Prescilia Isedeh

Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study

BACKGROUND Few large-scale studies have quantified the burden of comorbid autoimmune diseases in patients with vitiligo. OBJECTIVE We sought to determine the prevalence of comorbid autoimmune diseases in patients with vitiligo. METHODS We conducted a manual chart review on a cohort of 1873 patients with vitiligo seen between January 2002 and October 2012 at the Henry Ford Health System in Detroit, MI. Patients were excluded if they had fewer than 2 dermatology notes (N = 595) or if they were never given a diagnosis of vitiligo by a dermatologist (N = 180). RESULTS Of 1098 patients with vitiligo, nearly 20% had at least 1 comorbid autoimmune disease. Compared with the general US population, we found a higher prevalence of thyroid disease (12.9%, P < .001), alopecia areata (3.8%, P < .001), inflammatory bowel disease (0.9%, P = .046), pernicious anemia (0.5%, P = .007), systemic lupus erythematosus (0.3%, P = .048), Guillain-Barre syndrome (0.3%, P < .001), discoid lupus (0.2%, P = .003), linear morphea (0.2%, P < .001), myasthenia gravis (0.2%, P = .002), and Sjögren syndrome (0.2%, P = .011). LIMITATIONS The study lacked a control group. This was a single-institution study with possible selection bias, and thus the findings may not be representative of the overall population of patients with vitiligo. CONCLUSIONS We observed a high prevalence of comorbid autoimmune diseases in patients with vitiligo and report several new associations.

The impact of oral Polypodium leucotomos extract on ultraviolet B response: A human clinical study

Background There is a rationale for adding systemic photoprotective agents to the current photoprotection regimen. Objective This study was designed to objectively evaluate the molecular and photobiologic effects of oral administration of Polypodium leucotomos extract (PLE). Methods In all, 22 subjects with Fitzpatrick skin phototype I to III were enrolled. On day 1, subjects were irradiated with visible light, ultraviolet (UV) A1, and UVB (using 308‐nm excimer laser). Evaluation was done immediately and 24 hours after irradiation. On days 3 and 4, irradiation and evaluation process was repeated after ingestion of PLE. Results Clinical assessments and colorimetry data showed a decrease in UVB‐induced changes in 17 of 22 subjects post‐PLE administration; histology findings demonstrated such a decrease in all 22 subjects. Limitations Only 2 doses of PLE were given. Furthermore, subjects with skin phototypes I to III only were studied. Conclusion The results suggest that PLE can potentially be used as an adjunctive agent to lessen the negative photobiologic effects of UVB. Abbreviations used: COX‐2: cyclooxygenase‐2; IGA: Investigator Global Assessment; MED: minimal erythema dose; PLE: Polypodium leucotomos extract; UV: ultraviolet.

Three‐dimensional imaging of vitiligo

Keywords: body Surface Area (BSA); imaging; Measurement error; three dimensional; vitiligo

Uncommon Responses of Segmental Vitiligo to Melanocyte-Keratinocyte Transplantation Procedure

Background Patients with segmental vitiligo (SV), unlike those with nonsegmental vitiligo (NSV), have a more predictable course and are more responsive to surgery. Objective To report 10 patients with SV treated with the melanocyte-keratinocyte transplantation procedure (MKTP), who responded with unusual responses not previously reported in the literature. Methods This is a retrospective, observational study that reports 10 patients with SV who underwent the MKTP between May 2003 and May 2012. Results Two patients had successful repigmentation after split-thickness skin grafting after failure of the MKTP. Two patients developed a hypopigmented ring at a margin of the MKTP-treated area. One patient had complete repigmentation after a second MKTP. Two patients developed koebnerization of the recipient site. Three patients developed new vitiligo patches in previously unaffected areas after the MKTP. Conclusions Uncommon and even suboptimal responses can occur following the MKTP in SV patients. There is a need for studies to provide better understanding and outcomes for SV patients undergoing the MKTP.

Polymorphous Light Eruption

Polymorphous light eruption (PMLE) is the most common of the immunologically mediated (formerly categorized as idiopathic) photodermatoses. Its onset is typically within the first three decades of life affecting females more than males. PMLE lesions are characterized by as non-scarring, erythematous, pruritic papules, vesicles, papulovesicles, plaques, or nodules, affecting sun-exposed skin. The pinpoint variant of PMLE is the most common morphology seen in individuals with darker skin types. Diagnosis is based on history, morphology, as well as clinical course. Treatments for PMLE include photoprotection, light tolerance or “hardening” with phototherapy before sunny weather occurs, and topical corticosteroids, but some systemic medications may be warranted in cases of acute exacerbation of the disease.

Vitiligo: a review of the pathogenesis

Vitiligo is a cutaneous pigmentary disorder caused by selective destruction of melanocytes and is characterized by progressive, patchy loss of pigmentation from skin. The cause of vitiligo is not fully understood. There are a few major hypotheses for the pathogenesis of vitiligo which include the genetic, neural, autoimmune, biochemical, and melanocytorrhagy theories. The objective of this paper was to comprehensively review the body of literature supporting the various theories behind the pathogenesis of vitiligo and present the most relevant findings. A comprehensive literature review of vitiligo studies was performed on Pub Med. This article explains the most relevant findings for the five main theories that have been proposed as the underlying cause for vitiligo. It was concluded that while etiology of vitiligo is not fully understood, great strides have been made in gaining a better picture of the various causes of vitiligo. There is substantial amount of evidence supporting the genetic, neural, autoimmune, biochemical, and melanocytorrhagy theories of vitiligo which provides a solid foundation for future research.