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Yang S, Hu X, Zou P, Zeng Z, Hu Y, Xiao R. Roles of blood metabolites in mediating the relationship between vitiligo and autoimmune diseases: Evidence from a Mendelian randomization study. Int Immunopharmacol 2024; 133:112132. [PMID: 38691918 DOI: 10.1016/j.intimp.2024.112132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study employed Mendelian Randomization (MR) to investigate the causal relationship between genetic susceptibility to vitiligo and the risk of various autoimmune diseases, along with the mediating role of blood metabolites. METHODS We performed two-sample MR analyses using aggregated genome-wide association studies (GWAS) data on 486 blood metabolites, vitiligo, and nine autoimmune diseases to investigate blood metabolites' causal effects on the susceptibility of vitiligo and the associations of vitiligo with nine autoimmune comorbidities. We also applied multivariable MR to unravel metabolites by which vitiligo influences the pathogenesis of autoimmune diseases. RESULTS Our findings indicate that vitiligo amplified the risk of several autoimmune diseases, including rheumatoid arthritis (OR 1.17; 95 % CI 1.08-1.27), psoriasis (OR 1.10; 95 % CI 1.04-1.17), type 1 diabetes (OR 1.41; 95 % CI 1.23-1.63), pernicious anemia (OR 1.23; 95 % CI 1.12-1.36), autoimmune hypothyroidism (OR 1.19; 95 % CI 1.11-1.26), alopecia areata (OR 1.22; 95 % CI 1.10-1.35), and autoimmune Addison's disease (OR 1.22; 95 % CI 1.12-1.33). Additionally, our analysis identified correlations with vitiligo for 14 known (nine risk, five protective) and seven uncharacterized serum metabolites. After adjusting for genetically predicted levels of histidine and pyruvate, the associations between vitiligo and these diseases were attenuated. CONCLUSIONS We substantiated vitiligo's influence on susceptibility to seven autoimmune diseases and conducted a thorough investigation of serum metabolites correlated with vitiligo. Histidine and pyruvate are potential mediators of vitiligo associated with autoimmune diseases.By combining metabolomics with genomics, we provide new perspectives on the etiology of vitiligo and its immune comorbidities.
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Affiliation(s)
- Siyu Yang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Xinglin Hu
- Department of Dermatology and Institute of Translation Medicine, Affiliated the First People's Hospital of Chenzhou of University of South China, Chenzhou, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Puyu Zou
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Zhuotong Zeng
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Yibo Hu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Research Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China.
| | - Rong Xiao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China.
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Ezzedine K, Soliman AM, Li C, Camp HS, Pandya AG. Comorbidity Burden Among Patients with Vitiligo in the United States: A Large-Scale Retrospective Claims Database Analysis. Dermatol Ther (Heidelb) 2023; 13:2265-2277. [PMID: 37668899 PMCID: PMC10539259 DOI: 10.1007/s13555-023-01001-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Vitiligo is often associated with comorbid conditions that may increase economic burden and affect patients' health-related quality of life. No large-scale study has been published to date using claims databases to evaluate the burden of comorbidities among patients with vitiligo. Herein, we evaluate the comorbidity burden among patients diagnosed with vitiligo from the US. METHODS This retrospective cohort analysis used the Merative MarketScan Commercial Database. Eligible patients were diagnosed with vitiligo between January 2008 and December 2020 and matched 1:4 (vitiligo:control) with control subjects with no diagnosis of vitiligo between January 2007 and December 2021. Study outcomes were the incidence of comorbidities after matching, adjusted hazard ratios of comorbidity incidence among patients with vitiligo relative to matched control subjects, and time to comorbidity diagnosis or incidence. RESULTS Baseline demographics were well balanced between matched vitiligo (n = 13,687) and control cohorts (n = 54,748). Incidence rates of comorbidities were higher among patients compared with control subjects (psychiatric, 28.4% vs 22.8%; autoimmune, 13.4% vs 5.1%; and non-autoimmune, 10.0% vs 7.0%). The most common psychiatric and autoimmune comorbidities in patients with vitiligo compared with control subjects included anxiety (14.3% vs 11.0%, respectively), sleep disturbance (9.1% vs 7.1%), depression (8.0% vs 6.3%), atopic dermatitis (3.1% vs 1.1%), psoriasis (2.7% vs 0.6%), and linear morphea (1.5% vs 0.1%). The risk of developing any psychiatric (hazard ratio 1.31; P < 0.01), autoimmune (hazard ratio 2.77; P < 0.01), or non-autoimmune (hazard ratio 1.45; P < 0.01) comorbidity was significantly higher among patients with vitiligo. Time to diagnosis of most vitiligo comorbidities was 1-3 years, although linear morphea was diagnosed at < 1 year. CONCLUSION Results of this retrospective analysis demonstrated that patients were much more likely to be diagnosed with autoimmune or psychiatric comorbidities following a vitiligo diagnosis, which likely contributed to increased economic burden and lower quality of life.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, 51 Avenue de Lattre de Tassignv, 94000, Créteil, France.
