10.1016/j.intimp.2022.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
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Dai T, Wu Y, Song W, Li F, Wang L. Inverse association between autoimmunity and elevated IgE among childhood vitiligo. Int J Dermatol 2022; 61:1131-1136. [PMID: 35325476 DOI: 10.1111/ijd.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple factors contribute to the pathogenesis of childhood vitiligo. The characteristics in a different population under modified environmental factors need further reevaluation. The present study aimed to reevaluate the clinical and laboratory features in consequent children vitiligo patients. MATERIALS AND METHODS We retrospectively reviewed consequent children vitiligo patients who visited Children's Hospital of Fudan University (National Children's Medical Center of China). The prevalence rate of thyroid dysfunction, circulating autoantibodies, serum IgE, and associated factors were analyzed. RESULTS A total of 244 consequent vitiligo patients were included, of which 20 children had personal autoimmune history. Two hundred and nineteen of the 244 patients took a thyroid function test, and the abnormal rate was only 3.7% (8/219). The elevated IgE rate was 31.7% (52/157), the antinuclear antibody (ANA) positive rate was 9.8% (12/123), and the extractable nuclear antigens (ENA) positive rate was 4.4% (4/91), respectively. The elevated IgE was significantly associated with atopic disease history and male gender. Of note, personal autoimmune history showed a significant inverse association with elevated IgE. CONCLUSIONS Thyroid dysfunction rate was low among the consequent children vitiligo patients. Personal autoimmune history was inversely associated with elevated IgE. Various clinical characteristics and pathogenesis might contribute to different long-term outcomes of vitiligo.
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Affiliation(s)
- Ting Dai
- Department of Dermatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yao Wu
- Department of Dermatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wei Song
- Department of Dermatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Fulun Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuhui Wang
- Department of Dermatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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8
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Mufti AH, AlJahdali IA, Elhawary NA, Ekram SN, Abumansour I, Sindi IA, Naffadi H, Elhawary EN, Alyamani NM, Alghamdi G, Alosaimi W, Rawas G, Alharbi A, Tayeb MT. Variations in TAP1 and PSMB9 Genes Involved in Antigen Processing and Presentation Increase the Risk of Vitiligo in the Saudi Community. Int J Gen Med 2022. [PMID: 34984025 DOI: 10.2147/ijgm.s341079]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The antigen processing 1 (TAP1) and proteasome 20S subunit beta 9 (PSMB9) genes are associated with strong susceptibility to many autoimmune diseases. Here, we explored whether TAP1/PSMB9 genetic variants, individually or combined, affected susceptibility to the complex, autoimmune-based skin disorder vitiligo. Methods Samples of genomic DNA from buccal cells of 172 patients with vitiligo and 129 healthy controls were analyzed using TaqMan™ genotyping assays for the TAP1 rs1135216 (A>G) and PSMB9 rs17587 (A>G) single nucleotide polymorphisms (SNPs). SNPStats software (https://www.snpstats.net) was utilized to choose the best interactive inheritance mode for selected SNPs. Results The genotype frequencies for the TAP1 rs1135216 and PSMB9 rs17587 SNPs were in Hardy-Weinberg equilibrium for cases (P= 0.11 and P= 0.10, respectively) but not for controls (P< 0.05). The TAP1 rs1135216 (D637G) and PSMB9 rs17587 (R60H) SNPs increased the risk of vitiligo four-fold and two-fold, respectively (odds ratio [OR]= 4.6; 95% confidence interval [CI], 3.2-6.5; P< 0.0001 and OR= 2.2; 95% CI, 1.5-3.1; P< 0.0001). The recessive model (G/G-D/G versus D/D) and the codominant model (R/R versus R/H) were the best models of inheritance for the rs113526 and rs17587 SNPs, respectively (OR= 16.4; 95% CI, 2.0-138; P= 0.0006 and OR= 1.7; 95% CI, 0.3-1.8; P= 0.013). Vulgaris, focal vulgaris, and acryl/acrofacial were the most common vitiligo subtypes in our sample (51%, 21%, and 19%, respectively). Heterozygous rs113526 (637D/G) and rs17587 (60R/H) were the most common genotypes in most vitiligo subtypes. The heterozygous 637D/G genotype and the 637G variant allele were significantly more common in patients with active disease than in patients with stable disease (P= 0.000052 and P= 0.0063, respectively). Conclusion Our findings suggest a crucial role for TAP1 rs1135216 and PSMB9 rs17587 in the risk and progression of vitiligo in the Saudi community. Genomic analyses are needed to identify more candidate genes and more genetic variants associated with vitiligo.
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Affiliation(s)
- Ahmad H Mufti
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Imad A AlJahdali
- Department of Community Medicine, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Nasser A Elhawary
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Samar N Ekram
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Iman Abumansour
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Ikhlas A Sindi
- Department of Biotechnology, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Hind Naffadi
- Common Science, First Year Deanship, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Ezzeldin N Elhawary
- MS Genomic Medicine Program, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Najiah M Alyamani
- Department of Biology, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Ghydda Alghamdi
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Wafaa Alosaimi
- Department of Hematology, Maternity and Children Hospital, Mecca, Saudi Arabia
| | | | - Amaal Alharbi
- Saudi Biobank National ProjectKing Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed T Tayeb
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
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Martins C, Migayron L, Drullion C, Jacquemin C, Lucchese F, Rambert J, Merhi R, Michon P, Taieb A, Rezvani HR, de Rinaldis E, Seneschal J, Boniface K. Vitiligo skin T cells are prone to produce type 1- and type 2-cytokines to induce melanocyte dysfunction and epidermal inflammatory response through JAK signaling. J Invest Dermatol 2021; 142:1194-1205.e7. [PMID: 34655610 DOI: 10.1016/j.jid.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Vitiligo is a T cell-mediated inflammatory skin disorder characterized by the loss of epidermal melanocytes. However, the contribution of melanocytes to the physiopathology of the disease in response to the T cell microenvironment remains unclear. Here, using NanoString technology and multiplex ELISA, we show that active vitiligo perilesional skin is characterized by prominent type 1 and 2 associated immune responses. The vitiligo skin T cell secretome downregulated melanocyte function and adhesion, while increasing melanocyte mitochondrial metabolism and expression of inflammatory cytokines and chemokines by epidermal cells. The JAK1/2 inhibitor ruxolitinib strongly inhibited such effects on epidermal cells. Our data highlight that vitiligo is more complex than previously thought with prominent combined activities of both Th1- and Th2-related cytokines inducing inflammatory responses of epidermal cells. Melanocytes do not appear only to be a target of T cells in vitiligo but could actively contribute to perpetuate inflammation. JAK inhibitors could prevent the impact of T cells on epidermal cells and pigmentation, highlighting their potential clinical benefit in vitiligo.
