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Background: The treatment of vitiligo is a persistent challenge in dermatology. New treatments are being offered and studied in this field for those resistant to or intolerant of classical therapies. Aims: In this systematic review, we study the use of prostaglandin analogues (PGAs) and phosphodiesterase inhibitors (PDEIs) in the treatment of vitiligo, as they are known for their pigmentation inducing effects through activating melanocytes. Methods: We searched four main online databases with the keywords "Vitiligo", "Prostaglandin analogue" and "Phosphodiesterase inhibitor". Results: A total of 42 articles were included, with 1027 cases, studying drugs like bimatoprost, latanoprost, travoprost, dinoprostone, apremilast, crisaborole, etc. Among the included studies, the treatment regimens are commonly once or twice daily for 12–48 weeks, with a mean of 20.61 weeks, and the routes of administration are mainly topical gels or ophthalmic solutions and oral tablets. Side effects are mild and tolerable, namely erythema, itching or burning sensations at application site for topicals, or gastrointestinal problems with apremilast. Repigmentation results are significant in both adult and pediatric patients and progressive or stable vitiligo. PGAs and PDEIs outperform many classical therapies, for example, narrowband ultraviolet B phototherapy (NB‐UVB), tacrolimus, mometasone or methylprednisolone mini‐pulse. PGAs or PDEIs are usually used in combination therapies to either cause synergism or increase drug delivery, and almost always enhance repigmentation, for example, with NB‐UVB, fractional CO2 laser, microneedling, and mometasone. Conclusion: Monotherapy or add‐on PGAs and PDEIs can be considered effective treatments for vitiligo and promising last resorts for those resistant to other therapies. [ABSTRACT FROM AUTHOR]

Non‐cultured epidermal suspension (NCES) is one of the most widely used surgical therapy for stable vitiligo patients in which recipient size preparation plays an important role in the outcome of NCES. The primary objective is to evaluate and compare the efficacy and safety of conventional suspension delivery after manual dermabrasion (CSMD) versus tattooing pen‐assisted suspension delivery (TPSD) in NCES. Paired vitiligo units (VU) in 36 patients, matched with respect to size and location were divided into two groups. The VU in Group 1 underwent suspension delivery by CSMD while the VU in Group 2 underwent same by TPSD. All the VU were followed up at regular intervals until 24 weeks. At the end of 24 weeks, 31 VU (86.1%) in Group 1 achieved >75% repigmentation which was significantly higher (p =.02, chi‐square test) as compared to 22 VU (61.1%) in Group 2. The color matching in both the groups VU was also comparable (p =.84, chi‐square test). The patient global assessment (PGA) was significantly higher in Group 1 VU as compared to Group 2. Treatment response in terms of repigmentation and PGA was significantly better in VU treated with CSMD as compared to TPSD. Recipient site complications were seen more commonly in Group 1 VU as compared to Group 2. Perilesional halo at the recipient site was seen in none of the VU in Group 2 which was significantly lower than 6 VU in Group 1 than (p =.02, chi‐square test). Better results may be possible with technical improvisations in tattooing pen needle diameter and depth of penetration. [ABSTRACT FROM AUTHOR]

Vitiligo is a chronic autoimmune disorder characterized by progressive skin depigmentation. Vitiligo significantly impacts patients’ quality of life, contributing to psychological and social burdens. Despite readily available therapeutic options, many cases remain refractory to treatment, highlighting the critical need for safer and more effective therapies. Currently, ruxolitinib is the only FDA-approved medication for vitiligo; however, it carries a black box warning for serious adverse effects, including infections, malignancy, and major cardiovascular events, limiting its use. Recent studies have identified the aryl hydrocarbon receptor (AhR) as a promising therapeutic target, suggesting that AhR agonists could address the multifaceted pathogenesis of vitiligo. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search to analyze the role of AhR agonists in the treatment of vitiligo on PubMed, Cochrane, Embase, MEDLINE, and Web of Science databases on April 15, 2024. Fourteen studies met the inclusion criteria, comprising two clinical trials, two case reports, and nine basic science studies. Our search revealed that culturing AhR agonists with melanocytes upregulates melanin-synthesizing enzymes, reduces reactive oxygen species, and modulates pro-inflammatory cytokines such as IL-17A and IL-22. Tapinarof, a topical AhR agonist used commonly for the treatment of psoriasis, demonstrated clinical efficacy in repigmentation with a favorable safety profile compared to long-term steroid use. Although limited by the number of clinical studies, this review underscores the potential of using AhR agonists, such as tapinarof, as a transformative approach to vitiligo management. Future clinical trials are necessary to evaluate the safety, efficacy, and long-term outcomes of AhR agonists. [ABSTRACT FROM AUTHOR]

The use of medications which target the JAK-STAT signaling pathway, also known as janus kinase (JAK) inhibitors, has rapidly increased in recent years. Patient perceptions, opinions, and concerns regarding the use of JAK inhibitors are largely uninvestigated. Our objective is to better understand patient concerns, reported side effects, and sentiments regarding the use of JAK inhibitors for dermatologic disease. The authors performed a cross-sectional analysis of the most frequented subreddits for dermatologic disease in which JAK inhibitors have obtained FDA approval (r/atopic dermatitis, r/psoriasis, r/alopecia areata, r/vitiligo, and r/eczeJAKS). The sentiment, central theme, and engagement level of each post was evaluated using previously utilized methods. Nine hundred twenty-three posts were analyzed, with the majority focusing on efficacy (433, 47%) and medication-related side effects (150, 16%). Other themes of interest to patients were Payment/Insurance (84, 9%), Study Results/News (69, 7%), Administration/Dosage (33, 4%), and Medication Interactions (31, 3%). The most frequently reported side effects were acne/folliculitis (24, 22%), nausea/gastrointestinal disturbance (11,10%), and fatigue/muscle aches (10, 9%). At the same time, the medication interactions garnering the most concern were sunscreens/facial moisturizers (5, 16%), topical calcineurin inhibitors (4, 13%), and Marijuana/THC (3, 9.%). This analysis highlights that patients are most concerned about the efficacy and side effects of JAK inhibitors in addition to issues regarding access to JAK inhibitors. Providers can use the insights gained from this study to address hesitancy better and guide comprehensive, patient-centered discussions with patients regarding JAK inhibitor use. [ABSTRACT FROM AUTHOR]

