The Prevalence of Vitiligo: A Meta-Analysis

Autologous skin cell suspension plus phototherapy in stable vitiligo: findings from a US economic model

INTRODUCTION

A cell harvesting device for preparing non-cultured autologous skin cell suspension (ASCS) at the point-of-care is FDA-approved for repigmentation of stable depigmented vitiligo lesions in patients 18 years and older. The pivotal RSVP trial showed ≥80% repigmentation at Week-24 in 36% of lesions treated with laser ablation, ASCS, and narrowband ultraviolet B phototherapy compared to 0% with phototherapy alone (p = 0.012). The objective of this analysis was to evaluate the potential economic impact of laser ablation plus ASCS with phototherapy versus phototherapy alone for repigmentation of stable vitiligo lesions from a US payer perspective.

METHODS

A 5-year decision-tree model was developed reflecting clinical pathways of adults with stable vitiligo lesions who had an inadequate response to prior topicals and phototherapy. Patients entering the model were treated with ASCS plus phototherapy or phototherapy alone and assessed for treatment response at Weeks-24 and 52 based on the RSVP trial's effectiveness endpoints. Durable response for Year-2 onwards was proxied by melanocyte-keratinocyte transplantation data. Model outcomes included per-patient total and incremental healthcare costs, treatment costs and total costs, cost per-patient per-month (PPPM), and cost per-patient per-year (PPPY). One-way sensitivity analyses assessed model result robustness.

RESULTS

The cumulative total per-patient cost for ASCS plus phototherapy increased from $28,177 to $92,779 between Year-1 and Year-5. Phototherapy alone increased from $21,146 to $101,518 over the same period. Compared to phototherapy alone, ASCS plus phototherapy incurred $7,030 more total per-patient cumulative costs in Year-1 and $8,738 less by Year-5 (-$146 PMPM; -$1,748 PPPY). Breakeven occurred between Years 2-3. Results were most sensitive to changes in ASCS response at Weeks-24 and 52 and healthcare costs.

CONCLUSION

Among adults with stable vitiligo with prior inadequate response to topicals or phototherapy, ASCS treatment may lead to lower all-cause direct medical costs over 5 years compared to phototherapy alone.

Clinical efficacy and safety profile of handheld narrow band ultraviolet B device therapy in vitiligo - Systematic review and meta-analysis

Background Handheld narrowband ultraviolet B (NB-UVB) device is a portable, home-based, patient-friendly equipment used in vitiligo. It is a newer promising treatment that lacks generalised consensus due to heterogenicity among studies. Objective To determine the clinical efficacy and safety profile of handheld NB-UVB devices in the treatment of vitiligo. Methods Following the PRISMA guidelines and using appropriate keywords, the Embase, PubMed and Scopus databases were searched on 28 November 2023. Data on the proportion of patients with a percentage of re-pigmentation and toxicity were extracted from the included studies. Random effects and fixed model were utilised to generate pooled estimates via meta-analysis. Results Out of 250 articles, 13 studies (557 patients) were included. The extent of repigmentation achieved over a median duration of 6 months (range 3-12 months) was quantified to be > 25%, > 50%, and >75 % in 63.6% (95% CI: 51.0-75.3%), 40.8% (95% CI: 30.4-51.6%) and 15.4% (95% CI: 7.6-25.3%) of patients respectively. After 12 weeks of treatment, the proportions of patients achieving > 25%, > 50%, and >75% re-pigmentation were 31.1% (95% CI: 9.6-58.3%), 12.9% (95% CI: 3.1-28.1%) and 6.5% (95% CI: 1.7-14.1%), respectively. Similarly, at 24 weeks, these proportions were 53.2% (95% CI: 24.5-80.7%), 36.7% (95% CI: 15.8-60.5%), and 11.1% (95% CI: 2.9-23.7%). Minimal erythema dose (MED) calculation-based therapy was not significantly better than therapy given without MED calculation (p = 0.43). The studies with only stable vitiligo patients did not achieve significantly greater > 25% (p = 0.06), > 50% (p = 0.80), and > 75% (p = 0.25) re-pigmentation compared to the studies that also included active or slowly progressive vitiligo. Three sessions per week resulted in significantly higher > 50% (p < 0.01) and > 75% (p = 0.01) re-pigmentation. Totally, 11.3% (38/334) of patients showed no response to therapy. The most commonly reported adverse event was erythema in 33.4% (95% CI: 19.3-49.2%) of patients, with grade 3 and 4 erythema in 27 and 15 patients, respectively. Other adverse events included pruritus, burning, hyperpigmentation, dryness, and blister formation observed in 22.1%, 16.4%, 19.1%, 9.8%, and 9.7% of patients, respectively. Conclusion Handheld NB-UVB portable home-based devices are an efficacious and safe treatment option in vitiligo patients even without MED calculation, when the treatment frequency is three to four sessions per week.

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.

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.

Metabolic anomalies in vitiligo: a new frontier for drug repurposing strategies

Vitiligo is a chronic autoimmune condition characterized by the destruction of melanocytes, leading to patchy loss of skin depigmentation. Although its precise cause remains unclear, recent evidence suggests that metabolic disturbances, particularly oxidative stress and mitochondrial dysfunction, may play a significant role in the pathogenesis of the disease. Oxidative stress is thought to damage melanocytes and trigger inflammatory responses, culminating in melanocyte immune-mediate destruction. Additionally, patients with vitiligo often exhibit extra-cutaneous metabolic abnormalities such as abnormal glucose metabolism, dyslipidemia, high fasting plasma glucose levels, high blood pressure, out of range C-peptide and low biological antioxidant capacity, suggesting a potential link between metabolic impairment and vitiligo development. This implies that the loss of functional melanocytes mirrors a more general systemic targetable dysfunction. Notably, therapies targeting metabolic pathways, particularly those involving mitochondrial metabolism, such as the peroxisome proliferator-activated nuclear receptor γ (PPARγ) agonists, are currently being investigated as potential treatments for vitiligo. PPARγ activation restores mitochondrial membrane potential, mitochondrial DNA copy number and, consequently, ATP production. Moreover, PPARγ agonists counteract oxidative stress, reduce inflammation, inhibit apoptosis, and maintain fatty acid metabolism, in addition to the well-known capability to enhance insulin sensitivity. Additionally, increasing evidence of a strong relationship between metabolic alterations and vitiligo pathogenesis suggests a role for other approved anti-diabetic treatments, like metformin and fibrates, in vitiligo treatment. Taken together, these data support the use of approaches alternative to traditional immune-suppressive treatments for the treatment of vitiligo.

Evaluation of the clinical and sociodemographic features of patients with vitiligo from the central region of Romania

Background

In this study, we aimed to investigate and analyze the clinical and sociodemographic features and possible correlation with factors associated with the development of vitiligo in a cohort of patients suffering from this disease in the central region of Romania.

Methods

Patients diagnosed with vitiligo from private outpatient clinics in the region and from the outpatient clinic of the Dermatology Clinic in Târgu Mureş participated in the study. The study period was between March 2021 and March 2022. Both sets of patients adhered to the same specified inclusion and exclusion criteria. Included just patients who received a complete dermatological clinical examination. They were asked by experienced physicians about epidemiological and clinical data of the disease, using the questions about vitiligo from the validated questionnaire edited by the Vitiligo Research Foundation from the United States of America. The patients who were given incomplete responses were excluded. This questionnaire contains 30 questions with multiple answers, about the patients with vitiligo, divided into seven subgroups as follows: group 1. Origins (demographic data), 2. History of vitiligo, 3. Vitiligo description, 4. Vitiligo treatments, 5. Skin condition, 6. Other conditions (comorbidities), 7. Impact (cost of treatments). Our study consisted of 114 patients, all of whom were Caucasians with Fitzpatrick skin types ranging from I-III.

Results

We have analyzed the found data and compared the result with the data found in the literature. Most of the clinical and epidemiological characteristics of vitiligo in our patients were similar to those in other studies. A few of the characteristics linked to the possible appearance of the disease were present in higher percentages like the presence of the disease in the family, lighter color of the eyes, gray colored hair, the presence of the halo naevus, the predisposition to sunburn, the skin trauma as starting cause and the presence of increased level of thyroid disease.

Conclusion

Based on our results, we can conclude a profile of a potential patient who can develop vitiligo. To our knowledge, this study is the first of its kind from our country, however, our inferences remain limited by the single center, a relatively small sample size, recall bias, and a self-decided classification of some clinical aspects, which are potential limitations of this study.