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Affiliation(s)
| | - Laure Migayron
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France; R&D Department, SILAB, Brive-la-Gaillarde, France
| | - Claire Drullion
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France
| | | | | | | | - Ribal Merhi
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France
| | - Pauline Michon
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France
| | - Alain Taieb
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France; Department of Dermatology and Pediatric Dermatology; National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France
| | - Hamid-Reza Rezvani
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France; AQUIDERM, University of Bordeaux
| | - Emanuele de Rinaldis
- Sanofi Immunology and Inflammation Research Therapeutic Area, Precision Immunology Cluster, Cambridge, MA, 02139, USA
| | - Julien Seneschal
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France; Department of Dermatology and Pediatric Dermatology; National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France
| | - Katia Boniface
- Univ. Bordeaux, INSERM, BMGIC, U1035, F-33000 Bordeaux, France.
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10
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Bertolani M, Rodighiero E, de Felici del Giudice MB, Lotti T, Feliciani C, Satolli F. Vitiligo: What's old, what's new. Dermatol Reports 2021; 13:9142. [PMID: 34659674 PMCID: PMC8451070 DOI: 10.4081/dr.2021.9142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/05/2021] [Indexed: 02/04/2023] Open
Abstract
Vitiligo is an acquired pigmentary disorder afflicting 0.5-2% of the world population for both sexes and all races with a capricious and unpredictable course. It has a complex etiology and varies in its manifestation, progression and response to treatment. Even if the precise aetiology and pathobiology of the disease are complex and still debated, recent evidence supports that vitiligo is a T CD8+ cell-mediated autoimmune disease triggered by oxidative stress. To date no clinical, biological and histological criteria allow us to establish the prognosis with certainty. The choice of the best therapy for adult and childhood vitiligo is based on various factors, such as the patient's age, psychological condition and expectations, distribution and extension of skin lesions, type of vitiligo (stable or not) and availability and cost of therapeutic options. Since vitiligo has a deep psychological impact on patients and their quality of life, treating the disease is very important. As dermatologists, we have important goals in the treatment of vitiligo patients: stabilization of the disease progression, repigmentation of the lesions and especially the persistence of the aforementioned repigmentation. Although several medical and surgical therapeutic options have been proposed, no definite cure has yet been developed and the long-term persistence of repigmentation is unpredictable. We review the different therapeutic options with particular attention on the recurrence rate.
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Affiliation(s)
| | - Eleonora Rodighiero
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
| | | | - Torello Lotti
- Unit of Dermatology and Regenerative Medicine, University of Rome G. Marconi, Rome, Italy
- Department of Dermatology and Communicable Diseases, Ministry of Health, Moscow – Russia First Medical Moscow State University, Higher Education Institution I. M. Sechenov, Russian Federation
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
- Dermatologic Unit, University Hospital of Parma, Italy
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11
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Eleftheriadou V, Atkar R, Batchelor J, McDonald B, Novakovic L, Patel JV, Ravenscroft J, Rush E, Shah D, Shah R, Shaw L, Thompson AR, Hashme M, Exton LS, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of people with vitiligo 2021. Br J Dermatol 2021; 186:18-29. [PMID: 34160061 DOI: 10.1111/bjd.20596] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- V Eleftheriadou
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - R Atkar
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - J Batchelor
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, UK
| | - B McDonald
- The Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1FR, UK
| | - L Novakovic
- Queen Elizabeth Hospital, Department of Dermatology, Lewisham and Greenwich NHS Trust, London, SE18 4QH, UK.,St John's Institute of Dermatology, Department of Photodermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | | | | | - E Rush
- Patient representative.,Vitiligo Support UK, London, UK
| | - D Shah
- Amersham Hospital, Amersham, HP7 0JD, UK
| | - R Shah
- Central & North West London NHS Trust, London, NW1 2PL, UK.,British Psychological Society, Leicester, LE1 7DR, UK
| | - L Shaw
- Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - A R Thompson
- British Psychological Society, Leicester, LE1 7DR, UK.,South Wales Clinical Psychology Training, Cardiff University, Cardiff, CF10 3AT, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
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Condamina M, Shourick J, Seneschal J, Sbidian E, Andreu N, Pane I, Ravaud P, Tran VT, Ezzedine K. Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort. J Am Acad Dermatol 2021; 86:696-698. [PMID: 33684495 DOI: 10.1016/j.jaad.2021.02.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Morgane Condamina
- Service de Dermatologie-Vénéréologie, CHU Robert Debré, Reims, France
| | - Jason Shourick
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Julien Seneschal
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France; INSERM U1035 Biothérapie des Maladies Génétiques Inflammatoires et Cancers, Immuno-Dermatologie ATIP AVENIR, Université de Bordeaux, Bordeaux, France
| | - Emilie Sbidian
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Nicolas Andreu
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Philippe Ravaud
- Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Viet-Thi Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Khaled Ezzedine
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France.