Ultraviolet B narrow band (UVB-NB) phototherapy is the gold standard treatment for vitiligo, primarily due to its immunomodulatory effects. Additionally, it may influence circadian melatonin balance, that may indirectly induce sleep regulation, which in turn could potentially contribute to vitiligo improvement. The association between melatonin, vitiligo and phototherapy has been little investigated. The aim of this study was to evaluate the current evidence regarding the effects of circadian melatonin regulation and sleep, particularly during vitiligo treatment with phototherapy. We undertook a narrative review to synthetize the evidence on this association through the MEDLINE/PubMed database, using combined search terms: melatonin, vitiligo, phototherapy, and circadian rhythm (sleep). A total of 56 articles were included. There are few studies on this relationship, and conflicting findings. Some studies have suggested that UV exposure and phototherapy might benefit vitiligo by stimulating melanocytes, which have melatonin receptors, and this could potentially synchronize the circadian regulation of melatonin. This improved melatonin balance could result in better sleep quality further enhancing the antiinflammatory properties of melatonin and contributing to vitiligo improvement. Less is known about the possible effects of the use of topical melatonin, with or without phototherapy, to treat vitiligo lesions. In conclusion, there is some evidence that circadian melatonin regulation plays an important role in the course of vitiligo, both through sleep regulation and its anti-inflammatory properties. The evidence suggests that the systemic and physiological properties of melatonin, especially its circadian behavior regulated by phototherapy, may be more effective in respect of vitiligo improvement than the use of topical melatonin. However, the effects of the oral intake of melatonin are less clear. Phototherapy, as a potential modulator of circadian melatonin rhythm, that influences sleep and clinical improvement of vitiligo, needs further examination, as does the use of melatonin as an adjuvant treatment to UVB phototherapy in vitiligo. [ABSTRACT FROM AUTHOR]

Maroteaux-Lamy syndrome (mucopolysaccharidoses VI) is a rare genetic disease results in functional deficiency of arylsulfatase B and accumulation of dermatan sulfate within lysosomes in various tissues. Here we present an 8-year-old male who was referred for treatment of limited mouth opening. The patient had been diagnosed with mucopolysaccharidoses VI at age of 6 months. He had received bone marrow transplantation at age of 3.5 years, developed graft-versus-host disease and subsequent vitiligo-like changes. The patient presented with short stature, and some skeletal anomalies. In radiographic images bilateral hyperplasia of the coronoid process, underdeveloped condyles, and dentigerous cyst-like follicles in the jaws were noted. Bilateral coronoidectomy was performed to improve the maximum opening of the mouth. Post-op follow-up examinations in 5 years showed moderate improvement. Abnormal coronoid and condylar processes are unusual in MPS VI. Proper management is needed to improve patients' oral and general health for the remainder of their lives. [ABSTRACT FROM AUTHOR]

Melanoma is the most severe form of skin cancer with an incidence that is increasing all over the world. Melanoma cells derive from normal melanocytes and share different melanocyte-specific antigens, the same antigens against which an immune reaction develops in vitiligo, a skin disease characterized by autoimmune-mediated melanocyte destruction. The purpose of this review is to present the autoimmune-mediated melanocyte destruction associated with melanoma development, progression and treatment. Patients with vitiligo seem to have a lower chance of developing melanoma. On the other hand, patients with melanoma can develop depigmented lesions even at distant sites from the primary tumor, defined as melanoma-associated leukoderma (MAL). Drug-associated leukoderma (DAL) was also described in melanoma patients treated with immunotherapy or targeted therapy and it seems to be a favorable prognostic factor. Clinically, MAL and DAL can be diagnosed as vitiligo and there are few differences between these three entities. In this review, the incidence of DAL in melanoma patients treated with different therapies was researched in the literature and patient outcome was recorded, with studies showing a prolonged disease-free survival in melanoma patients with DAL, treated with immune checkpoint inhibitors. Further studies are however needed to understand the dynamics of autoimmune-mediated melanocyte destruction. [ABSTRACT FROM AUTHOR]

A 70‐year‐old African American female with a history of stage IV mycosis fungoides in remission presented with a gradually enlarging, red, ulcerated nodule on her right dorsal hand. The lesion was biopsied, and it showed intraepidermal proliferation with cytologic atypia and increased vasculature in the papillary dermis. Immunohistochemical staining indicated a yes‐associated protein 1 (YAP1) rearrangement, confirmed by RNA sequencing, revealing a YAP1::MAML2 (mastermind‐like transcriptional coactivator 2) fusion. The lesion was diagnosed as an eccrine porocarcinoma (EPC). The occurrence of EPCs following radiotherapy or trauma has been documented. This case highlights the importance of considering EPCs in patients with extensive skin treatments and immunosuppression history. [ABSTRACT FROM AUTHOR]

ABSTRACT Vitiligo is a chronic autoimmune disease, and current treatments for vitiligo have limited efficacy. Janus kinase (JAK) inhibitors could offer new therapeutic options. To evaluate the efficacy and safety of baricitinib, an oral JAK1/2 inhibitor, combined with narrow‐band ultraviolet B (NB‐UVB) in vitiligo treatment. This prospective, controlled, open‐label study included adults with progressive non‐segmental vitiligo (NSV). Patients were assigned to combination therapy with baricitinib 2 mg daily and NB‐UVB three times a week or NB‐UVB alone three times a week (control). The primary endpoint was the proportion of patients achieving 50% or greater improvement from baseline in the total Vitiligo Area Scoring Index (T‐VASI50) at week 16. Of the 33 patients (mean age, 34.1 years; 27.3% women) who completed the study, 12 of 17 (70.6%) patients in the combination group and 2 of 16 (12.5%) in the control group had a T‐VASI50 response at week 16 (relative risk [RR] = 5.6; 95% CI = 1.5–21.4; p = 0.001). Adverse events were minor, including erythema, mild blister after phototherapy and acne. Combination therapy with low‐dose baricitinib and NB‐UVB was effective and well tolerated in adults with progressive NSV. [ABSTRACT FROM AUTHOR]

Vitiligo is a skin disorder that is associated with a decreased risk of skin cancer, but it can lead to increased susceptibility to sunburn, psychological distress, and disruptions in daily life, consists of two primary subtypes: segmental and nonsegmental vitiligo, each with distinct underlying mechanisms. However, the reliable identification of diagnostic markers and the ability to differentiate between these subtypes have remained elusive challenges. This study aims to pioneer predictive algorithms for vitiligo diagnosis, harnessing the capabilities of AI (Artificial Intelligence) to amalgamate multisource data and uncover essential features for distinguishing vitiligo subtypes.An ensemble algorithm was thoughtfully developed for vitiligo diagnosis, utilizing a spectrum of machine learning techniques to evaluate the likelihood of vitiligo, whether segmental or nonsegmental. Diverse machine learning methodologies were applied to distinguish between healthy individuals and vitiligo patients, as well as to differentiate segmental from nonsegmental vitiligo. The ensemble algorithm achieved a remarkable AUC (Area Under the Curve) of 0.99 and an accuracy of 0.98 for diagnosing vitiligo. Furthermore, in predicting the development of segmental or nonsegmental vitiligo, the model exhibited an AUC of 0.79 and an accuracy of 0.73. Key parameters for vitiligo identification encompassed factors such as age, FBC (full blood count)-neutrophils, FBC-lymphocytes, LKF(liver and kidney function)-direct bilirubin, LKF-total bilirubin, and LKF-total protein levels. In contrast, vital indicators for monitoring the progression of segmental and nonsegmental vitiligo included FBC-B lymphocyte count, FBC-NK (Natural Killer) cell count, and LKF-alkaline phosphatase levels. This retrospective study underscores the potential of AI-driven analysis in identifying significant risk factors for vitiligo and predicting its subtypes at an early stage. These findings offer great promise for the development of effective diagnostic tools and the implementation of personalized treatment approaches in managing this challenging skin disorder. [ABSTRACT FROM AUTHOR]