Efficacy of CLT4A variants as immunoregulatory molecules among Vitiligo patients in Saudi Arabia

Vitiligo is a skin depigmentation condition caused by the immune-mediated perdition of melanocytes. In vitiligo, cytotoxic T-lymphocytes damage melanocytes, causing skin depigmentation. The Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) gene has been reported to be related to vitiligo and other autoimmune diseases. The purpose of this study was to explore the molecular involvement of rs231775 and rs3087243 SNPs in the CTLA4 gene in vitiligo patients. The recruitment was based on the sample size calculation and based on it, we have recruited 300 Saudi individuals who were evenly divided into vitiligo cases and controls. Extracted genomic DNA was utilized to amplify rs231775 and rs3087243 SNPs in the CTLA4 gene, which were subsequently digested and verified using Sanger sequencing. The polymerase chain reaction and restriction fragment length polymorphism analysis laboratory data were stored in Excel and used for further statistical analysis. Although baseline details had no correlation (p > 0.05) between the two groups, Hardy-Weinberg Equilibrium analysis was in agreement with the vitiligo patients (p > 0.05). The genotype and allele frequencies were frequently associated (p < 0.05) with rs3087243, and rs231775 SNP showed a nominal association with GG genotype and G allele (p < 0.05). The specific relationship in vitiligo cases was revealed by MDR, GDMR, and linkage disequilibrium (p < 0.05), but not with haplotype analysis (p > 0.05). Thus, the study concluded that rs3087243 SNP was associated and rs231775 SNP showed a nominal association with vitiligo in the Saudi population.

The Efficacy of 308-nm Excimer Laser With TopicalBimatoprost 0.03% for Facial Vitiligo

BACKGROUND

Vitiligo is a commonly acquired autoimmune pigmentary disorder. Some patients resist conventional treatments, leading to the search for combination therapies.

AIMS

This study aimed to compare the efficacy of 308-nm excimer laser monotherapy versus combined treatment with topical bimatoprost 0.03% in patients with facial vitiligo.

PATIENTS AND METHODS

A single-blind randomized clinical trial was conducted at Razi Hospital, Tehran, on 38 patients with facial vitiligo who had at least one facial vitiligo patch and had not undergone treatment in the past 3 months. The patients were randomly allocated to either the intervention group (n = 18) or the control group (n = 20). Both groups received 308-nm EL therapy twice weekly for 15 weeks, while the intervention group additionally applied 0.03% bimatoprost solution daily. The patients were visited at the end of every 5 weeks and after the 15th week. Efficacy was evaluated using the scale for improvement assessment (SAI), visual analog scale satisfaction (VASS), and visual analog scale improvement (VASI). Data analysis was performed using the Mann-Whitney and t-tests, with a significance level set at p < 0.05.

RESULTS

Of the total patients, 27 (71.05%) were female and 11 (28.95%) were male. The male-to-female ratio was 50% in the intervention group and 33.33% in the control group. The mean VASI score, as the primary outcome, showed a significant increase over time in the intervention group (p ≤ 0.001), increasing from 4.53 to 7.20 (an increase of 2.67 units). Additionally, the intervention had a significant effect on the VASI outcome compared to the control (p ≤ 0.001; mean difference: 2.55 [1.63 to 3.47]). As the secondary outcomes, the mean VASS and SAI scores significantly decreased over time in the intervention group (p ≤ 0.05). The intervention also significantly affected the VASS and SAI outcomes compared to the control (p ≤ 0.001). The side effects of the intervention group were hypertrichosis in three patients and erythema burning in one patient.

CONCLUSIONS

Adding bimatoprost 0.03% to the treatment regimen may improve the outcomes of patients with facial vitiligo who are resistant to conventional treatments.

Evaluation of the serum level of Lipocalin 2 in vitiligo

Vitiligo is considered as depigmenting skin disorder where patches of skin losing their pigment. Lipocalin-2 (LCN2) is one of the Inflammatory adipokines that has a potential role in skin disorders and other inflammatory diseases as well. To measure the concentration level of LCN2 in vitiligo patients compared to healthy controls and to investigate its relation to disease activity and other clinical data to evaluate its role in the pathogenesis of the disease. Eighty individuals subdivided equally into two groups (vitiligo and controls) were enrolled in the study. The serum level of LCN2 was measured by ELISA where from all participants, a 5-mL venous blood was withdrawn in plain tube from each subject. There were high significant difference of LCN2 in serum between both groups where LCN2 was higher in vitiligo patients than than controls with mean and standard deviations of 399.2 ± 134.6 and 257.2 ± 42.5 respectively (p < 0.001). The level of LCN2 tended to increase in vitiligo patients with sudden onset than gradual patients showing a significant difference with p-value 0.030. Regarding the severity of the disease results showed that the level of LCN2 tended to increase in moderate and severe patients than mild but with no significant difference between the groups. LCN2 may play a vital role and a good marker for the early diagnosis and the pathogenesis of vitiligo disease.

Short-term efficacy and safety of upadacitinib combined with 308 excimer light versus upadacitinib alone and 308 excimer light alone in patients with progressing facial vitiligo

Patients with progressing facial vitiligo who had been treated with upadacitinib, 308 nm excimer light and upadacitinib combined with 308 nm excimer light were selected for retrospective analysis and comparison of their efficacy and safety. Efficacy was evaluated using the Vitiligo Area Severity Index (VASI) and Dermatology Life Quality Index (DLQI) at baseline, after 8 weeks, and after 20 weeks. The progression of skin lesions was monitored through reflectance confocal microscopy (RCM), while adverse reactions were documented. In the combination treatment group, the average VASI at baseline was 0.875 ± 0.4111, which decreased to 0.56 ± 0.32 at week 8 and 0.23 ± 0.218 at week 20 of follow-up (F = 9.918, p = 0.001). RCM analysis indicated that cases achieving VASI100 showed restoration to normalcy regarding loss of integrity within the pigment ring in lesion areas. Although one patient experienced exacerbation of acne, this condition was manageable with topical medication. In contrast, the average VASI score in the 308 nm excimer light group prior to treatment was recorded at 0.908 ± 0.334; by week twenty, it further declined to an average of 0.495 ± 0.4196. The differences observed were statistically significant (F = 28.644, p < 0.001). For patients in the upadacitinib group, the initial average VASI score was noted as being 0.825 ± 0.34; by twenty weeks it averaged approximately 0.53 ± 0.33; however, these differences did not reach statistical significance (F = 2.87, p = 0.14). The efficacy of the combined treatment group was significantly superior compared to both other groups (F = 3.927, p = 0.026). In conclusion, upadacitinib combined with308nm excimer light represents an effective therapeutic option for progressive facial vitiligo and is associated with fewer adverse reactions as well as improved quality of life for patients.

Safety and Efficacy of Tacrolimus Ointment Alone in the Treatment of Pediatric Vitiligo: A Systematic Review and Meta-Analysis

Introduction

Vitiligo, a skin disorder affecting melanocytes, poses treatment challenges. There is a need to investigate the role of tacrolimus in pediatric cases for its efficacy and safety. The present study aimed to assess the safety and efficacy of tacrolimus ointment in treating pediatric vitiligo patients.

Methods

A review study was conducted, and a literature search was done on 2 August 2023, by using the words "vitiligo" and "tacrolimus" through five databases including PubMed. We found 8 studies from 930 records.

Results

The rates of excellent, moderate, mild, minimal improvement, and no response were 29% (95% CI: 16-47), 26% (95% CI: 19-35), 28% (95% CI: 20-37), 19% (95% CI: 12-29), and 8% (95% CI: 2-25). No systemic side effects were reported. The overall prevalence of local side effects was 14% (95% CI: 7-24). Burning sensation prevalence was 11% (95% CI: 7-18), while pruritus prevalence was 9% (95% CI: 2-33). Study limitations encompassed varied vitiligo sites, patient demographics, and follow-up durations, lacked comparative treatment data, and necessitated further research on combined therapies, especially in pediatric cases.

Conclusion

Tacrolimus showed good efficacy regarding the re-pigmentation improvement in pediatric vitiligo patients. Furthermore, no systemic side effects were reported and local side effects were minimal mainly in the form of a burning sensation and pruritus.

The lifetime risk and impact of vitiligo across sociodemographic groups: a UK population-based cohort study

BACKGROUND

Vitiligo is an autoimmune skin disorder characterized by depigmented patches of skin, which can have significant psychological impacts.