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13
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Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol 2021; 48:252-270. [DOI: 10.1111/1346-8138.15743] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Christina Bergqvist
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
| | - Khaled Ezzedine
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil, UPEC Créteil France
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Mufti AH, AlJahdali IA, Elhawary NA, Ekram SN, Abumansour I, Sindi IA, Naffadi H, Elhawary EN, Alyamani NM, Alghamdi G, Alosaimi W, Rawas G, Alharbi A, Tayeb MT. Variations in TAP1 and PSMB9 Genes Involved in Antigen Processing and Presentation Increase the Risk of Vitiligo in the Saudi Community. Int J Gen Med 2021; 14:10031-10044. [PMID: 34984025 PMCID: PMC8702990 DOI: 10.2147/ijgm.s341079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The antigen processing 1 (TAP1) and proteasome 20S subunit beta 9 (PSMB9) genes are associated with strong susceptibility to many autoimmune diseases. Here, we explored whether TAP1/PSMB9 genetic variants, individually or combined, affected susceptibility to the complex, autoimmune-based skin disorder vitiligo. METHODS Samples of genomic DNA from buccal cells of 172 patients with vitiligo and 129 healthy controls were analyzed using TaqMan™ genotyping assays for the TAP1 rs1135216 (A>G) and PSMB9 rs17587 (A>G) single nucleotide polymorphisms (SNPs). SNPStats software (https://www.snpstats.net) was utilized to choose the best interactive inheritance mode for selected SNPs. RESULTS The genotype frequencies for the TAP1 rs1135216 and PSMB9 rs17587 SNPs were in Hardy-Weinberg equilibrium for cases (P= 0.11 and P= 0.10, respectively) but not for controls (P< 0.05). The TAP1 rs1135216 (D637G) and PSMB9 rs17587 (R60H) SNPs increased the risk of vitiligo four-fold and two-fold, respectively (odds ratio [OR]= 4.6; 95% confidence interval [CI], 3.2-6.5; P< 0.0001 and OR= 2.2; 95% CI, 1.5-3.1; P< 0.0001). The recessive model (G/G-D/G versus D/D) and the codominant model (R/R versus R/H) were the best models of inheritance for the rs113526 and rs17587 SNPs, respectively (OR= 16.4; 95% CI, 2.0-138; P= 0.0006 and OR= 1.7; 95% CI, 0.3-1.8; P= 0.013). Vulgaris, focal vulgaris, and acryl/acrofacial were the most common vitiligo subtypes in our sample (51%, 21%, and 19%, respectively). Heterozygous rs113526 (637D/G) and rs17587 (60R/H) were the most common genotypes in most vitiligo subtypes. The heterozygous 637D/G genotype and the 637G variant allele were significantly more common in patients with active disease than in patients with stable disease (P= 0.000052 and P= 0.0063, respectively). CONCLUSION Our findings suggest a crucial role for TAP1 rs1135216 and PSMB9 rs17587 in the risk and progression of vitiligo in the Saudi community. Genomic analyses are needed to identify more candidate genes and more genetic variants associated with vitiligo.
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Affiliation(s)
- Ahmad H Mufti
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Imad A AlJahdali
- Department of Community Medicine, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Nasser A Elhawary
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
- Correspondence: Nasser A Elhawary Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955, Saudi ArabiaTel +966 55 369 2180 Email
| | - Samar N Ekram
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Iman Abumansour
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Ikhlas A Sindi
- Department of Biotechnology, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Hind Naffadi
- Common Science, First Year Deanship, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Ezzeldin N Elhawary
- MS Genomic Medicine Program, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Najiah M Alyamani
- Department of Biology, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Ghydda Alghamdi
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
| | - Wafaa Alosaimi
- Department of Hematology, Maternity and Children Hospital, Mecca, Saudi Arabia
| | | | - Amaal Alharbi
- Saudi Biobank National ProjectKing Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed T Tayeb
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia
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Mahajan VK, Verma YR, Mehta KS, Chauhan PS, Sharma R, Sharma A, Sharma H, Rana A. Adults with a more extensive body involvement, moderate to extremely severe vitiligo and a prolonged clinical course have an early onset in childhood in addition to other prognostic factors as compared to individuals with later-onset vitiligo. Australas J Dermatol 2020; 62:e24-e28. [PMID: 32812240 DOI: 10.1111/ajd.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The extent and disease severity, duration and other associated prognostic cofactors in vitiligo in adults may vary with the age of onset (before or after 10 years of age). OBJECTIVES To compare extent and disease severity, duration and other cofactors in adults with early-onset and late-onset vitiligo. METHODS The medical records of 408 (M:F 1:1.1) adults aged 20-75 years diagnosed with vitiligo between January 2016 and December 2019 were examined retrospectively. The extent and severity of vitiligo were defined. Characteristics of vitiligo with early onset and late onset were compared statistically and odds ratios calculated for risk assessment. RESULTS 31 (7.6%, M:F 1:2.4) patients had early-onset vitiligo, and 377 (92.4%, M:F 0.8:1) patients had later-onset vitiligo. Compared to late onset, patients with early-onset vitiligo had a significant number of males (71% vs 45.9%), higher percentages of body surface area involvement and moderate to extremely severe disease (29% vs 10.6%), longer duration of disease (41.9% vs 9%), Koebner's phenomenon (48.4% vs 15.6%) and halo nevus (9.7% vs 1.9%). Differences between the two groups were not significant for types of vitiligo, family history of vitiligo and presence of cutaneous and systemic/autoimmune diseases. CONCLUSION The adults, males in particular, with generalised vitiligo (>10% BSA involvement) appear to have an early onset and a prolonged clinical course. The presence of Koebner's phenomenon and halo nevus in patients with early-onset vitiligo was other poor prognostic factors compared to patients with late-onset vitiligo. The retrospective, hospital-based cross-sectional design and small sample size for stratification remain major limitations.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Yog Raj Verma
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Pushpinder Singh Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Reena Sharma
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Anuj Sharma
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Hitender Sharma
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Ashwani Rana
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
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El-Husseiny R, Abd-Elhaleem A, Salah El-Din W, Abdallah M. Childhood vitiligo in Egypt: Clinico-epidemiologic Profile of 483 patients. J Cosmet Dermatol 2020; 20:237-242. [PMID: 32320520 DOI: 10.1111/jocd.13451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Childhood vitiligo is commonly encountered. Pattern and distribution of childhood vitiligo were not clearly described in past. AIMS To study clinical characteristics of vitiligo among Egyptian children in relation to epidemiological data and compare them with those of adolescents and adults. PATIENTS AND METHODS Recruited clinically diagnosed vitiligo patients were categorized into three groups: I (children): <12 years old (yo), II (adolescents): 12-18 yo, and III (adults): 18-30 yo. Patients were subjected to history taking, general and dermatological examination to determine skin phototype, type, presentation, and distribution of vitiligo, percentage of body area involved using vitiligo extent score (VES), associated mucosal involvement, presence of leukotrichia, koebnerization, and halo nevi. RESULTS A total of 483 vitiligo patients were included: 220 children, 123 adolescents, and 140 adults. The most common form of vitiligo was nonsegmental vitiligo (NSV). Segmental and active vitiligo were more common in children than in adolescents and adults. The most common site of distribution of NSV in children was the face (periocular) vs arms and forearms in adults followed by thighs and legs in both. The mean age of onset of vitiligo in children was 6.18 (SD 2.93) yo, while mean duration of disease was 2.12 (SD 2.21) y. Face was the most common site of onset of vitiligo in children and adolescents vs arms and forearms in adults. CONCLUSIONS Childhood vitiligo differs from adult onset vitiligo regarding several features as type, site of onset, distribution, extent, and activity of disease.
