Epidemiology, genetics and management of vitiligo in the USA: an All of Us investigation

BACKGROUND

Vitiligo is an autoimmune skin depigmentation disorder significantly impacting quality of life. This condition is difficult to treat, with high relapse rates. Additionally, vitiligo associates with other autoimmune conditions, complicating patient management. Improving patient outcomes relies on understanding vitiligo's clinical landscape and genetic risk factors.

OBJECTIVES

We aimed to understand vitiligo's patient distribution, current management practices, how comorbid autoimmune conditions influence treatment and how genetic risk factors vary in diverse populations.

METHODS

We conducted a cross-sectional study of the All of Us research program, consisting of surveys, electronic health records and genomic data from 206,173 participants in the USA recruited between the summer of 2017 and 1 July 2022. We determined diagnostic and prescribing rates and elucidated differences in genetic risk within different populations.

RESULTS

Oral corticosteroids are most frequently prescribed, followed by other immunosuppressive drugs and topical medications. Comorbid systemic lupus erythematosus impacted treatment choices. Single nucleotide polymorphisms associated with increased risk in patients of European decent were not always associated with increase risk in patients of other ancestry.

CONCLUSIONS

This work highlights the current treatment landscape for vitiligo in the USA. We demonstrated that comorbid conditions impact treatment choices and genetic risk factors vary between ethnic groups.

The efficacy of combined phototherapy with topical therapy in vitiligo: a network meta-analysis

BACKGROUND

The comparative effects of phototherapy and topical therapy in patients with vitiligo remain unclear. A network meta-analysis (NMA) was conducted to assess which combination therapy was more beneficial for patients with vitiligo.

METHODS

This study analyzed phototherapy, including narrowband ultraviolet B (NB-UVB) and 308-nm excimer laser/light (EL) combined with topical therapies. Randomized controlled trials were sourced from PubMed, Embase, and Cochrane Library. Data analysis was based on a random-effects model, and surface under the cumulative ranking (SUCRA) curves employed to assess the efficacy of the interventions.

RESULTS

This NMA included 27 trials, with a total of 2417 lesions (patches). According to the results of the SUCRA, for achieving ≥50% repigmentation, the top three combination therapies were phototherapy combined with antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5), while for ≥75% repigmentation, the leading therapies were phototherapy combined with antioxidants (SUCRA 89.0), calcineurin inhibitors (SUCRA 70.3), and fractional CO2 laser (SUCRA 63.6).

CONCLUSIONS

This meta-analysis suggests that combining phototherapy with topical antioxidants, corticosteroids, or calcineurin inhibitors may offer superior outcomes for vitiligo patients. This study provides a reference for clinicians to develop personalized treatment plans for patients with vitiligo.

Clinical observation of 10 cases of stable non-segmental vitiligo in adults treated with upadacitinib

OBJECTIVE

To evaluate the efficacy and safety of upadacitinib in treating stable nonsegmental vitiligo in adults.

METHODS

Data were collected from adult patients with stable nonsegmental vitiligo treated with upadacitinib at Jingzhou Hospital of Yangtze University between November 2023 and November 2024. Treatment efficacy was compared at 8 and 16 weeks and any adverse reactions were recorded.

RESULTS

A total of 10 patients were included, 6 of whom also received 308 nm excimer laser therapy. A total of 200 lesions were observed, with 146 receiving additional laser therapy. After 8 weeks of treatment, 60.0% of lesions achieved at least 25% pigmentation, while 27.0% achieved more than 50% pigmentation. After 16 weeks, these rates increased to 78.0% and 52.5%, respectively. Treatment efficacy was greater at 16 weeks compared to 8 weeks (p < 0.001). Acral lesions showed lower response rates compared to lesions on the face, neck, trunk, and limbs (p < 0.05). There was no statistically significant difference in efficacy between upadacitinib monotherapy and combination therapy with phototherapy (p > 0.05). Among the 10 patients, 6 achieved over 50% improvement in total VASI score after 16 weeks, while 4 showed more than 75% improvement.

CONCLUSION

Upadacitinib is safe and effective treatment for stable non-segmental vitiligo in adults.

In vivo 3D photoacoustic and ultrasound analysis of hypopigmented skin lesions: A pilot study

Vitiligo needs early identification for proper intervention. Current adjunct diagnostic methods rely mostly on subjective visual inspection. Thus, identification of early or atypical vitiligo lesions among other hypopigmentation disorders may pose challenges. To overcome this, we investigate the feasibility of a three-dimensional (3D) photoacoustic (PA) and ultrasound (US) imaging technique as a new adjuvant analytic tool providing quantitative characterization of hypopigmentation features. This cross-sectional study was conducted at Seoul St. Mary's Hospital (Seoul, Republic of Korea) between August 2022 and January 2024. Lesions diagnosed vitiligo or IGH in locations that could safely be irradiated with laser were analyzed with 3D PA/US imaging along with the conventional diagnostic methods. A total of 53 lesions consisted of 36 vitiligo lesions and 17 IGH lesions from 39 participants with confirmed diagnosis were analyzed. The PA amplitude greatly differed between normal skin and hypopigmentation lesions, and the mean PA amplitudes of vitiligo lesions were slightly higher than that of IGH [mean (standard deviation, SD): vitiligo: 0.117 (0.043); IGH: 0.135 (0.028)]. The local SD of the PA amplitude were higher in IGH than in vitiligo lesions [vitiligo: 0.043 (0.018); IGH: 0.067 (0.017)]. The mean PA slope across the lesion boundary was significantly higher in IGH than in vitiligo [vitiligo: 0.173 (0.061); IGH: 0.342 (0.099)], whereas the PA peak depth was deeper in vitiligo than in IGH [vitiligo: 0.568 (0.262); IGH: 0.266 (0.116)]. Unlike conventional qualitative methods, 3D PA/US imaging can non-invasively provide quantitative metrics which might aid in the differentiation of vitiligo from IGH lesions.

Investigating the molecular mechanism of purslane‑based vitiligo treatment using network pharmacology, molecular docking and in vitro analyses

Purslane is a traditional Chinese medicine with a long‑standing history of efficacy in the management of dermatological conditions such as vitiligo. However, the molecular mechanisms underlying its therapeutic effects on vitiligo remain unclear. Therefore, the present study explored these mechanisms using network pharmacology, molecular docking and in vitro experiments. Following the screening process, seven principal active components were identified, namely kaempferol, hesperetin, luteolin, quercetin, arachidonic acid, cycloartenol and β‑sitosterol. In addition, six key targets, namely AKT1, tumor protein p53, peroxisome proliferator‑activated receptor γ (PPARG), estrogen receptor 1, prostaglandin‑endoperoxidase synthase 2 and mitogen‑activated protein kinase 1, and eight pathways in purslane‑based vitiligo treatment were identified. Network pharmacology and molecular docking demonstrated that flavonoids are the key components of purslane likely to mitigate oxidative stress damage in vitiligo. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed that the phosphatidylinositol 3‑kinase (PI3K)/AKT, p53 and PPARG signaling pathways are associated with purslane components and vitiligo. In vitro experiments revealed that purslane total flavones (PTF) increased cell viability, decreased ROS levels and increased antioxidant enzyme activities in H2O2‑induced B16F10 cells. In addition, PTF activated the PI3K/AKT signaling pathway in H2O2‑induced B16F10 cells, and the antioxidant effect of PTF was attenuated by a PI3K/AKT inhibitor. In conclusion, the findings of the present study suggest that the flavonoids of purslane contribute, at least in part, to its therapeutic effectiveness in vitiligo by mitigating oxidative stress in melanocytes through the PI3K/AKT signaling pathway.

Demographics and Clinical Characteristics among Patients with Distinct Psychosocial Burden Profiles Related to Vitiligo: Results of a Latent Class Analysis

INTRODUCTION

Vitiligo may negatively impact quality of life (QOL). This study aimed to classify patients on the basis of the impact of vitiligo on emotional/psychological and social functioning and describe patient characteristics and patient-reported outcome (PRO) responses for each profile.

METHODS

Physician and patient surveys from the Vitiligo Disease Specific Programme in France, Germany, Italy, Spain, and the USA were analyzed. PROs were assessed using the Vitiligo Patient Priority Outcomes (ViPPO), Work Productivity Activity Index-Vitiligo, Vitiligo-Specific Quality-of-Life instrument, 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L), and Hospital Anxiety and Depression Scale questionnaires. Latent class analysis identified distinct classes on the basis of ViPPO response options.

RESULTS

A three-class model was selected. Of 530 patients, 64.2%, 24.3%, and 11.5% were grouped into classes 1, 2, and 3, respectively. Class 3 reported the most emotional/psychological and social functioning impact; classes 1 and 2 reported mild and moderate impact, respectively. More patients in classes 1 and 2 had moderate physician-assessed disease; class 3 had a higher proportion of patients with moderate-to-severe disease; however, approximately one third had limited/mild physician-reported disease. Class 3 had the highest mean body surface area involvement and proportion of patients with face involvement (n = 30 [49.2%]). Across all 4 PRO measures, class 3 reported more severe impacts.

