Fenómeno infrecuente la co-localización de alopecia frontal fibrosante y vitiligo en un varón: informe de un caso / Infrequent phenomenon the co-localization of fibrosing frontal alopecia and vitiligo in a male: case repor

La alopecia frontal fibrosante es una alopecia cicatricial que se caracteriza por la recesión de la línea de implantación frontotemporal que afecta principalmente a mujeres caucásicas en edad posmenopáusica y rara vez a hombres. Actualmente los mecanismos específicos de desarrollo continúan en estudio; sin embargo hay varias hipótesis sobre la asociación de la alopecia frontal fibrosante con otros trastornos autoinmunitarios. Se comunica el caso de un paciente masculino de 58 años con alopecia frontal fibrosante en áreas comprometidas por vitiligo. (AU)

Frontal fibrosing alopecia is a cicatricial alopecic characterized by progressive regression of the frontotemporal hairline. It usually affects postmenopausal caucasian women, and rarely men. Currently the specific mechanisms of development remain unknown, however there are several hypotheses about the association of frontal fibrosing alopecia with other autoimmune disorders. The case of a 58-year-old male patient with frontal fibrosing alopecia in areas affected by vitiligo. (AU)

Convivendo com o Vitiligo: Impacto da Doença na Qualidade de Vida das Pessoas / Living With Vitiligo: Impact of the Disease on the Individuals' Quality of Life / Vivir con Vitíligo: El Impacto de la Enfermedad en la Calidad de Vida de las Personas

Introdução:O vitiligo é uma doença caracterizada por máculas hipocrômicas e/ou acrômicas assintomáticas, localizadas ou generalizadas no sistema tegumentar. A despigmentação visível na pele do indivíduo e, usualmente, exposta no cotidiano altera a imagem corporal, impactando na sua qualidade de vida. Objetivo: Avaliar a qualidade de vida das pessoas que convivem com o vitiligo. Método: Trata-se de um estudo transversal realizado com 86 indivíduos com vitiligo. Para a coleta de dados, utilizou-se o questionário Vitiligo-Specific Quality-of-Life Instrument para a qualidade de vida. Resultados: As mulheres (81,4%) em idade adulta (média de 39 anos) com vitiligo apresentaram médio impacto na qualidade de vida, e os fatores que interferiram na qualidade de vida estão relacionados aos cuidados intensificados com a pele, à progressão e à aparência da patologia. Conclusão: A patologia vitiligo interferiu na qualidade de vida dos indivíduos adultos. Os fatores que impactaram na qualidade de vida foram os cuidados intensificados com a pele em atividades de lazer, a preocupação com a progressão da doença e a aparência das manchas hipocrômicas.

Introduction:Vitiligo is a disease characterized by asymptomatic hypochromic and/or achromic macules, localized or generalized in the integumentary system. The visible depigmentation in the skin of the individual and usually exposed in daily life changes the body image, impacting their quality of life. Objective: To evaluate the quality of life of people living with vitiligo. Method: This is a cross-sectional study carried out with 86 individuals with vitiligo. For data collection, the Vitiligo-Specific Quality-of-Life Instrument questionnaire was used for quality of life. Results: Adult women (81.4%) (mean age 39 years old) with vitiligo had a medium impact on quality of life, and the factors that interfered with quality of life are related to intensified skin care, progression, and appearance of the disease. Conclusion: The vitiligo pathology interfered in the quality of life of adults. The factors that impacted quality of life were intensified skin care in leisure activities, the progression of the disease and the appearance of hypochromic spots.

Introducción:El vitíligo es una enfermedad caracterizada por máculas hipocrómicas y/o acrómicas asintomáticas, localizadas o generalizadas en el sistema tegumentario. La despigmentación visible en la piel del individuo y, generalmente expuesta en la vida diaria, cambia la imagen corporal impactando en su calidad de vida. Objetivo:Evaluar la calidad de vida de las personas que viven con vitíligo. Método: Se trata de un estudio transversal realizado con 86 individuos con vitíligo. Para la recolección de datos se utilizó el cuestionario Vitiligo-specific Quality-of-Life Instrument (VitQol) para la calidad de vida. Resultados: Las mujeres adultas (81,4%) (edad media 39 años) con vitíligo tuvieron un impacto medio en la calidad de vida y los factores que interfieren en la calidad de vida están relacionados con el cuidado intensificado de la piel, la progresión y aparición de la patologia. Conclusión:La patología vitíligo interfirió en la calidad de vida de los adultos. Los factores que impactaron en la CV fueron el cuidado intensificado de la piel en las actividades de ocio, la preocupación por la progresión de la enfermedad y la aparición de manchas hipocrómicas.