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Affiliation(s)
- Rania El-Husseiny
- Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
| | - Ahmed Abd-Elhaleem
- Dermatology Department, Kobry Al Qubba Armed Forces Medical Complex, Cairo, Egypt
| | | | - Marwa Abdallah
- Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
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17
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Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
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18
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Abstract
Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.
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Affiliation(s)
- Electra Nicolaidou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Styliani Mastraftsi
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece.
| | - Vassiliki Tzanetakou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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19
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Boniface K, Seneschal J, Picardo M, Taïeb A. Vitiligo: Focus on Clinical Aspects, Immunopathogenesis, and Therapy. Clin Rev Allergy Immunol 2018; 54:52-67. [PMID: 28685247 DOI: 10.1007/s12016-017-8622-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vitiligo is an acquired chronic depigmenting disorder of the skin, with an estimated prevalence of 0.5% of the general population, characterized by the development of white macules resulting from a loss of epidermal melanocytes. The nomenclature has been revised after an extensive international work within the vitiligo global issues consensus conference, and vitiligo (formerly non-segmental vitiligo) is now a consensus umbrella term for all forms of generalized vitiligo. Two other subsets of vitiligo are segmental vitiligo and unclassified/undetermined vitiligo, which corresponds to focal disease and rare variants. A series of hypopigmented disorders may masquerade as vitiligo, and some of them need to be ruled out by specific procedures including a skin biopsy. Multiple mechanisms are involved in melanocyte disappearance, namely genetic predisposition, environmental triggers, metabolic abnormalities, impaired renewal, and altered inflammatory and immune responses. The auto-immune/inflammatory theory is the leading hypothesis because (1) vitiligo is often associated with autoimmune diseases; (2) most vitiligo susceptibility loci identified through genome-wide association studies encode immunomodulatory proteins; and (3) prominent immune cell infiltrates are found in the perilesional margin of actively depigmenting skin. However, other studies support melanocyte intrinsic abnormalities with poor adaptation of melanocytes to stressors leading to melanocyte instability in the basal layer, and release of danger signals important for the activation of the immune system. Recent progress in the understanding of immune pathomechanisms opens interesting perspectives for innovative treatment strategies. The proof of concept in humans of targeting of the IFNγ /Th1 pathway is much awaited. The interplay between oxidative stress and altered immune responses suggests that additional strategies aiming at limiting type I interferon activation pathway as background stabilizing therapies could be an interesting approach in vitiligo. This review covers classification and clinical aspects, pathophysiology with emphasis on immunopathogenesis, and promising therapeutic approaches.
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Affiliation(s)
- Katia Boniface
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France
| | - Julien Seneschal
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France.,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France
| | | | - Alain Taïeb
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France. .,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France. .,Department of Dermatology and Pediatric Dermatology, St André Hospital, Bordeaux University Hospitals, 1 Rue Jean Burguet, 33075, Bordeaux, France.
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20
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Rahman R, Hasija Y. Exploring vitiligo susceptibility and management: a brief review. BIOMEDICAL DERMATOLOGY 2018. [DOI: 10.1186/s41702-018-0030-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Zhou H, Wu LC, Chen MK, Liao QM, Mao RX, Han JD. Factors Associated with Development of Vitiligo in Patients with Halo Nevus. Chin Med J (Engl) 2018; 130:2703-2708. [PMID: 29133759 PMCID: PMC5695056 DOI: 10.4103/0366-6999.218011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Halo nevus (HN) has been shown to be associated with vitiligo, but no standard signs are currently available to identify HN patients at risk of vitiligo, and the relevant data obtained in previous studies are somewhat conflicting. This study aimed to identify factors affecting the presence of vitiligo in HN patients. Methods: We performed a retrospective study on consecutive patients with HN at the First Affiliated Hospital of Sun Yat-sen University between January 2011 and December 2016. Detailed demographic and clinical data were collected to identify the factors associated with the presence of vitiligo in this cohort of patients using uni- and multi-variate logistic regression analyses. Results: A total of 212 HN patients were included, 101 of whom had vitiligo-associated HN (HNV). Univariate analysis indicated that a personal history of thyroid diseases was positively associated with HNV (odds ratio [OR] = 10.761, P = 0.025), while the onset age of HN was negatively associated with HNV (OR = 0.537, P = 0.026). Multivariate analysis demonstrated that the Koebner phenomenon (KP; OR = 10.632, P < 0.0001), multiple HN (OR = 3.918, P < 0.0001), and a familial history of vitiligo (OR = 3.222, P = 0.014) were independent factors associated with HNV. Conclusions: HN without vitiligo has clinical features distinct from HN associated with vitiligo. HN patients with KP, multiple lesions, or familial history of vitiligo are more likely to develop vitiligo and therefore should be monitored for clinical signs of such accompanied conditions.