Autoimmune diseases, a disease characterized by immune imbalance caused by the human immune system mistakenly attacking its own components, include vitiligo, psoriasis and atopic dermatitis (AD). Previous studies on autoimmune diseases have focused mainly on immune cells, keratinocytes and endothelial cells. Fibroblasts, the main cells that secrete the extracellular matrix (ECM) in the dermis, have been studied thoroughly in terms of fibrosis and wound healing. However, an increasing number of studies have shown that fibroblasts play an important role in nonfibrotic autoimmune skin diseases. In this article, the previously reported role of fibroblasts in nonfibrous autoimmune skin diseases such as psoriasis, vitiligo and AD is summarized to provide new ideas for the treatment of this disease. [ABSTRACT FROM AUTHOR]

BackgroundAimSubjects and methodsResultsConclusionAlthough numerous mechanisms are involved in vitiligo pathogenesis, few studies correlate N-acetyltransferase 2 to this disease.To assess the N-acetyltransferase 2 (rs1799929) gene and its serum levels in vitiligo patients.In this case-control study, 65 vitiligo cases were compared to 65 age- and sex-matched healthy controls. Serum NAT2 levels and the NAT2 gene polymorphism (rs1799929) were evaluated using ELISA and real-time PCR, respectively.Serum N-acetyltransferase 2 levels were significantly lower in cases than in controls, 1.24 ± 0.31 vs. 2.01 ± 0.46 (p = 0.001). CC genotype was more dominant in controls (58.5%) than in cases (20%). TT and CT genotypes were more dominant in cases (30.8% and 49.2%) than in controls (13.8% and 27.7%), respectively (p = 0.001). The C allele was more prominent in controls (72.3%) than in cases (44.6%) while the T allele was more dominant in cases (55.4%) than in controls (27.7%) (p = 0.001). N-acetyltransferase 2 slow acetylator phenotype (TT genotype) was higher in cases (30.8%) than in controls (13.8%) and rapid acetylator phenotypes (CC and CT genotypes) were higher in controls (86.2%) than in cases (69.2%) (p = 0.035).Slow acetylator genotype (TT) of NAT2 gene (rs1799929) and low serum levels of NAT2 enzyme might play a role in the susceptibility and pathogenesis of vitiligo. [ABSTRACT FROM AUTHOR]

Background: Cadonilimab is the first approved dual immune checkpoint inhibitor targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), currently utilized for the treatment of various solid tumors. Oral mucosal adverse reactions, such as oral lichenoid lesions, represent one of the most prevalent immune-related adverse events associated with immune checkpoint antibodies. However, reports detailing oral side effects specifically linked to Cadonilimab are lacking. Documenting these side effects is essential to alert oncologists and stomatologists, facilitating timely intervention for affected patients. Case Presentation: We present a case involving a 35-year-old male patient diagnosed with hepatocellular carcinoma who received Cadonilimab following hepatectomy and subsequently developed extensive oral lichenoid lesions along with mucosal erosion at 13–14 weeks post-treatment initiation. A biopsy was conducted revealing immunohistochemical findings of CD3+, CD4+, CD8+, CD20 + lymphocytes, CD68 + macrophages, and α-SMA + myofibroblasts infiltrating the tissue of the oral lichenoid lesions. The patient's oral lesions improved after administration of systemic and local glucocorticoid therapy alongside cessation of Cadonilimab treatment. Conclusion: This report marks the first documented instance of an oral adverse effect associated with Cadonilimab use. It underscores that administration of this agent may lead to significant lichenoid lesions and erosions within the oral cavity—an issue warranting increased vigilance from both oncologists and stomatologists. [ABSTRACT FROM AUTHOR]

Melanoma is the most severe form of skin cancer with an incidence that is increasing all over the world. Melanoma cells derive from normal melanocytes and share different melanocyte-specific antigens, the same antigens against which an immune reaction develops in vitiligo, a skin disease characterized by autoimmune-mediated melanocyte destruction. The purpose of this review is to present the autoimmune-mediated melanocyte destruction associated with melanoma development, progression and treatment. Patients with vitiligo seem to have a lower chance of developing melanoma. On the other hand, patients with melanoma can develop depigmented lesions even at distant sites from the primary tumor, defined as melanoma-associated leukoderma (MAL). Drug-associated leukoderma (DAL) was also described in melanoma patients treated with immunotherapy or targeted therapy and it seems to be a favorable prognostic factor. Clinically, MAL and DAL can be diagnosed as vitiligo and there are few differences between these three entities. In this review, the incidence of DAL in melanoma patients treated with different therapies was researched in the literature and patient outcome was recorded, with studies showing a prolonged disease-free survival in melanoma patients with DAL, treated with immune checkpoint inhibitors. Further studies are however needed to understand the dynamics of autoimmune-mediated melanocyte destruction. [ABSTRACT FROM AUTHOR]

Vitiligo is a dermatological disease characterized by loss of melanocytes, causing non-scaly white macules on the skin. Zinc, copper, and selenium are important micronutrients that play a role in the normal functioning of the body and have been found to potentially aid in vitiligo treatment, although the relationship between their serum levels and vitiligo is not yet fully understood. This is a systematic review aimed at assessing the levels of serum zinc, copper, and selenium and their association with vitiligo. This review was performed following the Preferred Reporting Items of the systematic Review and Meta-Analysis (PRISMA) checklist and Cochrane guidelines. A comprehensive literature search was conducted on PubMed, Google Scholar and 41 studies published between 1970 and 2022 including 3353 vitiligo cases and 10,638 controls were included in the meta-analysis conducted from August 2022 till September 2023. The quality of the studies was assessed using the National Heart Lung and Blood Institute Study Quality Assessment tool, and the risk of bias was represented using the RobVis tool. The statistical analysis was performed using Review Manager (RevMan) Version 5.4. This meta-analysis indicate a significant decline in serum zinc levels (Z = 4.97; P < 0.0001; SMD = − 0.86; 95% CI − 1.19 to − 0.52) in vitiligo group with high statistical heterogeneity (Tau2 = 0.74; Chi2 = 513.95, d.f. = 26 [P < 0.00001]; I2 = 95%). Similarly for serum copper levels there was decline (Z = 2.43; P < 0.0001; SMD = − 0.50; 95% confidence interval [CI] − 0.91 to − 0.10) in vitiligo group and high statistical heterogeneity (Tau2 = 0.92; Chi2 = 475.10, d.f. = 22 [P < 0.00001]; I2 = 95%). On the other hand, there was a increase of serum selenium levels in the vitiligo group (Z = 0.56; P < 0.0001; SMD = 0.23; 95% confidence interval [CI], 0.58 to 1.04) and the results reveals high statistical heterogeneity among studies (Tau2 = 1.93; Chi2 = 406.44, d.f. = 11 [P < 0.00001]; I2 = 97%) in vitiligo patients compared to healthy controls. Publication bias was not found for the studies analysed. This study analyses the association of serum micronutrient levels and vitiligo among patients and controls from published research along with sub-group analysis specific to Asian populations using a meta-analysis. Low serum levels of Zinc and copper and high selenium levels are associated with Vitiligo. [ABSTRACT FROM AUTHOR]