Fatty acid-binding protein 4 circulating levels in non-segmental vitiligo

Abstract Background: Vitiligo is an acquired and progressive mucocutaneous disease resulting from the loss of active epidermal melanocytes. Metabolic syndrome (MetS) affects about 25% of the world's population and is linked to inflammatory skin diseases including vitiligo. Fatty AcidBinding Protein 4 (FABP4) is an intracellular lipid chaperone. FABP4 is closely associated with MetS. Objectives: To evaluate the serum level of FABP4 in vitiligo patients and its relation to MetS in the investigated cases. Methods: This case control study was conducted on 45 patients having non segmental vitiligo and 45 matched controls. Their lipid profile, blood glucose and serum FABP4 levels were measured. Results: There were significant elevations in FABP4 (p < 0.001), cholesterol (p < 0.001), triglycerides (p = 0.005), and glucose (fasting [p = 0.001] and 2 hours post prandial [p < 0.001]) levels in patients in comparison with controls. MetS was significantly more prevalent among vitiligo patients (p < 0.001) and associated with high FABP4 serum levels (p = 0.037). In vitiligo patients, there were significant positive correlations between FABP4 serum levels and triglycerides (p = 0.047), cholesterol (p = 0.001) and LDL (p = 0.001) levels and negative correlation regarding HDL level (p = 0.009). FABP4 level was a significantly good diagnostic test for early detection of vitiligo (p < 0.001). Study limitations: The small number of studied subjects. Conclusions: FABP4 may play an active role in the disease process of vitiligo that could be mediated through associated dyslipidemia and hyperglycemia. FABP4 may be a marker of vitiligo helping in its early diagnosis, but it does not appear to be useful for determining vitiligo severity, activity or associated MetS.

Spontaneous Re-pigmentation of Vitiligo Following Excision of Halo Congenital Melanocytic nevi: An Interesting Case Report

Summary@#Halo nevi (HN) are benign skin lesion that represent melanocytic nevi in which an inflammatory infiltrate develops, resulting in zone of depigmentation around nevus. Although Sutton originally described the lesion in 1916 as leukoderma acquista centrifugum, the lesions were noted earlier as evidenced in the painting by Matthias Grunwald cica 1512-1516. The prevalence of HNs in the general population is 1%, and HNs usually appear in childhood or early adulthood. Up to 26% of patients with HN have vitiligo, but in very few instances is there an association of HN around congenital melanocytic nevi (CMN) and vitiligo. The exact mechanisms responsible for the development of vitiligo and HN and its resolution are unknown. One of the most accepted hypotheses considers that both phenomena are a result of a self-limited immunologic response to pigmented cells, either in the “normal” skin or within the melanocytic lesion. Hereby we present a rare case report of a girl with halo CMN and infraorbital vitiligo. The halo CMN was excised which was followed by spontaneous improvement of vitiligo.

Pediatric oral vitiligo: Case report and literature review / Vitiligo oral pediátrico: reporte de caso y revisión de la literatura

ABSTRACT: Vitiligo is an acquired hypomelanotic disorder of the skin resulting from loss of functional melanoctyes and it affects approximately 0.5-1% of individuals. 25% of vitiligo in children are diagnosed before 10 years of age. The age of onset of vitiligo in children ranges between 4 to 8 years. Depigmentation in oral cavity can be easily noted and awareness about the condition can be created if they are not aware about vitiligo elsewhere in their body and can be guided for the treatment.

RESUMEN: El vitíligo es un trastorno hipomelanótico en la piel que resulta de la pérdida de melanocitos funcionales y afecta aproximadamente al 0,5-1% de los individuos. El 25% de los casos de vitiligo en niños se diagnostican antes de los 10 años. La edad de aparición del vitiligo en los niños oscila entre los 4 y los 8 años. La despigmentación en la cavidad oral se puede notar fácilmente y se puede crear conciencia sobre la afección, si no son conscientes del vitiligo en otras partes de su cuerpo, y pueden ser guiados para el tratamiento.