CONCLUSIONS

Generally, classes with more severe impacts had more severe physician-assessed disease and lesion involvement and greater work productivity and QOL impairment. Although patients in class 3 had severe psychosocial burden, a large proportion had mild physician-reported disease severity, suggesting that only physical symptoms were considered when assessing disease severity.

Neurological Mechanisms Exploration and Therapeutic Targets in Segmental Vitiligo Accompanied by White Hair

Vitiligo is the most common skin depigmentation disease, affecting 0.1%-2% of people in the world. 3.5%-20.5% of segmental patients account for the total number of vitiligo patients. It has been clinically observed that segmental vitiligo patients are more likely to generate white hair, which may be related to neuroendocrine factors. The color of human skin and hair is affected by the number and functional status of melanocytes. Vitiligo affects patients' physical and mental health due to the shame it causes from the white patches and hair. This article reviews the underlying mechanisms of segmental vitiligo with white hair based on skin and hair follicle melanocytes. The article attempts to propose possible targets for the treatment of this disease.

Efficacy and Safety of Ruxolitinib Cream in Vitiligo by Patient Characteristic Subgroups: Descriptive Pooled Analysis From Two Phase 3 Studies

INTRODUCTION

Two phase 3 trials (TRuE-V1 and TRuE-V2) demonstrated that a topical formulation of the Janus kinase (JAK) 1/JAK2 inhibitor ruxolitinib significantly improved repigmentation versus vehicle cream in adolescent and adult patients with vitiligo. This post hoc analysis of pooled TRuE-V1/TRuE-V2 data evaluated efficacy and safety by baseline demographics and clinical characteristics.

METHODS

Patients aged ≥ 12 years with nonsegmental vitiligo were randomized to vehicle cream or 1.5% ruxolitinib cream twice daily for 24 weeks, after which all patients could apply ruxolitinib cream through Week 52. Efficacy was evaluated using achievement of ≥ 75% improvement from baseline in facial Vitiligo Area Scoring Index [F-VASI75] at Week 52. Safety assessments included the frequency of treatment-emergent adverse events (AEs) and treatment-related AEs.

RESULTS

The TRuE-V studies enrolled 674 patients. Week 52 F-VASI75 was achieved by 50.3% (176/350) of patients who applied ruxolitinib cream throughout and 28.2% (46/163) who crossed over from vehicle to ruxolitinib cream after Week 24. F-VASI75 responses were observed across subgroups regardless of patient age, sex, Fitzpatrick skin type, affected facial body surface area, disease duration, disease stability, and prior treatment status. Treatment-emergent AEs occurred in 52.1% (332/637) of patients, and treatment-related AEs occurred in 13.7% (87/637); rates were generally similar across demographic subgroups.

CONCLUSIONS

Adolescent and adult patients with vitiligo who applied ruxolitinib cream could achieve clinically meaningful repigmentation per F-VASI75 response at 1 year, regardless of their baseline demographics or clinical characteristics. Ruxolitinib cream was well tolerated, with a similar incidence of treatment-emergent and treatment-related AEs across subgroups.

TRIAL REGISTRATION

NCT04052425/NCT04057573.

Combined tofacitinib citrate and 308-nm excimer laser treatment for vitiligo: a pilot study

BACKGROUND

Vitiligo is a clinically prevalent acquired skin disorder characterized by depigmentation. Currently, the therapeutic options for vitiligo are restricted, and numerous issues exist, such as a prolonged treatment course, unsatisfactory therapeutic efficacy, adverse reactions and a high propensity for recurrence after treatment cessation.

OBJECTIVES

To assess the safety and efficacy of combined treatment involving oral tofacitinib citrate (TC) and a 308-nm excimer laser (EL), with the aim of discovering a rapid and effective treatment approach to minimize the side-effects of various drugs.

METHODS

In total, 63 patients with progressive vitiligo and a Vitiligo Disease Activity Score of 4 from January 2022 to January 2024 were enrolled and divided into three groups. The three groups were: the TC combined with 308-nm EL and methylprednisolone treatment group (group 1); the TC and 308-nm EL treatment group (group 2); and the methylprednisolone alone treatment group (group 3). The treatment was continued for 24 weeks, and an assessment of therapy outcomes was performed.

RESULTS

When TC was combined with 308-nm EL and methylprednisolone treatment (group 1), the effect was more rapid than in the other two groups. When TC was combined with 308-nm EL (group 2), it had a more favourable treatment effect than that of methylprednisolone alone (group 3), despite having a slower onset of effect. After 24 weeks of treatment, there was no significant difference between group 1 and group 2 in terms of the total response rate or significant response. However, when only methylprednisolone treatment was applied, the effect was relatively slow and ineffective.

CONCLUSIONS

This study confirmed a rapid and effective treatment of vitiligo was achieved through a combination of TC and 308-nm EL. No serious adverse reactions were reported, and therefore this could potentially offer an optimal treatment plan for patients with vitiligo.

Canadian Consensus Guidelines for the Management of Vitiligo

INTRODUCTION

Vitiligo remains a highly burdensome disease associated with significant autoimmune and psychosocial comorbidities. Although the therapeutic landscape has long been dominated by off-label therapy, new treatments are emerging. Limited guidance on how to safely and effectively utilize available therapies poses challenges for healthcare providers. Herein, we provide generally accepted principles, consensus recommendations, and a treatment algorithm for the management of vitiligo, as developed by a panel of ten Canadian dermatologists with expertise in managing vitiligo.

METHODS

The three-phase process consisted of identifying themes and research questions; conducting a systematic literature review; and discussing/voting on generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process.

RESULTS

Experts agreed to 27 generally accepted principles, ten consensus statements, and a treatment algorithm. Education about vitiligo pathogenesis and repigmentation biology can help patients, caregivers, and healthcare providers set realistic expectations for treatment. Treatment should focus on repigmentation or stabilizing progression, rather than on depigmentation. Topical therapies include topical corticosteroids, topical calcineurin inhibitors, and the topical Janus kinase inhibitor ruxolitinib cream. Phototherapy, such as narrow-band ultraviolet B and excimer laser/lamp, can be used as monotherapy or in combination with other treatments. Off-label systemic therapies may be appropriate for patients with unstable or rapidly progressing disease. Surgical therapy may be suitable for patients with localized or stable recalcitrant disease. Maintenance therapy may help mitigate the risk of disease relapse.

CONCLUSION

Improved clarity around the benefits, risks, and limitations of available therapies has supported the development of robust guidelines and a treatment algorithm for vitiligo. Disease stabilization and repigmentation are goals that can largely be achieved, particularly when patients share a mutual understanding of vitiligo and its treatment options. A Graphical Abstract is available for this article.

Knowledge and attitudes towards vitiligo in egyptian and palestinian communities: a cross-sectional study

BACKGROUND

Vitiligo is an acquired dermatological condition characterized by localized skin depigmentation. It affects 0.5% to 2% of the population, impacting individuals across various ages, races, and genders. The psychosocial effects of Vitiligo can significantly influence quality of life, particularly in people with darker skin tones, where the contrast of lesions is more pronounced.

OBJECTIVES

This study evaluated public knowledge, attitudes, and misconceptions regarding Vitiligo in Egypt and Palestine, focusing on specific demographic Variations and the potential need for improved community engagement and education.

METHOD

A multicenter cross-sectional study was conducted involving 1,045 participants from Egypt and 450 participants from the West Bank. An online self-administered questionnaire was developed using Google Forms. The eligibility criteria for participation included Egyptian and Palestinian citizens residing in the West Bank. Individuals under 18 years or outside the designated study settings were excluded from participation. This study was conducted from April 2024 to August 2024.

RESULTS

The analysis indicated that 62.8% of participants demonstrated adequate knowledge of Vitiligo; however, only 87.6% exhibited favorable attitudes toward the condition. The study revealed significant variations in knowledge and attitudes based on gender, occupation, previous health professional experience, and social status. Economic level and geographic location. Educational level was found to have a considerable impact on attitudes. Multiple linear regression analysis identified several significant predictors of. Knowledge and attitude scores included male gender, age categories of 18 to 25 and over 50, marital status, occupation in a health profession, personal experience with Vitiligo, prior awareness of the condition, and the attitude score itself. This explained 30.2% of the variance in knowledge scores and 28.1% in attitude ratings.fig.

CONCLUSION

This study provides valuable insights into public awareness and perceptions of Vitiligo in Egypt and Palestine. A significant proportion of the participants demonstrated adequate awareness of the condition; however, favorable opinions appeared less prevalent. Notable discrepancies were observed among the various demographic characteristics, highlighting the need for targeted initiatives, such as media campaigns and school-based education, aimed at addressing information gaps and improving public perception.

