Vitiligo and thyroid dysfunction in children and adolescents

The link between vitiligo and thyroid disease has been proved in adult patients. The aim of our study was to assess the prevalence of thyroid dysfunction in children and adolescents with vitiligo and to identify any predisposing factors of this association. This retrospective study included 75 children and adolescents with vitiligo: 47 (62.66%) females and 28 (37.33%) males. Physical examination, thyroid ultrasonography and laboratory parameters of thyroid disease were performed in all study subjects. Various degrees of thyroid parameter alterations were found in 19 (25.33%) of 75 patients. Hashimoto's thyroiditis associated with non-segmental vitiligo was present in 11 (14.66%) patients. The most common site of vitiligo onset in patients with Hashimoto's thyroiditis were upper limbs, which was significantly more frequent compared with patients without Hashimoto's thyroiditis (χ(2); P<0.05). Since vitiligo usually appears before the development of thyroid disease, it may be useful to screen the children and adolescents with vitiligo for thyroid autoantibodies.     

Vitiligo in association with human immunodeficiency virus infection

Autoimmune disorders such as vitiligo have been previously reported in patients with human immunodeficiency virus (HIV) infection. We describe a case of vitiligo in association with HIV where a rising CD4 lymphocyte count due to highly active antiretroviral therapy (HAART) closely correlated with changes in the skin. This effect, to our knowledge, has not been previously observed.     

Thyroid dysfunction in patients with psoriasis: Higher prevalence of thyroid dysfunction in patients with generalized pustular psoriasis

The association of psoriasis with thyroid dysfunction has been investigated; however, it remains controversial. Some papers indicate it, and others do not. Thereby, we investigated the prevalence of thyroid dysfunction in patients with psoriasis vulgaris (PsV), psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP), and the relationship between the severity of psoriasis with serum free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone levels. Data on 85 psoriatic patients visiting our hospital from January 2015 to November 2017 (54 men and 31 women; 51 PsV, 23 PsA 23 and 11 GPP) were retrospectively analyzed. Fourteen percent of psoriatic patients had thyroid dysfunction. The percentage of patients with thyroid dysfunction was the highest in those with GPP (45% GPP, 13% PsA, 8% PsV). Patients with thyroid dysfunction demonstrated significantly higher Psoriasis Area and Severity Index scores and elevated serum C-reactive protein (CRP) levels than those without thyroid dysfunction. A significant negative correlation was observed between the serum levels of CRP and fT3 (P = 0.0032, r = −0.4635). Our data indicate that thyroid dysfunction in patients with psoriasis is associated with inflammation caused by psoriasis.     

Higher prevalence of thyroid dysfunction in patients with erythrodermic psoriasis

The association of psoriasis with thyroid dysfunction has been investigated. However, it remains unclear; some papers indicate it, and others do not. In this study, we evaluate the prevalence of thyroid dysfunction in patients with psoriasis vulgaris (PsV), psoriatic arthritis (PsA), generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP), and the association of thyroid dysfunction with inflammation. Data on 201 psoriatic patients visiting our hospital from January 2014 to November 2017 (159 men and 42 women; 74 PsV, 42 PsA, 38 GPP and 47 EP) were retrospectively analyzed. Thirty-three percent of psoriatic patients had thyroid dysfunction. The percentage of patients with thyroid dysfunction was the highest in those with EP (60% EP, 42% GPP, 19% PsA, 19% PsV). The prevalence of thyroid dysfunction decreased significantly when patients switched from EP to PsV or PsA (58% vs 17%; median, 20.5; range, 4–65 months). Most of the patients with thyroid dysfunction had low thyroxine syndrome (serum levels of free thyroxine are low, but serum thyroid-stimulating hormone level is normal). Patients with thyroid dysfunction demonstrated significantly higher CD3⁺ and CD4⁺ T-cell absolute count levels than those without thyroid dysfunction. Meanwhile, patients with thyroid dysfunction demonstrated lower immunoglobulin (Ig)A and IgM levels than those without thyroid dysfunction. Finally, patients with thyroid dysfunction demonstrated higher elevated serum C-reactive protein levels than those without dysfunction in total, although there were no statistical differences. Our data indicate that thyroid dysfunction in patients with psoriasis may be associated with inflammation caused by psoriasis.     

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age.

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p<0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p<0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.     