Centro de Histoterapia Placentaria "Dr. Carlos Manuel Miyares Cao", 35 años de entrega a la Ciencia Cubana / "Dr. Carlos Miyares Cao" Placental Histotherapy Center, 35 years of dedication to Cuban Science

Introducción: La fundación del Centro de Histoterapia Placentaria, el 25 de abril de 1986, como resultado de la repercusión internacional por el nuevo método cubano del tratamiento del vitiligo con un medicamento obtenido de la placenta humana, descubierto por el doctor Carlos Manuel Miyares Cao, favoreció el desarrollo de las Ciencias Médicas en Cuba. Institución de prestigio, que arribó este 2021 a su Aniversario 35, y que ha obtenido un gran impacto en la salud y calidad de vida de personas con enfermedades dermatológicas como vitiligo, psoriasis y alopecia. Objetivo: Conocedores de la importancia de salvaguardar los hitos históricos como elementos imprescindibles en la trayectoria científico-social de una institución, nos propusimos exponer los componentes fundamentales que conforman este Centro de Histoterapia Placentaria e incentivar a las nuevas generaciones para continuar la labor investigativa que realiza este y la necesidad de preservar su historia. Material y Métodos: Se realizó una investigación histórico-bibliográfica de los documentos compilados que se conservan en la Biblioteca del Centro para poder fundamentar este artículo. Desarrollo: Se incluyen los aspectos esenciales que avalan la historia del Centro y la imbricación científico-social-humana en este del Dr. Carlos Manuel Miyares Cao. Conclusiones: Históricamente ofrecer toda la trayectoria de este Centro de Histoterapia Placentaria y su significación e importancia para la Ciencia Cubana, así como transmitir a especialistas, médicos y, en general, trabajadores de la salud, su destacada labor en la recuperación de graves enfermedades que aquejan a la población mundial(AU)

Introduction: As a result of the international repercussion of a new Cuban method for treating vitiligo with a drug obtained from human placenta, discovered by Dr. Carlos Manuel Miyares Cao, the Placental Histotherapy Center was founded on April 25, 1986 to support the development of Medical Sciences in Cuba. This prestigious institution, which arrived to its 35th Anniversary this year, has made a significant impact on the health and quality of life of people with dermatological diseases such as vitiligo, psoriasis and alopecia. Objective: Knowing the importance of safeguarding historical milestones as essential elements in the scientific and social trajectory of an institution, we intend to present the fundamental components that make up the Placental Histotherapy Center as well as to encourage new generations to continue the research work carried out in this center and the need to preserve its history. Material and Methods: A historical and bibliographical investigation of the documents preserved in the Library of the Center was carried out to base this article. Development: The essential aspects that support the history of the Center as well as the scientific, social and human involvement of Dr. Carlos Manuel Miyares Cao in this process are included. Conclusions: Our objective is to offer the entire trajectory of the Placental Histotherapy Center and its significance and importance for Cuban Science from a historical perspective as well as to inform specialists, doctors, and health workers in general about its outstanding work related to the recovery from serious diseases that afflict the world's population(AU)

Drug Reaction with eosinophilia and systemic symptoms with alopecia universalis and vitiligo / Reação a drogas com eosinofilia e sintomas sistêmicos associada a alopecia universal e vitiligo

ABSTRACT: Drug reactions with eosinophilia and systemic symptoms (DRESS) are rare and potentially fatal adverse hypersen-sitivity reaction to some drugs, especially anticonvulsants.The syndrome affects not only the skin but also other organs, especially the liver. The incidence can vary from 1 to 5 cases per 10.000 patients exposed to anticonvul-sants. The recognition of the syndrome is of fundamental importance since the mortality rate is between 10 and 40%. Once the diagnosis is established, the triggering drug must be identified and discontinued. Corticosteroids are usually associated with therapy. Autoimmune sequelae have been reported, including vitiligo and rarely alopecia. Alopecia universalis is a variant of alopecia areata, characterized by hair loss throughout the body. We report a case of DRESS, associated with two autoimmune dermatological diseases: alopecia universalis and vitiligo. (AU)

RESUMO: A reação a drogas com eosinofilia e sintomas sistêmicos (DRESS) é uma rara e potencialmente fatal reação adversa de hipersensibilidade, decorrente de alguns medicamentos, principalmente os anticonvulsivantes. A síndrome não afeta apenas a pele, mas também outros órgãos, principalmente o fígado. A incidência pode variar de 1 a 5 casos por 10.000 pacientes expostos aos anticonvulsivantes. O reconhecimento da síndrome é de fundamental importân-cia devido a taxa de mortalidade entre 10-40%. Uma vez estabelecido o diagnóstico, deve-se identificar o medica-mento desencadeante e suspendê-lo. O corticosteróide geralmente é associado na terapia. Sequelas autoimunes foram relatadas, incluindo vitiligo e raramente alopecia. A alopecia universal é uma variante da alopecia areata, caracterizada pela perda de pelos em todo o corpo. Relatamos um caso de DRESS, associado a duas doenças au-toimunes dermatológicas: alopecia universal e vitiligo. (AU)