Exosomes enriched with miR-31-3p from keratinocytes under oxidative stress promote vitiligo progression by destructing melanocytes and activating CD8+ T cells

Vitiligo is a skin disease characterized by the destruction of epidermal melanocytes due to oxidative stress. Keratinocytes are the main responder to oxidative stress and facilitate melanocyte loss by inducing melanocyte death and recruiting antigen-specific CD8+ T cell to skin to destroy melanocytes. It has been proved that keratinocytes secrete functional exosomes, but the role of exosomes secreted from keratinocytes under oxidative stress in vitiligo pathogenesis is unknown. The present study investigated the role of exosomes from H2O2-treated human keratinocytes in the vitiligo progression in vitro. and in vivo. The results demonstrated that oxidative stress enhanced the secretion of exosomes from keratinocytes. These exosomes (OS-Exos) suppressed the survival of melanocytes while promoting the proliferation and activation of CD8+ T cells in vitro. Then, we confirmed that OS-Exos administration aggravated melanocyte loss and CD8+ T cell infiltration in the epidermis in the vitiligo mouse model, thereby driving vitiligo progression. Further, we performed Small RNAs-seq to screen miRNAs enriched in OS-Exos. The subsequent results revealed that miR-31-3p, which was enriched in OS-Exos, facilitated melanocyte death and decreased the expression of melanogenesis-related genes through MITF signaling. Meanwhile, it was found that miR-31-3p promoted the activation of CD8+ T cells, which could depend on impaired immunosuppression and activated T-cell growth. Taken together, these data suggest that OS-Exos enriched with miR-31-3p facilitated vitiligo progression through the destruction of melanocytes and activation of CD8+ T cells. Keratinocytes-derived exosomes under oxidative stress could serve as an important mediator for oxidative stress-induced killing of melanocytes in vitiligo.

Beyond skin deep: exploring the complex molecular mechanisms and holistic management strategies of vitiligo

Vitiligo is a multifactorial skin disorder characterized by the progressive loss of pigmentation due to the destruction of melanocytes, affecting 0.5-2% of the global population. This condition not only impacts physical appearance but also has profound psychosocial effects on patients. In this review, various aspects of vitiligo are explored, including its clinical forms, epidemiology, and underlying mechanisms. Advances in research have identified key molecular pathways, such as Wnt/β-Catenin, JAK-STAT, and AhR signaling, which are essential for melanocyte survival and immune regulation. These pathways provide valuable insights into the disease's progression and potential treatment targets. Furthermore, the role of microbial imbalances in the gut and skin microbiomes, stress-related factors, and nutritional deficiencies in influencing the onset and progression of vitiligo is investigated. The potential of herbal treatments to stimulate repigmentation is also discussed. By presenting a comprehensive overview, this review aims to deepen the understanding of vitiligo's complex pathology and foster the development of effective therapeutic strategies to enhance patient care.

The experience of living with vitiligo in Nigeria: A participatory Interpretative Phenomenological Analysis

Vitiligo is a visible depigmenting skin condition, particularly noticeable on Black skin. There is widespread misunderstanding of the condition. Using a participatory form of Interpretative Phenomenological Analysis (IPA), we conducted eight semi-structured interviews with Nigerians living with vitiligo. Participants described their initial attempts to understand the condition, which typically drew on both traditional illness beliefs, religious influences, and the biomedical disease model. All participants reported experiencing marked stigmatization and discrimination. Participants experienced distress associated with thoughts about the personal meaning of the disease including its impact on their appearance and from concerns about anticipated and direct discrimination. Despite the wide-ranging impact, the participants' narratives also contained references to the development of strategies that maintained wellbeing. This study provides valuable insights into the role of faith and traditional beliefs in both the experience and management of vitiligo in Nigeria. These insights can be used to develop individual and community interventions.

Evaluating cancer risk in a large cohort of 25,008 patients with vitiligo: Insights from a comprehensive cohort population-based study

BACKGROUND

Current research presents inconsistent results concerning the incidence of various malignancies among patients with vitiligo.

OBJECTIVES

To evaluate the risk of cancer in patients with vitiligo.

METHODS

A population-based study was conducted using Clalit Health Services database (2000-2023) using a cohort study design. Adjusted hazard ratios (HRs) were calculated using multivariate Cox regressions.

RESULTS

The study included 25,008 patients with vitiligo and 245,550 matched controls. The mean (SD) age of patients with vitiligo was 35.96 (22.39) years; 12,679 (50.70%) patients were men. There were 499 (95% confidence interval [CI]: 468-532) and 487 (95% CI: 476-497) incident cancer cases per 100,000 person-years among patients with and without vitiligo, respectively (adjusted HR: 1.00; 95% CI: 0.93-1.07; P = .999). Patients with vitiligo had a reduced risk of melanoma (adjusted HR: 0.70; 95% CI: 0.50-0.99; P = .0337), lung cancer (adjusted HR: 0.73; 95% CI: 0.57-0.93; P = .007), and bladder cancer (adjusted HR: 0.70; 95% CI: 0.52-0.94; P = .0138).

LIMITATIONS

The secondary analysis involved multiple comparisons, which could potentially influence the results.

CONCLUSION

Our study found that cancer incidence rates in patients with vitiligo are not elevated. Consequently, cancer screening for these patients should follow the standard guidelines recommended for the general population.

Impact of COVID-19 disease and vaccination on dermatological immune-mediated inflammatory diseases atopic dermatitis, psoriasis, and vitiligo: a Target2B! substudy

During the COVID-19 pandemic, the daily life of many patients with dermatological immune-mediated inflammatory diseases (DIMIDs), such as atopic dermatitis (AD), psoriasis, and vitiligo, was impacted by social restrictions caused by (fear of) morbidity, mortality associated with COVID-19, and vaccine hesitancy. This prospective observational, multicenter, multidisciplinary cohort study explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo. Data from patients with DIMIDs were collected as part of the Target2B! study (between February 2021 and October 2022). We analyzed the differences in baseline characteristics, risk of developing COVID-19, proportion of DIMIDs in patients reaching seroconversion upon vaccination per DIMID, and self-reported increase in DIMID activity by multivariable logistic regression and sensitivity analyses. A total of 424 patients with DIMID were included. COVID-19 disease commonly occurred in patients with vitiligo (51.1%), AD (42.0%), and psoriasis (34.3%) (p = 0.038). COVID-19 was not associated with the use of immunosuppressive therapy. Three patients (two with AD and one with vitiligo) were hospitalized due to COVID-19. Nearly all patients with DIMIDs exhibited effective seroconversion after regular vaccination regimens (vitiligo 100%, psoriasis 97.9%, AD 96.5%). Increased DIMID activity after COVID-19 (6.6%) or severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) vaccination (12.26%) was reported in a minority of patients, with baseline progressive disease (disease activity 3 months preceding baseline survey) being the only associated risk factor (COVID-19: odds ratio [OR], 4.27 [p = 0.02]; vaccination OR, 3.45 [p = 0.002]). In conclusion, no alarming signs were shown in this study regarding (severe) COVID-19 in patients with AD, psoriasis, or vitiligo. Vaccination against COVID-19 is advised in patients with DIMIDs. Moreover, patients with DIMIDs can safely continue their immunosuppressant therapy, since this does not increase the risk of COVID-19, while vaccination-induced humoral responses are adequate. In only a minority of patients, increased DIMID activity after COVID-19 or SARS-CoV-2 vaccination occurred.

Response to ritlecitinib with or without narrow-band ultraviolet B add-on therapy in patients with active nonsegmental vitiligo: Results from a phase 2b extension study

BACKGROUND

Ritlecitinib demonstrated efficacy in a phase 2b trial of nonsegmental vitiligo.

OBJECTIVE

To evaluate the efficacy and tolerability of ritlecitinib with add-on narrow-band ultraviolet B (nbUVB) phototherapy in patients with nonsegmental vitiligo.

METHODS

Following a 24-week, placebo-controlled, dose-ranging period, patients received ritlecitinib 200 mg for 4 weeks then 50 mg for 20 weeks, with or without nbUVB phototherapy 2x/week. Missing data were handled using last observation carried forward and observed case (OC).

RESULTS

Forty-three patients received ritlecitinib + nbUVB and 187 received ritlecitinib-monotherapy. Nine patients receiving ritlecitinib + nbUVB discontinued due to nbUVB group-specific efficacy criteria requiring >10% improvement in % change from baseline (% change from baseline) in Total-Vitiligo Area Scoring Index at week 12. At week 24, mean % change from baseline in Facial-VASI score was -57.0 vs -51.5 (last observation carried forward; P = .158) and -69.6 vs -55.1 (OC; P = .009), for ritlecitinib + nbUVB vs ritlecitinib-monotherapy, respectively. Mean % change from baseline in Total-Vitiligo Area Scoring Index at week 24 was -29.4 vs -21.2 (last observation carried forward; P = .043) and -46.8 vs -24.5 (OC; P < .001), respectively. nbUVB addition to ritlecitinib was well tolerated with no new safety signals.

LIMITATIONS

Exploratory analysis; discontinuation criterion applied only to the ritlecitinib + nbUVB group; small sample size.

CONCLUSION

Ritlecitinib alone and with nbUVB therapy improved facial and total body repigmentation and was well tolerated. Adding nbUVB may improve ritlecitinib efficacy.

Antera 3D® skin image analysis system for objective evaluation of clinical treatment efficacy in a patient with facial vitiligo

OBJECTIVE

To evaluate the changes of skin surface parameters in a patient with vitiligo using Antera 3D® Skin Image Analysis System, and to observe the clinical efficacy of the treatment of facial vitiligo.