OBJECTIVES

To estimate the lifetime incidence of vitiligo, overall, by ethnicity and across other sociodemographic subgroups, and to investigate the impacts of vitiligo on mental health, work and healthcare utilization.

METHODS

Incident cases of vitiligo were identified in the Optimum Patient Care Database of primary care records in the UK between 1 January 2004 and 31 December 2020. The lifetime incidence of vitiligo was estimated at age 80 years using modified time-to-event models with age as the timescale, overall and stratified by ethnicity, sex and deprivation. Depression, anxiety, sleep disturbance, healthcare utilization and work-related outcomes were assessed in the 2 years after vitiligo diagnosis and compared with matched controls without vitiligo. The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (NCT06097494).

RESULTS

In total, 9460 adults and children were newly diagnosed with vitiligo during the study period. The overall cumulative lifetime incidence was 0.92% at 80 years of age [95% confidence interval (CI) 0.90-0.94]. Cumulative incidence was similar in female (0.94%, 95% CI 0.92-0.97) and male patients (0.89%, 95% CI 0.86-0.92). There were substantial differences in lifetime incidence across ethnic groups, listed by Office for National Statistics criteria [Asian 3.58% (95% CI 3.38-3.78); Black 2.18% (95% CI 1.85-2.50); Mixed/multiple 2.03% (95% CI 1.58-2.47); Other 1.05% (95% CI 0.94-1.17); and White 0.73% (95% CI 0.71-0.76)]. Compared with matched controls, people with vitiligo had an increased risk of depression [adjusted odds ratio (aOR) 1.08, 95% CI 1.01-1.15]; anxiety (aOR 1.19, 95% CI 1.09-1.30); depression or anxiety (aOR 1.10, 95% CI 1.03-1.17); and sleep disturbance [adjusted hazard ratio (aHR) 1.15, 95% CI 1.02-1.31]. People with vitiligo also had a greater number of primary care encounters (adjusted incidence rate ratio 1.29, 95% CI 1.26-1.32) and a greater risk of time off work (aHR 1.15, 95% CI 1.06-1.24). There was little evidence of disparities in vitiligo-related impacts across ethnic subgroups.

CONCLUSIONS

Clinicians should be aware of the markedly increased incidence of vitiligo in people belonging to Asian, Black, Mixed/multiple and Other groups. The negative impact of vitiligo on mental health, work and healthcare utilization highlights the importance of monitoring people with vitiligo to identify those who need additional support.

An Overview of the Biological Complexity of Vitiligo

Vitiligo is a skin disease that affects all ethnicities and genders and is characterized by the loss of pigment essentially due to the selective loss of melanocytes. Although it is generally considered a systemic disease associated with polymorphisms in genes involved in the immune response, vitiligo is also considered an oxidative imbalance-associated disease. It represents a multifactorial pathology in which some genetic predisposition and epigenetic factors coupled with some critical biochemical and molecular pathways could play a pivotal role. The aim of this work was thus to review some of the fine cellular mechanisms involved in the etiopathogenesis of vitiligo, mainly focusing on the nonimmunological ones, extensively highlighted elsewhere. We took into consideration, in addition to oxidative stress, both the cause and the hallmark of the pathology, some less investigated aspects such as the role of epigenetic factors, e.g., microRNAs, of receptors of catecholamines, and the more recently recognized role of the mitochondria. Sex differences associated with vitiligo have also been investigated starting from sex hormones and the receptors through which they exert their influence. From literature analysis, a picture seems to emerge in which vitiligo can be considered not just a melanocyte-affecting disease but a systemic pathology that compromises the homeostasis of a complex tissue such as the skin, in which different cell types reside playing multifaceted physiological roles for the entire organism. The exact sequence of cellular and subcellular events associated with vitiligo is still a matter of debate. However, the knowledge of the individual biological factors implicated in vitiligo could help physicians to highlight useful innovative markers of progression and provide, in the long run, new targets for more tailored treatments based on individual manifestations of the disease.

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.

Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence

OBJECTIVE

The relationship between vitiligo and cardiovascular diseases remains controversial. This study aimed to systematically review the evidence comparing cardiovascular disease risk factors between patients with vitiligo and controls and to perform a meta-analysis of the results.

DATA SOURCES

A comprehensive database search was performed for all studies in PubMed, EMBASE, and Cochrane Central Register databases from inception to November, 2023. The main keywords used were vitiligo, hypertension, diabetes, hyperlipidemia, metabolic syndrome, obesity, smoking, alcohol consumption, C-reactive protein, and homocysteine.

STUDY SELECTION

Only observational studies and no randomized controlled trials were included. Of the 1269 studies initially selected, the full texts of 108 were assessed for eligibility, and 74 were ultimately included in the analysis.

DATA EXTRACTION AND SYNTHESIS

Three reviewers independently extracted the following data: study design, number and characteristics of participants, inclusion indicators, and disease duration. A meta-analysis of the single-group rates was performed for the diabetes, hypertension, hyperlipidemia, and obesity groups. Random-effects or fixed-effects models were used to calculate the sample-size weighted averages for the indicators included in the studies.

MAIN OUTCOMES AND MEASURES

The primary outcomes were co-morbidity analysis and co-morbidity rates of vitiligo with metabolic syndrome, obesity, hyperlipidemia, hypertension, and diabetes mellitus. Secondary outcomes were factors associated with vitiligo and cardiovascular disease.

RESULTS

This meta-analysis concluded that comorbidities in patients with vitiligo included metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%, respectively. Simultaneously, we showed that the vitiligo group differed significantly from the control group in the following aspects: fasting blood glucose, insulin, systolic and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, homocysteine, C-reactive protein, smoking, and alcohol consumption. However, no significant differences were observed between the vitiligo and control groups in terms of waist circumference, body mass index, or phospholipid levels.

LIMITATIONS

The vast majority of the studies were from Eastern countries; therefore, extrapolation of these results to Western populations is questionable. The significant heterogeneity may be due to different protocols, doses, durations, center settings, population registries, etc., which severely compromise the validity of the results.

CONCLUSION

This study summarized not only the factors associated with, but also those not associated with, cardiovascular disease in patients with vitiligo. This study provides a foundation for the prevention and treatment of cardiovascular disease in patients with vitiligo.

Silymarin in combination with hair follicle transplantation as a potential treatment for refractory vitiligo: A double-blind randomized controlled trial

BACKGROUND

There is still no certain effective treatment for vitiligo as a common chronic skin disorder characterized by depigmented patches and loss of skin melanocytes.

OBJECTIVES

This study evaluates the efficacy of oral silymarin combined with hair follicle transplantation compared to follicle transplantation alone in the treatment of refractory vitiligo.

MATERIALS AND METHODS

Twenty refractory vitiligo patients were enrolled in this randomized controlled clinical trial, following up for 3 months. One group underwent hair transplantation plus oral silymarin, while the other group underwent follicle transplantation alone. We assessed the progress with Vitiligo Extent Tensity Index (VETI) in both groups and the peri-follicular pigmentation diameter was estimated monthly. The Friedman test for comparing two groups at the end and the Mann-Whitney test for comparing two groups during each month was used.

RESULTS

The mean age was 30.22 (18-59) years, with the male to female ratio of 1:1. The decrease in the VETI and increase in the perifollicular pigmentation was statistically significant between silymarin and another group in monthly follow-up (p-value: 0.019, 0.019, and 0.035, respectively). Finally, the re-pigmentation was notable in silymarin group (p-value <0.001 vs. 0.029, respectively). In addition, both genders had a significant increase in peri-follicular re-pigmentation in the last follow-up (p-value: 0.012 and 0.044, respectively); although the improvement was not statistically significant between genders in each month.

CONCLUSION

According to our study, silymarin in combination with hair transplantation could be a potential medical treatment for vitiligo; however, further trials are needed to establish the efficacy of combination therapies.

Unexpected Repigmentation of Vitiligo Universalis Following Hemodialysis Initiation: A Rare Case Report and Literature Overview

Vitiligo is a chronic skin depigmentation disorder affecting 0.2-1.8% of the global population, with a significant prevalence in Saudi Arabia. Although not life-threatening, it severely impacts the quality of life and psychological well-being of patients. We report a rare instance of hemodialysis-induced skin repigmentation involving a 25-year-old woman with vitiligo universalis.

Prevalence of co-existing autoimmune and autoinflammatory diseases in vitiligo: a survey-based study from Egypt

BACKGROUND

The exact cause of vitiligo is still unknown. Genetic factors, self-destruction of melanocytes, the autoimmune process, and oxidative stress all can contribute to the pathogenesis of vitiligo.