Phototherapy

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Estratégias terapêuticas e atualizações no tratamento de vitiligo / Therapeutic strategies and updates for treatment of vitiligo

O vitiligo é uma desordem dermatológica complexa, cuja patogênese ainda não é totalmente esclarecida. Apesar de não apresentar complicações funcionais no organismo dos pacientes acometidos, o vitiligo pode resultar em um grande impacto psicossocial. Desse modo, é importante que os médicos saibam como conduzir o tratamento dessa patologia. O objetivo deste estudo foi documentar as terapias disponíveis para o tratamento do vitiligo, assim como apontar pesquisas que relataram a utilização dessas opções terapêuticas e os dados resultantes. As terapias abordadas foram corticoides tópicos e sistêmicos, fototerapia e fotoquimioterapias, antioxidantes, imunomoduladores, fenilalanina, despigmentação, procedimentos cirúrgicos e novas abordagens. A monoterapia parece ser menos eficaz no tratamento do vitiligo. A associação de medicação tópica e/ou sistêmica com o uso da fototerapia ultravioleta B de banda estreita parece ser o padrão-ouro para a repigmentação da pele dos pacientes. Medicamentos novos estão em estudo, porém sua eficácia e o estudo dos possíveis efeitos colaterais, principalmente a longo prazo, têm que ser melhores investigados. É necessário que o médico dermatologista, em conjunto com o paciente, escolha a melhor terapia dentre as disponíveis, de acordo com critérios clínicos e a possibilidade de acesso ao tratamento pelo portador. O acompanhamento e a abordagem por uma equipe multiprofissional também são importantes. (AU)

Vitiligo is a complex dermatological disorder, whose pathogenesis has not yet been fully elucidated. Although it does not present functional complications in the affected patients' body, vitiligo can result in a great psychosocial impact. Therefore, it is important that physicians know how to conduct its treatment. This study aimed at documenting the available therapies for the treatment of vitiligo, as well as pointing out studies reporting the use of these therapeutic options and their resulting data. The therapies addressed were topical and systemic corticosteroids, phototherapy, and photochemotherapies, antioxidants, immunomodulators, phenylalanine, depigmentation, surgical procedures, and new approaches. Monotherapy appears to be less effective in the treatment of vitiligo. The combination of topical and/or systemic medication with the use of narrowband ultraviolet B phototherapy seems to be the gold standard for the patients' skin repigmentation. New drugs are under study, but their effectiveness and study of possible side effects, especially in the long run, have to be better investigated. It is necessary that the dermatologist, together with the patient, choose the best therapy among those available, according to clinical criteria and the possibility of access to treatment by the patient. Monitoring and approach by a multiprofessional team is also important. (AU)

Tratamentos atuais e novos para controle do vitiligo: uma revisão de literatura / Established and novel treatments for vitiligo control: a literature review

RESUMO O vitiligo é um transtorno pigmentar com importante repercussão para o bem-estar do indivíduo. A prevalência do vitiligo varia de 0,1 a 2% da população. O objetivo deste trabalho é revisar a literatura a respeito de quais são as atuais modalidades de tratamento oferecidas para esta condição, bem como quais são os novos tratamentos que têm sido propostos. Em face disso, foi feito uma pesquisa nas plataformas PubMed e UpToDate utilizando as palavras-chaves: vitiligo, tratamento, placebo, treatment, body suface area - o que resultou em 987 artigos e desses foram selecionados os mais relevantes e atuais, dos últimos 10 anos. No final, um total de 56 artigos foram revisados, sendo que 55 eram oriundos do PubMed e 1 foi encontrado diretamente na plataforma UpToDate. Contudo, viu-se que para os casos de vitiligo focal, a primeira linha de escolha são os corticoesteroides tópicos; já no caso de locais em que a pele é mais fina ou que o paciente é criança, a preferência é pelos inibidores da calcineurina. Os tratamentos com fototerapia ficam reservados para pacientes com mais de 5-10% da área de superfície corporal afetada. Referente aos tratamentos com transplante de células, viu-se que são modalidades muito eficazes, porém, têm um alto custo e poucos profissionais que os realizam. Além disso, é importante ressaltar que novas drogas como alfamelanotide, inibidores da janus quinase e o bimatoprost estão sendo estudadas, entretanto, seu perfil de segurança e dosagem ainda não estão estabelecidos. PALAVRAS-CHAVE: Vitiligo, tratamento, superfície de área corporal

