Is there a relationship between homocysteine and vitiligo? A pilot study

Background Pigmentary dilution is observed in patients with homocystinuria. Therefore, it is possible that an increase of local homocysteine (Hcy) interferes with normal melanogenesis and plays a role in the pathogenesis of vitiligo. Vitamin B₁₂ and folic acid, levels of which are decreased in vitiligo, are important cofactors in the metabolism of Hcy. Consequently, a nutritional deficiency in either of these two vitamins will result in an increase in homocysteine in the circulation, a finding that we expect to find in vitiligo. Objective To determine the level of Hcy in the blood of patients with vitiligo as a first step in revealing if it has any relationship with the pathogenesis of vitiligo and consequently if this will have an impact on the treatment of vitiligo. Methods Twenty‐six patients of both sexes with vitiligo (age range 20–50 years, mean 31·4 ± 8·09) and 26 age‐matched healthy controls were included in the study. After excluding factors that may affect serum Hcy levels, blood samples from patients and controls were obtained for homocysteine determination by enzyme immunoassay. Results The mean serum level of Hcy was significantly higher in patients with vitiligo than in controls (21·61 ± 13·28 vs. 13·1 ± 4·88 μmol L^?1; P < 0·001). The Hcy level was significantly higher in male patients than in female patients (28·67 ± 15·95 vs. 15·56 ± 6·2 μmol L^?1; P < 0·001) and in male controls compared with female controls (15·07 ± 4·61 vs. 12·05 ± 4·82 μmol L^?1; P < 0·001). The homocysteine level was related to the activity of vitiligo and was significantly higher in patients with progressive disease than in controls (25·4 ± 14·99 vs. 13·1 ± 4·88 μmol L^?1; P < 0·001). No significant difference in Hcy levels was found between either untreated vitiligo patients (22·77 ± 13·36 μmol L^?1) or patients receiving ultraviolet therapy (20·45 ± 13·73 μmol L^?1) and the total patient group (21·62 ± 13·28 μmol L^?1). Conclusion An elevated homocysteine level may be a precipitating factor for vitiligo in predisposed individuals. In view of the biological role of vitamin B₁₂ and folic acid in Hcy metabolism, we present our recommendations regarding the investigation and treatment of this common disease.     

Relevance of autoimmune thyroiditis in children and adolescents with vitiligo

Background Vitiligo is the most common pigmentation‐related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. Methods Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid‐stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. Results The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris‐type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. Conclusions Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris‐type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.     

Vascular endothelial growth factor levels are increased and associated with disease activity in patients with Behçet's syndrome

Background/aims Vascular endothelial growth factor (VEGF) is a cytokine participating in inflammation with potent endothelial cell effects. It is produced by macrophages, neutrophils and vascular endothelial cells and can alter vessel permeability. Behçet's syndrome is a systemic inflammatory disorder with unknown etiology. Vascular endothelial dysfunction is one of the prominent features of the disease. We previously demonstrated the possible involvement of proinflammatory cytokines [tumor necrosis factor (TNF)‐α, soluble interleukin‐2 receptor (sIL‐2R), interleukin (IL)‐6 and IL‐8], nitric oxide (NO) and adrenomedullin in the etiopathogenesis of Behçet's syndrome. Since VEGF expression is induced by these cytokines and VEGF itself is a potent stimulator of NO production with endothelial cell effects, this study aimed to investigate whether VEGF was affected during the course of Behçet's syndrome. We also assessed the possible involvement of VEGF in ocular Behçet's syndrome or in disease activity. Methods This multicenter case–control study included a total of 39 patients with active (n = 22) or inactive (n = 17) Behçet's syndrome (mean age, 38.1 ± 10.4 years; 21 men and 18 women) satisfying International Study Group criteria, and 15 healthy hospital‐based control volunteers (mean age, 39.2 ± 9.3 years; eight men and seven women) matched for age and gender from a similar ethnic background. Patients were examined by a dermatologist and an ophthalmologist with an interest in Behçet's syndrome. Plasma VEGF concentrations were measured using a newly established enzyme‐linked immunosorbent assay. Clinical findings and acute‐phase reactant parameters such as erythrocyte sedimentation rate, α₁‐antitrypsin, α₂‐macroglobulin, and neutrophil count were used to classify the disease in Behçet's patients as active or inactive. The Wilcoxon test or the Mann–Whitney U‐test was used for statistical analysis as indicated and the results were expressed as mean ± SD, with range. Results The mean plasma VEGF level in patients with Behçet's syndrome (291.9 ± 97.1 pg/mL; range 121–532 pg/mL) was higher than that in control subjects (103.0 ± 43.6 pg/mL; range 25–187 pg/mL) and the difference was significant (P < 0.001). Patients with active disease had significantly (P < 0.001) higher VEGF levels than patients with inactive disease (347.6 ± 87.1 vs. 219.9 ± 51.6 pg/mL). In addition, ocular Behçet's patients (n = 23) had higher VEGF levels (315.7 ± 92.1 pg/mL) than nonocular patients (n = 16, 257.8 ± 96.6 pg/mL) and the difference was of borderline significance (P = 0.041). The levels of all acute‐phase reactant parameters were significantly higher in the active stage than in the inactive stage (for each, P < 0.01) or in control subjects (for each, P < 0.001). Conclusions VEGF may participate in the course of Behçet's syndrome, especially in the active stage, and elevated levels of VEGF may be an additional risk factor for the development of ocular disease, contributing to poor visual outcome.     