Treatment of vitiligo in children and adolescents by autologous cultured pure melanocytes transplantation with comparison of efficacy to results in adults

Background Transplantation of autologous cultured pure melanocytes is a well‐established procedure for the treatment of refractory and stabilized vitiligo. However, there was no report specifically comparing the efficacy with the regard to defined age groups (children‐adolescence‐adult). Objective We analysed the efficacy of this procedure in the treatment of vitiligo in children and adolescents and compare it with the results in adults treated during the same period and using identical procedures. Methods Melanocytes were isolated from the roof of suction blister, cultured and expanded with Hu16 medium in vitro, and transplanted to laser‐denuded receipt area. A total of 12 children (8–12 years), 20 adolescents (13–17 years) and 70 adults with vitiligo were treated using this procedure. Results The patients obtained satisfactory results (repigmentation of 50% or more) results in children, adolescents and adults were 83.3%, 95.0% and 84.0% respectively. The mean extent of repigmentation in children, adolescents and adults was 80.7%, 78.9% and 76.6% respectively. There was no statistical difference in repigmentation among these three groups. After adjusting for all factors (gender, type of vitiligo, period of stability, location of the lesion or transplanted cell density) individually or totally using multiple regression analysis, age still did not correlate to the extent of repigmentation. Conclusions The satisfactory results obtained in the treatment of vitiligo in children and adolescents by transplantation of cultured autologous pure melanocytes are comparable with the results in adults. Therefore, this procedure can be considered in refractory and stable vitiligo in children and adolescents, especially in patients with large vitiliginous lesions.     

Vitiligo Coexistent with Nevus Depigmentosus

A 45-year-old Korean man had two distinct types of hypopigmented lesions on the forehead and back: vitiligo and nevus depigmentosus (ND). The hypopigmented macules on the forehead were incidentally discovered 15 days previously and responsed well to steroid therapy. The hypopigmented macule on the back had been present since birth, was stable in size, and showed no response to steroid therapy. There were no remarkable differences between the two lesions in routine histopathology or Fontana-Masson staining. However, the lesion on the back was shown to contain melanocytes in electron microscopy (EM).     

Vitiligo: new and emerging treatments

ABSTRACT:  Vitiligo is a cosmetically disfiguring condition, and, although there is no therapeutic full solution yet, some treatment may induce good results in most patients. The disease can be successfully treated with various medical options. Both nonfocused or focused narrowband ultraviolet B phototherapy represents the current treatment of choice, to minimize side effects and reach optimal clinical results. Topical novel approaches are also considered. Surgical methods, consisting of autologous transplantation methods, is generally recommended for focal/stable vitiligo, after medical therapy has failed. Finally, for patients with extensive vitiligo, depigmentation of the residual melanin should be taken into account.     

Effectiveness of 0.1% topical tacrolimus in adult and children patients with vitiligo

Topical corticosteroids and phototherapy are the conventional treatments of vitiligo. However, the acrofacial and segmental types are often unresponsive to these treatments. Nowadays, a few studies have been conducted on efficacy of topical tacrolimus in treatment of vitiligo including vulgaris and segmental types. Nevertheless, the acrofacial type has never been investigated with this topical therapy. The aim of our study is to evaluate the effectiveness of 0.1% tacrolimus ointment in patients including all types of vitiligo. Forty-two patients with vitiligo (22 adults, 20 children) were enrolled in this study. They were treated with 0.1% tacrolimus ointment twice daily for 6 months. Of these 42 patients, 38 of them completed the treatment process. The mean age of the patients was 27.8 years. The response rate was 76.09%. The vulgaris and focalis had a maximum response rate of 94.12%. The response rates for segmentalis and acrofacialis were 76.92% and 56.25% respectively. Concerning the response, age groups, types and location of vitiligo, there was significant difference in all variables (P = 0.001, P = 0.001, P = 0.025, respectively). Children had approximately nine times higher odds (95% CI = 1.09, 81.88) of having better response to the treatment than adults. The disease duration of 5 years or less also showed a better response. In conclusion, topical tacrolimus can be used for the treatment of patients with vitiligo. We recommend that, other than in the vulgaris type, topical tacrolimus may be considered as a treatment for two difficult to treat types of vitiligo, acrofacialis and segmentalis, before considering other modalities.     