ABSTRACT Vitiligo is a pigmentary disorder with an important impact on the individual's well-being. The prevalence of vitiligo ranges from 0.1 to 2% of the population. The objective of this paper is to review the literature regarding what are the current treatment modalities offered for this condition, as well as what new treatments have been proposed. To do so, a search was carried out on the PubMed and UpToDate platforms using the keywords: vitiligo, treatment, placebo, treatment, body suface area, which resulted in 987 articles, and from these, the most relevant and current were selected from the last 10 years. In the end, a total of 56 articles were reviewed, of which 55 were from PubMed and 1 was found directly on the UpToDate platform. However, it was seen that for cases of focal vitiligo, the first line of choice is topical corticosteroids; in the case of areas where the skin is thinner or the patient is a child, the preference is for calcineurin inhibitors. Phototherapy treatments are reserved for patients with more than 5-10% of the body surface area affected. Regarding treatments with cell transplantation, it was seen that they are very effective modalities, but they have a high cost and few professionals perform them. In addition, it is important to emphasize that new drugs such as alfamelanotide, janus kinase inhibitors and bimatoprost are being studied, but their safety profile and dosage are not yet established. KEYWORDS: Vitiligo, treatments, body surface area

Decreased circulatory levels of Vitamin D in Vitiligo: a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Evolución clínica en pacientes tratados con Esencias Florales de Bach y costo del tratamiento / Clinical Evolution and Cost of Treatment in Patients Treated with Bach Flower Essences

Introducción: La Medicina Natural y Tradicional constituye hoy en día una necesidad, no como opción terapéutica, sino por su valor intrínseco, al tratar al paciente de forma holística, además de su inocuidad y bajo costo. Objetivo: Evaluar la evolución clínica en pacientes tratados con Esencias florales de Bach y costo del tratamiento. Métodos: Se realizó un estudio de evaluación de la evolución de pacientes con diagnóstico clínico de Psoriasis, Vitíligo y Liquen plano, los cuales fueron tratados con Esencias florales de Bach en el período de marzo del 2016 a marzo del 2018, en Consulta Multidisciplinaria Dermatología- Medicina Natural Tradicional- Psicología, del Policlínico Docente Héroes del Moncada; del municipio de Cárdenas, Matanzas. Los datos fueron recopilados y procesados en el software Excel, atendiendo a variables demográficas, se tuvieron en cuenta los criterios de inclusión, exclusión y consentimiento informado de pacientes vírgenes de tratamiento convencional. Las esencias florales utilizadas fueron: Crab Apple, Willow, Verbain, Impatiems, Walnut, Cherry Plum, Sweet Chestnut, Chicory, Clematis, Beech, Star of Bethlehem, While Chestnut y Larch de forma oral y tópica. Resultados: En el sexo femenino predominó el Vitíligo y Psoriasis. La ansiedad estuvo presente en 17 pacientes, en cuanto a la evolución, 14 pacientes asintomáticos y 14 mejorados. El costo de las Esencias florales oral fue gratuito y el tópico muy bajo. Conclusiones: La evolución clínica fue favorable y el costo del tratamiento muy bajo, lo cual demostró la efectividad de la terapia floral en la muestra(AU)

Introduction: Natural and traditional medicine is nowadays a necessity, not as a therapeutic option, but because of its intrinsic value, since it allows to treat the patient holistically, in addition to its innocuousness and low cost. Objective: To assess the clinical evolution and cost of treatment in patients treated with Bach flower essences. Methods: A study was carried out to assess the evolution of patients with a clinical diagnosis of psoriasis, vitiligo and lichen planus, who were treated with Bach flower essences in the period from March 2016 to March 2018, at a multidisciplinary consultation of dermatology, traditional natural medicine and psychology from Héroes del Moncada Teaching Polyclinic in Cárdenas Municipality, Matanzas Province. The data were collected and processed in the EXCEL software, taking into account demographic variables, together with inclusion and exclusion criteria, as well as informed consent of patients who had not received any conventional treatment. The flower essences used, orally and topically, were crab apple, willow, verbain, impatiens, walnut, cherry plum, sweet chestnut, chicory, clematis, beech, star of Bethlehem, white chestnut and larch. Results: The female sex predominated in cases of vitiligo and psoriasis. Anxiety was present in seventeen patients. Regarding evolution, fourteen patients were asymptomatic and the same amount achieved improvement. The cost of the oral flower essences was free and that of the topical ones was very low. Conclusions: Clinical evolution was favorable and the cost of treatment was very low, which demonstrated the effectiveness of flower therapy in the sample studied(AU)