Macrophage migration inhibitory factor in patients with vitiligo and relationship between duration and clinical type of disease

Background. Vitiligo is a disorder of pigmentation characterized by the presence of depigmented skin macules. Cellular immunity is known to have a role in the pathogenesis of vitiligo. Macrophage migration inhibitory factor (MIF) is a potent activator of macrophages and is considered to play an important role in cell‐mediated immunity. Aims. To determine serum level of MIF in patients with vitiligo and compare with healthy controls. We also aimed to determine whether there is a relationship between MIF levels and the disease duration, clinical vitiligo and involved body surface area (BSA) in patients with vitiligo. Methods. The study group comprised 30 patients with vitiligo (14 men, 16 women) and 30 healthy controls, matched for age and gender. Blood samples were taken for MIF analysis. Results. The mean serum level of MIF in patients with vitiligo (40.83 ± 31.66 pg/mL) was significantly higher than that of the control group (21.00 ± 6.48 pg/mL) (P = 0.002). There was a positive correlation between disease duration and MIF levels (r = 0.601, P < 0.001). Mean MIF level of patients with acral and acrofacial vitiligo (n = 6) was 48.25 ± 32.02 pg/mL, and of patients generalized vitiligo (n = 18) was 44.46 ± 35.25 pg/mL. There was no significant difference between these two groups (P > 0.05). However there was a significant difference in MIF levels between patients with localized (20.41 ± 5.23, n = 5) and acral–acrofacial (P = 0.02) vitiligo and those with generalized (P = 0.006) vitiligo. There was no relationship between BSA and MIF levels. Conclusions. Mean serum MIF level of patients with vitiligo was higher than that of controls, indicating that MIF has a role in the pathogenesis of vitiligo.     

Vitiligo patients from India (Mumbai) show differences in clinical,demographic and autoantibody profiles compared to patients in western countries

Background Vitiligo is a common, idiopathic skin disorder characterized by depigmented skin due to the loss of cutaneous melanocytes. Several studies have reported the clinical and demographic characteristics of Indian vitiligo patients, however, none has characterized their antibody profiles. Objective To establish the clinical, demographic and serological details of a population of vitiligo patients from Mumbai, India, and to evaluate the data for any associations between clinical presentations and the occurrence of antibody responses. Methods Vitiligo patients (n = 79) were recruited to the study and their clinical and demographic details recorded. Serum antibodies, including those against melanocyte‐specific antigens, thyroid antigens and keratinocytes, were evaluated. Results The prevalence of vitiligo was independent of sex, and non‐segmental vitiligo was the most common form of the disease occurring in 65% of the patients. Patients with segmental vitiligo (mean age = 14.4 ± 4.6 years) presented at a younger age than those with non‐segmental disease (mean age = 32.5 ± 17.8 years). Personal and family histories of other autoimmune diseases occurred in 3% and 8% of patients, respectively. Antibodies were detected against tyrosinase, tyrosine hydroxylase, thyroid peroxidase, thyroglobulin and keratinocytes at frequencies of 11%, 22%, 18%, 24% and 27%, respectively. Overall, antibodies were more common in patients with non‐segmental vitiligo (50–67%) than in those with segmental disease (0–17%), and were detected more frequently in patients with shorter disease durations (<10 years). Conclusion Our study provides novel information relative to the clinical details, demographic features and serological parameters of a population of vitiligo patients from Mumbai, India. Important distinctions from similar surveys conducted in European patients were evident such as an infrequency of family history, a low prevalence of clinical autoimmune disease, and an absence of particular antibody specificities. These differences may have a bearing on the pathogenesis and course of the disease in Indian patients.     