- EA 7379 EpiDermE, Université Paris-Est Créteil (UPEC), Créteil, France.
| | | | - Chao Li
- AbbVie Inc., North Chicago, IL, USA
| | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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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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Lee JH, Ju HJ, Seo JM, Almurayshid A, Kim GM, Ezzedine K, Bae JM. Comorbidities in Patients with Vitiligo: A Systematic Review and Meta-Analysis. J Invest Dermatol 2022; 143:777-789.e6. [PMID: 36574529 DOI: 10.1016/j.jid.2022.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Abstract
Vitiligo has been reported to be associated with a variety of diseases, but it has not been systematically reviewed. Therefore, we aimed to identify prevalent diseases in patients with vitiligo and quantify their associations compared with those in healthy controls. A comprehensive search of MEDLINE and EMBASE from the inception to June 2022 was conducted. Observational studies on prevalent diseases in patients with vitiligo compared with those in healthy controls were included, whereas studies limited to pediatrics or providing only laboratory results were excluded. A total of 78 studies were eligible for analyses. Patients with vitiligo showed higher risks of having comorbid autoimmune and connective tissue diseases, including alopecia areata (OR = 2.63, 95% confidence interval [CI] = 2.50‒2.78), discoid lupus erythematosus (OR = 2.54, 95% CI = 1.74‒3.72), Sjogren's syndrome (OR = 2.50, 95% CI = 1.98‒3.16), myasthenia gravis (OR = 2.30, 95% CI = 1.74‒3.02), systemic lupus erythematosus (OR = 1.96, 95% CI = 1.52‒2.52), and rheumatoid arthritis (OR = 1.82, 95% CI = 1.55‒2.15). Thyroid diseases, diabetes mellitus, metabolic syndrome, sensorineural hypoacusis, and ophthalmic abnormalities were also more prevalent in patients with vitiligo. In conclusion, vitiligo is associated with various systemic diseases. Physicians should evaluate and manage potential comorbid conditions in patients with vitiligo.
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Affiliation(s)
- Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Min Seo
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Abdurrahman Almurayshid
- Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj City, Saudi Arabia
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henry Mondor Hospital, Paris Est Créteil University, Créteil, France
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Kim JS, Lee MG, Lee SK, Yeom SW, Kang MG, Lee JH, Lee IJ, Park J, Yun SK, Nam KH. Association of adenotonsillar disease and adenotonsillectomy with the development of vitiligo: A nationwide population-based cohort study. Front Med (Lausanne) 2022; 9:1004218. [PMID: 36405619 PMCID: PMC9669660 DOI: 10.3389/fmed.2022.1004218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/12/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Vitiligo is a common acquired skin depigmentation disorder and is associated with various other autoimmune diseases which include thyroid disease and rheumatoid arthritis. Similarly, adenotonsillar disease (ATD) may induce inflammatory or autoimmune diseases in other organs which include the skin. However, the influence of ATD on the development of vitiligo has not been studied. OBJECTIVES To determine the association between ATD and adenotonsillectomy, and the development of vitiligo. DESIGN AND METHODS Using data from the National Health Insurance Service database, patients diagnosed with ATD between 2008 and 2010 were included in the study. We performed two rounds of 1:1 propensity score matching in the ATD and adenotonsillectomy groups. The ATD and non-ATD groups both included 206,514 individuals. Among the ATD group, the adenotonsillectomy and non-adenotonsillectomy groups both included 23,354 individuals. Each individual was monitored until 2019. The primary end point was the risk of vitiligo. Using the Cox Proportional Hazards model, the incidence of vitiligo and the hazard ratio (HR) were calculated. RESULTS The incidence of vitiligo was 1.16-fold higher in the ATD group than in the non-ATD group [adjusted HR (aHR), 1.16; 95% confidence interval (CI), 1.09-1.24] and 0.82-fold lower in the adenotonsillectomy group than in the non-adenotonsillectomy group (aHR, 0.82; 95% CI, 0.68-0.99). Additionally, the other risk factors for developing vitiligo included thyroid disease (aHR, 1.48; 95% CI, 1.11-1.98), age younger than 30 years (aHR, 1.18; 95% CI, 1.09-1.27), and age over 60 years (aHR, 1.22; 95% CI, 1.06-1.41), whereas factors including rural residency (aHR, 0.91; 95% CI, 0.85-0.98) and low economic status (aHR 0.87; 95% CI, 0.82-0.93) were associated with decreased incidence of vitiligo. CONCLUSION In this study, ATD increases the risk of vitiligo and adenotonsillectomy attenuates its development. Clinicians should consider ATD as a pathogenic factor for vitiligo and the potential effect of adenotonsillectomy in its management.