METHODS

A patient with facial vitiligo was treated with intradermal injection of psoralen solution into the lesion combined with 308 nm excimer laser therapy. Vitiligo lesion images were captured using the Antera 3D® camera before treatment and every 2 weeks after the start of the treatment. The associated software analysis system was used to measure the parameters of melanin level, ultra-low melanin concentration, and L* value as objective indexes for the evaluation of vitiligo treatment efficacy.

RESULTS

After 10 treatments, the melanin level of the patient's skin lesions increased from 0.480 to 0.580, while the ultra-low melanin concentration and L* value decreased from 9.360 to 64.10 to 3.032 and 58.10, respectively.

CONCLUSION

The Antera 3D® skin image analysis system provides objective data, which are conducive to improving patients' treatment compliance and confidence, as well as facilitating the development of treatment plans.

Vitiligo associated with type 2 immune inhibitors: FAERS analysis and literature review

With the widespread use of type 2 immune response inhibitors (IRIs), there is growing concern about their association with the occurrence of vitiligo. This study aimed to comprehensively search for cases of vitiligo associated with type 2 IRIs in the US Food and Drug Administration Adverse Event Reporting System (FAERS). We retrieved the clinical characteristics of cases from January 2004 to September 2024 from the FAERS database. Disproportionality and Bayesian analyses were conducted to detect signals for vitiligo associated with type 2 IRIs. A total of 86 cases of vitiligo were identified in association with these inhibitors. The mean onset time was 326 days. Vitiligo associated with dupilumab was the most common (81.4%), with the highest reporting odds ratio (2.67, 95% confidence interval  2.11-3.4), proportional reporting ratio (2.67, χ2 = 70.59), information component (1.38, [IC025 = 1.09), and empirical Bayes geometric mean (2.61, EBGM05 = 2.14). The link between vitiligo and type 2 IRIs underscores the need for continued pharmacovigilance to better understand these drugs and the incidence of related conditions.

Emerging Therapeutic Innovations for Vitiligo Treatment

Vitiligo is a chronic autoimmune disorder with a multifactorial etiology, typically manifesting as localized or generalized hypopigmentation or depigmentation of the skin and mucous membranes. The pathogenesis of vitiligo is complex and significantly impacts patients' quality of life. Although traditional treatments such as hormone therapy, topical medications, and laser therapy can help control the disease to some extent, their outcomes remain unsatisfactory. Therefore, ongoing research is crucial to explore and develop novel treatment strategies while assessing their efficacy and safety. This review aims to classify and summarize various new candidate drugs for vitiligo currently undergoing clinical trials, providing a reference for clinical practice. Recent advancements in the understanding of the pathogenesis of vitiligo have facilitated the development of potential treatment strategies, such as Janus kinase inhibitors, cytokine blockers, and agents targeting tissue-resident memory or regulatory T cells. These emerging therapies offer hope to patients with vitiligo, though further investigation is needed to confirm their safety, efficacy, and optimal treatment regimens.

Hair regrowth in alopecia areata and re-pigmentation in vitiligo in response to treatment: Commonalities and differences

Both alopecia areata (AA) and vitiligo share common pathogenesis involving, interferon-γ (IFN-γ) and interleukin-15 (IL-15) signalling pathways that activate cytotoxic CD8+ T lymphocytes. These shared mechanisms may explain why both diseases respond to currently available treatments (e.g. topical/systemic corticosteroid) and emerging treatment modalities. As compared with the speed of re-pigmentation in vitiligo lesions, the regeneration of pigmented terminal hair follicles in AA lesions appears fast in response to treatments targeting the inhibition of the Janus kinases (JAKs) and other kinases. We summarize the commonalities and differences between AA and vitiligo focusing on the treatment modalities, followed by recent findings associated with hair follicle stem cells (HFSC) in hair bulge (HBg) and melanocyte stem cells (McSC) in HBg and hair germ (HGm). We then discuss how HFSC and HGm-McSC are involved in the initiation of anagen phase, followed by pigmented terminal hair regrowth in the recovering AA lesions in association with immunology. We also discuss how HBg-McSC contribute to the migration of fully dendritic mature melanocytes into interfollicular epidermis and the equal distribution of melanin in recovering vitiligo lesions. Finally, we present four hypotheses to elucidate the delayed distribution of melanin by mature melanocytes in depigmented vitiligo lesions from the aspects of stem cell biology, as compared with quick hair recovery in AA: (1) McSC are less abundant than HFSC. (2) McSC require a long travel, whereas HFSC reside close to hair regeneration trigger point. (3) Keratinocyte scaffold to accept melanin is not well preserved, whereas scaffold for hair regrowth is well preserved. (4) Inhibitors targeting JAKs and other kinases have less direct effects on melanocyte proliferation and differentiation in vitiligo than hair regrowth in AA. Our review provides an overview of treatment modalities and bridges the gap between scientific advancement and clinical practice in AA and vitiligo management.

Mitochondria in cutaneous health, disease, ageing and rejuvenation-the 3PM-guided mitochondria-centric dermatology

Association of both intrinsic and extrinsic risk factors leading to accelerated skin ageing is reflected in excessive ROS production and ir/reversible mitochondrial injury and burnout, as abundantly demonstrated by accumulating research data. Due to the critical role of mitochondrial stress in the pathophysiology of skin ageing and disorders, maintained (primary care) and restored (secondary care) mitochondrial health, rejuvenation and homoeostasis are considered the most effective holistic approach to advance dermatological treatments based on systemic health-supportive and stimulating measures. Per evidence, an effective skin anti-ageing protection, wound healing and scarring quality - all strongly depend on the sustainable mitochondrial functionality and well-balanced homoeostasis. The latter can be objectively measured and, if necessary, restored in a systemic manner by pre- and rehabilitation algorithms tailored to individualised patient profiles. The entire spectrum of corresponding innovations in the area includes natural and systemic skin rejuvenation, aesthetic and reconstructive medicine, sustainable skin protection and targeted treatments of skin disorders. Contextually, mitochondria-centric dermatology is instrumental for advanced 3PM-guided approach which makes a good use of predictive multi-level diagnostics and targeted protection of skin against both - the health-to-disease transition and progression of relevant disorders. Cost-effective targeted protection and new treatment avenues focused on sustainable mitochondrial health and physiologic homoeostasis are proposed in the article including in-depth analysis of patient cases and exemplified 3PM-guided care with detailed mechanisms and corresponding expert recommendations presented.

Concurrent management of vitiligo and acquired disorders of hyperpigmentation: a comprehensive literature review and current practice gaps

Few studies discuss the co-management of vitiligo and acquired hyperpigmentation disorders (AHD) such as melasma, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, and lichen planus pigmentosus. This review discusses clinical studies examining co-management strategies and identifies current practice gaps. Dermatology Life Quality Index scores are higher in individuals with vitiligo or melasma. It is plausible that populations experiencing both conditions may exhibit worsened psychological outcomes because of stigmas and perceived social beauty standards. Standard treatments for vitiligo aim to increase pigmentation, while AHD treatments target decreasing pigmentation, causing potential worsening of contrast between multiple skin tones for patients experiencing both disorders. Tretinoin may prevent narrowband ultraviolet B (NBUVB)-induced hyperpigmentation in patients with vitiligo without altering treatment response and is also beneficial for managing AHD. In addition, the use of oral tranexamic acid to treat melasma does not diminish the response to NBUVB phototherapy. Platelet-rich plasma (PRP) injections and oral Polypodium leucotomos extract may also be beneficial for comanaging vitiligo and AHD. However, practice guidelines are needed to optimize care for this patient population.

Segmental vitiligo: autoimmune pathogenesis, neuronal mechanisms, and somatic mosaicism

Vitiligo is a common depigmentation disorder classified into nonsegmental vitiligo (NSV) and segmental vitiligo (SV). SV accounts for 5-27.9% of patients with vitiligo. The primary pathogenesis of NSV involves the autoimmune-mediated destruction of melanocytes. Recently, an autoimmune pathogenesis of SV was identified. High levels of melanocyte antigen-specific CD8+ T cells are found in early SV lesional skin infiltrating around melanocytes along the basal layer. Mixed vitiligo suggests an overlap in pathogenesis between SV and NSV. In active SV, serum innate immune cytokines, and CD8+ T cell cytokines are increased. Oxidative stress in SV may activate autoimmune responses. SV pathogenesis is associated with a local cytotoxic response targeting epidermal melanocytes. Theories have been put forward to explain the segmental pattern in SV. The previous basis of the neurogenic theory that SV results from dermatomes is no longer accepted. However, there are still research reports supporting this theory. Evaluating the distribution pattern of SV lesions has provided clues to the mosaicism detection of suspected melanocytic defects at the site of SV lesions, supporting this theory. Evidence points to a cytotoxic response targeting mosaic melanocytes. Understanding SV's autoimmune pathogenesis prompts a reevaluation of immunosuppressive medical treatments for SV. The excellent results of autologous melanocyte transplantation in SV lesions compared with the moderate to limited results in patients with NSV support the mosaicism theory.