Vitiligo is a common skin disorder where melanocytes, the cells that produce skin pigment, are destroyed by the immune system, leading to white patches on the skin and mucous membranes. This condition affects 0.4% to 2.0% of the global population, with a higher prevalence in females and often beginning in childhood. In India, about 1% of the population is affected, particularly in northern regions, with a higher incidence in females and links to other autoimmune diseases. This review examines recent progress in understanding vitiligo and its treatment. It focuses on the genetic, autoimmune, and environmental factors involved in the disease and highlights new therapies, such as targeted molecular treatments and advanced repigmentation methods. Current research shows that oxidative stress and genetic predispositions contribute to the autoimmune destruction of melanocytes. Novel drug delivery systems, including liposomes, nanoemulsions, and nanostructured lipid carriers, have improved treatment effectiveness. Clinical trials are exploring new treatments like Ruxolitinib cream and melanocyte transplantation, while teledermatology is becoming useful for managing patients. Vitiligo also poses a significant economic burden due to its impact on patients’ quality of life. Continued research is essential to develop better, more accessible treatments and reduce the economic impact of vitiligo. [ABSTRACT FROM AUTHOR]

Cold atmospheric plasma (CAP) technology has emerged as a revolutionary therapeutic technology in dermatology, recognized for its safety, effectiveness, and minimal side effects. CAP demonstrates substantial antimicrobial properties against bacteria, viruses, and fungi, promotes tissue proliferation and wound healing, and inhibits the growth and migration of tumor cells. This paper explores the versatile applications of CAP in dermatology, skin health, and skincare. It provides an in-depth analysis of plasma technology, medical plasma applications, and CAP. The review covers the classification of CAP, its direct and indirect applications, and the penetration and mechanisms of action of its active components in the skin. Briefly introduce CAP's suppressive effects on microbial infections, detailing its impact on infectious skin diseases and its specific effects on bacteria, fungi, viruses, and parasites. It also highlights CAP's role in promoting tissue proliferation and wound healing and its effectiveness in treating inflammatory skin diseases such as psoriasis, atopic dermatitis, and vitiligo. Additionally, the review examines CAP's potential in suppressing tumor cell proliferation and migration and its applications in cosmetic and skincare treatments. The therapeutic potential of CAP in treating immune-mediated skin diseases is also discussed. CAP presents significant promise as a dermatological treatment, offering a safe and effective approach for various skin conditions. Its ability to operate at room temperature and its broad spectrum of applications make it a valuable tool in dermatology. Finally, introduce further research is required to fully elucidate its mechanisms, optimize its use, and expand its clinical applications. [ABSTRACT FROM AUTHOR]

Objective: To clarify the causal relationship between anxiety-depression and the progression and outcomes of vitiligo, providing a basis for enhancing psychological interventions in the treatment of vitiligo. Methods: A two-sample Mendelian randomization analysis was used to validate the causal relationship between anxiety, depression, and vitiligo. The Hospital Anxiety and Depression Scale (HADS) assessed the psychiatric condition of vitiligo patients. Fisher's chi-square tests and rank sum tests analyzed the differences in clinical characteristics among vitiligo patients with different HADS scores. Regression analysis assessed the correlation between anxiety-depression and disease progression and treatment outcomes. Results: Mendelian randomization analysis showed that depression significantly increases the risk of vitiligo (OR = 4.46, 95% CI: 1.16-17.18, p = 0.03). According to the HADS scores, clinical characteristics differed significantly among the groups (p < 0.05). Univariate regression analysis demonstrated that both HADS (B = -1.168, p < 0.001, 95% CI: -1.532 to -0.804) and VIDA (B = -2.157, p < 0.001, 95% CI: -3.464 to -0.887) were significantly negative associated factors for disease outcomes. However, HADS (B = -1.006, p < 0.001, 95% CI: -1.475 to -0.657) emerged as the only factor influencing therapeutic efficacy in multivariate regression analysis. A restricted cubic spline graph illustrates a U-shaped relationship between HADS and clinical efficacy, with the most significant impact on therapeutic efficacy occurring when HADS equals 15. Conclusion: Anxiety--depression exhibit a bidirectional positive causal relationship with vitiligo. Moderate to severe anxiety-depression significantly influences the clinical efficacy of vitiligo treatment. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a chronic autoimmune skin disorder characterized by depigmented skin regions caused by a loss of melanocytes. Although vitiligo's origin is unknown, environmental, immunological, and genetic factors are involved. In treating vitiligo, microneedling is an effective adjuvant that improves the administration and effectiveness of medications such as trichloroacetic acid, 5-fluorouracil, and latanoprost. There is currently little data regarding the combination that is both safe and effective. This study aimed to compare the efficacy of microneedling delivery of latanoprost versus microneedling delivery of 5-fluorouracil and microneedling delivery of Trichloroacetic acid 35% in induction of skin re-pigmentation in stable vitiligo. Methods: This non-randomized controlled clinical trial was conducted on 54 patients, 18-60 years old, with stable vitiligo. They were divided into; Group (A) patients treated with dermapen followed by 5% 5-fluorouracil, Group (B) patients treated with dermapen followed by latanoprost, and Group (C) patients treated with dermapen followed by Trichloroacetic acid 35%. Results: There was an increase in excellent response among the group compared to B&C but without statistical significance. Also, there was no statistically significant difference between the studied groups in time of starting response. There was an increase in the frequency of very satisfaction among group A compared to B&C but without statistical significance. Conclusion: The combination of microneedling with either 5-Flourouracil or latanoprost or Trichloroacetic acid 35% is safe and effective in treatment of localized stable vitiligo. The degree of improvement was higher with 5-5-fluorouracil than with latanoprost and Trichloroacetic acid 35%. [ABSTRACT FROM AUTHOR]