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Affiliation(s)
- Jong Seung Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, South Korea,Department of Medical Informatics, Jeonbuk National University, Jeonju, South Korea,Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - Min Gyu Lee
- Department of Medical Informatics, Jeonbuk National University, Jeonju, South Korea
| | - Sang-Kyung Lee
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Sang-Woo Yeom
- Department of Medical Informatics, Jeonbuk National University, Jeonju, South Korea
| | - Min-Gu Kang
- Department of Medical Informatics, Jeonbuk National University, Jeonju, South Korea
| | - Jong Hwan Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Il-Jae Lee
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Jin Park
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea,Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Seok-kweon Yun
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea,Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Kyung-Hwa Nam
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea,Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea,*Correspondence: Kyung-Hwa Nam,
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D’Arino A, Picardo M, Truglio M, Pacifico A, Iacovelli P. Metabolic Comorbidities in Vitiligo: A Brief Review and Report of New Data from a Single-Center Experience. Int J Mol Sci 2021; 22:ijms22168820. [PMID: 34445526 PMCID: PMC8396221 DOI: 10.3390/ijms22168820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/21/2022] Open
Abstract
Among disorders of pigmentation, vitiligo is the most common, with an estimated prevalence between 0.5% and 1%. The disease has gathered increased attention in the most recent years, leading to a better understanding of the disease’s pathophysiology and its implications and to the development of newer therapeutic strategies. A better, more integrated approach is already in use for other chronic inflammatory dermatological diseases such as psoriasis, for which metabolic comorbidities are well-established and part of the routine clinical evaluation. The pathogenesis of these might be linked to cytokines which also play a role in vitiligo pathogenesis, such as IL-1, IL-6, TNF-α, and possibly IL-17. Following the reports of intrinsic metabolic alterations reported by our group, in this brief review, we analyze the available data on metabolic comorbidities in vitiligo, accompanied by our single-center experience. Increased awareness of the metabolic aspects of vitiligo is crucial to improving patient care.
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Affiliation(s)
- Andrea D’Arino
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.D.); (M.T.)
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.D.); (M.T.)
- Correspondence: ; Tel.: +39-0652666257
| | - Mauro Truglio
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.D.); (M.T.)
| | - Alessia Pacifico
- Clinical Dermatology, Phototherapy Unit, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.P.); (P.I.)
| | - Paolo Iacovelli
- Clinical Dermatology, Phototherapy Unit, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.P.); (P.I.)
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Troshina EA, Volnukhin VA, Petrov VA, Nuralieva NF, Yukina MY, Orlova EM, Frigo NV. [The prevalence of autoimmune endocrine diseases in vitiligo patients]. TERAPEVT ARKH 2020; 92:88-96. [PMID: 33346485 DOI: 10.26442/00403660.2020.10.000736] [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: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
Vitiligo is a common polygenic autoimmune disease in which the foci of depigmentation are formed on the skin and/or mucous membranes as a result of the death of melanocytes. There are several hypotheses for the pathogenesis of the disease, the leading role among them is played the autoimmune hypothesis. This review summarizes the available literature data on the prevalence and structure of comorbid endocrine autoimmune pathology in vitiligo patients. In most studies conducted in Europe, America and Asia the prevalence of autoimmune thyroid diseases (including autoimmune thyroiditis and Graves disease), diabetes mellitus and autoimmune adrenal insufficiency was higher in vitiligo patients than in the general population. The results of some studies indicate a frequent association of vitiligo with autoimmune polyglandular syndromes. In the structure of comorbid pathology the highest prevalence was in autoimmune thyroid diseases. A number of studies have established a higher prevalence of autoimmune endocrine diseases in women, as well as in nonsegmental vitiligo patients and in cases of family history of vitiligo and/or other autoimmune diseases. In addition, it was shown that the prevalence of endocrine diseases increases with increasing area of depigmentation. The data obtained justify the advisability of conducting a timely examination of vitiligo patients with the aim of early detection of comorbid diseases and the appointment of appropriate treatment. Further studies are needed to investigate the effect of the identified associations on the course of vitiligo and comorbid endocrinopathies, as well as the effectiveness of therapy and the quality of life of patients.
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Affiliation(s)
| | - V A Volnukhin
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
| | - V A Petrov
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
| | | | | | | | - N V Frigo
- Moscow Research and Practical Center for Dermatovenereology and Cosmetology
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The Role of T RM Cells in the Pathogenesis of Vitiligo-A Review of the Current State-Of-The-Art. Int J Mol Sci 2020; 21:ijms21103552. [PMID: 32443482 PMCID: PMC7278984 DOI: 10.3390/ijms21103552] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is the most common hypopigmentation disease affecting both the skin and mucous membranes. The pathogenesis of this disorder is complex and involves the influence of genetic and environmental factors, oxidative stress, and autoimmune responses. Recent studies have indicated that skin lesions observed in vitiligo tend to recur in the same places where they were found before treatment. This phenomenon is explained by the presence of recently discovered tissue-resident memory T cells (TRM), whose primary function is to provide antiviral and antibacterial protection in non-lymphoid tissues. TRM cells show the presence of CD49a, CD69, and CD103 markers on their surface, although not all of them express these particles. Due to their ability to produce and secrete perforin, IFN-γ, and granzyme B, TRM cells demonstrate a cytotoxic effect on melanocytes, thus inducing depigmented lesions in the course of the vitiligo. It has been proved that the occurrence of TRM cells largely depends on IL-15, which promotes the TRM function ex vivo. The findings above, as well as their reference to the pathogenesis of autoimmune skin diseases will have a considerable influence on the development of new therapeutic strategies in the near future. This article presents an up-to-date review of information regarding the role of TRM cells in the development and progression of vitiligo.
