Prognostic factors in childhood vitiligo.

BACKGROUND: Vitiligo is a multifactorial disease characterized by the progressive loss of melanocytes. The worldwide prevalence ranges from 0.5% to 2%, and in children from 0% to 2.16%. The objective of this study was to determine the variables associated with progression of vitiligo. METHODS: A retrospective cohort was carried out where a random sample of records of pediatric patients with vitiligo from January 2016 to December 2020 was analyzed. The variables were studied: age at onset, sex, hereditary family history, personal history of thyroid diseases, time of evolution, classification, Köebner phenomena, mucosal vitiligo, halo nevus, premature graying and the presence of other dermatoses. The final state was classified as progression, stability, partial remission and complete remission. RESULTS: 574 children with vitiligo; 290 (50.5%) women, 284 (49.5%) men. Non-segmental vitiligo in 324 (56.4%), segmental vitiligo in 250 (43.6%). Mean age of onset 8.7 years (SD: 4.54). Median evolution time 6 months (25th percentile of 3 months and 75th percentile of 24 months). Family history 27 (4.70%). Thyroid disease 7 (1.21%). Evolution remained stable in 44 (7.7%), 68 (11.8%) had progression, 32 (5.6%) complete remission, 222 (38.7%) partial remission and 208 (36.2%) one consultation. Non-segmental vitiligo was obtained p < 0.028, younger age of onset p < 0.000, and none skin comorbidities p < 0.009. CONCLUSIONS: The variables that were associated with a more progression were non-segmental vitiligo, early ages at the onset of the disease, and not presenting with other skin diseases.

INTRODUCCIÓN: El vitiligo es una enfermedad multifactorial caracterizada por la pérdida de melanocitos. La prevalencia mundial oscila entre el 0.5% y el 2%, y en niños entre el 0% y el 2.16%. El objetivo de este estudio fue determinar las características clínicas asociadas a la progresión del vitiligo. MÉTODOS: En una cohorte retrospectiva se analizó una muestra aleatoria de expedientes de pacientes con vitiligo de 0-18 años de edad, de enero de 2016 a diciembre de 2020. Se estudiaron la edad de inicio, el sexo, los antecedentes heredofamiliares, el antecedente personal de enfermedades tiroideas, el tiempo de evolución, la clasificación, el fenómeno de Köebner, el vitiligo en mucosas, el halo nevo, el encanecimiento prematuro y la relación con otras dermatosis. El estado final se clasificó en progresión, estabilidad, remisión parcial y remisión completa. RESULTADOS: 574 niños con vitiligo; 290 (50.5%) mujeres y 284 (49.5%) varones. Vitiligo no segmentario en 324 (56.4%), vitiligo segmentario en 250 (43.6%). Edad promedio de aparición 8.7 años (DE: 4.54). Mediana de tiempo de evolución 6 meses (percentil 25 de 3 meses y percentil 75 de 24 meses). Se encontraron antecedentes familiares en 27 (4.70%). Enfermedad tiroidea en 7 (1.21%). En la evolución permanecieron estables 44 (7.7%), progresaron 68 (11.8%), remisión completa 32 (5.6%), remisión parcial 222 (38.7%) y una consulta 208 (36.2%). Se obtuvo p < 0.028 en vitiligo no segmentario, p < 0.000 en menor edad de aparición y p < 0.009 en comorbilidad cutánea. CONCLUSIONES: Las variables que se asociaron a progresión fueron vitiligo no segmentario, edad temprana de inicio y no cursar con otras enfermedades cutáneas.

Use of the Vitiligo Extent Score: a protocol for a scoping review.

INTRODUCTION: Vitiligo is a chronic skin condition with no cure. Clinical assessment and treatment evaluation relies heavily on clinometry tools and expert knowledge. The Vitiligo Extent Score has been proposed as one of the most reliable and easy-to-use clinometry tools for vitiligo. METHODS AND ANALYSIS: We proposed a scoping review to identify all the available evidence on the clinical research availability around the Vitiligo Extent Score. The following databases will be searched: MEDLINE (PubMed), Embase, Open Grey, Lens and Directory of Open Access Journals. In addition, the approach proposed in the Joanna Briggs Institute Reviewer's Manual will be followed. Finally, this review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. ETHICS AND DISSEMINATION: Ethics approval for this review is not required. We intend to publish the results in a specialised peer-reviewed journal and local, national and international conference presentations. It will also be incorporated as educational material in our institution's postgraduate programme in dermatology.