Vitiligo in equine: a four-year case study of a roan horse - case report / [Vitiligo em equinos: um estudo de caso de quatro anos de um cavalo roan - relato de caso]

Vitiligo is a dermatological disease affecting both animals and humans. It is characterized by depigmented macules of varying shape and size, originated from melanocyte destruction. Even though there are some theories tackling causation, disease etiopathology is not yet certain. Moreover, lesion areas can either increase or diminish over time, and therefore, available treatment alternatives tend to prove inconsistencies. No epidemiological data or registered cases were found for equines in Brazil. The horse in this case description displayed depigmentation areas in facial regions, including upper lip, nose and lips. However, the individual did not happen to develop any systemic alteration. Through clinical evaluation, backed by a histopathological exam, a definitive vitiligo diagnosis was obtained. However, no therapeutic plan was stipulated. The animal was accompanied for four years, during which period some affected areas diminished while others increased in size. In addition, emergence of new skin lesions was also observed during the time the animal was studied. Overall, this disease does not display alterations to organism functionality, only aesthetic changes. Therefore, treatment plans may vary from case to case, occasionally being even ruled out.(AU)

O vitiligo é uma doença dermatológica que pode afetar animais e humanos. Caracteriza-se por áreas despigmentadas, de formas e tamanhos variáveis, que surgem devido a destruição dos melanócitos. Existem algumas teorias que tentam explicar a etiopatogenia da doença, entretanto ainda não é totalmente esclarecida. As lesões podem aumentar ou diminuir com o tempo, por isso os tratamentos disponíveis são inconsistentes. Não foram encontrados dados epidemiológicos ou relatos de vitiligo em cavalos no Brasil. O equino deste relato apresentava lesões despigmentadas na região da face, incluindo pálpebras, narina e lábios, sem alterações sistêmicas. Por meio da avaliação clínica em conjunto com o exame histopatológico obteve-se o diagnóstico definitivo de vitiligo. Não foi instituído nenhuma terapia, e o equino foi acompanhado durante quatro anos. Durante esse período algumas lesões diminuíram e outras aumentaram de tamanho sendo também observado o aparecimento de novas lesões. O vitiligo não traz alterações sistêmicas, apenas mudanças estéticas, por isso a escolha pelo tratamento dependerá de cada caso.(AU)

The role of skin punch grafting with platelet-rich plasma injection on stable segmental vitiligo

@#Vitiligo is a non-communicable, chronic skin condition that has psychosocial effects for the patient. The case of an otherwise healthy skin phototype IV Filipino male with a two-year history of stable vitiligo is presented here. Three sessions of skin punch grafting and platelet-rich plasma injection under local anesthetic were done on the patient three months apart, resulting in excellent cosmetic results and patient satisfaction.

The role of skin punch grafting with plasma-rich plasma injection on stable segmental vitiligo

@#Vitiligo is a non-communicable, chronic skin condition that has psychosocial effects for the patient. The case of an otherwise healthy skin phototype IV Filipino male with a two-year history of stable vitiligo is presented here. Three sessions of skin punch grafting and platelet-rich plasma injection under local anesthetic were done on the patient three months apart, resulting in excellent cosmetic results and patient satisfaction.

Analysis of genetic variant in a case of sporadic neurofibromatosis type I with alopecia areata and vitiligo / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a patient with clinically suspected neurofibromatosis type I, alopecia areata and vitiligo.@*METHODS@#Variant of the NF1 gene was detected by chip capture and high-throughput sequencing. Candidate variant was verified by Sanger sequencing of the family trio.@*RESULTS@#The patient was found to harbor a novel missense c.1885G>A (p.Gly629Arg) variant of the NF1 gene, for which neither parent was carrier. The variant was not recorded in the public database. Based on the guidelines for genetic variation of the American College of Medical Genetics and Genomics, the c.1885G>A missense variant was predicted to be pathogenic (PS1+PS2+PM2+PP3+PP4).@*CONCLUSION@#The c.1885G>A missense variant probably underlay the disease in this child. Above finding has enriched the spectrum of the NF1 gene variants.

Consensus on the treatment of vitiligo - Brazilian Society of Dermatology

Abstract Background: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.