OBJECTIVES

The aim of this study was to figure out the frequency of coexisting autoimmune and autoinflammatory diseases (AIIDs) in Egyptian patients with vitiligo and identify the associated risk factors.

MATERIALS AND METHODS

Egyptian children and adults with vitiligo and their parents were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical, and therapeutic data. The vitiligo disease activity (VIDA) score was evaluated for all the patients. Patients were also asked about the presence of co-existing AIIDs.

RESULTS

There was a total of 294 participants, mostly females (54.8%), with a median age of 35 years and a median disease duration of 9 years. Nearly 27% had at least one AIID. The most common associated AIIDs were autoimmune thyroid disease (47 patients, 16%), followed by alopecia areata (14 patients,4.8%), then psoriasis and rheumatoid arthritis (11 patients, 3.7%). Univariate regression analysis revealed that age (OR 1.02, P = 0.036), female gender (OR 2.2, P = 0.004), disease duration (OR 1.04, P < 0.001), affected body surface area (OR 1.7, P = 0.048), and family history of AIIDs (OR 2.7, P < 0.001) were predictors for the presence of AIIDs in patients with vitiligo.

CONCLUSION

AIIDs are prevalent among vitiligo patients. Age, female gender, and family history of AIIDs are the main predictors of the presence of AIIDs in vitiligo patients.

Short-term (24 weeks) treatment efficacy and safety of ruxolitinib cream in participants with vitiligo: a systematic review and meta-analysis

IMPORTANCE

Vitiligo is a chronic skin disorder causing depigmentation. There is a lack of evidence-based medical evidence regarding ruxolitinib efficacy and safety for vitiligo.

OBJECTIVE

To assess the efficacy and safety of ruxolitinib cream in the treatment of vitiligo.

METHODS

The databases of PubMed, Embase, and Cochrane Library were searched. The literature screening was independently conducted by two reviewers.

DATA EXTRACTION AND SYNTHESIS

For continuous variables, weighted mean difference (WMD) along with a 95% confidence interval (CI) was performed. For dichotomous outcomes, we calculated the odds ratios (ORs) or risk ratios (RRs), and their corresponding 95% CIs. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

MAIN OUTCOMES AND MEASURES

Symptoms, quality of life, and safety were evaluated using various measures, including the Facial Vitiligo Area Scoring Index (F-VASI), Total Vitiligo Area Scoring Index (T-VASI), Facial Body Surface Area (F-BAS), Total Body Surface Area (T-BAS) and Treatment-emergent Adverse Events (TEAEs).

RESULTS

Three trials, involving a total of 830 participants from nine countries were included (female 388, 46.7%, male 442, 53.3%). The meta-analysis demonstrated a significant increase in the likelihood of participants achieving F-VASI75 (OR, 4.34 [95% CI 2.67-7.06]; high), F-VASI50 (OR 4.71 [95% CI 3.24-6.84]; high), T-VASI75 (OR 2.78 [95% CI 1.10-7.00]; moderate), and T-VASI50 (OR 4.47 [95% CI 2.52-7.92]; high) when compared ruxolitinib to vehicle. Ruxolitinib was associated with more lowered percentage change of F-VASI scores (MD - 32.79 [95% CI - 36.37 to - 29.21]; moderate), and T-VASI scores (MD - 20.22 [95% CI - 23.11 to - 17.33]; moderate) from baseline compared to vehicle. There may not be a significant difference in the occurrence of TEAEs between ruxolitinib and vehicle (RR 1.46 [95% CI 0.85-2.49]; high).

CONCLUSIONS

The findings suggest that ruxolitinib cream holds promise as a treatment option for vitiligo. Further long-term studies are needed to assess its sustained efficacy and safety profile.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023431112.

Vitiligo - a disease: A position paper on stigmatization, life quality impairment and psychosocial comorbidity

Vitiligo is a common disorder characterized by the visible loss of skin pigmentation. Non-segmental vitiligo (NSV) is the major subtype. The disease is caused by autoimmune-mediated destruction of melanocytes. Vitiligo leads to stigmatization and a significant reduction in quality of life. Disregarding the psychosocial burden, vitiligo is sometimes viewed solely as a cosmetic problem and, according to a global survey, is diagnosed on average only after 2.4 years. This delay contributes to a considerable burden of disease, including suicidal ideation. Stigmatization promotes the development of psychological comorbidities such as anxiety and depressive disorders, with prevalence rates varying by country and study (0.1%-67.9%). Data for Germany are heterogeneous and largely based on estimates. Due to psychosocial factors, the inflammatory component, and a higher incidence of somatic comorbidities, NSV may be regarded as an inflammatory systemic disease. We recommend optimizing care by incorporating the assessment of quality of life as a standard in routine care, in addition to monitoring disease activity. Moreover, early screening for psychological comorbidities is crucial to initiate appropriate treatment before the condition becomes chronic and cumulative (irreversible) impairments occur. The goal is a personalized and patient-centered integrated care approach that sustainably improves the health status of those affected.

Proportion Of vitiligo and associated factors among patients visiting dermatology opd in tibebe ghion specialized hospital and addisalem primary hospital, bahirdar city, Ethiopia,2023

OBJECTIVE

This study aimed to determine the prevalence of vitiligo and associated factors among patients visiting the dermatologic outpatient departments at Tibebe Ghion Specialized Hospital and Addisalem Primary Hospitals, Bahir Dar, Ethiopia, from September 15 to November 15, 2023.

RESULTS

Among the 460 patients studied, 243 (52.8%) were female, with the majority (28.9%) aged between 25 and 34 years. The overall prevalence of vitiligo was found to be 7.4% (34 patients). Significant predictors of vitiligo included rural residence (AOR: 3.18; 95% CI: 1.10-9.18), family history of vitiligo (AOR: 2.20; 95% CI: 2.16-4.76), and aggravating factors such as trauma (AOR: 1.08; 95% CI: 1.01-2.08). The highest prevalence was observed in the 14-24 age group. These findings suggest the importance of awareness campaigns focusing on the causes, symptoms, and treatments of vitiligo, particularly among young adults in rural areas.

Off-Label Uses of Abrocitinib: Review of Emerging Therapeutic Applications beyond Atopic Dermatitis

Abrocitinib, an oral small-molecule Janus Kinase 1 (JAK1) inhibitor, is primarily approved for treating moderate-to-severe atopic dermatitis (AD) in adults and adolescents aged 12 and older. This review examines the emerging off-label uses of Abrocitinib. We identified 37 papers reporting on the use of Abrocitinib in various conditions other than AD. The most commonly reported uses were for vitiligo, prurigo nodularis, and hand eczema, with 12 cases each. There were also 10 cases of lichen sclerosus and chronic pruritus of unknown origin and 5 cases each of pityriasis rubra pilaris alopecia areata. Additionally, erythematotelangiectatic rosacea and steroid-induced rosacea were reported in four cases each. Other conditions treated with Abrocitinib were noted, but these mostly had only one or two reported cases. Interestingly, out of the 103 patients reviewed, all studies reported favorable clinical outcomes and satisfactory results, with the exception of one isolated case where Abrocitinib was used to treat erythematotelangiectatic rosacea.

Identification of dietary factors that impact the gut microbiota associated with vitiligo: A Mendelian randomization study and meta-analysis

Previous observational studies have suggested that gut microbiota might be associated with vitiligo. However, owing to the limitations in observational studies of reverse causality and confounders, it remains unclear that whether and how the causal relationships exist. The results suggested that pylum.Bacteroidetes, family.BacteroidalesS24.7, genus.LachnospiraceaeND3007, genus.Marvinbryantia are protective factors for vitiligo. Conversely, family.Lachnospiraceae, order.Burkholderiales, genus.Adlercreutzia, genus.Catenibacterium and genus.Lachnospira are risk factors for vitiligo. In addition, the causative connection between dietary factors and the gut microbiota associated with vitiligo was also investigated. The results revealed that 'alcohol intake versus 10 years pervious' results in a reduction in the abundance of genus.Lachnospiraceae ND3007 and family.BacteroidalesS24.7, bread intake leads to a reduction of genus.Marvinbryantia, 'average weekly red wine intake' is linked to a decrease in the abundance of order.Burkholderiales, tea intake is associated with an augmentation in the abundance of genus.Catenibacterium, salad/raw vegetable intake elevates the abundance of order.Burkholderiales. In summary, this Mendelian randomization study substantiates potential causal effects of gut microbiota on vitiligo. Modulating the gut microbiota through regulating dietary composition may be a novel strategy for preventing vitiligo.