Vitiligo: A Review of Pathogenesis and Treatments, Including New Therapies on the Horizon

Vitiligo is an acquired depigmentation skin disease caused by the immune-mediated death of melanocytes. It is the most common cause of depigmentation with an estimated worldwide prevalence of 1% but has shown insufficient response to current therapies. The latest research in vitiligo pathogenesis has translated into finding new molecular targets [type I interferon and Janus kinase signal transducers and transcription activators (JAK STAT) pathways], with new therapies generating promising results, such as JAK inhibitors. Other therapeutic strategies include phototherapy, surgical treatment, and complementary options such as micropigmentation, microneedling, and lasers. This review aimed to discuss the mechanisms involved in the development of the disease and the new therapeutic options that have become available, as well as the evidence on complementary therapies. For this purpose, a review of the evidence was conducted using the PubMed database. Based on this review, it was concluded that the progress in understanding the pathophysiology of vitiligo has allowed for the consideration of new molecular targets, with JAK inhibitors showing particular promise in both systemic and topical applications. Nonetheless, further investigation is required to assess the safety of JAK inhibitors and to determine the optimal regimen and dosage for administering these drugs. Complementary treatments should be considered on a case-by-case basis.

The efficacy and safety of micro-needling combined with tacrolimus versus tacrolimus monotherapy for vitiligo treatment: a systematic review and meta-analysis

Tacrolimus is a topical immunomodulator that has been used successfully in treating vitiligo; however, recent studies suggested that combining tacrolimus with micro-needling can increase its efficacy. This systematic review aimed to assess the efficacy and safety of micro-needling combined with tacrolimus to treat localized and stable nonsegmental vitiligo. We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The risk ratio (RR) was used to represent dichotomous outcomes, whereas the odds ratio (OR) was used for adverse events. Three randomized control trials (RCTs) (n=148 participants) were deemed eligible. The pooled effect estimate showed a statistically significant higher re-pigmentation rate in all assessed body areas in favor of treatment with micro-needling combined with tacrolimus (RR=2.02, 95% CI: 1.51-2.70). Nonetheless, no significant difference was found between micro-needling combined with tacrolimus and tacrolimus monotherapy in terms of 5-grade re-pigmentation scale (RR=0.93, 95% CI: 0.53-1.62), histopathological assessment (RR=0.90, 95% CI 0.47-1.75), and adverse events (OR: 1.72, 95% CI: 0.10-29.36). The number of included studies is low, with a relatively low sample size. Micro-needling combined with tacrolimus showed a clinically and statistically substantial improvement in the re-pigmentation of vitiligo sites with acceptable tolerability and safety profile.

Predictive analysis of vitiligo treatment drugs using degree and neighborhood degree-based topological descriptors

Vitiligo is a chronic autoimmune condition that leads to the loss of skin pigmentation in certain areas due to the destruction of melanocytes, which produce pigment. A topological index is a numerical value obtained from the structure of a chemical graph and is useful for studying the theoretical characteristics of organic molecules. It can also help determine the physico-chemical and biological aspects of various drugs. This article uses novel neighborhood degree-based topological indices to study vitiligo drugs and demonstrates a strong correlation with physico-chemical properties. Additionally, the results are compared with those obtained through degree-based topological indices.

Candidate approaches for predicting vitiligo recurrence: an effective model and biomarkers

Background

Vitiligo is a challenging chronic condition with unpredictable disease course and high propensity for relapse post-treatment. Recent studies have reported the biomarkers for disease activity, severity, and therapeutic response of vitiligo, yet very few have investigated cytokines as predictive biomarkers for disease recurrence in vitiligo. This study aims to explore cytokines that serve as biomarkers for disease recurrence and extend research on factors related to the disease's activity.

Methods

92 patients and 40 healthy controls were recruited at the Air Force Medical Center from September 20, 2023, to November 30, 2023. Ultrasensitive multiplex cytokine array was used to measure plasma concentrations of cytokines, including IFN-γ, CXCL9, CXCL10, CXCL11, IL-6, and IL-15.

Results

IFN-γ, CXCL9, CXCL10, CXCL11, IL-6, and IL-15 were expressed at higher levels in the circulation of patients with both segmental and non-segmental vitiligo compared to healthy controls (p < 0.001). There were no significant differences in these cytokine levels between the two types of vitiligo. CXCL9 was associated with the activity of vitiligo (p = 0.027). Correlation analysis showed a positive relationship between IFN-γ, CXCL9, CXCL10, CXCL11, IL-6, and IL-15 in the plasma of patients with recurrent vitiligo. The expression of IFN-γ, CXCL9, CXCL10, CXCL11, and IL-6 was significantly higher in recurrent vitiligo than in cases of persistent stable vitiligo (p = 0.001, p = 0.003, p < 0.001, p = 0.002, p = 0.026, respectively), with ROC analysis demonstrating their predictive capability for vitiligo recurrence, with AUC values of 0.806, 0.773, 0.896, 0.785, and 0.709, respectively. Multivariate logistic regression model showed IFN-γ is an independent predictor for vitiligo recurrence [OR (95%CI) =1.051 (1.012~1.116)], with a prediction accuracy of 90.5% (38/42) on the training dataset and 88.9% (16/18) on the testing dataset.

Conclusion

Plasma IFN-γ, CXCL9, CXCL10, CXCL11 and IL-6 might be potential biomarkers for vitiligo recurrence, with CXCL9 also associated with disease activity. Additionally, multivariate logistic regression model demonstrated that IFN-γ is an independent predictor of vitiligo recurrence and the model could be a candidate approach for predicting vitiligo recurrence.

Identification of disease-specific gut microbial markers in vitiligo

There is a potential correlation between vitiligo and gut microbiota, although research in this area is currently limited. The research employed high-throughput sequencing of 16S rRNA to examine the gut microbiome in the stool samples of 49 individuals with vitiligo and 49 without the condition. The study encompassed four comparison groups: (1) DI (disease) group vs. HC (healthy control) group; (2) DI_m group (disease group of minors) vs. HC_m group (healthy control group of minors); (3) DI_a group (adult disease group) vs. HC_a group (adult healthy control group); (4) DI_m group vs. DI_a group. Research findings have indicated the presence of spatial heterogeneity in the gut microbiota composition between individuals with vitiligo and healthy controls. A significant reduction in gut microbiota diversity has been observed in vitiligo patients across both minors and adult groups. However, variations have been noted in the composition of disease-related differential microbial markers among different age groups. Specifically, Bacteroides and Parabacteroides have been identified as specific markers of the intestinal microbiota of vitiligo patients in both minor and adult groups. Correlative analyses have revealed a positive correlation of these two genera with the Vitiligo Area Scoring Index (VASI) and disease duration. It is noteworthy that there are no significant differences in diversity between the DI_m group and the DI_a group, with similarities in microbiota composition and functional characteristics. Nevertheless, correlative analyses suggest a declining trend in Bacteroides and Parabacteroides with increasing age. Individuals with vitiligo exhibit distinct features in their gut microbiome when contrasted with those in the healthy control group. Additionally, the microbial marker genera that show variances between patients and healthy controls vary among different age groups. Disease-specific microbial marker genera (Bacteroides and Parabacteroides) are associated with VASI, duration of the condition, and age. These findings are essential for improving early diagnosis and developing potential treatment strategies for individuals with vitiligo.

Postautologous Hematopoietic Stem Cell Transplantation Disseminated Hypopigmented Keratosis

ABSTRACT

Disseminated hypopigmented keratosis is a rare distinct clinical entity. This report describes the case of a 19-year-old male patient who developed disseminated hypopigmented keratosis 2 months after autologous hematopoietic stem cell transplantation for pineal choriocarcinoma. The patient displayed numerous tiny whitish or depigmented macules and papules on the chest, back, posterior neck, shoulders, arms, and thighs, closely resembling lichen nitidus. Microscopically, the lesion was orthokeratotic, acanthotic, and flat-bottomed without cytological atypia. Dermal inflammation was minimal. Fontana-Masson, Melan-A, and sex-determining region Y-box transcription factor 10 staining revealed a significant decrease in both basal melanin content and the number of melanocytes. The patient was initially administered a topical agent comprising hydrocortisone and urea, which exhibited minimal improvement. This case report suggests that disseminated hypopigmented keratosis may be a rare cutaneous manifestation of autologous hematopoietic stem cell transplantation. Additional research is necessary to gain a more comprehensive understanding of the pathogenesis and the clinical course of this disease.

The Efficacy of Non-Cultured Epidermal Cell Suspension and Excimer Lamps Combination Therapy in Vitiligo: Results of 18 Months Follow-Up

BACKGROUND

Research on evaluating the efficacy of non-cultured epidermal cell suspension (NCECS) combined with excimer lamps for the treatment of vitiligo is currently unavailable. This research aims to evaluate the efficacy of this combination in treating vitiligo.

METHODS

A prospective, controlled study was conducted from November 2021 to January 2024. Patients with stable vitiligo were randomly assigned into groups 1 (NCECS combined with excimer lamps) or 2 (NCECS alone). All patients were followed up 18 months after the procedure. Treatment effectiveness and adverse events were recorded.