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El-Gayyar MA, Helmy ME, Amer ER, Elsaied MA, Gaballah MA. Antimelanocyte Antibodies: A Possible Role in Patients with Vitiligo. Indian J Dermatol 2020; 65:33-37. [PMID: 32029937 PMCID: PMC6986111 DOI: 10.4103/ijd.ijd_344_18] [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] [Indexed: 01/08/2023] Open
Abstract
Background: Vitiligo is an acquired depigmenting skin disorder with multifactorial pathogenesis including genetic, autoimmune, and neuronal factors. Both humoral- and cell-mediated immunities are supposed to have a role in the pathogenesis of vitiligo. Patients with vitiligo have an increased concentration of circulating autoantibodies that are specific to melanocyte cytoplasm and surface antigens that related to the extent of the disease. Aims and Objectives: The aim of the present study was to evaluate the role of antimelanocyte antibodies (AMAs), complement 3 and 4 (C3 and C4), and antinuclear antibodies (ANAs) in the pathogenesis of vitiligo. Materials and Methods: This study included 49 patients with nonsegmental vitiligo and 36 healthy individuals as a control group. All participants were subjected to detailed history, general examination, and detailed dermatological examination of the skin, hair, nails, and oral mucosa. The severity of vitiligo was assessed according to the Vitiligo Area Scoring Index (VASI). AMA, C3 and C4, and ANA serum levels were measured for patients and controls. Results: ANA, AMA, and C4 levels were significantly higher in the sera of patients than in controls. ANA, AMA, and C4 serum levels showed significant positive correlations with VASI score. Conclusion: Our results support the role of AMA in the pathogenesis of nonsegmental vitiligo, correlating with the disease extent and severity. However, a longitudinal study in a large cohort of patients to evaluate the clinical and predictive value of AMA is warranted.
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Affiliation(s)
- Maha A El-Gayyar
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Manal E Helmy
- Department of Clinical Pathology, Banha Educational Hospital, Banha, Egypt
| | - Eman R Amer
- Department of Clinical Pathology, Banha Educational Hospital, Banha, Egypt
| | - Moustafa A Elsaied
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad A Gaballah
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Dahir AM, Thomsen SF. Comorbidities in vitiligo: comprehensive review. Int J Dermatol 2018; 57:1157-1164. [PMID: 29808541 DOI: 10.1111/ijd.14055] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Vitiligo is a common skin disorder characterized by idiopathic, progressive cutaneous hypomelanosis. Vitiligo is associated with several comorbid autoimmune, systemic, and dermatological diseases, primarily thyroid disease, alopecia areata, diabetes mellitus, pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, Addison's disease, inflammatory bowel disease, Sjögren's syndrome, dermatomyositis, scleroderma, ocular and audiological abnormalities, psoriasis, and atopic dermatitis. It is essential to increase awareness of these comorbidities in order to improve the disease burden and quality of life of patients with vitiligo. Herein, we review the association with the most frequent comorbidities associated with vitiligo.
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Affiliation(s)
- Aisha M Dahir
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chobot A, Rusak E, Wenzlau J, Davidson H, Adamczyk P, Krzywicka A, Mazur B, Polańska J, Rewers M. ATP4A autoimmunity in pediatric patients with type 1 diabetes and its relationship to blood count, iron metabolism, and vitamin B12. Pediatr Diabetes 2018; 19:80-84. [PMID: 28401620 DOI: 10.1111/pedi.12528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We aimed to assess the prevalence of autoantibodies against the 4A subunit of the gastric proton pump (ATP4A) in pediatric type 1 diabetes (T1D) patients and explore the relationship between ATP4A positivity and blood cell count, iron turnover, and vitamin B12 concentration. SUBJECTS The study included 94 (59% female) T1D children (aged 12.5 ± 4.1 years, T1D duration 4.2 ± 3.6 years, HbA1c 7.3 ± 1.5% (57 ± 12.6 mmol/mol) with no other autoimmune diseases. METHODS ATP4A antibodies were measured in T1D patients using a radioimmunoprecipitation assay. Blood cell count, iron concentration, total iron binding capacity, ferritin, transferrin, hepcidin, and vitamin B12 concentration were measured in all the study participants. RESULTS A total of 16 (17%) children were ATP4A positive. Serum concentrations of ferritin were significantly lower in ATP4A positive than in antibody negative subjects (P = .034). Overall the levels of ATP4A antibodies (ATP4A Index) correlated positively with the age at T1D diagnosis (r = 0.228, P = .026) and negatively with ferritin levels (r = -0.215, P = .037). In ATP4A positive patients, the ATP4A Index correlated positively with age at diagnosis (r = 0.544, P = .032) and negatively with vitamin B12 levels (r = -0.685, P = .004). CONCLUSIONS ATP4A antibodies were present in a significant proportion of children with T1D. Higher ATP4A levels in T1D children are associated with lower, yet still fitting within the normal range, levels of vitamin B12, and ferritin. Routine screening of T1D children for gastric autoimmunity (ATP4A) should be considered with follow-up of those positive for vitamin B12 and iron deficiency.