Genome-Wide Meta-Analysis Identifies 11 Susceptibility Variants of Vitiligo in the Chinese Han Population

Vitiligo is an autoimmune disease involving loss of melanocytes. Although several genetic studies have confirmed that genetic factors play an important role, its pathogenesis remains incompletely characterized. In this study, a genome-wide meta-analysis was conducted to search for more susceptibility variants of vitiligo. Tang et al performed a GWAS for cohort I (1117 vitiligo cases and 1701 healthy controls) previously, and we conducted a GWAS for cohort II (3323 vitiligo cases and 7186 healthy controls) in this study, with the results subjected to a genome-wide meta-analysis and linkage disequilibrium analysis. We identify, to our knowledge, 11 previously unreported susceptibility variants, of which 6 variants are located in the intronic regions, and the remaining 5 variants are located within intergenic regions between genes. In addition, the results of polygenic risk score show that the best evaluated effect for target data is among significant SNVs of the base data. The susceptibility genes of vitiligo are mainly enriched in the immune-related functions and pathways. The susceptibility variants expand the role of genetic factors associated with vitiligo. The bioinformatics analysis for risk genes provides further insight into the pathogenesis of vitiligo.

Estimation of genetic variation in vitiligo associated genes: Population genomics perspective

BACKGROUND

Vitiligo is an auto-immune progressive depigmentation disorder of the skin due to loss of melanocytes. Genetic risk is one of the important factors for development of vitiligo. Preponderance of vitiligo in certain ethnicities is known which can be analysed by understanding the distribution of allele frequencies across normal populations. Earlier GWAS identified 108 risk alleles for vitiligo in Europeans and East Asians. In this study, 64 of these risk alleles were used for analysing their enrichment and depletion across populations (1000 Genomes Project and IndiGen) with reference to 1000 Genomes dataset. Genetic risk scores were calculated and Fisher's exact test was performed to understand statistical significance of their variation in each population with respect to 1000 Genomes dataset as reference. In addition to SNPs reported in GWAS, significant variation in allele frequencies of 1079 vitiligo-related genes were also analysed. Two-tailed Chi-square test and Bonferroni's multiple adjustment values along with fixation index (≥ 0.5) and minimum allele frequency (≥ 0.05) were calculated and used to prioritise the variants based on pairwise comparison across populations.

RESULTS

Risk alleles rs1043101 and rs10768122 belong to 3 prime UTR of glutamate receptor gene SLC1A2 are found to be highly enriched in the South Asian population when compared with the 'global normal' population. Intron variant rs4766578 (ATXN2) was found to be deleted in SAS, EAS and AFR and enriched in EUR and AMR1. This risk allele is found to be under positive selection in SAS, AMR1 and EUR. From the ancillary vitiligo gene list, nonsynonymous variant rs16891982 was found to be enriched in the European and the Admixed American populations and depleted in all others. rs2279238 and rs11039155 belonging to the LXR-α gene involved in regulation of metalloproteinase 2 and 9 (melanocyte precursors) were found to be associated with vitiligo in the North Indian population (in earlier study).

CONCLUSION

The differential enrichment/depletion profile of the risk alleles provides insight into the underlying inter-population variations. This would provide clues towards prioritisation of SNPs associated with vitiligo thereby elucidating its preponderance in different ethnic groups.

Polyphenols targeting multiple molecular targets and pathways for the treatment of vitiligo

Vitiligo, a pigmentary autoimmune disorder, is marked by the selective loss of melanocytes in the skin, leading to the appearance of depigmented patches. The principal pathological mechanism is the melanocyte destruction mediated by CD8+ T cells, modulated by oxidative stress and immune dysregulation. Vitiligo affects both physical health and psychological well-being, diminishing the quality of life. Polyphenols, naturally occurring compounds with diverse pharmacological properties, including antioxidant and anti-inflammatory activities, have demonstrated efficacy in managing various dermatological conditions through multiple pathways. This review provides a comprehensive analysis of vitiligo and the therapeutic potential of natural polyphenolic compounds. We examine the roles of various polyphenols in vitiligo management through antioxidant and immunomodulatory effects, melanogenesis promotion, and apoptosis reduction. The review underscores the need for further investigation into the precise molecular mechanisms of these compounds in vitiligo treatment and the exploration of their combination with current therapies to augment therapeutic outcomes.

Burden of disease and treatment patterns in patients with vitiligo: findings from a national longitudinal retrospective study in the UK

BACKGROUND

UK studies examining vitiligo burden and vitiligo-related healthcare resource utilization (HCRU) are lacking.

OBJECTIVE

To describe the incidence and prevalence of vitiligo, the demographic and clinical characteristics of patients with vitiligo, vitiligo burden, HCRU, incidence of mental health comorbidities and management strategies, including treatment patterns.

METHODS

This retrospective study used UK Clinical Practice Research Datalink and Hospital Episode Statistics databases to analyse patients with vitiligo from 1 January 2010 to 31 December 2021.

RESULTS

Among 17 239 incident patients, mean incidence of vitiligo was 0.16 (2010-2021) per 1000 person-years [PY; range 0.10 (2020-COVID-19) to 0.19 (2010/2013/2018)]; among 66 217 prevalent patients, prevalence increased from 0.21% (2010) to 0.38% (2021). The most common comorbidities recorded after vitiligo diagnosis were diabetes (19.4%), eczema (8.9%), thyroid disease (7.5%) and rheumatoid arthritis (6.9%). Mental health diagnoses recorded at any time included depression and/or anxiety (24.6%), depression (18.5%), anxiety (16.0%) and sleep disturbance (12.7%), and recorded after vitiligo diagnosis in 6.4%, 4.4%, 5.5% and 3.9%, respectively. Mental health comorbidities were more common in White (e.g. depression and/or anxiety 29.0%) than in Black (18.8%) and Asian (16.1%) patients. In adolescents, depression and/or anxiety was most commonly diagnosed after a vitiligo diagnosis than before (7.4% vs. 1.8%). Healthcare resources were used most frequently in the first year after vitiligo diagnosis (incident cohort), typically dermatology-related outpatient appointments (101.9/100 PY) and general practitioner consultations (97.9/100 PY). In the year after diagnosis, 60.8% of incident patients did not receive vitiligo-related treatment (i.e. topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids or phototherapy), increasing to 82.0% the next year; median time from diagnosis to first treatment was 34.0 months (95% confidence interval 31.6-36.4). Antidepressants and/or anxiolytics were recorded for 16.7% of incident patients in the year after diagnosis. In 2019, 85.0% of prevalent patients did not receive vitiligo-related treatments.

CONCLUSION

Most patients were not on vitiligo-related treatments within a year of diagnosis, with the time to first treatment exceeding 2 years, suggesting that vitiligo may be dismissed as unimportant. New effective treatments, early initiation and psychological intervention and support are needed to reduce the vitiligo burden on patients.

Differential expression of serum CXCL9 and CXCL10 levels in vitiligo patients and their correlation with disease severity and stability: A cross-sectional study

Background Vitiligo is an acquired disorder of pigmentation with an elusive pathogenesis, though various theories have been proposed. The presence of peri-lesional autoreactive CD8+ T cell infiltrate suggests the involvement of abnormal immune responses and autoimmunity in vitiligo. Recent studies have identified the IFN-γ-CXCL9/CXCL-10 axis as a key component of the autoimmune response that perpetuates disease activity in vitiligo. Objectives The primary objective was to estimate serum CXCL9 and CXCL10 levels in vitiligo patients compared to age- and sex-matched controls. Additionally, the study aimed to find correlations between CXCL9 and CXCL10 levels and disease severity and stability. Secondary objectives included comparing levels in segmental/nonsegmental vitiligo and stable/progressive vitiligo and assessing the impact of age and gender. Methods A hospital-based cross-sectional study included 60 vitiligo patients and 30 age- and sex-matched controls. Serum levels of CXCL9 and CXCL10 were assessed using Enzyme-linked immunosorbent assay (ELISA). Cases were clinically evaluated for the type of vitiligo (segmental or non-segmental), disease severity (VASI score), and disease stability (VIDA score). Statistical analysis included t-tests, chi-square tests, and correlation coefficients. P value less than 0.5 was taken as significant. Results Serum CXCL9 and CXCL10, both, were significantly raised in vitiligo patients as compared to controls (p-value = 0.001* & 0.001* respectively) and correlated positively with both VASI score (p-value = 0.001* & 0.001* respectively) and with VIDA score (p-value = 0.032* & 0.001* respectively). Serum CXCL10 showed significant elevation in progressive vitiligo, and CXCL9 exhibited a non-significant trend. No significant difference was observed between segmental and non-segmental vitiligo. Both chemokines positively correlated with disease severity and stability, while age and gender did not significantly impact chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlated positively with disease severity & instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. Both serum CXCL9 and CXCL10 were significantly elevated in vitiligo patients compared to controls and they can be used as potential serum biomarkers for assessing the disease activity. Limitations Small sample size of control population. The voluntary sampling technique led to an unequal number of patients in progressive and stable vitiligo groups, as well as in segmental and non-segmental groups. The current study did not include blister fluid analysis and the effect of therapy on the chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlates positively with disease severity and instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. *represents statistically significant results.