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Affiliation(s)
- Hui Zhou
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Liang-Cai Wu
- Department of Dermatology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510650, China
| | - Mu-Kai Chen
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Qi-Man Liao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Ren-Xiang Mao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jian-De Han
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Bae JM, Jung YS, Jung HM, Park JH, Hann SK. Classification of facial vitiligo: A cluster analysis of 473 patients. Pigment Cell Melanoma Res 2018; 31:585-591. [PMID: 29509997 DOI: 10.1111/pcmr.12699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/10/2018] [Indexed: 12/31/2022]
Abstract
Vitiligo has a substantial negative impact on quality of life in affected patients, especially those with the involvement of the face. However, the current system can barely distinguish between specific patterns of facial involvement except for the segmental type when focusing only on facial lesions. We classified facial vitiligo into three distinct subtypes using cluster analysis based on facial topography (n = 473): centrofacial vitiligo (72.9%), panfacial vitiligo (18.0%), and hairline vitiligo (9.1%). Centrofacial vitiligo was the most common type and is thought to comprise the typical facial involvement of generalized vitiligo. Panfacial vitiligo was a distinct subtype with onset in old age and less involvement of other body parts. Hairline vitiligo was another distinct subtype with onset in old age and a poor response to conventional phototherapy. A relevant classification system could help us to explore the causes, anticipate the prognosis, and manage the condition in patients with vitiligo.
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Affiliation(s)
- Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yu Seok Jung
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Han Mi Jung
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Hun Park
- Korea Institute of Vitiligo Research, Seoul, Korea.,Drs Woo and Hann's Skin Center, Seoul, Korea
| | - Seung-Kyung Hann
- Korea Institute of Vitiligo Research, Seoul, Korea.,Drs Woo and Hann's Skin Center, Seoul, Korea
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23
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Khurrum H, AlGhamdi KM. Prepubertal and postpubertal vitiligo: a multivariate comparative study in 375 patients. An Bras Dermatol 2018; 92:811-815. [PMID: 29364437 PMCID: PMC5786395 DOI: 10.1590/abd1806-4841.20176154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022] Open
Abstract
Background The onset of vitiligo during childhood is common. Limited data exist that
compare the clinical associations of prepubertal and postpubertal vitiligo
in Arabs. Objective To compare the clinical profile of pre and postpubertal onset vitiligo. Methods A cross-sectional observational study was conducted. The Vitiligo European
Task Force questionnaire was completed for each patient. Results A total of 375 patients were included; 199 had postpubertal vitiligo (>12
years), and 176 had prepubertal onset vitiligo (<12years). There were
more females in the prepubertal group (49%) than in the postpubertal group
(29%), p-value <0.001. The prepubertal group has had more involvement
than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental
vitiligo were observed; five were observed in the prepubertal group of
patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus
(OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9)
were positively associated with prepubertal vitiligo. Stress, as an onset
factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with
postpubertal onset vitiligo. Study limitations A possible selection bias toward more severe vitiligo cases can be a
limitation, because the study was conducted in a clinic specialized in
vitiligo. Moreover, a likelihood of false recall bias cannot be
excluded. Conclusions Our data present clinical evidence that vitiligo behaves mostly the same way
in the prepubertal group as in the postpubertal group. However, female
over-representation, more face involvement and more halo nevi were observed
in prepubertal vitiligo, while stress was more prevalent as an aggravating
factor in postpubertal vitiligo patients.
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Affiliation(s)
- Huma Khurrum
- Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M AlGhamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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25
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Abstract
Childhood vitiligo differs from adult-onset vitiligo for several features including increased incidence of the segmental variant, higher prevalence of halo nevi, and more common family history for autoimmune diseases and atopic diathesis. The major differential diagnoses are the postinflammatory hypomelanoses for nonsegmental vitiligo and nevus depigmentosus for segmental vitiligo. From a therapeutic standpoint, early awareness of the diagnosis seems to correlate with a good treatment outcome in this age group.
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Lommerts J, Njoo M, Rie M, Wolkerstorfer A, Bekkenk M. Twenty‐year follow‐up using a postal survey of childhood vitiligo treated with narrowband ultraviolet B phototherapy. Br J Dermatol 2017; 177:e60-e61. [DOI: 10.1111/bjd.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.E. Lommerts
- Netherlands Institute for Pigment Disorders (NIPD) Department of Dermatology Academic Medical Centre Amsterdam the Netherlands
| | - M.D. Njoo
- Department of Dermatology Ziekenhuisgroep Twente Almelo/Hengelo the Netherlands
| | - M.A. Rie
- Netherlands Institute for Pigment Disorders (NIPD) Department of Dermatology Academic Medical Centre Amsterdam the Netherlands
- VU University Medical Centre Department of Dermatology Amsterdam the Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders (NIPD) Department of Dermatology Academic Medical Centre Amsterdam the Netherlands
| | - M.W. Bekkenk
- Netherlands Institute for Pigment Disorders (NIPD) Department of Dermatology Academic Medical Centre Amsterdam the Netherlands
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Forsea AM, Mihai C, Predescu T, Tudose I, Margaritescu I, Giurcaneanu C. POLYGLANDULAR AUTOIMMUNE SYNDROME ASSOCIATED WITH MULTIPLE AUTOIMMUNE CONDITIONS AND ATOPIC DERMATITIS - AN UNUSUAL MANIFESTATION OF A POLYAUTOIMMUNITY PHENOTYPE. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:106-110. [PMID: 31149156 DOI: 10.4183/aeb.2017.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction The polyglandular autoimmune syndrome (PAS) type III is a rare condition defined as the coexistence of autoimmune thyroid disorder with other endocrine autoimmune diseases, including type 1 diabetes, without adrenal dysfunction. PAS may associate with other non-endocrine autoimmune diseases, overlapping with the multiple autoimmune syndromes (MAS). We present a case of PAS III/ MAS type 3, including autoimmune thyroiditis, autoimmune diabetes, vitiligo, lupus erythematosus, associated with adult-onset atopic dermatitis, a combination not reported previously. Case report A 40 years old woman, registered as nurse working in dialysis unit, previously diagnosed with vitiligo, euthyroid autoimmune thyroiditis and disseminated granuloma annulare, with personal and familial history of atopic disorders, presented in our clinic for disseminated eczematous and lichenoid cutaneous rashes. She was tested positive for antinuclear, anti-double stranded DNA and anti-histone antibodies, with inflammatory syndrome and marginal lymphopenia and she was diagnosed with systemic lupus erythematosus (SLE). Subsequently, moderate hyperglycemia, positive anti-glutamic acid decarboxylase antibodies and low C-peptide level prompted the diagnosis of autoimmune diabetes. Recurrent flexural eczematous rashes, with negative epicutaneous tests but positive specific IgE tests for common allergens fulfilled the clinical criteria for the diagnosis of atopic dermatitis. The clinical, immunological and glycemic status were controlled with low doses of oral prednisone (<0.5 mg/kg), methotrexate (10mg/week), antimalarials, metformin, emollients and photoprotection. After changing her workplace, the immunosuppressive treatment could be discontinued, and the patient maintained normal immunological and biochemical profile at 6 months follow-up.This case brings a unique perspective on the evolution, associations spectrum and the management challenges of endocrine polyautoimmunity associated with atopic diathesis.