PERIPHERAL BLOOD LYMPHOCYTE IMBALANCE IN KOREANS WITH ACTIVE VITILIGO

Background. An immune-mediated destruction of melanocytes is the most popular current theory of vitiligo. There have been a few published reports on the assessment of lymphocyte population in vitiligo, and they showed mixed results. The purpose of our investigation was to assess peripheral lymphocyte subpopulations in Koreans with actively spreading vitiligo. Methods. Fifty patients with actively spreading vitiligo and 30 normal persons were studied for peripheral blood lymphocyte imbalance using flow cytometry. The percentages of total T-lymphocytes, B-lymphocytes, helper T cells, suppressor T cells, and natural killer cells were evaluated with the use of CD3, CD19, CD4, CD8, and CD16 monoclonal antibodies, respectively. Results. The mean value of helper T cells showed a significant difference between the two groups with the value being 38.2% in patients and 43.5% in control subjects. Seventeen of the 50 patients showed reversed helper/suppressor T cell ratio, whereas only 1 of 30 control subjects showed reversed ratio. There was a statistically significant difference in the mean percentage of helper T cells and suppressor T cells between generalized vitiligo patients and control subjects. The percentage of B cells in patients with recent onset less than 1 year was higher than control subjects and patients with late onset. The mean percentage of natural killer cells was increased significantly in patients with negative autoantibody test. Conclusions. The present data show that immunologic abnormalities, both cellular and humoral, are involved in the pathogenesis of vitiligo.     

Evaluation of ocular findings in patients with vitiligo

In this study, we aimed to investigate ocular manifestations in patients with vitiligo. Sixty‐one patients with vitiligo were included in the study. From the patients who referred for examination to the dermatology and ophthalmology clinic, 57 patients without any systemic disease were taken as the control group. In both groups, otorefractometry, keratometry, visual acuity test, intraocular pressure measurement, anterior segment, and fundus examinations of the eye with slit lamp, Schirmer test, and perimetry were carried out. The mean age was 24.54 ± 11.90 years and 23.03 ± 8.72 years in the patients and control group, respectively. The mean Schirmer test results were as follows: 16.74 ± 9.11 mm and 17.64 ± 9.41 mm for the right and left eyes of the patients, and 21.96 ± 12.51 mm and 23.42 ± 12.51 mm for the right and left eyes of controls, respectively. Of the patients, 36 eyes showed lenticular findings. However, only 12 eyes of the controls have some lenticular findings. Twenty‐nine eyes in the vitiligo group and four in the controls showed some fundus findings. When the two groups were compared with each other, there was a statistically significant difference between them in terms of Schirmer test results, lens, and fundus findings (P < 0.05 for all). However, there was no significant difference in terms of age, gender, visual acuity, refraction, keratometry, intraocular pressure, perimetry, and corneal findings (P > 0.05 for all). Patients with vitiligo may have more lenticular and retinal findings than normal. They can be more prone to dry eye syndrome as well.     

Caspase-9 expression is increased in endothelial cells of active Behçet's disease patients

Background Behçet's disease is a multisystem disease of unknown etiology. Caspase‐9 is responsible for initiating the caspase activation cascade during apoptosis. The aim of this study was to examine caspase‐9 expression in both endothelial and perivascular infiltrates of patients with active Behçet's disease. Methods Fifteen patients with active Behçet's disease, attending the First Dermatology Department, Ankara Numune Hospital, Ankara, Turkey between June 2003 and December 2005, were included in the study. Oral biopsy specimens from nine healthy volunteers were taken as the healthy control group, and skin biopsies from 18 psoriasis patients were used as the inflammatory control group. The specimens were examined with caspase‐9 primary antibody. Statistical analyses were performed using SPSS 11.5. Results The mean caspase‐9‐positive endothelial cell counts were 7.17 ± 2.45 in active Behçet's disease, 4.81 ± 0.76 in healthy controls, and 4.35 ± 1.34 in inflammatory controls. The difference between Behçet's disease and healthy controls was statistically significant, with increased endothelial staining in active Behçet's disease (P = 0.049). The difference between Behçet's disease and inflammatory controls was also statistically significant; the rate of staining was higher in Behçet's disease (P = 0.006). The mean caspase‐9‐positive dermal perivascular cell counts were 5.15 ± 2.32 in Behçet's disease, 3.32 ± 0.82 in healthy controls, and 5.54 ± 4.95 in inflammatory controls. These values did not show any statistically significant difference (P = 0.407). Conclusion Endothelial cells are one of the key cells in Behçet's disease, and our findings support the role of endothelial cells in the etiopathogenesis of Behçet's disease.     