Assessment of the Quality of Life of Vitiligo Patients: A Cross-Sectional Study in the Eastern Region of Saudi Arabia

Background Vitiligo is a prevalent skin disease that results from the loss of melanocytes and subsequent hypo-melanosis, resulting in the depigmentation of the skin. It not only presents as pathological manifestations but also imposes a substantial psychological burden and exerts a significant influence on the quality of life (QOL) of individuals. This research proposal seeks to systematically explore the association between vitiligo and the QOL of affected individuals, employing rigorous scientific methodologies to identify effective interventions aimed at improving their holistic well-being. Methodology It was a cross-sectional survey conducted in the Eastern Region of the Kingdom of Saudi Arabia (KSA). Data collection utilizes an online survey through Google Forms and employs the Dermatology Life Quality Index (DLQI). Appropriate statistical analyses were performed. Results Our study comprised 263 vitiligo patients, 55.1% of whom were females and 54.4% of whom were aged 18-30. Impact assessment revealed a substantial emotional toll (56.3% embarrassed), affecting daily activities (42.6%) and clothing choices (43.7%). Notably, 36.5% reported very much impact on relationships and 35.7% on sexual problems. Notably, 41.4% face a very large impact, and 35.4% face an extremely large impact. Linear regression identified a significant gender difference (p = 0.008), with males experiencing less QOL impact or females experiencing more QOL impact due to vitiligo. Age and marital status showed nonsignificant associations. Conclusions Our study highlights the substantial impact of vitiligo on the QOL among Saudi adults. Gender significantly influences severity, with females experiencing a more severe impact on the QoL, emphasizing the need for tailored interventions and support.

Radiotherapy-induced vitiligo in a patient with breast cancer, a case report

Vitiligo is a disease characterised by the autoimmune destruction of melanocytes, manifesting as depigmentation of the skin. We present the case of a female patient with a history of breast cancer who developed vitiligo in the area of the treatment field 12 months after the end of radiotherapy. It has been reported in the literature that vitiligo can occur in patients with a history of vitiligo after radiotherapy, attributable to the Koebner phenomenon, where some treatments can induce new vitiligo lesions in the patient.

Vitiligo and Prostate Cancer Correlation

A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of cutaneous depigmentation. A shave biopsy of different regions of depigmented skin indicated vitiligo. The patient was prescribed Opzelura (ruxolitinib) 1.5% topical cream as well as tacrolimus 0.1% topical ointment for vitiligo. He also had a history of prostate cancer. A prostate biopsy revealed three sites of prostatic adenocarcinoma with a Gleason score of 6 and a Prostate Imaging-Reporting and Data System (PI-RADS) score of 2. The patient remained in active surveillance for prostate cancer without treatment, due to its low severity. A subsequent biopsy five years later revealed a decrease in prostate cancer prevalence, with cancer present in only one core and at a lower severity. The purpose of this case presentation is to discuss possible links between vitiligo and prostate cancer, as well as their shared mechanisms and pathways.

Characteristics of vitiligo patients with versus without associated autoimmune thyroid disease

BACKGROUND

Clinical data are limited in patients with vitiligo with or without autoimmune thyroid disease.

OBJECTIVES

The objective of the study was to investigate the clinical features and basic data of patients with vitiligo, especially those with autoimmune thyroid disease.

METHODS

The study was a single-center retrospective study. A total of 1305 patients with vitiligo from June 2018 to May 2023 were included, and the clinical characteristics and basic information of the patients were recorded in detail.

RESULTS

We identified an association between sex (odds ratio [OR]: 2.380; 95% confidence interval [CI]: 1.772-1.198), vitiligo duration (OR: 1.449; 95% CI: 1.076-1.952), skin involvement exceeding 5% of the body surface area (OR: 3.764; 95% CI: 2.134-6.640), negative emotions (OR: 3.076; 95% CI: 2.292-4.127), vitiligo type (OR: 1.974; 95% CI: 1.096-3.555), family history of AITD (OR: 4.979; 95% CI: 2.687-9.225), and family history of AD (OR: 2.418; 95% CI: 1.410-4.146) and patients with vitiligo.

CONCLUSIONS

For patients with statistically significant associated risk factors, differential diagnosis and early intervention should be performed.

The IFN-γ-CXCL9/CXCL10-CXCR3 axis in vitiligo: Pathological mechanism and treatment

Vitiligo is a disease featuring distinct white patches that result from melanocyte destruction. The overall pathogenesis of vitiligo remains to be elucidated. Nevertheless, considerable research indicates that adaptive immune activation plays a key role in this process. Specifically, the interferon-gamma (IFN-γ), C-X-C motif chemokine ligands (CXCL9/10), and C-X-C motif chemokine receptor (CXCR3) signaling axis, collectively referred to as IFN-γ-CXCL9/10-CXCR3 or ICC axis, has emerged as a key mediator responsible for the recruitment of autoimmune CXCR3+ CD8+ T cells. These cells serve as executioners of melanocytes by promoting their detachment and apoptosis. Moreover, IFN-γ is generated by activated T cells to create a positive feedback loop, exacerbating the autoimmune response. This review not only delves into the mechanistic insights of the ICC axis but also explores the significant immunological effects of associated cytokines and their receptors. Additionally, the review provides a thorough comparison of existing and emerging treatment options that target the ICC axis for managing vitiligo. This review aims to foster further advancements in basic research within related fields and facilitate a deeper understanding of alternative treatment strategies targeting different elements of the axis.

Human Mesenchymal Stem Cell-Derived Exosomes Promote the Proliferation and Melanogenesis of Primary Melanocytes by Attenuating the H2O2-Related Cytotoxicity in vitro

Background

Mesenchymal stem cell-derived exosomes (MSC-Exo) have therapeutic potential. However, the impact of MSC-Exo on the survival and melanogenesis of human primary melanocytes following H2O2-induced damage has not been clarified. We therefore investigated the effects of MSC-Exo on the H2O2-affected survival of human primary melanocytes and their proliferation, apoptosis, senescence, and melanogenesis in vitro.

Methods

MSC-Exo were prepared from human MSCs by sequential centrifugations and characterized by Transmission Electron Microscopy, Western blot and Nanoparticle Tracking Analysis. Human primary melanocytes were isolated and treated with different concentrations of MSC-Exo, followed by exposing to H2O2. Furthermore, the impact of pretreatment with MSC-Exo on the proliferation, apoptosis, senescence and melanogenesis of melanocytes were tested by CCK-8, flow cytometry, Western blot, L-Dopa staining, tyrosinase activity and RT-qPCR.

Results

Pretreatment with lower doses of MSC-Exo protected human primary melanocytes from the H2O2-triggered apoptosis, while pretreatment with higher doses of MSC-Exo enhanced the H2O2-induced melanocyte apoptosis. Compared with the untreated control, pretreatment with a lower dose (1 µg/mL) of MSC-Exo enhanced the proliferation of melanocytes, abrogated the H2O2-increased p53, p21, IL-1β, IL-6 and IL-8 expression and partially rescued the H2O2-decreased L-dopa staining reaction, tyrosinase activity, MITF and TRP1 expression in melanocytes.

Conclusion

Our findings indicate that treatment with a low dose of MSC-Exo promotes the proliferation and melanogenesis of human primary melanocytes by ameliorating the H2O2-induced apoptosis and senescence of melanocytes. MSC-Exo may be a promising therapeutic strategy of vitiligo.