RESULTS

Sixty patients were randomly assigned to groups 1 (30 patients) and 2 (30 patients). A total of 33.3% of patients in group 1 achieved 100% repigmentation, significantly higher than the 6.7% in group 2 (p-value = 0.021). Meanwhile, 63.3% of patients in group 1 achieved ≥ 90% repigmentation, higher than the 50% in group 2 but not statistically significant (p-value = 0.435). The mean time to initial repigmentation in group 1 (2.35 ± 0.575 weeks) was significantly shorter than in group 2 (2.72 ± 0.665 weeks) (p-value = 0.003). Both groups demonstrated a similar rate of good color match, but group 1 exhibited a lower incidence of the halo phenomenon. A total of 23.3% of patients in group 1 experienced mild erythema, which spontaneously resolved in a few days.

CONCLUSIONS

The combination of NCECS and excimer lamps can substantially stimulate the onset of repigmentation and enhance 100% repigmentation compared to NCECS monotherapy. Excimer lamps may reduce the incidence of the halo phenomenon.

Treatment Advances in Vitiligo: An Updated Review

INTRODUCTION

Vitiligo is a common disorder of depigmentation caused by the progressive destruction of melanocytes that affects the skin, hair, and mucous membranes, clinically presenting as depigmented macules and leukotrichia. This condition, affecting millions of people worldwide, has a significant psychosocial burden on patients' quality of life, particularly in relation to skin colour. The etiopathogenesis of this disorder is obscure, but multiple factors contribute to the loss of melanocytes in the skin, like oxidative stress, inflammation, genetics, and autoimmunity. The treatment of vitiligo has been challenging over the past years, but recent developments in understanding the etiopathogenesis of the disease have paved the way for the development of more effective and promising therapeutic treatment options.

OBJECTIVE

The aim of this review was to provide an overview of the underlying mechanisms and highlight the latest advances in the treatment of vitiligo.

METHODOLOGY

This review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalyses) guidelines. A comprehensive search of the literature was carried out through the PubMed electronic database from inception to 31 December 2023 using the following search terms "vitiligo" AND "JAK inhibitors", "vitiligo" AND "prostaglandin", " vitiligo" AND " afamelanotide", "vitiligo" AND "antioxidants", "vitiligo" AND "vitamin D3", "vitiligo" AND "statins", "vitiligo" AND "TNF-alpha", "vitiligo" AND "interleukin", "vitiligo" AND "light therapy". Two independent reviewers screened titles, abstracts, and full texts to select papers dealing with vitiligo and its treatment.

CONCLUSION

The advent of treatment modalities like Janus kinase inhibitors, prostaglandin analogues, antioxidants, TNF-α inhibitors, targeted phototherapy, and excimer lasers has revolutionized the therapeutic possibilities, offering a ray of hope to the individuals suffering from this devastating condition.

Burden of Vitiligo in Canada: Retrospective Analysis of a Canadian Public Claims Database

BACKGROUND

Vitiligo is an autoimmune disease resulting in skin depigmentation. Treatment options are limited.

OBJECTIVES

To examine disease burden and healthcare resource utilization (HCRU) among patients with vitiligo in Québec, Canada.

METHODS

In this retrospective study, data were obtained from the Régie de l'Assurance Maladie du Québec (RAMQ) databases for 125,000 random individuals from January 2010 to December 2019. The International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code [709.x (other skin disorders)] with vitiligo-related treatment was used to identify patients with vitiligo. Patient characteristics and treatments, including treatment type, episodes (treatments used without discontinuation), and sequences (treatment episodes ≥30 days), were assessed. Annualized HCRU and costs (2021 adjusted) included all-cause hospitalization, emergency department visits, outpatient visits, and medications among patients with vitiligo (n = 113) and age- and sex-matched non-vitiligo controls (n = 339).

RESULTS

Of patients with vitiligo (mean age, 50.0 years; 68.1% female) identified using ICD-9 code 709.x with vitiligo-related treatment, 36.3% received ≥4 treatment episodes. Treatment patterns were heterogeneous, with 43 different sequences reported. Annualized mean outpatient visits (16.1 vs 5.5) and all-cause outpatient service costs per patient were significantly higher in the vitiligo versus the control group (CAN$1037 vs CAN$523; P < .01). Total all-cause services costs were higher for patients with vitiligo in the year after versus before diagnosis (CAN$3679 vs CAN$2085; P = .04).

CONCLUSIONS

Vitiligo is associated with significant burden and HCRU among patients in Québec, Canada, who were identified by ICD-9 code 709.x plus vitiligo-related treatment. Measurement of true vitiligo burden remains challenging.

Clinical patterns of vitiligo in Japan: A descriptive study using the JMDC claims database

Vitiligo is a chronic autoimmune disorder that profoundly impacts patients' quality of life. Real-world data on vitiligo in Japan are limited. This descriptive, cross-sectional study used a claims database to evaluate vitiligo prevalence, patient demographics, treatments, and comorbidities in Japanese patients with vitiligo. Patients with claims for a vitiligo diagnosis in the JMDC database from January 2010 to December 2022 were included. Annual vitiligo prevalence, comorbidities, treatments, and medical facility visits were analyzed. Of 16 947 087 patients in the database during the 13-year analysis period, a total of 26 358 patients (0.16%, 95% confidence interval 0.15-0.16) had a diagnosis of vitiligo. The standardized prevalence of vitiligo by sex and age in Japan remained generally consistent between 2010 (0.051%) and 2022 (0.056%). Atopic dermatitis was the most prevalent comorbidity. Comorbid atopic dermatitis prevalence increased between 2010 (21.8%) and 2022 (34.0%), and was highest among children aged 5-9 years. Other common comorbidities in 2022 included hypertension (10.4%), dyslipidemia (8.0%), anxiety disorder (7.4%), and psoriasis (7.0%). Topical corticosteroids were the most commonly used treatment throughout the period analyzed. Between 2010 and 2022, topical corticosteroid use decreased from 75.1% to 66.9%, and the use of narrowband ultraviolet B procedures increased from 19.2% to 28.1%. Mean duration of care was 12.9 months (standard deviation 20.5 months) and the median total number of outpatient medical facility visits was 3.0 (interquartile range 1.0-12.0). Key limitations include age and occupational biases in the JMDC database and potential misclassification of comorbidities due to off-label treatment coding. Despite limitations in using a claims database, this study demonstrates consistent vitiligo prevalence in Japan, a high comorbidity burden, and evolving treatment patterns. Findings may guide clinical practice and treatment guidelines to improve management of vitiligo in Japanese patients.

Preparation of Ethosome Gel with Total Flavonoids from Vernonia anthelmintica (L.) Willd. for the Treatment of Vitiligo

Vernonia anthelmintica (L.) Willd. is a traditional medicinal herb in Chinese medicine, extensively used by various ethnic groups due to the numerous advantages derived from its total flavonoids. These benefits encompass anti-inflammatory and antioxidant effects, and the promotion of melanin production, showcasing its significant efficacy in addressing vitiligo. To improve transdermal absorption and enhance the antioxidant effectiveness of the treatment, ethosome containing total flavonoids were prepared utilizing the ultrasound injection technique. The resulting ethosome was then carefully mixed with 0.7% Carbomer 934 gel in equal parts, yielding a gel concentration of 0.302 mg/g. This formulation produced small, consistent ethosome that exhibited high encapsulation efficiency and notable stability. In vitro analyses demonstrated sustained release characteristics of the gel and considerable therapeutic effectiveness against vitiligo resulting from hydroquinone exposure. Histological examinations performed through hematoxylin and eosin (H&E) staining of mouse skin revealed increased melanin production and increased activities of tyrosinase (TYR), cholinesterase (CHE), and mouse monoamine oxidase (MAO), while levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were reduced. These findings underscore the promising effectiveness of this treatment strategy and validate the efficacy of the dosage form.

Fractional CO2 laser combined with narrow-band ultraviolet B (NB-UVB) phototherapy versus NB-UVB monotherapy in vitiligo patients: prospective, self-controlled, and randomized trial

Vitiligo is a chronic depigmenting condition that causes amelanotic macules and patches on the skin. Despite various treatment options, treating vitiligo is a challenge. This study aimed to evaluate the combination of laser CO2 fractional and narrow-band ultraviolet B (NB-UVB) versus NB-UVB monotherapy in vitiligo patients. This was a prospective, self-controlled, and randomized trial. Ten patients with symmetrical vitiligo lesions on both sides of their body and who had a history of insufficient response to conventional therapies were included in this trial. Group A received three sessions of fractional CO2 laser at 1-month intervals during NB-UVB phototherapy which was performed three times a week for three months. Patients in group B only received phototherapy same as group A. The primary endpoint was the repigmentation rate. The mean age was 34.40 ± 11.93 years (range of 19-63). After the intervention, repigmentation was better in group A and the difference was statistically significant (P = 0.025). Patients in group A showed a better reduction of VASI score than group B (39.12 ± 27.81 Vs. 44.45 ± 30.77), although it was not statistically significant (P = 0.518). VETF and VIDA outcomes were slightly better in Group A than B, but it was not statistically significant (P = 0.317 and P = 0.180, respectively). The results of this study indicated that combining fractional CO2 laser with NB-UVB is superior to NB-UVB monotherapy, providing a promising modality in vitiligo patients.