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Affiliation(s)
- Agata Chobot
- Public Clinical Hospital No. 1 in Zabrze, Zabrze, Poland
| | - Ewa Rusak
- The Upper Silesian Center for Child Health, Katowice, Poland
| | - Janet Wenzlau
- University of Colorado Denver, Barbara Davis Center for Diabetes, Aurora, Colorado
| | - Howard Davidson
- University of Colorado Denver, Barbara Davis Center for Diabetes, Aurora, Colorado
| | - Piotr Adamczyk
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Bogdan Mazur
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Marian Rewers
- University of Colorado Denver, Barbara Davis Center for Diabetes, Aurora, Colorado
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Yuan J, Sun C, Jiang S, Lu Y, Zhang Y, Gao XH, Wu Y, Chen HD. The Prevalence of Thyroid Disorders in Patients With Vitiligo: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2018; 9:803. [PMID: 30697190 PMCID: PMC6340922 DOI: 10.3389/fendo.2018.00803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Associations between vitiligo and thyroid disorders have been suggested, However, the prevalence of thyroid disorders in vitiligo vary widely. Purpose: To conduct a systematic review and meta-analysis assessing the prevalence of thyroid disorders in patients with vitiligo. Method: The PubMed, Cochrane Library, EMBASE, CNKI (China National Knowledge Infrastructure), Chongqing VIP database, and Wanfang database from inception to August 2, 2018 were systematically searched. The pooled prevalence and its 95% confidence interval (CI) were calculated. Results: A total of 77 eligible studies were identified and included, published from 1968 to 2018. Six thyroid disorders including subclinical hyperthyroidism, overt hyperthyroidism, subclinical hypothyroidism, overt hypothyroidism, Graves disease, and Hashimoto thyroiditis were described. The numbers of relative studies were 54 in overt hypothyroidism, 50 in overt hyperthyroidism, 25 in subclinical hypothyroidism, 19 in Hashimoto thyroiditis, 16 in Graves disease, and 10 in subclinical hyperthyroidism. The highest prevalence was 0.06 (95% CI: 0.04-0.07) in subclinical hypothyroidism, and the lowest was 0.01 in subclinical hyperthyroidism (95% CI: 0.00-0.01) or Graves disease (95% CI: 0.01-0.02). Conclusion: Six thyroid disorders showed various prevalence in vitiligo. The highest prevalence was in subclinical hypothyroidism, and the lowest was in subclinical hyperthyroidism or Graves disease. Screening vitiligo patients for thyroid disorders seem plausible, in an effort to detect potential thyroid diseases or to assess the risk of future onset.
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Prevalence of Thyroid Abnormalities in Thai Patients with Vitiligo. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7502935. [PMID: 29362715 PMCID: PMC5738563 DOI: 10.1155/2017/7502935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
Abstract
Background Vitiligo is an acquired hypopigmentary disorder. The prevalence of vitiligo is 0.1–2% worldwide. Numerous autoimmune diseases are associated with vitiligo, including autoimmune thyroid diseases. The prevalence of thyroid abnormalities is up to 34% in vitiligo patients depending on ethnicities. Objective This study aims to investigate thyroid abnormalities in Thai patients with vitiligo. Methods Medical records of vitiligo patients attending outpatient dermatology clinic at a university-based hospital from 2012 to 2016 were retrospectively reviewed. Data regarding vitiligo, clinical features, and autoimmune thyroid laboratory results were retrieved and analyzed. Results Among 325 vitiligo patients identified, anti-thyroid peroxidase and anti-thyroglobulin were positive in 90 (27.7%) and 63 patients (19.4%), respectively. Positive thyroid antibody was associated with female gender (p < 0.001) and vitiliginous hand lesions (p < 0.02). Out of 197 patients with complete thyroid function test, the prevalence of autoimmune thyroid diseases (AITD) is 12.7%. Female, nonsegmental type, higher affected area, and the presence of leukotrichia are significantly associated with AITD in vitiligo patients. Conclusions Prevalence of positive thyroid antibodies and AITD in Thai patients with vitiligo is compatible with previous studies around the world. Screening for AITD with thyroid antibodies and serum TSH is essential for vitiligo patients.