The landscape of vitiligo in Latin America: a call to action.

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.

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)

Clinical and epidemiological profile of patients attended in a vulvar clinic of the dermatology outpatient unit of a tertiary hospital during a 4-year period.

BACKGROUND: Vulvar complaints are among the most frequent causes for a woman to visit a healthcare provider. The diseases of this area of the body may be a challenge to diagnose. In this study, we assess epidemiologic and clinical data of patients in an outpatient vulvar clinic in the dermatology department of a tertiary hospital. METHODS: We performed an observational retrospective study of patients who attended our consultation service for vulvar diseases at the Dermatology Division at Hospital das Clínicas da Faculdade de Medicina da USP during a 4-year period. Data were obtained by patient medical records and by phone. RESULTS: During the 4-year period under study, a total of 136 patients were treated in the outpatient service specialized in vulvar care. All patients were included in the study. The most frequent diagnoses were lichen sclerosus et atrophicus (64.7%), lichen planus (8.8%), and vitiligo (8%). We registered that 26.7% of the patients showed extravulvar involvement. CONCLUSIONS: Women with vulvar diseases need specific care, considering not only genital aspects but also all skin changes. In this context, the dermatologist is a very well trained professional to take good and complete care of these patients. However, ideally vulvar clinics should have a multidisciplinary team.

Patrón cutáneo pigmentario de disposición lineal en un niño, vitíligo segmentario vs. hipomelanosis de Ito / Linear disposition pigmentary skin pattern in a child, segmental vitiligo vs. Hypomelanosis of Ito

Introducción: algunas enfermedades dermatológicas siguen disposición con patrones lineales. Con hipopigmentación en la infancia se encuentran el vitíligo segmentario, que sigue los dermatomas, aunque puede seguir las líneas de Blaschko y la hipomelanosis de Ito, que a su vez sigue las líneas de Blaschko. Estas dermatosis son infrecuentes en la práctica dermatólogica. Objetivo: profundizar en los elementos diagnósticos que permiten diferenciar dos dermatosis clínicamente caracterizadas por hipopigmentación segmentaria lineal de tipo blaschkoide y el tratamiento. Presentación del caso: a la consulta de Genodermatosis en Las Tunas acude un niño con máculas acrómicas en hemicuerpo izquierdo, sin otras alteraciones. Después de ser evaluado por varias especialidades (Dermatología, Genética, Pediatría, Oftalmología y Neurología), se determina que solo presentaba afectación cutánea, se le realizó biopsia de piel, que corroboró el diagnóstico de vitíligo segmentario. Conclusiones: se presenta el caso porque el vitíligo segmentario es infrecuente, sigue un patrón lineal que puede ser diferenciado de otra dermatosis infrecuente, como la hipomelanosis de Ito, y en el tratamiento es importante brindar apoyo psicológico al paciente para favorecer la obtención de mejores resultados con la Melagenina Plus(AU)

Introduction: some dermatological diseases are still available with linear patterns. In childhood with hypopigmentation can be found segmental vitiligo (which follows the dermatomes although it can follow the lines of Blaschko), and Hypomelanosis of Ito (which in turn follows the lines of Blaschko). These dermatoses are infrequent in dermatological practice. Objective: to deepen into the diagnostic elements that allows the differentiation of two dermatoses clinically characterized by linear segmental hypopigmentation of blaschkoid type and treatment. Case presentation: a child attends to the consultation of Genodermatoses in Las Tunas presenting acromic macules in left half of the body, without other alterations. After being evaluated by several specialties (Dermatology, Genetics, Pediatrics, Ophthalmology and Neurology), it was determined that only skin affectation was present. A skin biopsy was performed, which corroborated the diagnosis of segmental vitiligo. Conclusions: The case is presented because segmental vitiligo is infrequent, it follows a linear pattern that can be differentiated from another uncommon dermatosis, such as Hypomelanosis of Ito, and in the treatment it is important to provide psychological support to the patient to favor obtaining better results with Melagenina Plus(AU)

Reduced immunohistochemical expression of CCN3 in vitiligo.

