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The Journal of Dermatological Treatment Dec 2023Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and... (Review)
Review
Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10-12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.
Topics: Humans; Latin America; Vitiligo; Quality of Life; Brazil
PubMed: 36594681
DOI: 10.1080/09546634.2022.2164171 -
BMJ Clinical Evidence Mar 2015Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution... (Review)
Review
INTRODUCTION
Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution of vitiligo often changes during the course of a person's lifetime and its progression is unpredictable.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of surgical interventions for vitiligo in adults and in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found four studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: blister grafts, cultured cellular transplantation, non-cultured cellular transplantation, punch/mini grafts, and split thickness skin grafts.
Topics: Humans; Melanocytes; Skin Transplantation; Vitiligo
PubMed: 25800413
DOI: No ID Found -
Oxidative Medicine and Cellular... 2022Vitiligo is a common acquired depigmenting disease characterized by the loss of functional melanocytes and epidermal melanin. Vitiligo has a long treatment cycle and... (Review)
Review
Vitiligo is a common acquired depigmenting disease characterized by the loss of functional melanocytes and epidermal melanin. Vitiligo has a long treatment cycle and slow results, which is one of the most difficult challenges for skin diseases. Oxidative stress plays an important role as an initiating and driving factor in the pathogenesis of vitiligo. Antioxidant therapy has recently become a research hotspot in vitiligo treatment. A series of antioxidants has been discovered and applied to the treatment of vitiligo, which has returned satisfactory results. This article briefly reviews the relationship between oxidative stress and vitiligo. We also describe the progress of targeted antioxidant therapy in vitiligo, with the aim of providing a reference for new drug development and treatment options for this condition.
Topics: Antioxidants; Epidermis; Humans; Melanocytes; Oxidative Stress; Vitiligo
PubMed: 35320978
DOI: 10.1155/2022/1821780 -
Current Opinion in Pediatrics Aug 2016Vitiligo and alopecia areata are common, disfiguring skin diseases. Treatment options are limited and include nontargeted approaches, such as corticosteroids, topical... (Review)
Review
PURPOSE OF REVIEW
Vitiligo and alopecia areata are common, disfiguring skin diseases. Treatment options are limited and include nontargeted approaches, such as corticosteroids, topical calcineurin inhibitors, narrow band ultraviolet B phototherapy, and other immune-modifying agents. The purpose of this article is to review shared, novel mechanisms between vitiligo and alopecia areata, as well as discuss how they inform the development of future targeted treatments.
RECENT FINDINGS
Vitiligo and alopecia areata are both autoimmune diseases, and striking similarities in pathogenesis have been identified at the level of both the innate and adaptive immune system. Increased reactive oxygen species and high cellular stress level have been suggested as the initiating trigger of the innate immune system in both diseases, and genome-wide association studies have implicated risk alleles that influence both innate and adaptive immunity. Most importantly, mechanistic studies in mouse models of vitiligo and alopecia areata have specifically implicated an interferon (IFN)γ-driven immune response, including IFNγ, IFNγ-induced chemokines, and cytotoxic CD8 T cells as the main drivers of disease pathogenesis. These recent discoveries may reveal an effective strategy to develop new treatments, and several proof-of-concept clinical studies support this hypothesis.
SUMMARY
The identification of IFNγ-driven immune signaling pathways has enabled discoveries of potential new treatments for vitiligo and alopecia areata, and supports initiation of larger clinical trials.
Topics: Adaptive Immunity; Alopecia Areata; Autoimmunity; Genome-Wide Association Study; Humans; Immunity, Innate; Immunosuppressive Agents; Immunotherapy; Interferon-gamma; Reactive Oxygen Species; Signal Transduction; Vitiligo
PubMed: 27191524
DOI: 10.1097/MOP.0000000000000375 -
Acta Dermato-venereologica Oct 2023In China, there is a lack of data regarding the awareness and treatment preferences among patients with vitiligo and their families. To address this gap, a...
In China, there is a lack of data regarding the awareness and treatment preferences among patients with vitiligo and their families. To address this gap, a cross-sectional questionnaire-based study was conducted to investigate disease awareness and treatment preferences in Chinese patients with vitiligo. The study also evaluated willingness to pay, using 2 standardized items, and assessed quality of life, using the Dermatology Life Quality Index (DLQI) score. Data from 307 patients with vitiligo (59.3% women, mean age 28.98 years, range 2-73 years) were analysed. Of these patients, 44.7% had insufficient knowledge of vitiligo, particularly those from rural areas or with low levels of education. Mean DLQI total score was 4.86 (5.24 for women and 4.30 for men). Among the most accepted treatments were topical drugs, phototherapy, and systemic therapy. Patients were relatively conservative about the duration and cost of treatment, with only 27.7% willing to pay more than 10,000 Chinese yuan renminbi (CNY) for complete disease remission. High level of education, high income, skin lesions in specific areas, and skin transplantation therapy predicted higher willingness to pay. Insufficient knowledge was associated with a higher burden of disease. In order to reduce the disease burden and improve treatment adherence it is crucial to enhance disease awareness and take into account patient preferences.
Topics: Male; Humans; Female; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Vitiligo; Quality of Life; Cross-Sectional Studies; Surveys and Questionnaires; China
PubMed: 37787420
DOI: 10.2340/actadv.v103.11643 -
Journal of the European Academy of... Jun 2022Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of... (Review)
Review
Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB-UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte-keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB-UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q-switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.