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Affiliation(s)
- A M Forsea
- "Carol Davila" University of Medicine and Pharmacy, Dept. of Dermatology, Elias University Hospital, Bucharest, Romania.,Dept. of Oncologic Dermatology and Allergology, Bucharest, Romania
| | - C Mihai
- "Carol Davila" University of Medicine and Pharmacy, Dept. of Dermatology, Elias University Hospital, Bucharest, Romania.,"Dr. I. Cantacuzino" Hospital, Bucharest, Romania
| | - T Predescu
- Dept. of Oncologic Dermatology and Allergology, Bucharest, Romania
| | - I Tudose
- Dept. of Pathology, Bucharest, Romania
| | - I Margaritescu
- Monza Hospital, Dept. of Oncoteam Pathology, Bucharest, Romania
| | - C Giurcaneanu
- "Carol Davila" University of Medicine and Pharmacy, Dept. of Dermatology, Elias University Hospital, Bucharest, Romania.,Dept. of Oncologic Dermatology and Allergology, Bucharest, Romania
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Adult Onset Vitiligo: Multivariate Analysis Suggests the Need for a Thyroid Screening. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8065765. [PMID: 27747240 PMCID: PMC5055927 DOI: 10.1155/2016/8065765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/30/2016] [Indexed: 12/02/2022]
Abstract
Background. There are limited epidemiological studies evaluating the effect of age at onset on disease features in vitiligo. Objectives. To identify factors associated with adult onset vitiligo in comparison with childhood onset vitiligo. Patients and Methods. We retrospectively collected medical records of 191 patients. Such records included clinical examination, personal and familial medical history, laboratory evaluations, concomitant vitiligo treatment and drug assumption. Results. 123 patients with a disease onset after the age of 40 (adult onset vitiligo) were compared with 68 patients who developed vitiligo before the age of 12 (childhood onset vitiligo). Multivariate analysis revealed that personal history of thyroid diseases (P = 0.04; OR 0.4), stress at onset (P = 0.002; OR = 0.34), personal history of autoimmune thyroid disease (ATD) (P = 0.003; OR = 0.23), and thyroid nodules (P = 0.001; OR 0.90) were independently associated with adult onset vitiligo, whereas family history of dermatological diseases (P = 0.003; OR = 2.87) and Koebner phenomenon (P < 0.001; OR = 4.73) with childhood onset vitiligo. Moreover, in the adult onset group, concomitant thyroid disease preceded vitiligo in a statistically significant number of patients (P = 0.014). Conclusions. Childhood onset and adult onset vitiligo have different clinical features. In particular, ATD and thyroid nodules were significantly associated with adult onset vitiligo, suggesting that a thyroid screening should be recommended in this group of patients.
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Teulings H, Ceylan E, Overkamp M, Vrijman C, Bos J, Nijsten T, Wolkerstorfer A, Luiten R, van der Veen J. Nonsegmental vitiligo disease duration and female sex are associated with comorbidity and disease extent: a retrospective analysis in 1307 patients aged ≥ 50 years. Br J Dermatol 2016; 175:821-4. [DOI: 10.1111/bjd.14640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- H.E. Teulings
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - E. Ceylan
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M. Overkamp
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - C. Vrijman
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - J.D. Bos
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - T.E. Nijsten
- Department of Dermatology; Erasmus Medical Center; Rotterdam the Netherlands
| | - A. Wolkerstorfer
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - R.M. Luiten
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - J.P.W. van der Veen
- Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP); Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Dermatology; Medisch Centrum Haaglanden/Bronovo; Den Haag the Netherlands
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de Menezes AF, Shanmugam S, Gomes IA, de Carvalho FO, Quintans-Júnior LJ, Gurgel RQ, de Santana Silva B, Serafini MR, Araújo AADS. Synthetic drugs for the treatment of vitiligo: a patent review (2010–2015). Expert Opin Ther Pat 2016; 26:1175-1187. [DOI: 10.1080/13543776.2016.1215434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ezzedine K, Silverberg N. A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children. Pediatrics 2016; 138:peds.2015-4126. [PMID: 27328922 DOI: 10.1542/peds.2015-4126] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/24/2022] Open
Abstract
Vitiligo is a common inflammatory skin disease with a worldwide prevalence of 0.5% to 2.0% of the population. In the pediatric population, the exact prevalence of vitiligo is unknown, although many studies state that most cases of vitiligo are acquired early in life. The disease is disfiguring, with a major psychological impact on children and their parents. Half of vitiligo cases have a childhood onset, needing thus a treatment approach that will minimize treatment side effects while avoiding psychological impacts. Management of vitiligo should take into account several factors, including extension, psychological impact, and possible associations with other autoimmune diseases. This review discusses the epidemiology of vitiligo and outlines the various clinical presentations associated with the disorder and their differential diagnosis. In addition, the pathophysiology and genetic determinants, the psychological impact of vitiligo, and management strategies are reviewed.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor Hospital and EpiDermE, Université Paris-Est Créteil Val-de-Marne, Créteil, France; and
| | - Nanette Silverberg
- Department of Dermatology and Pediatrics, Mount Sinai St. Luke's-Roosevelt and Beth Israel Medical Centers, New York, New York
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Abstract
Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1%. The disorder can be psychologically devastating and stigmatising, especially in dark skinned individuals. Vitiligo is clinically characterised by the development of white macules due to the loss of functioning melanocytes in the skin or hair, or both. Two forms of the disease are well recognised: segmental and non-segmental vitiligo (the commonest form). To distinguish between these two forms is of prime importance because therapeutic options and prognosis are quite different. The importance of early treatment and understanding of the profound psychosocial effect of vitiligo will be emphasised throughout this Seminar.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Hôpital Pellegrin, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale. U1035, University of Bordeaux, Bordeaux, France.