Bioinformatic analysis of ferroptosis related biomarkers and potential therapeutic targets in vitiligo

Vitiligo is a complex autoimmune skin disorder characterized by depigmentation and immune dysregulation. To elucidate the role of ferroptosis-related genes (FRGs) in vitiligo, we conducted a comprehensive analysis of gene expression data from the GSE53146 and GSE65127 datasets obtained from the GEO database. We identified 31 differentially expressed FRGs (DE-FRGs), with 21 genes upregulated and 10 downregulated. Functional enrichment analysis revealed that these DE-FRGs are significantly involved in oxidative stress, immune regulation, and vitiligo-associated signaling pathways. Utilizing machine learning approaches, including LASSO and SVM-RFE, we identified four key marker genes (ALOX5, SNCA, SLC1A4, and IL33) with strong diagnostic potential. Immune landscape analysis demonstrated that these marker genes influence immune cell composition, particularly showing correlations with CD8 + T cells and regulatory T cells. Furthermore, drug-gene interaction analysis proposed potential therapeutic targets, while ceRNA network analysis uncovered intricate regulatory relationships involving miRNAs and lncRNAs. Collectively, our findings provide novel insights into the molecular mechanisms underpinning vitiligo and suggest new avenues for diagnostic and therapeutic development.

Comorbidities Associated with Vitiligo: Results from the EpiChron Cohort

Background: Vitiligo is a pigmentation disorder that impacts approximately 0.5% to 2% of the global population. Growing interest surrounds the comorbidities associated with vitiligo. This study aimed to describe the socio-demographic characteristics of the patients with vitiligo in Aragón (Spain) and to investigate their associated comorbidities. Methods: A retrospective observational study was conducted using clinical data from individuals in the EpiChron Cohort (reference population of 1.3 million) who were diagnosed with vitiligo between 1 January and 31 December 2019. The prevalence of chronic comorbidities was calculated using logistic regression models, obtaining the odds ratio (OR) of each comorbidity (dependent variable) according to the presence or absence of vitiligo (independent variable). We used a cut-off point for a statistical significance of p-value < 0.05. Results: In total, 218 patients diagnosed with vitiligo were analyzed. The mean age was 44.0 years, and 56.42% were female. The largest proportion of patients (34.86%) were aged between 18 and 44 years. Among all vitiligo patients included, 71.5% presented multimorbidity, with an average of 3.21 diagnosed comorbidities. The conditions most frequently associated with vitiligo included thyroid disorders (OR: 3.01, p < 0.001), ocular and hearing abnormalities (OR: 1.54, p < 0.020), inflammatory skin disorders (OR: 2.21, p < 0.001), connective tissue diseases (OR: 1.84, p < 0.007), lower respiratory tract diseases (OR: 1.78, p < 0.014), urinary tract infections (OR: 1.69, p < 0.032), and cardiac arrhythmias (OR 1.84, p < 0.034). Conclusions: This research highlights the importance of understanding the broader health implications of vitiligo and provides a foundation for further exploration into the complex interplay between this dermatologic condition and a diverse range of comorbidities.

The role of serum S100B and serum thyroid stimulating hormone levels in vitiligo

Vitiligo is a depigmenting disorder characterized by melanocyte loss, which results in pigment dilution of the skin. Vitiligo is commonly associated with thyroid disorders and thyroid stimulating hormone (TSH) is a sensitive marker to detect thyroid disorders. S100B is damage associated molecular pattern (DAMP) molecule released when there is melanocyte damage. In this study, we are estimating the serum TSH and S100B levels in vitiligo patients and controls and correlating them with disease activity. A cross-sectional study was conducted on 39 cases of vitiligo and controls. Demographic details were collected, the cases were examined and Vitiligo European Task Force (VETF) scoring was performed. Serum S100B was analyzed using an ELISA kit and serum TSH levels were estimated. Age of the participants ranged from 14 to 81 years with a mean and standard deviation of 44.08 ± 16.078 years. Female preponderance was noted. Vitiligo vulgaris was the most common presentation. Serum TSH (p = 0.32) and S100B (p = 0.22) levels between cases and controls were not statistically significant. Serum S100B level had a weak positive correlation with the spreading component of VETF score and it was statistically significant (p = 0.004). Mucosal vitiligo had higher levels of serum S100B levels compared to other types of vitiligo. In our study both serum TSH and S100B levels have demonstrated limited utility in distinguishing between vitiligo patients and controls. S100B showed a weak correlation with VETF scores indicating its potential (though limited) as a disease activity marker. Therefore, the potential of using this as a biomarker is debatable, and further multicentric studies with a larger sample size are required to establish the correlation.

Update vulval dermatology - diagnostics and therapy

The vulva is a periorificial skin area and as such represents a transitional zone with unique functional and physiological characteristics. Knowledge of its anatomy is limited among both the general population and healthcare professionals, and unrealistic expectations of normal proportions are common. Ignorance of anatomical variations can cause unnecessary anxiety. In Germany, specialists in gynecology and obstetrics most commonly treat neoplastic vulvar dermatoses, while chronic inflammatory dermatoses commonly affecting the female genitalia (such as psoriasis, atopic dermatitis, hidradenitis suppurativa, and vitiligo) are typically treated by dermatologists. Both specialties treat infectious vulvar dermatoses and sexually transmitted infections. Certain dermatoses, such as lichen sclerosus, lichen planus, and lichen simplex chronicus, tend to affect the vulva preferentially; however, terminology can be confusing. Therefore, this article provides basic information on vulvar anatomy and physiology and summarizes recommendations for the diagnosis and management of the most common vulvar dermatoses, with a special focus on chronic inflammatory dermatoses, to provide a useful guide for all involved specialists in daily practice. Interdisciplinary collaboration and the establishment of dedicated consultation hours may help to improve the clinical care of vulvar dermatoses.

Psychometric Properties and Meaningful Change Thresholds of the Vitiligo Area Scoring Index

Importance

Defining meaningful improvement using the Total Vitiligo Area Scoring Index (T-VASI) and the Facial VASI (F-VASI) aids interpretation of findings from clinical trials evaluating vitiligo treatments; however, clear and clinically meaningful thresholds have not yet been established.

Objective

To assess concept validity and measurement performance of the T-VASI and F-VASI in patients with nonsegmental vitiligo and to identify meaningful change thresholds.

Design, Settings, and Participants

This mixed-methods study consisted of a secondary analysis of a phase 2 multicenter double-blind dose-ranging randomized clinical trial and embedded qualitative interviews conducted at 35 sites in Canada, France, Japan, and the US. The secondary analysis included the trial's adult patients with nonsegmental vitiligo (T-VASI ≥5 and F-VASI ≥0.5 at baseline). Psychometric performance of the T-VASI and F-VASI and thresholds for meaningful change were evaluated using clinician- and patient-reported information. The trial's embedded interviews were used to qualitatively assess content validity and patient perceptions of meaningful repigmentation. Data analyses were performed from March to July 2023.

Intervention

Participants were randomized to 6-, 11-, or 22-mg/day upadacitinib or placebo for 24 weeks.

Main Outcomes and Measures

Psychometric performance of the T-VASI and F-VASI and thresholds for meaningful changed plus content validity and patient perceptions of meaningful repigmentation. Measurement instruments included the T-VASI, F-VASI, Vitiligo Noticeability Scale, Total-Patient Global Vitiligo Assessment, Face-Patient Global Vitiligo Assessment, Total-Physician Global Vitiligo Assessment (PhGVA-T), Face-Physician Global Vitiligo Assessment (PhGVA-F), Patient's Global Impression of Change-Vitiligo, Physician's Global Impression of Change-Vitiligo (PhGIC-V), Vitiligo Quality-of-Life Instrument, Dermatology Life Quality Index, the Hospital Anxiety and Depression Scale, and transcribed verbatim interviews with patients.

Results

The psychometric analysis included 164 participants (mean [SD] age, 46 years; 103 [63%] females) and the qualitative analysis included 14 participants (mean [SD] age, 48.8 [12.2] years; 9 females [64%] and 5 males [36%]). Intraclass correlation coefficients were 0.98 for T-VASI and 0.99 for F-VASI in patients with clinically stable vitiligo between baseline and week 4, supporting test-retest reliability. At baseline and week 24, correlations were moderate to strong between T-VASI and PhGVA-T (r = 0.63-0.65) and between F-VASI and PhGVA-F (r = 0.65-0.71). Average baseline and week-24 VASI scores decreased with repigmentation (ie, increasing PhGVA scores). Least-square mean VASI scores increased with greater repigmentation as measured by the PhGIC-V. Least-square mean VASI scores also differed between patients with improved PhGIC-V and those with no change or worsened V-PhGIC scores. Using a multiple anchor approach, improvements of 30% in T-VASI and 50% in F-VASI scores reflected meaningful repigmentation between baseline and week 24.