Prevalence and burden of vitiligo in Africa, the Middle East and Latin America

Vitiligo is a common chronic autoimmune disorder characterized by skin and hair depigmentation that affects 0.5%-2.0% of the global population. Vitiligo is associated with diminished quality of life (QoL) and psychosocial burden. The burden of vitiligo may vary based on skin tone and cultural differences as well as geographical variations in disease awareness, societal stigma, healthcare systems and treatment options. Data on the burden and management of vitiligo in Africa, the Middle East and Latin America are scarce. Literature searches using terms covering vitiligo in Africa, the Middle East and Latin America were conducted using PubMed to identify relevant publications that focused on disease prevalence and burden, QoL and psychosocial impact and disease management between 2011 and 2021. Most of the reviewed studies were conducted in the Middle East, and most Latin American studies were from Brazil. Most studies involved small patient numbers and may not be generalizable. Reported prevalence of vitiligo ranged from 0.18% to 5.3% in Africa and the Middle East, and from 0.04% to 0.57% in Latin America. In several studies, prevalence was higher among female participants. Generally, non-segmental vitiligo was the dominant clinical variant identified and the age at onset varied widely across studies. Common comorbidities include autoimmune diseases such as Hashimoto's thyroiditis, alopecia areata and diabetes. Few treatment guidelines exist in these regions, with the exceptions of guidelines published by the Brazilian and Argentinian Societies of Dermatology. There is a clear unmet need for large epidemiological studies with uniform methodology to accurately ascertain the true prevalence of vitiligo in Africa, the Middle East and Latin America. Additional data on vitiligo burden and management in Africa and Latin America are also needed, along with local disease management guidelines that consider genetic variation, psychosocial burden and socioeconomic diversity in all 3 regions.

Management of the refractory vitiligo patient: current therapeutic strategies and future options

Vitiligo is an autoimmune disease that leads to disfiguring depigmented lesions of skin and mucosa. Although effective treatments are available for vitiligo, there are still some patients with poor responses to conventional treatment. Refractory vitiligo lesions are mostly located on exposed sites such as acral sites and lips, leading to significant life stress. Understanding the causes of refractory vitiligo and developing targeted treatments are essential to enhance vitiligo outcomes. In this review, we summarized recent treatment approaches and some potential methods for refractory vitiligo. Janus kinase inhibitors have shown efficacy in refractory vitiligo. A variety of surgical interventions and fractional carbon dioxide laser have been widely applied to combination therapies. Furthermore, melanocyte regeneration and activation therapies are potentially effective strategies. Patients with refractory vitiligo should be referred to psychological monitoring and interventions to reduce the potential pathogenic effects of chronic stress. Finally, methods for depigmentation and camouflage may be beneficial in achieving uniform skin color and improved quality of life. Our ultimate focus is to provide alternative options for refractory vitiligo and to bring inspiration to future research.

Cigarette smoking is an independent risk factor for developing vitiligo on the hands

BACKGROUND

Vitiligo presents with varying clinical features based on the type and location. Treatment tends to be more effective on the face, neck, trunk, and mid-extremities, while the lips and distal extremities may be more resistant. Vitiligo in frequently exposed areas such as the face, arms, legs, and hands is typically associated with a lower Dermatology Life Quality Index.

OBJECTIVES

We aimed to identify the characteristics and potential causes of vitiligo in challenging-to-treat regions, with particular focus on the hands.

METHODS

We analyzed the clinical data of 337 patients with generalized vitiligo who visited our hospital between 2016 and 2022. For this study, we focused on patients with non-segmental vitiligo (NSV) specifically on their hands. Of the 337 patients, 248 had NSV and 89 had segmental vitiligo; 119 (47%) of those with NSV had vitiligo on their hands. Logistic regression models were applied to identify factors the factors linked to hand vitiligo, such as age, sex, duration of the condition, and smoking and alcohol history.

RESULTS AND CONCLUSIONS

We developed a model to predict the risk of hand vitiligo using several factors. Among the factors analyzed, only smoking history was significantly associated with an increased risk (odds ratio: 3.13). In addition, we used clinical photography to evaluate color-graded frequency heat maps comprising 528 pixels. Vitiligo in nonsmokers widely distributed over the hand, predominantly the fingertips and joints, whereas vitiligo in smokers tended to be distributed mostly at the fingertips.

Vitiligo: Pathogenesis and New and Emerging Treatments

Vitiligo is a complex disease with a multifactorial nature and a high impact on the quality of life of patients. Although there are multiple therapeutic alternatives, there is currently no fully effective treatment for this disease. In the current era, multiple drugs are being developed for the treatment of autoimmune diseases. This review assesses the available evidence on the pathogenesis of vitiligo, and a comprehensive review of treatments available for vitiligo now and in the near future is provided. This qualitative analysis spans 116 articles. We reviewed the mechanism of action, efficacy and safety data of phototherapy, afamelanotide, cyclosporine, phosphodiesterase 4 inhibitors, trichloroacetic acid, basic fibroblast growth factor, tumor necrosis factor (TNF) inhibitors, secukinumab, pseudocatalase and janus kinase (JAK) inhibitors. At the moment, there is no clearly outstanding option or fully satisfactory treatment for vitiligo, so it is necessary to keep up the development of new drugs as well as the publication of long-term effectiveness and safety data for existing treatments.

Vitiligo: Epidemiology and Economic Impact

INTRODUCTION

Vitiligo is an acquired disorder of pigmentation, characterized by the development of white patches on the skin, often with a typical symmetrical distribution and progressive extension . Although vitiligo does not cause direct physical impairment, it can produce a relevant psychosocial burden. Despite this burden, effective treatments are lacking, emphasizing the need for new therapeutic options.

OBJECTIVES

The aim of this study was to systematically scan the scientific literature for studies dealing with vitiligo epidemiology. Additionally, the study aimed to assess the social costs of vitiligo, ultimately raising awareness about the societal impact of the condition. The focus was on Italian data.

METHODS

Our research employed a comprehensive methodology. For the epidemiology, we systematically searched PubMed database up to October 2023 and complemented the analysis with Real World Evidence. For social costs, we conducted an in-depth literature review, administered a web-survey to 20 Italian dermatologists and conducted an equivalent number of interviews during the same period in March 2022.

RESULTS

The data suggest that in Italy the prevalence of vitiligo increases with age, and it varies from 0.19% (age 18-21) to 0.6% (age >45) . We estimated 152,000 patients diagnosed with Non-Segmental Vitiligo (NSV) in Italy; based on Body Surface Area (BSA), 33% are Not Severe, 31% Mild, 27% Moderate/Severe, 9% Very Severe. The yearly social costs of vitiligo amount to €0.5Bln.

CONCLUSIONS

There is a remarkable association of vitiligo with anxiety and depression , and Mental Health is associated with 30% of social costs. Moreover, vitiligo social costs distribution highlights inequity, with patients bearing 55% of them.

The landscape of vitiligo in Latin America: a call to action

Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10-12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.

An extensive review of vitiligo-associated conditions

Vitiligo is an autoimmune disorder caused by the destruction of melanocytes in various body regions. Numerous diseases may accompany vitiligo. The prevalence of vitiligo varies among geographical regions and shows no relation to sex or age. However, vitiligo most commonly affects people aged 10 to 30 years. The clinical symptoms of vitiligo include irregular patches on the skin and various diseases associated with this disorder. The present review focuses on the clinical effects and risk factors of vitiligo-associated conditions and the current therapeutics for treating vitiligo. This systematic review was performed based on the PRISMA guidelines and articles published from 2000 to 2023 in several electronic databases (Web of Science, PubMed, PsycINFO, and others). The most clinically significant diseases associated with vitiligo are alopecia areata, autoimmune thyroid disease, Addison's disease, and type 1 diabetes mellitus. No targeted population is specifically prone to vitiligo; it does not affect any particular race or sex. Hence, awareness of the diseases associated with vitiligo is necessary to control them through various medical and surgical treatments with the proper facilities.

Unveiling the Unseen Struggles: A Comprehensive Review of Vitiligo's Psychological, Social, and Quality of Life Impacts

This review explores the psychosocial impact of vitiligo on patients, its consequences for their quality of life, and the need for holistic support. Vitiligo's psychosocial burden, driven by the need to conceal lesions and societal beauty ideals, leads to stress, sadness, and low self-esteem. Social stigma affects self-esteem, especially in cultural contexts, exacerbating the need for culturally sensitive support. Anxiety and depression are common due to visible differences and societal pressures. Vitiligo significantly reduces the quality of life, especially in younger patients, impacting daily activities, careers, and relationships. Disease severity worsens these effects, particularly in visible areas and among individuals with darker skin tones. Long-term disease activity may improve acceptance and quality of life. Psychological support and counseling are crucial, as many patients don't seek medical help. Education plays a key role, improving understanding and reducing anxiety. Raising awareness about the impact of vitiligo can challenge perceptions and contribute to enhancing patients' well-being. In conclusion, this review highlights the interplay between psychosocial factors, quality of life, and the importance of addressing social stigma, providing psychological support, and advancing education and awareness for those with vitiligo.