Efficacy and safety of desloratadine combined with dipyridamole in the treatment of chronic urticaria

Chronic urticaria (CU) imposes profound impairment on patient's quality of life. Our study was done to evaluate the clinical efficacy and safety of desloratadine combined with dipyridamole, which is a platelet adhesion inhibitor in the treatment of CU. A randomized study was done in 64 autoimmunity CU patients with positive autologous plasma skin test (APST): 34 patients as treatment and 30 controls. The treatment group was treated with desloratadine and dipyridamole, and the control group was treated with desloratadine only. The efficiency and side‐effect were evaluated at the end of treatment. The levels of fragment F₁₊₂ were measured by enzyme‐linked immunosorbent assay in all patients at pre‐ and post‐treatment. The clinical effectiveness rates of treatment and control group were, respectively, 85.20% (21 cured, 8 obvious effectiveness) and 70% (14 cured, 7 obvious effectiveness); they have a significant difference (x = 4.09, P < 0.05). Before treatment, the weals and pruritus in the treatment and control group were, respectively, (1.74 ± 0.90, 1.79 ± 0.73) and (1.67 ± 0.84, 1.73 ± 0.78). After treatment, the weals and pruritus in treatment and control group were, respectively, (0.38 ± 0.73, 0.58 ± 0.89) and (0.67 ± 0.96, 1.10 ± 1.12). These findings provide new insights into the pathogenesis of CU and suggest new therapeutic opportunities for treating this disease.     

Use of light-emitting diode photomodulation to reduce erythema and discomfort after intense pulsed light treatment of photodamage

Objectives This study evaluates the use of light‐emitting diode (LED) photomodulation therapy to accelerate resolution of post–intense pulsed light (IPL) erythema. Methods In this split‐face study, 15 subjects were randomized to receive LED treatment to one side of the face as determined by computer‐generated randomization numbers. All 15 subjects received a single IPL treatment for facial photodamage. Immediately after IPL treatment, one side of the face was treated for 35 s with the LED device. The other side was not treated. Subjects returned 24 h later for a second LED treatment on the same side of the face. Posttreatment erythema was rated on both sides of the face by the blinded investigator and by subjects immediately after IPL treatment, 24 h later, and 1 week later on a scale of 0% (no erythema) to 100% (severe erythema). Patients commented on posttreatment discomfort immediately after IPL treatment. Results Mean erythema scores on the first visit were significantly higher (P = 0.0054) on the side not treated with LED (52.7 ± 24.6) than on the LED‐treated side (43.3 ± 21.9). Visit 2 data showed a similar trend (P = 0.0281). The subjects reported similar findings with mean erythema scores on the first visit on the LED‐treated side (46.7 ± 25.3) compared with the untreated side (60.0 ± 23.3); the difference was significant (P = 0.0382). On the second visit, the mean erythema scores trended lower on the LED‐treated side (24.3 ± 22.1) than on the untreated side (27.9 ± 25.8), but the difference did not reach statistical significance (P = 0.1365). Erythema scores on both facial sides were 0 for all subjects 1 week after IPL treatment. Four patients commented that posttreatment discomfort was considerably less on the LED‐treated side immediately after treatment. Conclusion LED photomodulation treatment may accelerate the resolution of erythema and reduce posttreatment discomfort in IPL‐treated patients with photodamage.     

Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis

Background Climate therapy (heliotherapy) of psoriasis is an effective and natural treatment. Ultraviolet radiation (UVB) from the sun improves psoriasis and induces vitamin D₃ synthesis. Objective The aim of the study was to investigate the effect of climate therapy on vitamin D₃ synthesis, blood glucose, lipids and vitamin B12 in psoriasis patients. Methods Twenty Caucasian patients (6 women and 14 men; mean age, 47.2 years; range, 24–65) with moderate to severe psoriasis [mean Psoriasis Area and Severity Index (PASI) score 9.8; range, 3.8–18.8] received climate therapy at the Gran Canarias for 3 weeks. Blood samples were drawn before and after 15 days of sun exposure. In addition, the patients’ individual skin UV doses based on UV measurements were estimated. Results Sun exposure for 15 days lead to a 72.8% (± 18.0 SD) reduction in the PASI score in psoriasis patients. Although no direct correlation was observed between PASI score improvement and UVB dose, the sun exposure improved the vitamin D, lipid and carbohydrate status of the patients. The serum concentrations of 25‐hydroxyvitamin D [25(OH)D] increased from 57.2 ± 14.9 nmol/L before therapy to 104.5 ± 15.8 nmol/L (P < 0.0001) after 15 days of sun exposure; the serum levels of 1,25‐dihydroxyvitamin D [1,25(OH)₂D] increased from 146.5 ± 42.0 to 182.7 ± 59.1 pmol/L (P = 0.01); the ratio of low‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol decreased from 2.4 to 1.9 (P < 0.001); and the haemoglobin A₁c (HbA₁c) levels decreased from 5.6 ± 1.7% to 5.1 ± 0.3% (P < 0.0001). Conclusion Climate therapy with sun exposure had a positive effect on psoriasis, vitamin D production, lipid and carbohydrate status.     

Bone mineral density and bone turnover markers of patients with Behçet's disease

Background Behçet's disease (BD) is a systemic inflammatory disease of unknown aetiology. The pathogenesis of rheumatological findings and the status of bone metabolism in this disease are unknown. Inflammatory diseases may predispose to a decrease in bone mineral density (BMD) and there are many studies concerning osteoporosis in chronic inflammatory diseases. Objective The aim of this study was to investigate BMD and bone turnover markers in patients with BD. Methods Thirty BD patients (17 male and 13 female patients, mean age 36.9 ± 12.6 years) and a total of 30 age‐ and sex‐matched healthy controls (17 male and 13 female controls, mean age 34.9 ± 8.95 years) recruited from the general population were enrolled in the study. Bone mineral density was measured at the lumbar spine (L1‐4) and the left hip (total hip) using dual energy X‐ray absorptiometry. Serum samples were collected between 8 and 10 am after overnight fasting. Serum calcium (Ca), phosphate (P), parathormone (PTH), total alkaline phosphatase (ALP), osteocalcin (OC), erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) were measured. Free deoxypyridinoline cross‐links (DPD) in second‐void urine and total daily urinary calcium excretion were analysed. Results No statistically significant difference in lumbar spine or femoral BMD and bone turnover markers were found between BD patients and control groups (P > 0.05). Conclusion Although it is difficult to draw definite conclusions because of the limited number of patients involved, our study indicates that bone mineral density and bone turnover markers in Behçet's disease were no different than in healthy subjects.     

Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1–2% of the general population. Although not life threatening, vitiligo may considerably influence patients’ health‐related quality of life (QoL) and psychological well‐being. Willingness‐to‐pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ‐5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71·5% women, mean age 44·4 years, mean disease duration 20·3 years) with vitiligo. The mean DLQI was 7·0 (7·5 in women, 5·5 in men) compared with 8·6 in psoriasis. Of the patients with vitiligo, 24·6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34·1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20–29 years. EQ‐5D mean score was 83·6 compared with 75·3 in psoriasis. Of the patients with vitiligo, 32·9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle‐aged patients (30–60 years). There was a significant correlation between DLQI scores and WTP (χ² = 65·43, P < 0·001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0·001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients’ compliance and empowerment.     

Skin blood flow in necrobiosis lipoidica diabeticorum

Background Necrobiosis lipoidica diabeticorum (NLD) is a granulomatous skin reaction found in < 1% of diabetic patients. Our purpose was to determine if NLD represented areas of cutaneous ischemia. Methods Using laser Doppler flowmetry, we measured cutaneous blood flow in nine diabetic patients at NLD lesions and at contiguous uninvolved sites. Flow values were also determined at several reference sites noncontiguous with the NLD lesions and compared to age‐ and sex‐matched controls: 24 diabetic subjects without skin abnormalities, 18 diabetic patients with dermopathy, and 40 nondiabetic subjects. Results NLD lesions exhibited significantly higher blood flow (4.8 ± 0.7 ml/min/100 g) than areas of unaffected skin close to the lesions (1.2 ± 0.1 ml/min/100 g) (P < 0.01 for both comparisons). There were no significant differences in flow between normal skin sites in NLD patients and normal sites in diabetic patients without skin lesions. Conclusions Our findings refute the hypothesis that NLD is a manifestation of microvascular ischemic disease of the skin. The increased blood flow seen in NLD lesions suggests an ongoing inflammatory process.     