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Elbuluk N, Ezzedine K. Quality of Life, Burden of Disease, Co-morbidities, and Systemic Effects in Vitiligo Patients. Dermatol Clin 2017; 35:117-128. [PMID: 28317521 DOI: 10.1016/j.det.2016.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a complex, systemic disease associated with many autoimmune and autoinflammatory conditions. Additionally, the cutaneous changes of vitiligo have significant effects on quality of life and self-esteem. Further efforts are needed to increase our understanding of vitiligo comorbidities as well as to increase awareness of the psychological effects of vitiligo.
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Affiliation(s)
- Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, NYU Ambulatory Care Center, NYU Langone Medical Center, 240 East 38th Street, 12th Floor, New York, NY 10016, USA.
| | - Khaled Ezzedine
- Department of Dermatology, EpiDermE, Henri Mondor Hospital, Université Paris-Est Créteil Val-de-Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Bae JM, Lee JH, Yun JS, Han B, Han TY. Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea. J Am Acad Dermatol 2017; 76:871-878. [PMID: 28238453 DOI: 10.1016/j.jaad.2016.12.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/17/2016] [Accepted: 12/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Associations between vitiligo and thyroid diseases have been reported repeatedly. OBJECTIVE We investigated the associations between vitiligo and overt autoimmune thyroid diseases and thyroid cancer using the Korean National Health Insurance claims database. METHODS We defined patients with vitiligo as those whose records showed ≥4 physician contacts between 2009 and 2013 in which vitiligo was the principal diagnosis. We also established an age- and sex-matched control group without vitiligo (2 per 1 vitiligo patient). The outcomes of interest were concurrent Graves disease and Hashimoto thyroiditis (the patients were taking relevant thyroid medications) and thyroid cancer. RESULTS The study enrolled 73,336 vitiligo patients and 146,672 controls. Patients with vitiligo were at increased risks of Graves disease (odds ratio [OR] 2.610 [95% confidence interval {CI} 2.319-02.938]), Hashimoto thyroiditis (OR 1.609 [95% CI 1.437-1.802]), and thyroid cancer (OR 1.127 [95% CI 1.022-1.242]), compared with the controls. The associations were consistently stronger in males and younger patients. LIMITATIONS Individual clinical information was not available, and the homogeneous population may limit the generalizability of the results. CONCLUSION Vitiligo was significantly associated with overt autoimmune thyroid diseases and overt thyroid cancer.
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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
| | - June Hyunkyung Lee
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byeol Han
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, College of Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
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Lahner E, Brigatti C, Marzinotto I, Carabotti M, Scalese G, Davidson HW, Wenzlau JM, Bosi E, Piemonti L, Annibale B, Lampasona V. Luminescent Immunoprecipitation System (LIPS) for Detection of Autoantibodies Against ATP4A and ATP4B Subunits of Gastric Proton Pump H+,K+-ATPase in Atrophic Body Gastritis Patients. Clin Transl Gastroenterol 2017; 8:e215. [PMID: 28102858 PMCID: PMC5288605 DOI: 10.1038/ctg.2016.71] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/07/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Circulating autoantibodies targeting the H+/K+-ATPase proton pump of gastric parietal cells are considered markers of autoimmune gastritis, whose diagnostic accuracy in atrophic body gastritis, the pathological lesion of autoimmune gastritis, remains unknown. This study aimed to assess autoantibodies against ATP4A and ATP4B subunits of parietal cells H+, K+-ATPase in atrophic body gastritis patients and controls. METHODS One-hundred and four cases with atrophic body gastritis and 205 controls were assessed for serological autoantibodies specific for ATP4A or ATP4B subunits using luminescent immunoprecipitation system (LIPS). Recombinant luciferase-reporter-fused-antigens were expressed by in vitro transcription-translation (ATP4A) or after transfection in Expi293F cells (ATP4B), incubated with test sera, and immune complexes recovered using protein-A-sepharose. LIPS assays were compared with a commercial enzyme immunoassay (EIA) for parietal cell autoantibodies. RESULTS ATP4A and ATP4B autoantibody titers were higher in cases compared to controls (P<0.0001). The area under the receiver-operating characteristic curve was 0.98 (95% CI 0.965-0.996) for ATP4A, and 0.99 (95% CI 0.979-1.000) for ATP4B, both higher as compared with that of EIA: 0.86 (95% CI 0.809-0.896), P<0.0001. Sensitivity-specificity were 100-89% for ATP4A and 100-90% for ATP4B assay. Compared with LIPS, EIA for parietal cell autoantibodies showed a lower sensitivity (72%, P<0.0001) at a similar specificity (92%, P=0.558). CONCLUSIONS Positivity to both, ATP4A and ATP4B autoantibodies is closely associated with atrophic body gastritis. Both assays had the highest sensitivity, at the cost of diagnostic accuracy (89 and 90% specificity), outperforming traditional EIA. Once validated, these LIPS assays should be valuable screening tools for detecting biomarkers of damaged atrophic oxyntic mucosa.