| | | | - Maxine Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Abstract
Vitiligo is an acquired depigmenting disorder that affects 0.5% to 2% of the world population. Three different forms are classified according to the distribution of lesions; namely non-segmental, segmental and mixed vitiligo. Vitiligo is associated with polymorphisms in genes involved in the immune response and in melanogenesis. However, environmental factors are required for the development of manifest disease. In general, the diagnosis is clinical and no laboratory tests or biopsies are required. Metabolic alterations are central to current concepts in pathophysiology. They induce an increased generation of reactive oxygen species and susceptibility to mild exogenous stimuli in the epidermis. This produces a senescent phenotype of skin cells, leads to the release of innate immune molecules, which trigger autoimmunity, and ultimately causes dysfunction and death of melanocytes. Clinical management aims to halt depigmentation, and to either repigment or depigment the skin, depending on the extent of disease. New therapeutic approaches include stimulation of melanocyte differentiation and proliferation through α-melanocyte-stimulating hormone analogues and through epidermal stem cell engineering. Several questions remain unsolved, including the connection between melanocyte depletion and stem cell exhaustion, the underlying degenerative mechanisms and the biological mediators of cell death. Overall, vitiligo is an excellent model for studying degenerative and autoimmune processes and for testing novel approaches in regenerative medicine. For an illustrated summary of this Primer, visit: http://go.nature.com/vIhFSC.
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Affiliation(s)
- Mauro Picardo
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Maria L Dell'Anna
- Cutaneous Physiopathology, San Gallicano Dermatologic Institute, IFO IRCCS, via Elio Chianesi 53, 00144 Rome, Italy
| | - Khaled Ezzedine
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
| | - Iltefat Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital Detroit, Michigan, USA
| | - John E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | - Alain Taieb
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de Bordeaux, Bordeaux, France
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Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K. Interventions for vitiligo. Cochrane Database Syst Rev 2015; 2015:CD003263. [PMID: 25710794 PMCID: PMC10887429 DOI: 10.1002/14651858.cd003263.pub5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Around 1% of the world's population has vitiligo, a disease causing white patches on the skin. Several treatments are available. Some can restore pigment but none can cure the disease. OBJECTIVES To assess the effects of all therapeutic interventions used in the management of vitiligo. SEARCH METHODS We updated our searches of the following databases to October 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 10), MEDLINE, Embase, AMED, PsycINFO, CINAHL and LILACS. We also searched five trials databases, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effects of treatments for vitiligo. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and methodological quality, and extracted data. MAIN RESULTS This update of the 2010 review includes 96 studies, 57 from the previous update and 39 new studies, totalling 4512 participants. Most of the studies, covering a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, however only five reported on all of our three primary outcomes which were quality of life, > 75% repigmentation and adverse effects. Of our secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation resulting from treatment at two years follow-up.Most of the studies assessed combination therapies which generally reported better results. New interventions include seven new surgical interventions.We analysed the data from 25 studies which assessed our primary outcomes. We used the effect measures risk ratio (RR), and odds ratio (OR) with their 95% confidence intervals (CI) and where N is the number of participants in the study.We were only able to analyse one of nine studies assessing quality of life and this showed no statistically significant improvement between the comparators.Nine analyses from eight studies reported >75% repigmentation. In the following studies the repigmentation was better in the combination therapy group: calcipotriol plus PUVA (psoralen with UVA light) versus PUVA (paired OR 4.25, 95% CI 1.43 to 12.64, one study, N = 27); hydrocortisone-17-butyrate plus excimer laser versus excimer laser alone (RR 2.57, 95% CI 1.20 to 5.50, one study, N = 84); oral minipulse of prednisolone (OMP) plus NB-UVB (narrowband UVB) versus OMP alone (RR 7.41, 95% CI 1.03 to 53.26, one study, N = 47); azathioprine with PUVA versus PUVA alone (RR 17.77, 95% CI 1.08 to 291.82, one study, N = 58) and 8-Methoxypsoralen (8-MOP ) plus sunlight versus psoralen (RR 2.50, 95% CI 1.06 to 5.91, one study, N = 168). In these three studies ginkgo biloba was better than placebo (RR 4.40, 95% CI 1.08 to 17.95, one study, N = 47); clobetasol propionate was better than PUVAsol (PUVA with sunlight) (RR 4.70, 95% CI 1.14 to 19.39, one study, N = 45); split skin grafts with PUVAsol was better than minipunch grafts with PUVAsol (RR 1.89, 95% CI 1.25 to 2.85, one study, N = 64).We performed one meta-analysis of three studies, in which we found a non-significant 60% increase in the proportion of participants achieving >75% repigmentation in favour of NB-UVB compared to PUVA (RR 1.60, 95% CI 0.74 to 3.45; I² = 0%).Studies assessing topical preparations, in particular topical corticosteroids, reported most adverse effects. However, in combination studies it was difficult to ascertain which treatment caused these effects. We performed two analyses from a pooled analysis of three studies on adverse effects. Where NB-UVB was compared to PUVA, the NB-UVB group reported less observations of nausea in three studies (RR 0.13, 95% CI 0.02 to 0.69; I² = 0% three studies, N = 156) and erythema in two studies (RR 0.73, 95% CI 0.55 to 0.98; I² = 0%, two studies, N = 106), but not itching in two studies (RR 0.57, 95% CI 0.20 to 1.60; I² = 0%, two studies, N = 106).Very few studies only assessed children or included segmental vitiligo. We found one study of psychological interventions but we could not include the outcomes in our statistical analyses. We found no studies evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high- quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR. .