BACKGROUND: Defective adhesion seems to be involved in the chronic loss of melanocytes observed in vitiligo. Recent findings showed an association of genetic variants of an adhesion gene with vitiligo and reduced immunohistochemical expression of some adhesion molecules in vitiligo skin. AIMS: To compare CCN3 immunohistochemical expression in lesional and non-lesional epidermis of individuals with vitiligo. METHODS: A total of 66 skin specimens from 33 volunteers with vitiligo were analyzed by immunohistochemistry using anti-CCN3 antibodies. Absence of topical or systemic treatment for vitiligo over the previous 30 days and availability of an area of non-lesional skin for biopsy at least 15 cm away from any vitiliginous macules were the main inclusion criteria. RESULTS: A significant reduction of CCN3 expression was observed in lesional skin as compared to non-lesional skin (P = 0.001). LIMITATIONS: Paraffin embedded skin samples do not allow investigation by molecular biology methods. Not all samples allowed analysis due to the lamina preparation technique. Complete clinical data was not available for all patients. CONCLUSION: Our results support the hypothesis of impaired cell adhesion in vitiligo suggested by genetic studies. The pattern of immunohistochemical expression suggests that vitiligo might be an epithelial disease and not just a melanocyte disorder.

Predictive Model for Response Rate to Narrowband Ultraviolet B Phototherapy in Vitiligo: A Retrospective Cohort Study of 579 Patients.

Vitiligo is an acquired depigmenting disorder. To date, there is no predictive model for its response rate to narrowband ultraviolet B (NBUVB) phototherapy. The aim of this study was to investigate the different types of response of patients with non-segmental vitiligo undergoing NBUVB 3 times a week. Many patients who were previously considered non-responders were given the opportunity to continue the treatment. Long-term maintenance of treatment and follow-up of a cohort of 579 patients enabled different subtypes of response (very rapid, rapid, average, slow and "non-responders") to be described for the first time, and a predictive model of response to be constructed based on repigmentation rate in the first 48 sessions of NBUVB. Among those patients who did not respond during the first 48 sessions, a new subgroup of patients was found, termed "very-slow" responders, who achieved a low, but significant, level of repigmentation after 96 sessions of NBUVB.

Association of vitíligo and autoimmune thyroiditis disease in a male adolescent with obesity / Asociación de vitiligo y tiroiditis crónica autoinmune en adolescente masculino con obesidad

El vitíligo es el trastorno despigmentante adquirido más frecuente, con una prevalencia mundial del 0.5-2%. Su mayor incidencia se produce entre los 10 y 30 años. Se asocia a trastornos tiroideos autoinmunes con presencia de anticuerpos antitiroperoxidasa hasta en un 20%. Se presenta el caso de masculino de 15 años de edad, diagnosticado con vitíligo a los 10 años de edad con seguimiento por dermatología, actualmente en tratamiento. El paciente se encuentra en seguimiento médico por obesidad. Se ha descrito asociación positiva entre vitiligo y tiroiditis autoinmune, duplicando el riesgo a los cinco años de diagnóstico concomitante a patología autoinmune previa. Teniendo en cuenta que el vitiligo precede generalmente al inicio de la disfunción tiroidea, el seguimiento periódico de pacientes con vitiligo es de gran importancia.

Vitiligo is the most common acquired depigmentation disorder with a worldwide prevalence from 0.5 to 2%. It is highest incidence occurs between the ages of 10 to 30 years old. Frequently, it is associated with autoimmune thyroid disorders and related to the presence of anti-thyroid peroxidase antibodies in 20% of the times. We present the case of 15 years old male, diagnosed with vitiligo at 10 years old with currently dermatology follow up under treatment. The patient is in medical monitoring due to obesity. It has been described an association between Vitiligo and Thyroiditis, doubling the risk of presence in five years from the concomitant diagnose to a previous autoimmune pathology. Considering that vitiligo usually precedes the onset of thyroid dysfunction, periodic monitoring in patients with this disorder it is of great importance.

New approach in the treatment of refractory vitiligo: CO2 laser combined with betamethasone and salicylic acid solution.

The aim of this study is to evaluate the use of fractional carbon dioxide laser (CO2 ) with betamethasone and salicylic acid solution in the treatment of patients with refractory vitiligo in hands. Each hand of the patient was randomly assigned to one of two groups: lesion treated with fractional carbon dioxide laser associated with betamethasone and salicylic acid solution administration or lesion treated only with betamethasone and salicylic acid solution. We conclude that combined treatment with fractional carbon dioxide laser and betamethasone associated with salicylic acid solution could effectively and safely be used in the treatment of refractory vitiligo.