From basic research to the bedside: efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo

Background The epidermal accumulation of hydrogen peroxide (H₂O₂) has been documented in vitiligo. Aim To assess the effect on disease cessation and repigmentation of the reduction/removal of H₂O₂ using low‐dose, narrow‐band, ultraviolet‐B (UV‐B)‐activated pseudocatalase PC‐KUS in 71 children with vitiligo. Methods This uncontrolled and retrospective study included 45 girls and 26 boys (mean age, 10.3 years) who applied topical PC‐KUS twice daily to the entire body surface without narrow‐band UV‐B dose increments. The affected body areas were documented by special photography at the first visit and after 8–12 months. The response was evaluated by two independent physicians as > 75% vs. < 75% total repigmentation of the face/neck, trunk, extremities, and hands/feet. Generalized (n = 61) and segmental (n = 10) vitiligo were evaluated as different entities. The effect of total‐body, low‐dose, narrow‐band UV‐B (0.15 mJ/cm²) monotherapy once daily without any increments and without application of PC‐KUS was tested over 6 months in 10 children with vitiligo vulgaris (mean age, 8.4 years). Results One hundred per cent cessation was observed in 70 of the 71 children. More than 75% repigmentation was achieved in 66 of 71 patients on the face/neck, 48 of 61 on the trunk, and 40 of 55 on the extremities; however, repigmentation on the hands/feet was disappointing (five of 53). The response was independent of skin color, age of onset, duration of disease, other demographic features, and previous treatments. The follow‐up after narrow‐band UV‐B monotherapy showed no significant repigmentation in all areas. Seven of 10 patients showed progression of their vitiligo. Conclusion A reduction in epidermal H₂O₂ using low‐dose, narrow‐band UV‐B‐activated pseudocatalase PC‐KUS is an effective treatment for childhood vitiligo which can be safely performed at home.     

Investigation of the topical application of procyanidin oligomers from apples to identify their potential use as a hair-growing agent

Background Procyanidins are a family of condensed tannins, which have been shown to possess hair‐growing activity in both the in vitro and in vivo murine models. Aims We report a 12‐month clinical study aimed at treating male pattern baldness by external application of 0.7% apple procyanidin oligomers. Patients/methods A double‐blind clinical test involving a total of 43 subjects was performed. Twenty‐one men in the procyanidin group and 22 men in the placebo control group were subjected to analysis. In the first 6 months, we compared the procyanidin and the placebo groups to assess the medicinal effects of procyanidin oligomers. The application time of the procyanidin group was subsequently extended to 12 months, and the time course of its remedial value was examined. Results The increase in total number of hairs in a designated scalp area of the procyanidin group subjects after the 6‐month trial was significantly greater than that of the placebo control group subjects (procyanidin, 3.3 ± 13.0 (mean ± SD)/0.50 cm²; placebo, ?3.6 ± 8.1/0.50 cm²; P < 0.001, two‐sample t‐test). Time course‐dependent improvement in hair density was observed in the procyanidin subjects. No adverse side effects were observed in any of the subjects. Procyanidin therapy thus shows potential hair‐growing activity.     

Analysis of interleukin-10 levels in lesions of vitiligo following treatment with topical tacrolimus