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Affiliation(s)
- Edith Lahner
- Clinical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy
| | - Cristina Brigatti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Marzinotto
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilia Carabotti
- Department of Internal Medicine and Medical Specialties, University Sapienza, Rome, Italy
| | - Giulia Scalese
- Clinical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy
| | - Howard W Davidson
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janet M Wenzlau
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Annibale
- Clinical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy
- Clinical and Surgical Sciences and Translational Medicine, University Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome 00189, Italy. E-mail:
| | - Vito Lampasona
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Internal Medicine and Medical Specialties, University Sapienza, Rome, Italy
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Divisione di Genetica e Biologia Cellulare, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Divisione di Genetica e Biologia Cellulare & Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy. E-mail:
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17
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Avalos-Díaz E, Pérez-Pérez E, Rodríguez-Rodríguez M, Pacheco-Tovar MG, Herrera-Esparza R. Autoimmune vitiligo in rheumatic disease in the mestizo Mexican population. Biomed Rep 2016; 5:176-180. [PMID: 27446537 PMCID: PMC4950649 DOI: 10.3892/br.2016.700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
Vitiligo is a chronic disease characterized by the dysfunction or destruction of melanocytes with secondary depigmentation. The aim of the present study was to determine the prevalence of vitiligo associated with autoimmune rheumatic diseases. The clinical records from a 10-year database of patients with rheumatic diseases and associated vitiligo was analysed, with one group of patients having autoimmune rheumatic disease and another non-autoimmune rheumatic disease. Available serum samples were used to assess the anti-melanocyte antibodies. A total of 5,251 individual clinical files were archived in the last 10 years, and these patients underwent multiple rheumatology consultations, with 0.3% of the group presenting with vitiligo. The prevalence of vitiligo in the autoimmune rheumatic disease group was 0.672%, which was mainly associated with lupus and arthritis. However, patients with more than one autoimmune disease had an increased relative risk to develop vitiligo, and anti-melanocyte antibodies were positive in 92% of these patients. By contrast, the prevalence was 0.082% in the group that lacked autoimmune rheumatic disease and had negative autoantibodies. In conclusion, the association between vitiligo and autoimmune rheumatic diseases was relatively low. However, the relative risk increased when there were other autoimmune comorbidities, such as thyroiditis or celiac disease. Therefore, the presence of multiple autoimmune syndromes should be suspected.
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Affiliation(s)
- Esperanza Avalos-Díaz
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
| | - Elena Pérez-Pérez
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
| | | | | | - Rafael Herrera-Esparza
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
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Wang XX, Wang QQ, Wu JQ, Jiang M, Chen L, Zhang CF, Xiang LH. Increased expression of CXCR3 and its ligands in patients with vitiligo and CXCL10 as a potential clinical marker for vitiligo. Br J Dermatol 2016; 174:1318-26. [PMID: 26801009 DOI: 10.1111/bjd.14416] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Vitiligo is a skin disorder characterized by loss of melanocytes from the epidermis. A recent study reported that CXCL10 is critical for the progression and maintenance of depigmentation in a mouse model of vitiligo, but there is very limited clinical data regarding this issue and little is known about the dynamic changes or correlations with disease severity of these chemokines throughout the disease course. OBJECTIVES To present clinical data that supports and identifies the pathway of CXCR3 and its ligands in T-lymphocytic cell recruitment in vitiligo. METHODS Cytometric bead array, flow cytometry, quantitative real-time polymerase chain reaction and immunohistology were used to examine their systemic and local expression in 80 patients with vitiligo and 40 controls. RESULTS We showed that serum CXCL9 and CXCL10 were significantly elevated in patients with vitiligo and were higher in patients in progressive stages than in stable stages. The relative expression of CXCR3 mRNA in peripheral blood mononuclear cells was higher in vitiligo. There were higher percentages of both circulating CXCR3(+) CD4(+) and CXCR3(+) CD8(+) T cells in patients with progressive vitiligo compared with controls, while only the expression of CXCR3(+) CD8(+) T cells increased in patients with stable vitiligo. Histological findings also demonstrated an abundance of CXCR3(+) cells within vitiligo lesions. Furthermore, serum CXCL10 levels were associated with Vitiligo Area Scoring Index scores of patients with progressive vitiligo and were reduced after successful treatment. CONCLUSIONS The CXCL10/CXCR3 axis mediates T-cell recruitment into the skin in progressive vitiligo. Blocking this chemotactic mechanism may present a new form of therapy. Serum CXCL10 may be a novel biomarker in monitoring disease activity and guiding treatment of progressive vitiligo.