Topics: Combined Modality Therapy; Humans; Lasers, Excimer; Retrospective Studies; Treatment Outcome; Ultraviolet Therapy; Vitiligo
PubMed: 35176186
DOI: 10.1111/jdv.18005 -
Journal of the American Academy of... Oct 2023
Topics: Female; Humans; Vulvar Lichen Sclerosus; Vitiligo; Lichen Sclerosus et Atrophicus; Vulva; Hypopigmentation; Vulvar Neoplasms; Vulvar Diseases
PubMed: 37328003
DOI: 10.1016/j.jaad.2023.06.016 -
Turkish Journal of Ophthalmology Apr 2021To evaluate aqueous and lipid tear film parameters and the meibomian glands (MGs) with non-contact meibography in patients with vitiligo.
OBJECTIVES
To evaluate aqueous and lipid tear film parameters and the meibomian glands (MGs) with non-contact meibography in patients with vitiligo.
MATERIALS AND METHODS
This case-control study was conducted in the right (OD) and left (OS) eyes of 43 patients with vitiligo and 43 controls in Birjand, Iran. In addition to demographic information and skin disease characteristics, the Ocular Surface Disease Index (OSDI) questionnaire was completed for each patient, followed by eye examinations including slit lamp examination, Schirmer test, strip meniscometry (SMTube), and tear break-up time (TBUT) measurement. The MGs were also imaged using a non-contact meibography system (SBM System, Italy). The data were analyzed using SPSS version 22.0 with a significant level of less than 0.05.
RESULTS
Patients had higher OSDI score than controls but it was not significant (10.90±13.03 vs. 5.57±6.85; p=0.07). There were significant differences between the groups in mean Schirmer test values for both eyes (OD: 8.07±5.47 vs. 17.37±6.52; OS: 7.60±5.00 vs. 17.30±6.44, p<0.001) and mean SMTube results (OD: 4.49±2.40 vs. 9.74±3.67; OS: 4.30±2.81 vs. 9.65±4.52; p<0.001). However, mean TBUT did not differ between the groups (OD: 9.14±3.17 vs. 10.12±2.08, p=0.27; OS: 9.16±3.30 vs. 10.05±2.10, p=0.25). Meibography also showed no significant difference in MG dropout between the groups (OD: 20.86±9.79 vs. 21.05±12.07; p=0.74; OS: 18.16±8.83 vs. 19.53±10.30; p=0.51).
CONCLUSION
Vitiligo is associated with a reduction in the production of aqueous tear film, but does not affect the structure and function of the MGs.
Topics: Adult; Case-Control Studies; Dry Eye Syndromes; Female; Humans; Incidence; Iran; Male; Meibomian Glands; Slit Lamp Microscopy; Tears; Vitiligo
PubMed: 33951893
DOI: 10.4274/tjo.galenos.2020.78027 -
Oxidative Medicine and Cellular... 2015Vitiligo is an acquired dermatological disease frequently associated with autoimmune thyroid disorders. Several theories have been proposed so far to unravel the complex... (Review)
Review
Vitiligo is an acquired dermatological disease frequently associated with autoimmune thyroid disorders. Several theories have been proposed so far to unravel the complex vitiligo pathogenesis. Currently, the autocytotoxic and the autoimmune theories are the most accredited hypothesis, since they are sustained by several important clinical and experimental evidences. A growing body of evidences shows that autoimmunity and oxidative stress strictly interact to finally determine melanocyte loss. In this scenario, associated thyroid autoimmunity might play an active and important role in triggering and maintaining the depigmentation process of vitiligo.
Topics: Autoimmunity; Humans; Oxidative Stress; Reactive Oxygen Species; Thyroid Diseases; Vitiligo
PubMed: 25838868
DOI: 10.1155/2015/631927 -
Journal of the European Academy of... Oct 2022Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under-reported, in part because...
BACKGROUND
Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under-reported, in part because of misconceptions that it is a cosmetic disease.
OBJECTIVES
This survey sought to characterise vitiligo prevalence and explore the relationship between sociodemographic and clinical characteristics with QoL in a population-based, multinational study.
METHODS
Participants aged ≥18 years were recruited via an online panel in Europe, Japan and the USA to answer questions regarding skin disorders they may have experienced. Those reporting vitiligo (diagnosed or undiagnosed) or vitiligo signs (experiencing loss of skin colour but unaware of vitiligo and not diagnosed) were included in the analyses of vitiligo prevalence. Participants who self-reported physician-diagnosed vitiligo were given a broader survey to characterise disease progression, management and QoL (as measured with the Vitiligo-specific QoL [VitiQoL] instrument).
RESULTS
The total estimated vitiligo prevalence among 35 694 survey participants (Europe, n = 18 785; USA, n = 8517; Japan, n = 8392) was 1.3% (diagnosed, 0.6%; undiagnosed, 0.4%; vitiligo signs, 0.3%). Among 219 patients formally diagnosed with vitiligo (Europe, n = 150; USA, n = 48; Japan, n = 21), total VitiQoL scores were associated with age (P = 0.00017), disease extent (P < 0.0001), disease progression (P < 0.0001), disease management (P < 0.0001) and time since diagnosis (P = 0.0015). Behaviour scores varied based on skin phototype (P = 0.024) and ethnicity (P = 0.048). Higher total VitiQoL scores were reported in patients with head lesions (P = 0.027) and those with head and hand and/or wrist lesions (P = 0.018). Substantial high concern (rated 8-10 on an 11-point Likert scale) for lesions was found across all body areas and varied with geographical region.
CONCLUSIONS
The vitiligo prevalence rate may be higher than previously reported, with a substantial proportion attributed to people who have not received a formal diagnosis. Among formally diagnosed patients with vitiligo, QoL was most severely impacted by more progressive and higher extent of disease.
Topics: Adolescent; Adult; Disease Progression; Humans; Japan; Prevalence; Quality of Life; Surveys and Questionnaires; Vitiligo
PubMed: 35611638
DOI: 10.1111/jdv.18257