Conclusion and Relevance

This mixed-methods study found that the T-VASI and F-VASI are reliable, valid, able to differentiate between clinically distinct groups, and responsive in patients with nonsegmental vitiligo. The thresholds for meaningful change were lower than those historically used in clinical trials, suggesting that T-VASI 50 and F-VASI 75 are conservative estimates and reflect improvements that would be meaningful in patients with nonsegmental vitiligo.

Trial Registration

ClinicalTrials.gov Identifier: NCT04927975.

Sjögren's Syndrome Is Associated With an Increased Risk of Vitiligo

OBJECTIVES

Limited studies reported the correlation between Sjögren's syndrome (SS) and vitiligo. This study explores the association between SS and the risk of developing vitiligo and assesses comorbidity profiles and medication impacts.

METHODS

We conducted a retrospective, population-based analysis using data from Taiwan's National Health Insurance Research Database, spanning 2008 to 2019. The primary outcome was the incidence of vitiligo, which was analyzed using Cox proportional hazards models, with additional subgroup and sensitivity analyses conducted.

RESULTS

The study incorporated 223 582 individuals with SS and 9 775 363 controls. A total of 208 942 pairs of the SS and controls were analyzed following propensity score matching. Non-matched and matched cohort analyses have consistent results. In matched analysis, individuals with SS had a 1.90-fold increased risk of developing vitiligo compared to those without SS after adjustment (95% confidence interval [Cl], 1.67-2.15; p < 0.001). Age-related risk was evident, particularly in those aged 40-59 years and 60-79 years. Males had a lower risk of vitiligo than females. Comorbidities such as hyperlipidemia, chronic liver disease, hyperthyroidism, and spondylarthritis further increase the risk. During the first year following diagnosis, individuals with SS exhibited a significantly elevated risk of developing vitiligo compared to those without SS (aHR, 2.15; 95% Cl, 1.54-3.00; p < 0.001). Over a decade of follow-up, the SS cohort showed a markedly higher cumulative risk of vitiligo than the non-SS cohort (log-rank p < 0.001). Subgroup analysis revealed that systemic corticosteroid administration significantly mitigated the risk of developing vitiligo in SS patients (aHR, 0.67; 95% CI, 0.53-0.86; p < 0.001) compared to patients who did not receive systemic corticosteroids.

CONCLUSION

SS is significantly associated with an increased risk of developing vitiligo. Further research is warranted to elucidate the underlying mechanisms.

Focusing on the Dark Side of the Moon: Involvement of the Nonlesional Skin in Vitiligo

Research over the last decade has revealed that the normally pigmented skin of patients with vitiligo is not normal at all, as evidenced by alterations in cutaneous morphology and modifications in cellular and metabolic functions that ultimately drive immune activation against melanocytes. Furthermore, nonlesional skin is in a state of subclinical inflammation until triggered by internal and/or external exposomal events. Therefore, targeting early processes that drive immune dysregulation in normally pigmented skin may avoid or reduce melanocyte loss. Thus, shifting the focus to nonlesional skin may prevent the appearance of clinical manifestations of the disease rather than treating the lesions.

Combination Therapy with Baricitinib and Narrowband Ultraviolet B for Active Non-Segmental Vitiligo: A Retrospective Controlled Study

Background

Vitiligo is a chronic autoimmune disease manifested by depigmented patches of skin devoid of melanocytes. Baricitinib, a JAK inhibitor selectively targeting JAK1/2, has shown preliminary efficacy for vitiligo. We aimed to assess the efficacy and tolerability of combination therapy with baricitinib and narrowband UV-B (NB-UVB) to treat active nonsegmental vitiligo (NSV).

Methods

We formed a combination group of 52 patients with NSV receiving baricitinib and NB-UVB irradiation, and a control group of 49 patients with NSV receiving oral mini-pulse (OMP) methylprednisolone and NB-UVB irradiation. Efficacy analysis was conducted for the 6-month period. Six months after the last treatment, the recurrence rates were investigated through follow-up.

Results

From the first month, the mean total vitiligo area scoring index (VASI) score was significantly reduced in the combination group when compared to that in the control group. Starting on the fourth month, the overall response rates (ORRs) were significantly higher in the combination group than in the control group (P=0.034). By the sixth month, the ORRs reached 86.5% in the combination group, whereas they reached 67.3% in the control group (P=0.022). The serum levels of IFN-γ and CXCL10 in the combination group decreased from 38.52±5.98 pg/mL and 976.67±150.57 pg/mL at baseline to 26.46±5.93 pg/mL and 704.14±103.38 pg/mL at the 6-month juncture, respectively (P<0.001). Moreover, we found that there was no significant difference in recurrence rates within 6 months after stopping treatment in both groups. Three patients (5.8%) in the combination group reported developing itchy skin during the first month of treatment period, and one patient (1.9%) developed erythema; no other serious adverse events occurred.

Conclusion

Our observations suggest that the combination therapy with baricitinib and NB-UVB is a promising strategy against NSV. Patients tolerated the treatment well without serious AEs, these results expand treatment options for vitiligo patients, warranting larger clinical trials.

Vitiligo: Clinical and Laboratory Characteristics in 573 Saudi Patients

Background

Vitiligo is a common disease. Limited studies in Saudi Arabia have explored the detailed clinical characteristics of vitiligo, as outlined in recent consensus reports by vitiligo experts.

Objective

To determine vitiligo prevalence and detailed clinical characteristics in a Saudi cohort.

Methods

Cross-sectional study over six years. All cases were electronically identified and manually verified. Prevalence and sex were determined based on all vitiligo cases. Detailed analysis was done only for patients seen in a specialized vitiligo clinic with standardized documentation.

Results

There were 1555 vitiligo cases (prevalence 0.235% [95% confidence interval 0.224-0.247], 938 [60.32%] were female). Detailed analysis for other variables was done in 573 patients. Onset before age 20 years was found in 49%. Family history of vitiligo was reported in 42.15%. Triggering factors were present in 32% with stress being the most common (24%). Proportion of clinical characteristics was as follows: nonsegmental vitiligo (88%), signs of activity (49%), lesional pruritus (25%), halo nevi (4%), leukotrichia (19%). Some patients had isolated facial involvement and others had leukotrichia on the eyelids (not eyelashes). Atopy and hypothyroidism were the most prevalent systemic diseases, while alopecia areata, atopic dermatitis, and psoriasis were the top skin conditions. Antithyroid antibodies were high in approximately a third of patients and the majority of patients had low vitamin D. Elevated erythrocyte sedimentation rate (ESR) was observed more in patients with clinical signs of activity (70% vs 54%, p-value 0.0007).

Conclusion

Prevalence of vitiligo was found to be similar to worldwide figures, with a higher proportion having affected family members. Stress as a trigger, lesional pruritus, signs of activity, thyroid disease, and low vitamin D were all common and should be routinely checked. Novel findings include isolated facial involvement, eyelid leukotrichia, and high ESR in active vitiligo.

Concurrent Refractory Atopic Dermatitis and Generalized Vitiligo Successfully Treated with Abrocitinib: A Case Report

Atopic dermatitis (AD) may sometimes be comorbid with vitiligo. However, these therapeutic agents are often slow acting and lead to various adverse effects, resulting in poor patient compliance. This report describes a 65-year-old male patient with refractory moderate-to-severe atopic dermatitis (AD) and generalized vitiligo. The patient was treated with repeated antihistamine and dupilumab injections; however, erythema and pruritus did not improve. Consequently, oral abrocitinib was administered to treat AD and vitiligo, and the patient's generalized erythema, papules, and pruritus ameliorated with the repigmentation of vitiligo lesions. This case provided evidence of the efficacy and safety of oral abrocitinib for patients with concurrent refractory AD and vitiligo.

Prevalence of psychiatric comorbidities and treatment initiation in African American pediatric patients with vitiligo: A retrospective, single-center, case-control study

Background

Vitiligo may impact psychosocial development, especially among African American pediatric patients, given heightened visibility and increasing rates of anxiety and depression in this subpopulation.

Objective

Evaluate psychiatric comorbidities and treatment initiation in African American pediatric patients.

Methods

A total of 327 African American pediatric patients with vitiligo were each matched to 3 patients without vitiligo by age, race, and sex in this case-control study. Prevalence of psychiatric conditions and subsequent initiation of pharmacotherapy and/or psychotherapy were analyzed.

Results

Compared to controls, pediatric African American patients with vitiligo were significantly more likely to be diagnosed with depression (P < .001) disruptive behavior disorders (P < .001), eating disorders (P = .013), generalized anxiety disorder (P < .001), substance abuse (P = .011), and suicidal ideation (P = .005). Patients with depression, disruptive behavior disorders, and eating disorders had higher initiation rates (76.5%, 82.1%, and 100%, respectively) for psychiatric treatment compared to those with generalized anxiety disorder and substance abuse (55.3% and 61.5%). Nearly 15% of patients did not initiate treatment for suicidal ideation.

Limitations

This retrospective study has a limited sample size in a single institution and does not explore psychiatric treatment efficacy.

Conclusions

Better understanding of associated psychological comorbidities and impacts on African American children of vitiligo may improve quality of life and dermatologic outcomes for these individuals.