Background Vitiligo is an acquired dermatological condition that is characterized by depigmentation of patches of skin. It is relatively common, occuring in about 0·38–0·50% of the general population, and can engender significant cosmetic disfigurement and psychological sequelae in the affected individual. Recent studies demonstrate that topical tacrolimus (Protopic^®; Astellas, Markham, ON, Canada) is efficacious in the treatment of vitiligo. We propose that the successful treatment of vitiligo with topical tacrolimus involves the unique immunosuppressive actions of the T lymphocyte T‐helper (Th) 2 cytokine, interleukin (IL)‐10. Objectives We aimed to monitor clinical changes in lesions of vitiligo treated with topical tacrolimus 0·1% ointment and quantify IL‐10 cytokine levels in nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Methods Clinical evaluation of lesions of vitiligo on the basis of surface area and follicular repigmentation under Wood’s lamp was performed in 20 enrolled adult patients. Biopsy specimens were obtained from nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Specimens were processed and analysed for expression of IL‐10 using the method of enzyme‐linked immunosorbent assay. Results A statistically significant mean ± SEM decrease in vitiligo lesion size of 41·0 ± 5·2% was observed following 3 months of treatment. A pattern of follicular repigmentation was noted by the third month of treatment for all patients completing the study. In addition, there was a statistically significant difference between IL‐10 expression in vitiligo lesions following treatment for 3 months with topical tacrolimus compared with untreated vitiligo lesions (P = 0·017) and normal skin (P = 0·004). Conclusions These results confirm that topical tacrolimus is an effective treatment for vitiligo. We propose that topical tacrolimus increases IL‐10 expression in vitiligo lesions, and thereby inhibits melanocyte destruction triggered by unchecked Th1 pathways in vitiligo.     

Effect of melasma on quality of life in a sample of women living in southern Brazil

Background Melasma can cause a significant effect on individual emotional well‐being. Melasma Quality of Life Scale (MELASQoL) is a specific questionnaire elaborated to assess the burden of melasma on patient's quality of life. Objective To evaluate the clinical aspects, severity and the influence of melasma on daily living of a sample of Brazilian women. Methods Cross‐sectional study that enrolled 85 women with melasma older than 15 years of age. Trained investigators asked 55 questions to collect epidemiological and clinical data. The disease severity was clinically assessed using Melasma Area and Severity Index (MASI). Patients answered the Portuguese version of 10‐item MELASQoL scale without coaching. Results The mean ± SD age was 41.1 ± 6.8 years, and the mean ± SD of MELASQoL score was 37.5 ± 15.2 (median, 35). Patients with previous psychiatric diagnosis had significantly higher MELASQoL scores (mean, 42.8; SD, 13.6) than patients without this antecedent (mean, 35.4; SD, 15.4; P < 0.05). Patients with less than 8 years of school attendance also had significantly higher MELASQoL score (mean, 44; SD, 16.9) than more graduated ones (mean, 34.4; SD, 13.5; P < 0.05). The mean ± SD MASI was 10.6 ± 6.6 (median, 10.2). There was no correlation between MASI and MELASQoL. Conclusions This study confirms that MELASQoL‐BP is easy to administer, adds important information about the impact of melasma on South American women's life and, finally, contributes to building evidence on the validity, reliability and cultural adaptation of the Portuguese language MELASQoL version.     

Study of clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo undergoing melanocyte transplantation

Background Stability is considered the most important parameter before performing any melanocyte transplantation procedure in vitiligo; however, current criteria rely on the history given by the patients. Objective  This study was undertaken to determine the clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo to facilitate better patient selection for melanocyte transplantation and to understand immunological mechanisms for disease activity. Methods  Thirty‐three patients with generalized vitiligo with < 10% body surface area involved were allocated to three clinical stability groups: Group 1 (stability > 3 months but < 1 year), Group 2 (≥ 1 year but < 2 years) and Group 3 (≥ 2 years). Melanocyte transplantation was done using suction blister epidermal grafting (SBEG) on a single patch. Blood was drawn for catalase estimation from all patients and from 10 healthy control subjects. A 3‐mm punch biopsy was taken on the day of transplantation from the margin of the macule in the first five patients in each group for the immunohistochemistry of CD4, CD8, CD45RO, CD45RA and FoxP3. Those with ≥ 75% repigmentation at 6 months were labelled as responders. Results  The success rate was 0% in Group 1, 37·5% in Group 2 and 77·8% in Group 3. The difference in the success rate between the groups was statistically significant (P = 0·005). The median period of stability was significantly higher in the responders compared with that in the nonresponders (P = 0·001). Catalase levels were not significantly different between patients in the three groups of cases and in controls, or between responders and nonresponders. Lesional CD8 cells were significantly higher in Group 1 compared with Group 3. The percentages of CD8 and CD45RO cells were significantly higher in the nonresponders compared with the responders. Conclusion Along with clinical stability, the proportion of CD8 and CD45RO cells in skin biopsies might help to determine the stability of the disease and thereby predict the success of transplantation.