Nuclear Factor Erythroid 2-Related Factor 2 in Vitiligo. / Factor nuclear eritroide similar al factor 2 en el vitíligo.

Vitiligo is a pigmentary disorder, in which oxidative stress has been evidenced as part of the pathogenesis. Pathways responsible for protecting melanocytes from damage caused by reactive oxygen species are known as the nuclear factor erythroid factor 2 (Nrf2) pathway. Nrf2 is a transcription factor that remains inhibited when the organism is in homeostasis, but in the presence of oxidative stress it allows the encoding of phase ii antioxidant enzymes. In vitiligo there are abnormalities in the location and function of Nrf2 as well as polymorphisms that increase the risk of this disease. Currently, multiple molecules that act on Nrf2 have been investigated in order to find useful emerging treatments for vitiligo. A search for articles in Spanish and English was carried out in the PubMed, Ovid, Scopus and Web of Science Clarivate databases, using the keywords "Vitiligo AND nuclear factor erythroid derived 2 like 2 OR NRF2" without time restriction. All in vitro studies, narrative reviews, case series, cohort studies, and randomized and non-randomized clinical trials that specifically addressed the issue of Nrf2 associated with vitiligo were included.

Impact of Vitiligo on Quality of Life. / Impacto del vitíligo en la calidad de vida.

INTRODUCTION AND OBJECTIVE: Vitiligo is a chronic autoimmune skin disease caused by the destruction of melanocytes. Although quality of life (QOL) in vitiligo has been studied in different countries, it has not yet been investigated in Mexico. The aim of this study was to assess the QOL of Mexican patients with vitiligo. MATERIAL AND METHOD: We conducted a cross-sectional study at the research unit of Centro Dermatológico Dr. Ladislao de la Pascua in Mexico City. We included adults with vitiligo and excluded those with other pigmentation disorders or a neurological or psychiatric disorder. Patients on psychoactive medications were also excluded. All the patients were administered the Dermatology Life Quality Index (DLQI), a vitiligo-specific quality of life instrument (the VitiQoL), and the Beck Depression and Anxiety Inventories. RESULTS: We studied 150 patients with vitiligo (103 women [68.7%] and 47 men [31.3%]). The median (interquartile range) age was 38 (20) years. The mean (SD) scores on the DLQI and VitiQoL were 5.2 (5.4) and 32.1 (22.7) out of total possible scores of 30 and 90, respectively. The correlation between questionnaire scores was 0.675 (P<.001). Patients with genital involvement scored significantly worse on the VitiQoL than those without lesions in this area (43.95 [28.4]) vs. 28.98 [20.08], P<.001). The prevalence of depression and anxiety was 34% and 60%, respectively. CONCLUSION: Vitiligo has a minimal impact on the QOL of our patients. QOL was worse in patients with genital lesions.

Design and validation of a questionnaire for measuring perceived risk of skin cancer.

INTRODUCTION: A perceived risk of cancer encourages preventive behavior while the lack of such a perception is a barrier to risk reduction. There are no instruments in Spanish to measure this perceived risk and thus quantify response to interventions for preventing this disease at a population level. The aim of this study was to design and validate a self-administered questionnaire for measuring the perceived risk of skin cancer. MATERIAL AND METHODS: A self-administered questionnaire with a visual Likert-type scale was designed based on the results of the analysis of the content of a survey performed in 100 patients in the Dr. Ladislao de la Pascua Skin Clinic, Distrito Federal México, Mexico. Subsequently, the questionnaire was administered to a sample of 359 adult patients who attended the clinic for the first time. As no gold standard exists for measuring the perceived risk of skin cancer, the construct was validated through factor analysis. RESULTS: The final questionnaire had 18 items. The internal consistency measured with Cronbach α was 0.824 overall. In the factor analysis, 4 factors (denoted as affective, behavioral, severity, and susceptibility) and an indicator of risk accounted for 65.133% of the variance. CONCLUSIONS: The psychometric properties of the scale were appropriate for measuring the perception of risk in adult patients (aged 18 years or more) who attended the dermatology clinic.

[Immunization and bacterial pathogens in the oropharynx as risk factors for alopecia areata]. / Inmunizaciones y bacterias patógenas en la faringe como factores de riesgo para alopecia areata.

INTRODUCTION: Alopecia areata is an autoimmune inflammatory disease affecting the hair follicles. Researchers are currently interested in whether the presence of bacterial pathogens and/or a history of immunization can trigger an autoimmune response in patients who are genetically predisposed. OBJECTIVES: This study aimed to determine whether there is an association between the development of alopecia areata and throat carriage of bacterial pathogens or a history of immunization. MATERIAL AND METHODS: Sixty-five men and women with alopecia areata and 65 control patients with other skin diseases were studied at the Dr Ladislao de la Pascua Dermatology Clinic between September 2008 and February 2009. The patients ranged in age from 18-59 years. Patients with scalp diseases were excluded from the control group. In all cases, the patient was questioned about immunizations received in the previous 6 months, and a throat swab was cultured. RESULTS: A history of immunization (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.6-6.7; P=.001), the presence of bacterial pathogens in the oropharynx (OR, 2.6; 95% CI, 1.1-6.2; P=.033), and being a carrier of Streptococcus pyogenes (OR, 2.1; 95% CI, 1.7-2.5; P=.042) were risk factors for alopecia areata. Klebsiella pneumoniae, S. pyogenes, Pseudomonas aeruginosa, Streptococcus pneumoniae, Serratia marcescens and Escherichia coli were isolated from cultures. CONCLUSIONS: This is the first study to show an association between alopecia areata and throat carriage of bacterial pathogens or history of immunization, as risk factors for development of the disease. Given the characteristics of our study population, the association appears valid for patients with less than 25% hair loss and a course of disease under 1 year.