This narrative literature review examined the intricate relationship between body dysmorphic disorder (BDD) and dermatological conditions, with a brief focus on those characterized by conspicuous skin irregularities such as acne vulgaris, psoriasis, and vitiligo. Highlighting the significant prevalence of BDD among individuals afflicted with dermatological issues, our analysis illuminated the profound psychological repercussions stemming from an exaggerated preoccupation with perceived skin imperfections. Through an exploration of the underlying BDD symptoms, we analyzed the complex dynamics between skin health and mental well-being, emphasizing the disorder's impact on patients' psychological and social functioning. This narrative review further investigated the consequential effects of BDD on essential aspects of dermatological treatment, including patient adherence to therapeutic regimens, overall quality of life (QOL), and the effectiveness of available treatments. In addition to presenting current therapeutic approaches, we advocate for the integration of psycho-dermatological interventions tailored to mitigate the dual burden of skin conditions and psychological distress. Future research directions proposed include longitudinal studies to assess the long-term effects of BDD on skin disease prognosis and psychosocial well-being, which aim to refine and optimize treatment modalities to contribute to a more holistic understanding of BDD within dermatological practice. [ABSTRACT FROM AUTHOR]

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. Key points: Question: Does ruxolitinib cream effectively and safely treat vitiligo? Findings: Three trials, involving a total of 830 participants from nine countries were included (female 388, 46.7%, male 442, 53.3%) in this systematic review. High evidence showed that a significant increase in the likelihood of participants achieving F-VASI75 (OR = 4.34, 95%CI 2.67–7.06), F-VASI50 (OR = 4.71, 95%CI 3.24–6.84), T-VASI75 (OR = 2.78, 95%CI 1.10–7.00), and T-VASI50 (OR = 4.47, 95%CI 2.52–7.92) when compared ruxolitinib to vehicle. Meaning: This study found that ruxolitinib cream holds promise as a treatment option for vitiligo. [ABSTRACT FROM AUTHOR]

Background: Vitiligo remains a challenging condition to treat. Fire needle therapy, a traditional Chinese medicine technique, has potential as an alternative therapeutic strategy. However, rigorous evidence on its efficacy is lacking. Objective: We aimed to evaluate the efficacy and safety of fire needle therapy, alone and combined with topical tacrolimus ointment, for non‐segmental stable vitiligo. Methods: In this 6‐month randomized self‐controlled trial, 35 vitiligo patients were enrolled, providing three similar lesions each. Lesions were randomly allocated to receive fire needle monotherapy, 0.1% tacrolimus ointment monotherapy, or combined fire needle and tacrolimus ointment therapy. The main outcome was change in vitiligo surface area. Results: In total, 29 patients completed the 6‐month follow‐up. The combination therapy group showed significantly greater reductions in vitiligo surface area compared to monotherapy groups starting at months 4 and 5. By the end of the study, combination therapy resulted in remarkably higher repigmentation responses, with 89.7% of lesions showing at least mild (≥25%) repigmentation and 51.7% showing good (≥50%) repigmentation. This significantly exceeded the outcomes with topical tacrolimus ointment alone, which only achieved 6.9% mild response and 6.9% good response. Fire needle monotherapy also demonstrated steady repigmentation over time, with 69% of lesions attaining a mild response by month 6. Importantly, no major adverse events occurred. Conclusion: This study provides promising preliminary evidence supporting the use of fire needle therapy, alone or in combination with topical tacrolimus ointment, for inducing repigmentation in non‐segmental stable vitiligo. As a non‐pharmacological approach, fire needle therapy warrants further study as an alternative vitiligo treatment. [ABSTRACT FROM AUTHOR]

Vitiligo is an acquired autoimmune skin disease characterized by patchy depigmentation of the skin, often accompanied by white hair. The aetiology of vitiligo is complex and difficult to cure, and its disfiguring appearance significantly impacts patients' mental and physical health. Psychological stress is a major factor in inducing and exacerbating vitiligo, as well as affecting its treatment efficacy, though the specific mechanisms remain unclear. Increasing research on the brain-skin axis in skin immunity suggests that psychological stress can influence local skin immunity through this axis, which may play a crucial role in the pathogenesis of vitiligo. This review focuses on the role of brain-skin axis in the pathogenesis of vitiligo, and explores the possible mechanism of brain-skin axis mediating the pathogenesis of vitiligo from the aspects of sympathetic nervous system, hypothalamic–pituitary–adrenal (HPA) axis and hormones and neuropeptides, aiming to provide the necessary theoretical basis for psychological intervention in the prevention and treatment of vitiligo. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Two-sample Mendelian randomization (TSMR) was employed to examine the association between lipidome and five inflammatory skin diseases. Method: To evaluate the association between various molecular subtypes of lipidome and the risk of five inflammatory skin diseases, we analyzed a comprehensive GWAS dataset comprising 179 lipidome. The Two-Sample Mendelian Randomization (TSMR) method was employed to investigate causal relationships. Heterogeneity and pleiotropy were assessed using Cochran's Q test, MR-Egger intercept test, and MR-PRESSO global test. Additionally, a sensitivity analysis was conducted to evaluate the influence of individual single nucleotide polymorphisms on Mendelian Randomization study. Results: Using 179 serum lipidome as exposures and five common inflammatory skin diseases as outcomes, we investigated their associations in this large-scale study. Our findings reveal significant impacts of glycerophospholipids, glycerolipids, and sphingomyelins on inflammatory skin diseases. Glycerophospholipids were protective against pemphigus but predominantly posed risks for other inflammatory skin diseases. Specifically, phosphatidylcholine (16:0_0:0) exhibited the most significant risk association with lichen planus (OR = 1.25, 95% CI 1.11–1.40, P < 0.001). Conversely, glycerolipids showed no effect on lichen planus but were protective against pemphigus while potentially posing risks for other conditions. Triacylglycerol (46:2) showed the most substantial risk association with vitiligo (OR = 1.99, 95% CI 1.35–2.93, P < 0.001). Furthermore, sphingomyelins had no effect on atopic dermatitis but posed potential risks for other inflammatory skin diseases. Sphingomyelin (d40:1) notably emerged as a significant risk factor for pemphigus (OR = 1.91, 95% CI 1.37–2.66, P < 0.001). Conclusions: This study has elucidated the potential harmful effects of glycerophospholipids, glycerolipids, and sphingomyelins on inflammatory skin diseases, while also providing valuable insights for future research into the pathophysiology, prevention and treatment of these conditions. [ABSTRACT FROM AUTHOR]

