From Dalian China, comes some interesting research on the epidermis (the uppermost layer of the skin, where the pigment cells reside) in vitiligo. Dr Lui and colleagues (Skin Pharmacol Physiol. 2010; 23: 193-200) noted that studies have demonstrated that alterations in skin biophysical properties in vitiligo have not yet been well defined. In their study, stratum corneum (SC) hydration, the skin surface acidity and epidermal permeability barrier function in vitiligo were evaluated.
The research group of Professor Richard Spritz in the University of Colorado USA has undertaken many important studies of the genetic basis of vitiligo over the last few years. In the most recent paper (Nature Genetics 2012; 44: 676-80) they summarize that most genes that indicate a susceptibility to vitiligo are involved with proteins or parts of the pigment cell that are important for the functioning of the immune system.
Dr van Geel and researchers have looked at how halo naevi ( a common mole with a white ring around, showing the sort of pigment loss that is seen in vitiligo) can present together with vitiligo or separately (Br J Dermatol 2011; 164: 743-9). Their results support the theory that halo naevi can represent a distinct condition but in a subset of patients, the occurrence of halo naevi may be an initiating factor in the pathogenesis of vitiligo.
Dr N van Geel and colleagues of Ghent has looked at the Koebner phenomenon (KP), the occurrence of the development of vitiligo within an area of skin that has been damaged by localized often mild trauma (Br J Dermatol 2012;167:1017-24.). They developed a new assessment method for KP, taking into account both history and clinical examination, which seems to be a useful and valuable tool for assessing KP in daily practice. The results support the hypothesis that KP may be used to assess and predict the course of vitiligo
Patients often wonder whether lasers (other than the Excimer) will help their vitiligo. Some lasers can help with depigmentation, on the rare occasions when this is indicated. Hossani-Madani et al (of Washington DC, USA) have shown that the Q-switched ruby laser does seem to have the advantage of inducing depigmentation more quickly than the usual topical depigmentation treatment of monobenzyl ether of hydroquinone, but with more discomfort (G Ital Dermatol Venereol. 2011; 146: 373-95).
The pathogenesis of vitiligo is believed to involve oxidative stress (an imbalance between the presence of toxic so-called reactive oxygen species (ROS) and the body’s ability to detoxify them). Based on this, according to Dell’Anna and colleagues in Rome, Italy, the generation of reactive oxygen species (ROS) by the mitochondria within melanocytes and blood cells may be relevant in the pathogenesis of vitiligo (J Cell Physiol 2010; 223: 187-93).
Quality of Life And Psychological Aspects
Dr Kiprono and colleagues from Tanzania found that in vitiligo patients of African descent there was a moderate impairment of quality of life when studied using the Dermatology Life Quality Index (DLQI: Int J Dermatol. 2013; 52: 191-4). In Turkey Dr Bilgic and colleagues looked at depression in children and adolescents with vitiligo (Clin Exper Dermatol 2011; 36: 360-5).
Dr van Geel and collaborators have also looked at segmental vitiligo, which is characterized by a unilateral and localized distribution (Br J Dermatol. 2013; 168: 56-64). So far, the underlying mechanism is still an enigma. In order to obtain an insight into the aetiopathogenesis of segmental vitiligo the researchers compared its distribution pattern with those of dermatoses with a possible mosaic or neurogenic background.
With regard to the surgical treatment of vitiligo, Shane and colleagues from India write in the journal Dermatologic Surgery (2011; 37: 176-82) that the results of non-cultured pigment cell (melanocyte) transplantation (taken from the patient’s own normally pigmented skin) can be improved by suspending the melanocytes in the patients' own serum: this could be an important innovation in the surgical management of patients with stable vitiligo.
It is difficult to find a systemic treatment for vitiligo at the moment. Dr Szczurko et al have looked at ginkgo biloba (BMC Complement Altern Med. 2011 Mar 15;11:21). Twelve participants 12 to 35 years old were recruited to a prospective open-label pilot trial and treated with 60 mg of standardized Ginkgo biloba two times per day for 12 weeks. Effectiveness was assessed using the Vitiligo Area Scoring Index (VASI) and the Vitiligo European Task Force (VETF), which are validated outcome measures evaluating the area and intensity of depigmentation of vitiligo lesions.
Topical And Ultraviolet Treatments
Topical treatments are the usual place to start with treatments for vitiligo, though it does depend on the site and extent of involvement. Bhuvana et al (Indian J Dermatol 2001; 56: 445-6) suggest that topical tacrolimus is effective for localized vitiligo. Eryilmaz and colleagues find that the other topical immunomodulator, pimecrolimus, might be useful (J Eur Acad Dermatol Venereol 2009; 23: 1347-8). Both of these approaches have been mentioned in already published guidelines.
Vitiligo And Skin Cancer
The risk of skin cancer in patients with vitiligo might be thought of as increased since there is a tendency to burn when in the sun. The matter has been investigated by a team from The Netherlands (Teulings et al. Br J Dermatol 2013; 168: 162-71). They conducted a survey designed to assess lifetime prevalences of malignant melanoma and non-melanoma skin cancer (NMSC) in patients with vitiligo compared with non-vitiligo controls.
Vitiligo And Thyroid Disease
Clinically, dermatologists have noted for some years an association between vitiligo and thyroid disease. Vrijman and colleagues from Amsterdam, The Netherlands, undertook a review of this (Br J Dermatol 2012; 167: 1224-35) and found that there was indeed an association. They discovered the frequency of thyroid disease in vitiligo patients was 15.1% , autoimmune thyroid disease 14.3% and the presence of thyroid-specific autoantibodies 20·8%. All patients with vitiligo should have their thyroid function checked.