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Affiliation(s)
- X X Wang
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - Q Q Wang
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - J Q Wu
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - M Jiang
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - L Chen
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - C F Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - L H Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
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19
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Dey-Rao R, Sinha AA. Interactome analysis of gene expression profile reveals potential novel key transcriptional regulators of skin pathology in vitiligo. Genes Immun 2015; 17:30-45. [DOI: 10.1038/gene.2015.48] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 12/13/2022]
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Ezzedine K, Sheth V, Rodrigues M, Eleftheriadou V, Harris JE, Hamzavi IH, Pandya AG. Vitiligo is not a cosmetic disease. J Am Acad Dermatol 2015; 73:883-5. [DOI: 10.1016/j.jaad.2015.07.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
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Gill L, Zarbo A, Isedeh P, Jacobsen G, Lim HW, Hamzavi I. Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study. J Am Acad Dermatol 2015; 74:295-302. [PMID: 26518171 DOI: 10.1016/j.jaad.2015.08.063] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few large-scale studies have quantified the burden of comorbid autoimmune diseases in patients with vitiligo. OBJECTIVE We sought to determine the prevalence of comorbid autoimmune diseases in patients with vitiligo. METHODS We conducted a manual chart review on a cohort of 1873 patients with vitiligo seen between January 2002 and October 2012 at the Henry Ford Health System in Detroit, MI. Patients were excluded if they had fewer than 2 dermatology notes (N = 595) or if they were never given a diagnosis of vitiligo by a dermatologist (N = 180). RESULTS Of 1098 patients with vitiligo, nearly 20% had at least 1 comorbid autoimmune disease. Compared with the general US population, we found a higher prevalence of thyroid disease (12.9%, P < .001), alopecia areata (3.8%, P < .001), inflammatory bowel disease (0.9%, P = .046), pernicious anemia (0.5%, P = .007), systemic lupus erythematosus (0.3%, P = .048), Guillain-Barre syndrome (0.3%, P < .001), discoid lupus (0.2%, P = .003), linear morphea (0.2%, P < .001), myasthenia gravis (0.2%, P = .002), and Sjögren syndrome (0.2%, P = .011). LIMITATIONS The study lacked a control group. This was a single-institution study with possible selection bias, and thus the findings may not be representative of the overall population of patients with vitiligo. CONCLUSIONS We observed a high prevalence of comorbid autoimmune diseases in patients with vitiligo and report several new associations.
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Affiliation(s)
- Liza Gill
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Allison Zarbo
- Wayne State University School of Medicine, Detroit, Michigan
| | - Prescilia Isedeh
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Henry W Lim
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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Boza JC, Kundu RV, Fabbrin A, Horn R, Giongo N, Cestari TF. Translation, cross-cultural adaptation and validation of the vitiligo-specific health-related quality of life instrument (VitiQoL) into Brazilian Portuguese. An Bras Dermatol 2015; 90:358-62. [PMID: 26131866 PMCID: PMC4516093 DOI: 10.1590/abd1806-4841.20153684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/07/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Vitiligo, although asymptomatic, highly compromises patients' quality of life
(QoL). Therefore, an adequate evaluation of QoL is essential. OBJECTIVES: Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific
health-related quality of life instrument) into Brazilian Portuguese. METHODS: The study was conducted in two stages; the first stage was the translation and
cultural/linguistic adaptation of the instrument; the second stage was the
instrument's validation. RESULTS: The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944)
and high test-retest reliability and intraclass correlation coefficient=0.95 (CI
95% 0.86 - 0.98), p<0.001. There was no statistically significant difference
between the means of the first completion of the VitiQoL questionnaire and the
retest, p = 0.661. There was a significant correlation between VitiQoL and DLQI (r
= 0.776, p <0.001) and also between VitiQoL-PB and subjects' assessment of the
severity of their disease (r = 0.702, p <0.001). CONCLUSIONS: The impact of vitiligo on the QoL of Brazilian patients can be assessed by a
specific questionnaire.
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Affiliation(s)
| | - Roopal V Kundu
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Amanda Fabbrin
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberta Horn
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Natalia Giongo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Oxidative stress and immune system in vitiligo and thyroid diseases. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:631927. [PMID: 25838868 PMCID: PMC4370195 DOI: 10.1155/2015/631927] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/02/2015] [Indexed: 12/12/2022]
Abstract
Vitiligo is an acquired dermatological disease frequently associated with autoimmune thyroid disorders. Several theories have been proposed so far to unravel the complex vitiligo pathogenesis. Currently, the autocytotoxic and the autoimmune theories are the most accredited hypothesis, since they are sustained by several important clinical and experimental evidences. A growing body of evidences shows that autoimmunity and oxidative stress strictly interact to finally determine melanocyte loss. In this scenario, associated thyroid autoimmunity might play an active and important role in triggering and maintaining the depigmentation process of vitiligo.
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Ingordo V, Cazzaniga S, Medri M, Raone B, Digiuseppe MD, Musumeci ML, Romano I, Fai D, Pellegrino M, Pezzarossa E, Di Lernia V, Peccerillo F, Battarra VC, Sirna R, Patrizi A, Naldi L. To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index. Dermatology 2014; 229:240-7. [PMID: 25358871 DOI: 10.1159/000363407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is believed that vitiligo has an impact on the overall patient quality of life (QoL). OBJECTIVE To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. RESULTS The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. CONCLUSIONS The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.
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Affiliation(s)
- Vito Ingordo
- Outpatient Department of Dermatology, District No. 6, Health Local Unit, Taranto, Italy
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