Vitiligo is an autoimmune skin depigmenting disorder that can negatively impact quality of life. A new FDA approved treatment for vitiligo offers considerable promise, and to maximize benefits strategies to implementation should consider disease burden, healthcare access, and healthcare utilization of individuals with vitiligo. Using the All of Us Research Program’s large data set, including survey responses, we investigated these outcomes among participants with and without vitiligo. Our analysis used quality of life, delayed care due to an obstacle, and seeing a doctor in the past year as dichotomized proxies for disease burden, healthcare access, and healthcare utilization. The results show that people with vitiligo are more likely to report worse quality of life but ostensibly greater healthcare access and utilization compared to people without vitiligo. However, these relationships are not significant when adjusted for demographics, socioeconomic characteristics, and comorbidities of vitiligo. Prior research has shown non-Caucasian individuals have worse health outcomes in general, and worse quality of life within the vitiligo population. Our data demonstrated consistent findings; moreover, we found that non-Caucasian individuals with vitiligo had inferior healthcare access and lower health care utilization than Caucasian individuals. Implementation of new treatments for vitiligo should prioritize disadvantaged individuals to improve health equity. [ABSTRACT FROM AUTHOR]

Vitiligo is an autoimmune disorder characterized by epidermal melanocyte damage, with the typical clinical manifestation of white patches of skin. Keratinocytes, which work in concert with melanocytes to maintain the structural and functional integrity of the skin, are implicated in the progression of vitiligo. Recent studies have reported abnormal keratinocyte proliferation and epidermal thickening in some patients with vitiligo; however, the relationship between these changes and the clinical characteristics of vitiligo remains unclear. We assessed the changes in epidermal thickness in patients with vitiligo and their correlation with clinical characteristics. Compared to the non-lesional skins, the stratum corneum, viable epidermis, and full epidermis in the lesional skins were all significantly thicker. The thickness of the stratum corneum in the head, neck, and trunk was greatly lower than that in the extremities. The thickness of the stratum corneum in the sun-exposed area was higher than that in the sun-protected area, whereas the thickness of the viable epidermis decreased. In conclusion, our study found that the epidermis in the lesional skins of patients with vitiligo was significantly thickened, especially in the sun-exposed areas and extremities. [ABSTRACT FROM AUTHOR]

Vitiligo, an autoimmune condition characterized by depigmented skin patches due to the loss of functional melanocytes, has been linked to dysregulation in the JAK-STAT signaling pathway, particularly in IFN-g signaling. The use of JAK inhibitors, such as ruxolitinib cream, a JAK1 and JAK2 inhibitor, presents a promising approach for vitiligo treatment. This study aims to systematically assess the effectiveness and safety of ruxolitinib cream in patients with vitiligo. We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate the efficacy and safety of ruxolitinib cream for the treatment of vitiligo. A comprehensive search of PubMed, Google Scholar, and Cochrane Library databases for randomized controlled trials (RCTs). Data selection, screening, extraction, and risk of bias assessment were meticulously performed. Statistical analysis was conducted using Review Manager Software, version 5.4, with significant heterogeneity addressed through appropriate methods. Our meta-analysis included 3 studies with 830 vitiligo patients. Significant improvements were observed in F-VASI, T-VASI, F-BSA, and T-BSA scores, with greater efficacy at 24 weeks compared to 12 weeks [MD –24.17, 95% CI (–31.78 to –16.56), P < 0.00001], [MD –14.12, 95% CI (–20.54 to –7.70); P < 0.0000], [MD –16.25, 95% CI (–22.20 to –10.31), P < 0.00001], [MD –9.19, 95% CI (–13.47 to –4.92); P < 0.00001]. Ruxolitinib showed increased risk ratios for F-VASI75, F-VASI90, and F-VASI50, indicating better outcomes with longer treatment durations [MD 2.9, 95% CI 1.88–4.49; P < 0.00001], [MD 4.66, 95% CI 2.09–10.39; P = 0.0002], [MD 2.53, 95% CI 1.84–3.46; P < 0.00001]. No significant differences were found in mild and moderate adverse events, while severe cases favored ruxolitinib. Placebo had a significant advantage in any adverse events, with no significant difference in drug-related adverse events. Serious adverse events did not significantly differ between groups. The findings strongly support the efficacy of ruxolitinib therapy in improving various parameters over time for treating vitiligo. However, thorough consideration of its safety profile, particularly concerning adverse events and potential side effects, is warranted. Further studies with larger sample sizes are needed to confirm these conclusions. [ABSTRACT FROM AUTHOR]

Permanent makeup (PMU) is a popular form of tattooing applied to the eyebrows, eyelids, and lips for corrective and aesthetic purposes. It also has medical applications, such as reconstructing the breast areola, mimicking hair follicles on the head, and covering scars and vitiligo. Unlike body tattoos, PMU often requires reapplication to maintain color density and shape, as the pigments fade over time. This fading is likely due to the characteristics of PMU colorants rather than the application methods or apparatuses. The aim of our study was to assess the application depth of PMU colorants and tattoo ink after procedures. PMU colorants typically contain larger pigment particles in their composition compared to the nanoparticles found in traditional tattoo inks. We applied both tattoo ink and PMU colorants on SKH-1 mice using a PMU apparatus and a tattoo apparatus. To clarify the semi-permanent nature of PMU compared to the more permanent body tattoos, skin biopsies were performed at various intervals throughout this study. The results showed that PMU and tattoo ink were placed at approximately the same depth but exhibited key differences in behavior. PMU with larger inorganic pigments fades over time, while tattoos with smaller, stable organic pigments ensure permanence. [ABSTRACT FROM AUTHOR]

The Alma Hybrid™ not only bridges the gap between traditional ablative and non-ablative laser treatments but also introduces enhanced transdermal delivery through the Impact Handpiece, utilising ultrasound technology. This integration allows for the effective treatment of a wide range of dermatological concerns, including scar revision, skin rejuvenation, and resurfacing (Arellano-Huacuja, 2023; Arellano et al, 2023b). This article aims to provide an examination of the clinical evidence supporting the Alma Hybrid™ system, with a focus on its integration into treatment plans for aesthetic and dermatological practices. Through an analysis of patient case studies and a review of the literature, this paper will demonstrate how the Alma Hybrid™ can be employed to enhance patient outcomes, particularly in challenging cases such as hypertrophic and atrophic scars. Furthermore, we will explore the system's efficacy across diverse patient demographics, with an emphasis on its safety profile in treating different Fitzpatrick skin types. [ABSTRACT FROM AUTHOR]