Vitiligo skin types in Koreans

There is uncertainty and controversy about the relationship between skin type and development of vitiligo. The present study was undertaken to study whether vitiligo patients have a different skin type than the control group. We investigated the skin types of 201 Korean vitiligo patients and 70 healthy Korean volunteers. Skin type was determined by the skin phototyping method proposed by Fitzpatrick. Compared to normal controls, skin type II was significantly less frequent and skin type V was quite common in the vitiligo group. These results suggest that people with dark skin have a higher probability of developing vitiligo than people with light skin.     

Vitiligo associated with malignant melanoma and lupus erythematosus

There exists several reports where malignant melanoma is associated with vitiligo, vitiligo with discoid lupus erythematosus and lupus erythematosus with urticaria. However, there are no reports in which vitiligo, malignant melanoma, lupus erythematosus and urticaria coexist in the same case. Herein, we report a case of a patient who developed lupus erythematosus, malignant melanoma, vitiligo and urticaria simultaneously.     

白癜风患者血清可溶性细胞间黏附分子-1的检测

目的检测白癜风患者血清可溶性细胞间黏附分子-1(sICAM-1)的水平,并探讨其与白癜风活动性关系.方法采用酶联免疫吸附试验(ELISA)法检测40名健康人和40例白癜风患者血清sICAM-1水平.结果①白癜风患者血清sICAM-1浓度明显增高,与正常对照组比较有显著性差异(P＜0.001).②进展期白癜风患者血清sICAM-1浓度显著高于稳定期(P＜0.001).③稳定期白癜风患者血清sICAM-1浓度与正常对照组无显著性差异(P＞0.05).结论 sICAM-1与白癜风活动程度有关.     

Modified Thiersch Grafting in Stable Vitiligo

Medical management of vitiligo usually gives complete repigmentation in up to 60 to 90% of cases (4, 7). Modified Thiersh grafting, in which psoralen without UVA or solar radiation was used successfully, is described.     

白癜风并发自身免疫性甲状腺疾病的危险因素分析及列线图预测模型的建立

目的：分析白癜风并发自身免疫性甲状腺疾病的危险因素并建立列线图预测模型。方法：收集2017年2月至2019年1月我院276例白癜风患者的临床资料，使用Logistic回归分析白癜风并发自身免疫性甲状腺疾病的独立危险因素。采用R（R 3.5.3）软件包，rms程序包，建立列线图预测模型。同时应用caret程序包进行Bootstrap法重复抽样1000次做内部验证，采用rms程序包计算一致性指数（C-index）。采用ROCR及rms程序包制作ROC曲线。结果：本研究白癜风并发自身免疫性甲状腺疾病的发生率为17.75%，高血糖、白癜风病程、白癜风类型、负性情绪、吸烟、自身免疫性甲状腺病家族史及其他自身免疫性疾病家族史为白癜风并发自身免疫性甲状腺疾病的独立危险因素（均P<0.05）。基于筛选的独立危险因素，建立预测列线图模型结果显示，实际发生率与预测发生率基本一致（χ2=3.854，P=0.724），C-index指数高达0.857（95% CI：0.829~0.885）。结论：白癜风患者应尽可能筛查自身免疫性甲状腺疾病，特别是在有危险因素的白癜风患者中。     

Successful Treatment of Vitiligo with a Sex Steroid-Thyroid Hormone Mixture

Four patients with generalized vitiligo were successfully treated by oral administration of a sex steroid-thyroid hormone (Metharmon-F®, 2 tablets daily). Histopathologically, the repigmented skin showed increased numbers of melanocytes and melanin granules in the keratinocytes.     

Vitiligo: interplay between oxidative stress and immune system

Vitiligo is a multifactorial polygenic disorder with a complex pathogenesis, linked with both genetic and non‐genetic factors. The precise modus operandi for vitiligo pathogenesis has remained elusive. Theories regarding loss of melanocytes are based on autoimmune, cytotoxic, oxidant–antioxidant and neural mechanisms. Reactive oxygen species (ROS) in excess have been documented in active vitiligo skin. Numerous proteins in addition to tyrosinase are affected. It is possible that oxidative stress is one among the main principal causes of vitiligo. However, there also exists ample evidence for altered immunological processes in vitiligo, particularly in chronic and progressive conditions. Both innate and adaptive arms of the immune system appear to be involved as a primary event or as a secondary promotive consequence. There is speculation on the interplay, if any, between ROS and the immune system in the pathogenesis of vitiligo. The article focuses on the scientific evidences linking oxidative stress and immune system to vitiligo pathogenesis giving credence to a convergent terminal pathway of oxidative stress–autoimmunity‐mediated melanocyte loss.