Analysis of Serum Immunoglobulin G (IgG) Levels against Toxoplasma Gondii, Herpes Simplex Virus Types 1 and 2, Cytomegalovirus and Hepatitis C Virus in Vitiligo

Background

Pathogen infections have been associated with autoimmunity, which in turn has been implicated in the pathogenesis of vitiligo. However, the association between pathogen infections and vitiligo remains elusive.

Aims

This study aimed to assess the proportion of individuals who tested positive for specific IgG antibodies against selected pathogens in patients with vitiligo and control subjects.

Materials and Methods

Plasma from 51 patients with vitiligo and 51 age- and gender-matched controls were tested for anti-Toxoplasma gondii (T. gondii) IgG, anti-herpes simplex types 1 and 2 (HSV-1/2) IgG, anti-cytomegalovirus (CMV) IgG and anti-hepatitis C virus IgG.

Results

Among all participants (n = 102), 63%, 84% and 87% tested positive for anti-T. gondii, anti-HSV-1/2 and anti-CMV IgG antibodies, respectively. Anti-hepatitis C virus IgG was negative in all samples tested. Positive anti-T. gondii IgG was detected in plasma samples of 39 (78%) patients with vitiligo and 25 (49%) controls (odds ratio [OR] 3.68, 95% confidence interval [CI] 1.55-8.76, P = 0.0036). Anti-HSV-1/2 IgG was detected in samples of 47 (92%) patients with vitiligo and 38 (76%) controls (OR 3.71, 95% CI 1.11-12.44, P = 0.031). Differences in frequencies of positive results for anti-T. gondii IgG and anti-HSV-1/2 IgG were only significant in samples from female patients with vitiligo when compared with controls (P = 0.036 and 0.024, respectively). Anti-CMV IgG was detected in samples from 46 patients with vitiligo (90%) and 41 (84%) controls (P = 0.384).

Conclusions

T. gondii IgG and HSV-1/2 IgG were significantly more frequent in patients with vitiligo, especially in women, when compared with age- and gender-matched controls. Since T. gondii and HSV-1/2 infections can trigger autoimmune events, past exposure to these pathogens may be a risk factor for the development of vitiligo.

Human Skin Pigmentation: From a Biological Feature to a Social Determinant

Skin pigmentation is the most variable human characteristic that can be observed and has been used throughout history to classify humans into distinct groups. Many factors influence skin colour, but the melanin pigment is considered the most important because its type and quantity can determine variations in pigmentation shades. The evolution of skin pigmentation started around 1.6-2 million years ago. As a result of migratory phenomena to places with less ultraviolet radiation (UVR) and other seasonal regimes, the selection of depigmented skin and different tanning capabilities occurred over time. Thus, genetic adaptation to new environmental conditions gradually led to changes in skin pigmentation. Despite the biological importance of pigmentation, variation in skin colour has led to social and health inequalities. Since Linnaeus, skin colour classifications have been used to describe different human groups, encouraging the misuse of a biological characteristic. This review examines the characterisation of pigmentation and its evolution through history and society. The unequal perception of pigmentation diversity has led to an incomplete state of dermatological training and issues in medical approach in dermatology. The consciousness of all these aspects increases the need to address and overcome dermatologic and social health disparities related to skin pigmentation.

Etiopathogenesis and Emerging Methods for Treatment of Vitiligo

Vitiligo is an acquired chronic depigmenting disorder of skin. It is mostly asymptomatic and characterized by amelanotic macules and patches that affects 0.5% to 2% of the world's population. The etiology of vitiligo has not been clearly elucidated and multiple theories have been proposed regarding the causes of the disorder. Among the most prevalent theories, the genetic predisposition, oxidative stress theory, promotion of cellular stress and pathologic influence of lymphocytes T have been highlighted. As a result of increases in in-depth knowledge concerning the pathogenetic processes in vitiligo, we review the most recent information concerning its etiopathogenesis and treatment methods including topical and oral Janus kinase inhibitors, prostaglandins and their analogues, namely afamelanotide, Wnt/β-catenin-signaling agonists and cell-based therapies. Topical ruxolitinib has been registered for vitiligo treatment, whereas other agents as oral ritlecitinib, afamelanotide and latanoprost have been studied in ongoing clinical trials. New highly effective therapeutic strategies may be developed thanks to molecular and genetic studies.

Spontaneous Reversal of Vitiligo, a Rare Phenomenon Reported in a Case in Saudi Arabia with an Insight into Metabolic Biochemical Derangements

Background and Objectives: Vitiligo is a skin disorder characterized by hypopigmented macules occurring due to melanocyte destruction. An interplay of several biochemical mechanisms has been proposed to explain the etiopathogenesis of vitiligo, such as genetic, autoimmune responses, generation of inflammatory mediators, oxidative stress, and melanocyte detachment mechanisms. There is no cure for vitiligo; however, pharmacological treatment measures (cosmetic camouflage creams, steroids, psoralen and ultraviolet A (PUVA) therapy, narrowband UVB) are available, but they could have certain side effects. We reported an interesting case of vitiligo in Saudi Arabia that showed reversal of vitiligo, which is an extremely rare phenomenon, with the objective of probing the probable reasons for this reversal. To the best of our knowledge, there is no study on vitiligo that has reported spontaneous reversal of vitiligo in Saudi Arabia so far. Materials and Method: The patient presented to the Family Medicine clinic with a history of restoration of melanin pigment in his lesions after 3 years of the onset of vitiligo. Patients history was taken carefully along with clinical examination, carried out necessary biomedical lab investigations and compiled the data. The data at the time of pigment restoration were compared to the previous data when he developed the lesions. Result: The probable reasons for vitiligo reversal could be markedly decreased psychological stress, regular consumption of an antioxidant-rich herbal drink made of curcumin and honey, and dietary switchover to vegetarianism and an alcohol-free lifestyle. Conclusions: Curcumin-based herbal remedies could be an alternative option to treat vitiligo. These methods must be further explored through clinical trials as they are safer, easily available, and more affordable.

A review of JAK and IL-23 inhibitors to treat vitiligo

Vitiligo is an autoimmune skin disorder resulting in the depigmentation of skin characterised by patches of varying sizes and shapes. A common disorder of pigmentation that affects 0.5%-2% of the global population. Despite its well-understood autoimmune pathogenesis, the targets for effective cytokine intervention remain unclear. Current first-line treatments include oral or topical corticosteroids, calcineurin inhibitors and phototherapy. These treatments are limited, have varying efficacies, and are associated with significant adverse events or can be time-consuming. Therefore, biologics should be explored as a potential treatment for vitiligo. There are currently limited data for the use of JAK and IL-23 inhibitors for vitiligo. A total of 25 studies were identified in the review. There is promising evidence regarding the use of JAK and IL-23 inhibitors for the treatment of vitiligo.

Granzyme B in Autoimmune Skin Disease

Autoimmune diseases often present with cutaneous symptoms that contribute to dysfunction, disfigurement, and in many cases, reduced quality-of-life. Unfortunately, treatment options for many autoimmune skin diseases are limited. Local and systemic corticosteroids remain the current standard-of-care but are associated with significant adverse effects. Hence, there is an unmet need for novel therapies that block molecular drivers of disease in a local and/or targeted manner. Granzyme B (GzmB) is a serine protease with known cytotoxic activity and emerging extracellular functions, including the cleavage of cell-cell junctions, basement membranes, cell receptors, and other structural proteins. While minimal to absent in healthy skin, GzmB is markedly elevated in alopecia areata, interface dermatitis, pemphigoid disease, psoriasis, systemic sclerosis, and vitiligo. This review will discuss the role of GzmB in immunity, blistering, apoptosis, and barrier dysfunction in the context of autoimmune skin disease. GzmB plays a causal role in the development of pemphigoid disease and carries diagnostic and prognostic significance in cutaneous lupus erythematosus, vitiligo, and alopecia areata. Taken together, these data support GzmB as a promising therapeutic target for autoimmune skin diseases impacted by impaired barrier function, inflammation, and/or blistering.