Vitiligo is a significant dermatological challenge affecting 0.5 to 2% of the global population. Despite the various existing medical approaches, current vitiligo treatments are far from ideal. The present study aimed to prepare and evaluate a film-forming gel of 5 fluorouracil (5FU) using different ratios of hydroxypropyl methylcellulose (HPMC) and Zein for treating vitiligo. The prepared film-forming gels were fully characterized in terms of morphology, Fourier-transform infrared spectroscopy, drug content, pH, drying time, in-vitro drug release, and clinical investigation. A 32-full factorial design was used to study the impact of varying concentrations of HPMC (X1) and Zein (X2) on the percentage of 5FU released (Y1) from the prepared film-forming gels. Scanning electron microscopy (SEM) revealed a cross-linked network structure between polymers. An increase in HPMC concentration (2–4%) correlated with higher 5FU release, whereas increased Zein concentration (1–2%) resulted in reduced 5FU release. Furthermore, patients treated with 5FU film-forming gel after dermabrasion with fractional CO2 (FCO2) laser exhibited a significant decrease in JAK3 gene expression and higher effectiveness than those treated with FCO2 laser alone. Our results suggest that the film-forming gel of 5FU is promising as an effective formulation for treating vitiligo. [ABSTRACT FROM AUTHOR]

ABSTRACT Vitiligo is an autoimmune disorder characterized by chronic depigmentation and milk‐white patches on the skin. Skin infiltration by autoreactive CD8+ T cells causes melanocyte destruction in vitiligo. Multiple risk factors, particularly immune‐related inflammatory factors, are involved in the disappearance of melanocytes. LL37 is a classic damage‐associated molecular pattern molecule that is involved in the development of various autoimmune diseases. An enhanced expression of LL37 in vitiligo is known; however, the exact role of LL37 in melanocyte loss has not yet been elucidated. In the present study, we detected increased LL37 expression in vitiligo serum and lesions. Furthermore, we confirmed that cultured keratinocytes released LL37 after treatment with H2O2. Moreover, the LL37‐DNA complex enhanced the secretion of CXCL9, CXCL10, and CXCL16 from keratinocytes via the TLR9‐MyD88 signaling pathway and facilitated the migration of CD8+ T cells. Altogether, our study demonstrates that LL37 released from keratinocytes binds to DNA and contributes to melanocyte destruction under oxidative stress‐induced autoimmunity in vitiligo. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Monobenzyl ether hydroquinone (MEBHQ) is a cream that promotes the spread and evenness of skin patches in vitiligo. Our aim was to investigate the oxidative and inflammatory effects of this cream on vitiligo patients consuming MEBHQ.A case–control study was conducted with three groups of 30 people from the control group, vitiligo patients before and after treatment. The percentage of vitiligo spots was determined by a specialist doctor. The levels of biochemical factors, oxidative stress profile and inflammatory factors were measured by enzymatic, colorimetric and ELISA methods, respectively.Vitiligo patients showed a high level of inflammation and oxidative stress compared to healthy people. Although after 3 months of using MBEHQ cream, the percentage of skin spots in vitiligo patients increased from an average of 63%–91% and the skin color became almost uniform, but it still increased the level of oxidative stress and inflammation in these patients. Although the level of oxidative stress increased significantly in these patients, there was no significant increase in the level of malondialdehyde. The lack of significant differences in the levels of biochemical factors between healthy people and vitiligo patients before and after using the treatment shows the absence of side effects.The use of MBEHQ increased the size of skin spots and uneven skin color in vitiligo patients. Although MBEHQ did not show side effects such as diabetes, liver and kidney diseases, it increased the levels of oxidative stress and inflammatory cytokines, which needs further study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

While vitiligo is primarily caused by melanocyte deficiency or dysfunction, recent studies have revealed a notable prevalence of metabolic syndrome (MetS) among patients with vitiligo. This suggests shared pathogenic features between the two conditions. Individuals with vitiligo often exhibit variations in triglyceride levels, cholesterol, and blood pressure, which are also affected in MetS. Given the similarities in their underlying mechanisms, genetic factors, pro-inflammatory signalling pathways, and increased oxidative stress, this study aims to highlight the common traits between vitiligo and metabolic systemic disorders. Serum analyses confirmed increased low-density lipoprotein (LDL) levels in patients with vitiligo, compared to physiological values. In addition, we reported significant decreases in folate and vitamin D (Vit D) levels. Oxidative stress is one of the underlying causes of the development of metabolic syndromes and is related to the advancement of skin diseases. This study found high levels of inflammatory cytokines, such as interleukin-6 (IL-6) and chemokine 10 (CXCL10), which are markers of inflammation and disease progression. The accumulation of insulin growth factor binding proteins 5 (IGFBP5) and advanced glycation end products (AGEs) entailed in atherosclerosis and diabetes onset, respectively, were also disclosed in vitiligo. In addition, the blood-associated activity of the antioxidant enzymes catalase (Cat) and superoxide dismutase (SOD) was impaired. Moreover, the plasma fatty acid (FAs) profile analysis showed an alteration in composition and specific estimated activities of FAs biosynthetic enzymes resembling MetS development, resulting in an imbalance towards pro-inflammatory n6-series FAs. These results revealed a systemic metabolic alteration in vitiligo patients that could be considered a new target for developing a more effective therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. Methods: Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. Results: The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. Conclusions: The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is classified as an acquired chronic depigmentation disorder that includes the destruction of epidermal melanocytes. It affects 0.5–1% of the population all over the world. Wnt signaling pathway is vital in melanocytes differentiation and development. WIF-1 is an antagonist of the Wnt signaling pathway; it hinders Wnt from binding its receptors. The present study aims to detect WIF-1 expression in vitiligo skin and if it relates to the disease's severity. Results: This case–control study included 70 subjects: 35 vitiligo patients and 35 healthy controls. Skin WIF-1 expression was estimated using quantitative real-time PCR. Assessment of the vitiligo disease activity score and vitiligo area severity index score was determined. WIF-1 expression showed significant elevation in the skin of vitiligo patients compared to the healthy control group. Conclusion: Overexpression of WIF-1 may participate in the pathogenesis of vitiligo; hence, it should be a future therapeutic target. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions People with skin disease suffer due to disease‐related physical symptoms, as well as due to significant psychosocial burden. A major contributor of this burden is the experience of stigmatization. Research indicates that people with visible skin diseases deal with both social stigma and self‐stigma.This systematic literature review aimed to aggregate existing research on correlates and mechanisms that contribute to self‐stigmatization among people with atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa and to, ultimately, identify targets for psychosocial interventions.The review followed PRISMA guidelines. Four databases, PubMed, OVID, Web of Science and PsycINFO were searched for peer‐reviewed articles. Studies were identified by two independent researchers and were eligible if they (1) assessed adults with one of five chronic skin diseases—atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa, (2) measured self‐stigma or relevant synonyms, (3) evaluated psychosocial correlates, predictors or explanatory mechanisms of self‐stigma and (4) were published in German or English in a peer‐reviewed journal. The Johanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to evaluate the quality of studies.Twenty‐seven studies were included with a mean quality rating of 7.04 (out of 8). Social stigma, coping strategies (such as lack of acceptance) and lack of social support were identified as main predictors of self‐stigma. Although study quality was good, all but one study had a cross‐sectional design that does not allow examining causal relationships among the determinants of self‐stigma.Findings from the present review revealed several psychosocial variables that are malleable and potentially suitable as intervention targets. Those variables such as acceptance should be targeted in evidence‐based interventions specifically developed to reduce self‐stigma to, ultimately, improve mental health of people affected. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a chronic skin disorder characterized by the acquired depigmentation of the skin, arising from the selective destruction of melanocytes. This study aims to explore the public knowledge, awareness, and attitude towards vitiligo in Saudi Arabia. Method: An online cross-sectional survey study was conducted to assess public knowledge of vitiligo in October 2022. The questionnaire tool was created utilizing thorough literature reviews of papers that looked at public knowledge of vitiligo. The factors influencing the participants' knowledge of vitiligo were identified using binary logistic regression analysis. Results: A total of 372 individual participated in this study. The mean knowledge score of the study participants was 8.2 (SD: 3.6) out of 22 (37.3% out of 100%), which represents weak level of knowledge of vitiligo among the study participants. Logistic regression analysis identified that females, younger participants (19-30 years old), and those who work in the healthcare sector were more likely to be knowledgeable about vitiligo compared to others (p0≤0.5). Conclusion: It is highly recommended that Saudi Arabia prioritize awareness initiatives. The study demonstrates the widespread occurrence of the condition and the profound psychological impact it has, leading to feelings of isolation and diminished self-worth. Clearly, targeted educational programs are necessary to rectify misconceptions and foster comprehension, particularly among underinformed groups. Collaborating with healthcare professionals could prove to be highly beneficial. [ABSTRACT FROM AUTHOR]