Características epidemiológicas y clínicas en pacientes con vitíligo que acuden al Servicio de Dermatología del Hospital Policia Nacional del Perú Luis Nicasio Sáenz en el periodo enero a junio del 2013 / Epidemiological and clinical characteristics of patients with vitiligo attended in the Dermatology Service at the Hospital of National Police of Peru Luis Saenz Nicasio in the period January to June 2013

Objetivos: Determinar las características epidemiológicas y clínicas en pacientes con vitíligo que acuden al Hospital Policía Nacional del Perú Luis Nicasio Sáenz en el periodo de enero a junio del 2013. Introducción: A nivel mundial el vitíligo, es uno de los trastornos pigmentarios más frecuentes, caracterizado por la aparición de manchas acrómicas secundarias a la destrucción selectiva de melanocitos funcionales Se presenta a cualquier edad, apareciendo en más del 50 por ciento de los casos en menores de 20 años; y en igual proporción en mujeres y varones, siendo las mujeres más propensas a buscar tratamiento. Existe además una historia familiar positiva en al menos el 30 por ciento de los pacientes con vitíligo y es relacionada a múltiples enfermedades autoinmunes. Materiales y Métodos: Se realizó un estudio descriptivo observacional de corte transversal. Se encuestaron 71 pacientes, 2 fichas de recolección fueron eliminadas no poseer información completa. Los 69 pacientes incluidos en el estudio tenían diagnóstico clínico de vitíligo, obteniendo información sobre género, edad actual, edad de inicio, estado civil, grado de instrucción, patrón clínico, antecedentes familiares con vitíligo, y asociación con enfermedades autoinmunes. Los datos fueron sometidos a análisis estadístico en el programa SPSS 22.0 para Windows. Resultados: Se incluyeron 69 pacientes; el 46 por ciento fueron mujeres y el 54 por ciento hombres. La edad promedio fue de ±43.52 años. En el 49.3 por ciento el tiempo transcurrido desde el inicio de la enfermedad hasta el momento del examen fue en el periodo de 1 a 10 años. En el 43.5 por ciento la localización de inicio fue la cara. El 50.7 por ciento presentaron vitíligo vulgar, el 31.9 por ciento el tipo focal. El 10.1 por ciento presentó asociación con enfermedad tiroidea, y el 1.4 por ciento presentó alopecia areata. El 15.9 por ciento presentó antecedentes familiares. Conclusiones: En la población en estudio el vitíligo predominó en...

Objectives: To determine the epidemiological and clinical characteristics in patients with vitiligo who attend the Hospital Policia Nacional del Peru Luis Nicasio Saenz during the period from January to June 2013. Introduction: Vitiligo, is one of the most common pigmentary disorder worldwide, characterized by the appearance of amelanotic macules, secondary to a selective destruction of functional melanocytes. Vitiligo can onset at any age, appearing in more than 50 per cent of cases in people under 20 years old; it presents equally in men or women, the most likely to seek treatment being women. There is also a positive family history on at least 30 per cent of vitiligo patients and it exist an association to multiple autoimmune diseases. Materials and Methods: A descriptive cross-sectional study was carried out. We collect information from 71 patients, 2 records collection were eliminated for not possess complete information. The 69 patients included in the study had a clinical diagnosis of vitiligo, obtaining information on gender, current age, age of onset, marital status, level of education, clinical pattern, family history of vitiligo, and association with autoimmune diseases. The data were subjected to statistical analysis in SPSS 22.0 for Windows. Results: 69 patients were included; 46 per cent were women and 54 per cent men. The average age was 43.52 years ±. In 49.3 per cent the time passed since the onset of the disease until the time of examination was in the period of 1 to 10 years. In 43.5 per cent the most common site of onset of vitiligo lesion was the face. The 50.7 per cent of patients had vitiligo vulgaris, 3l.9 per cent had the focal type. The 10.1 per cent of patients had association with thyroid disease, and 1.4 per cent had alopecia are ataand 15.9 per cent had family history. Conclusions: In the study vitiligo predominated in males, and the most frequent clinical type was vulgar. Association with thyroid disease was found. Important to...