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Kuriyama S, Kasuya A, Fujiyama T, Tatsuno K, Sakabe JI, Yamaguchi H, Ito T, Tokura Y. Leukoderma in patients with atopic dermatitis. J Dermatol 2014; 42:215-8. [PMID: 25545320 DOI: 10.1111/1346-8138.12746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 02/01/2023]
Abstract
Atopic dermatitis (AD) is occasionally associated with vitiligo, however, the incidence and conditions of vitiligo or leukoderma, and the characteristics of concurrent AD, remain unclear. We conducted a prospective observational study to investigate the leukoderma-related clinical manifestations and bioparameters of AD. Because vitiligo in AD lesions is occasionally associated with inflammation, we used leukoderma in this study. Enrolled were all AD patients who had been followed up in our AD outpatient clinic and visited within the previous 4 months. During this period, we carefully inspected whether the patients had leukoderma. Eight of 52 patients had leukoderma (15.4%) and were designated as the leukoderma group, and the remaining 44 patients comprised the non-leukoderma group. While the ages were statistically not different between the two groups, female preponderance was significantly observed in the leukoderma group. The leukoderma patients tended to have higher values of SCORAD, CCL17/thymus and activation regulated chemokine and lactate dehydrogenase than the non-leukoderma patients. The leukoderma group was also characterized by a lower frequency of allergic rhinitis and a higher frequency of prurigo lesions. Thus, despite the possession of high AD severity, the leukoderma patients may possibly retain a relatively T-helper 1-skewing state in relation to the development of leukoderma and less association with rhinitis.
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Affiliation(s)
- Sachiko Kuriyama
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Shin S, Shin JY, Lee H, Oh SH. Spreading of pre-existing segmental vitiligo after immunotherapy with house dust mite in a patient with atopic dermatitis. Clin Exp Dermatol 2014; 40:920-1. [DOI: 10.1111/ced.12443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Shin
- Department of Dermatology; Cutaneous Biology Research Institute; Yonsei University College of Medicine; 50 Yonsei-ro, Seodaemun-gu Seoul 120-752 Korea
| | - J. Yo Shin
- Department of Dermatology; Cutaneous Biology Research Institute; Yonsei University College of Medicine; 50 Yonsei-ro, Seodaemun-gu Seoul 120-752 Korea
| | - He Lee
- Department of Dermatology; Cutaneous Biology Research Institute; Yonsei University College of Medicine; 50 Yonsei-ro, Seodaemun-gu Seoul 120-752 Korea
| | - S. H. Oh
- Department of Dermatology; Cutaneous Biology Research Institute; Yonsei University College of Medicine; 50 Yonsei-ro, Seodaemun-gu Seoul 120-752 Korea
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Abstract
Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue, Suite 11D, New York, NY 10025, USA.
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Tobin DJ. Alopecia areata and vitiligo - Partners in crime or a case of false alibis. Exp Dermatol 2014; 23:153-4. [DOI: 10.1111/exd.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Desmond J. Tobin
- Centre for Skin Sciences; School of Life Sciences; University of Bradford; Bradford West Yorkshire Great Britain
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Cho HR, Kim SK, Lim HK, Jeong Park H, Chung JH, Lee MH. Association study between nonsense polymorphism (rs2039381, Gln71Stop) of interferon-ε and susceptibility to vitiligo in Korean population. Immunol Invest 2014; 42:423-30. [PMID: 23802172 DOI: 10.3109/08820139.2013.804836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Interferons (IFNs) are related to autoimmune responses. IFN-epsilon (IFNE) is included in IFN family, and may modulate immunological functions. Inflammation modulating functions of IFNE may be related with the pathophysiology of vitiligo. To investigate the association of nonsense polymorphism (rs2039381, Gln71Stop) of interferon-ε (IFNE) and susceptibility to vitiligo, we conducted a case-control association study in 265 non-segmental vitiligo (NSV) patients and 320 healthy controls. The nonsense single nucleotide polymorphism (SNP) (rs2039381, Gln71Stop) of IFNE was genotyped by direct sequencing. Multiple logistic regression models (log-additive, dominant, and recessive models) were applied to determine odds ratios (OR), 95% confidence interval (CI), and p values. The rs2039381 (Gln71Stop) of IFNE did not show significant differences between NSV patient group and control group. However, we found that in childhood onset NSV groups, the IFNE nonsense polymorphism (rs2039381, Gln71Stop) showed a significant association. There was significantly different distribution of nonsense polymorphism of rs2039381 (Gln71Stop) of IFNE between NSV patients (childhood <18 years) and control subjects. This study suggests that rs2039381 (Gln71Stop) polymorphism of IFNE may be related to onset time of vitiligo in NSV patients.
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Affiliation(s)
- Hee-Ryung Cho
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Gey A, Diallo A, Seneschal J, Léauté-Labrèze C, Boralevi F, Jouary T, Taieb A, Ezzedine K. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. Br J Dermatol 2013; 168:756-61. [PMID: 23253044 DOI: 10.1111/bjd.12166] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. OBJECTIVE To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. METHODS This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. RESULTS A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD-vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD-vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD-vitiligo. CONCLUSION Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis.
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Affiliation(s)
- A Gey
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin, place Amélie Raba-Léon, 33076, Bordeaux, France
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Speeckaert R, van Geel N. Distribution patterns in generalized vitiligo. J Eur Acad Dermatol Venereol 2013; 28:755-62. [DOI: 10.1111/jdv.12171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- R. Speeckaert
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
| | - N. van Geel
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
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Barbarot S. [What's new in pediatric dermatology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S202-16. [PMID: 23522707 DOI: 10.1016/s0151-9638(12)70135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper is based on a review of the literature focused on pediatric dermatology, from October 2011 to september 2012. Our objective was to highlight the main advances in fields such as atopic dermatitis, infantile hemangiomas, infectious diseases, inflammatory disorders, and genodermatoses.
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Affiliation(s)
- S Barbarot
- Clinique dermatologique, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44000 Nantes, France.
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