Oral neomycin administration impacts the gut microbiome and delays vitiligo development in mice, and topical antibiotics may likewise allow the microbiome to preserve skin health and delay depigmentation. Here, we examined the effects of 6‐week topical antibiotic treatment on vitiligo‐prone pmel‐1 mice. Bacitracin, Neosporin, or Vaseline were applied to one denuded flank, while the contralateral flank was treated with Vaseline in all mice. Ventral depigmentation was quantified weekly. We found that topical Neosporin treatment significantly reduced depigmentation and exhibited effects beyond the treated area, while Bacitracin ointment had no effect. Stool samples collected from four representative mice/group during treatment revealed that Neosporin treatment aligned with reduced abundance of the Alistipes genus in the gut, while relevant changes to the skin microbiome at end point were less apparent. Either antibiotic treatment led to reduced expression of MR1, potentially limiting mucosal‐associated invariant T‐cell activation, while Neosporin‐treated skin selectively revealed significantly reduced CD8+ T‐cell abundance. The latter finding aligned with reduced expression of multiple inflammatory markers and markedly increased regulatory T‐cell density. Our studies on favorable skin and oral antibiotic treatment share the neomycin compound, and in either case, microbial changes were most apparent in stool samples. Taken together, neomycin‐containing antibiotic applications can mediate skin Treg infiltration to limit vitiligo development. Our study highlights the therapeutic potential of short‐term antibiotic applications to limit depigmentation vitiligo. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a complex disorder characterized by skin depigmentation; the canonical Wnt signaling pathway that involves β-catenin plays a crucial role in promoting the melanin production in melanocytes. Targeted inhibition of the Janus kinase JAK-STAT pathway can effectively diminish the secretion of the chemokine C-X-C motif ligand CXCL10, thereby safeguarding melanocytes. Ferula has been applied as a treatment regimen for a long period; however, its use for the treatment of vitiligo has not been previously documented. Methods: CCK-8 assay, Intracellular melanin content assay, Tyrosinase activity assay, Western blotting, qRT-PCR, and ELISA methods were employed. Using molecular docking verified the inhibitory effects of feshurin on the JAK1. Results: The sesquiterpene coumarin feshurin was separated from Ferula samarcandica. Feshurin was shown to induce GSK-3β phosphorylation, resulting in the translocation of β-catenin into the nucleus. This translocation subsequently upregulated the transcription of microphthalmia-associated transcription factor (MITF), leading to increased tyrosinase activity and melanin production. In addition, feshurin inhibited the production of chemokine CXCL10 via the JAK-STAT signaling pathway, which was verified by molecular docking. Conclusions: Based on these findings, it can be concluded that feshurin exhibits significant potential for the development of novel anti-vitiligo therapeutics. [ABSTRACT FROM AUTHOR]

Efficacy and safety of ritlecitinib (an oral JAK3/TEC family kinase inhibitor) were evaluated in patients with nonsegmental vitiligo (NSV) across Fitzpatrick skin types (FSTs). Patients with FST I‐III ('light skin'; n = 247) and FST IV‐VI ('dark skin'; n = 117) received once‐daily ritlecitinib 50 mg (with/without 4‐week loading dose), low‐dose ritlecitinib or placebo for 24 weeks. At baseline, patients with light skin displayed higher CLM‐1 and NCR1 serum levels than patients with dark skin (p < 0.05). At 24 weeks, ritlecitinib 50 mg improved the extent of depigmentation measured by percent change from baseline in facial‐vitiligo area scoring index (placebo‐adjusted mean difference [90% CI]) in patients with light (−15.2 [−24.7, −5.8]; p = 0.004) and dark (−37.4 [−50.3, −24.4]; p < 0.0001) skin, with continuous re‐pigmentation through week 48. Treatment‐emergent adverse events were similar across FSTs. At weeks 4 and 24, ritlecitinib 50 mg reduced CXCL11 serum levels (p < 0.001) in patients with light skin, whereas patients with dark skin had increased levels at week 4 (p = 0.05) and no significant change at week 24. Ritlecitinib 50 mg decreased IL‐9 and IL‐22 expression levels in dark skin compared with light skin (qPCR; p < 0.05). These differences in immune dysregulations may explain why NSV patients with dark skin respond to therapy earlier than patients with light skin. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The progression of vitiligo is unpredictable, emphasizing the need to identify periods of activity early for tailored treatment. Confetti‐like depigmentation, hypochromic areas/borders and Koebner's phenomenon are clinical visible signs associated with disease activity in vitiligo. However, their true clinical significance requires further investigation using standardized scoring systems. In the present study, the Vitiligo Signs of Activity Score (VSAS) and the Vitiligo Disease Activity Score (VDAS) were applied to assess disease activity signs and disease progression over time, respectively. Individuals with at least one disease activity sign had a 76.9% likelihood of having active vitiligo. The simultaneous presence of multiple signs or their appearance across body locations increased the likelihood to 94% and 87.1%, respectively. Patients with no disease activity signs had a 60.3% likelihood of having stable disease. This research provides an important nuance about the disease activity signs in vitiligo, which may help guide disease management. The risk of active disease increases when at least two types of vitiligo activity signs are present, or when they are present on different body locations. However, the absence of vitiligo activity signs does not rule out active vitiligo. [ABSTRACT FROM AUTHOR]