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Ultraviolet B narrow band (UVB-NB) phototherapy is the gold standard treatment for vitiligo, primarily due to its immunomodulatory effects. Additionally, it may influence circadian melatonin balance, that may indirectly induce sleep regulation, which in turn could potentially contribute to vitiligo improvement. The association between melatonin, vitiligo and phototherapy has been little investigated. The aim of this study was to evaluate the current evidence regarding the effects of circadian melatonin regulation and sleep, particularly during vitiligo treatment with phototherapy. We undertook a narrative review to synthetize the evidence on this association through the MEDLINE/PubMed database, using combined search terms: melatonin, vitiligo, phototherapy, and circadian rhythm (sleep). A total of 56 articles were included. There are few studies on this relationship, and conflicting findings. Some studies have suggested that UV exposure and phototherapy might benefit vitiligo by stimulating melanocytes, which have melatonin receptors, and this could potentially synchronize the circadian regulation of melatonin. This improved melatonin balance could result in better sleep quality further enhancing the antiinflammatory properties of melatonin and contributing to vitiligo improvement. Less is known about the possible effects of the use of topical melatonin, with or without phototherapy, to treat vitiligo lesions. In conclusion, there is some evidence that circadian melatonin regulation plays an important role in the course of vitiligo, both through sleep regulation and its anti-inflammatory properties. The evidence suggests that the systemic and physiological properties of melatonin, especially its circadian behavior regulated by phototherapy, may be more effective in respect of vitiligo improvement than the use of topical melatonin. However, the effects of the oral intake of melatonin are less clear. Phototherapy, as a potential modulator of circadian melatonin rhythm, that influences sleep and clinical improvement of vitiligo, needs further examination, as does the use of melatonin as an adjuvant treatment to UVB phototherapy in vitiligo.

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OBJECTIVE: Vitiligo is a dermatological autoimmune condition characterized by areas of progressive skin depigmentation. Vitiligo lesions are cosmetically disfiguring and associated with significant psychological conditions such as depression and anxiety and comorbidities such as thyroid disease and diabetes. All races, ethnicities, ages, and regions of the world are impacted by vitiligo, with a global prevalence of about 0.5-2%. Currently, there is no published information available on the prevalence of vitiligo in Puerto Rico. Our study's aim was to estimate the prevalence of vitiligo among patients attending the specialized clinic of dermatology at UPR School of Medicine in Puerto Rico and describe the distribution of cases by age and sex. METHODS: We performed a descriptive study to evaluate the patients attending the University of Puerto Rico School of Medicine Clinics from January 2017 to May 2022. Using ICD-10 code L80 and medical records, we identified 581 patients with vitiligo and their respective demographic data distributed by sex and age. RESULTS: Of the 581 vitiligo patients, 350 (60.2%) were women, and 231 (39.8%) were men. The median age in the vitiligo population was 33.5 years. Out of the studied sample, 30.2% were under the age of 18. Overall, there was an estimated prevalence of 5.2%. CONCLUSION: We report a vitiligo prevalence of 5.2% in a specialized clinic in Puerto Rico, suggesting further studies are necessary to discover possible underlying factors contributing to this increased prevalence.

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OBJECTIVE: Cellular and humoral immunity plays a role in the pathogenesis of vitiligo. T lymphocytes and natural killer cells involved in cellular immunity carry out their cytotoxic activities through perforin/granzyme-dependent granule exocytosis, in which granulysin and cathepsin-L are also involved. The aim of this study was to investigate the possible role of serum granulysin and cathepsin-L in the etiopathogenesis of vitiligo and their association with disease activity and severity. METHODS: This randomized, prospective case-control study was conducted with 46 vitiligo patients admitted to the hospital for vitiligo between January and November 2021 and 46 healthy volunteers of similar age and gender. Serum levels of granulysin and cathepsin-L were measured by the enzyme-linked immunosorbent assay method. RESULTS: The mean serum levels of granulysin and cathepsin-L were statistically significantly higher in vitiligo patients compared with the control group (p=0.048 and p=0.024, respectively). There was no statistically significant correlation between serum granulysin and serum cathepsin-L levels and disease severity in the patient group (r=0.30, p=0.062 and r=0.268, p=0.071, respectively). Disease activity also showed no significant association with serum granulysin and cathepsin-L levels (p=0.986 and p=0.962, respectively). CONCLUSION: Although granulysin and cathepsin-L are molecules involved in the pathogenesis of vitiligo, the use of these molecules may not be helpful in assessing disease activity and severity. It may be helpful to conduct comprehensive and prospective studies to find new molecules to fill the gap in this area.

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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.

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OBJECTIVES: To detect ultrasonographic anatomical alterations in all the skin layers in patients with vitiligo. METHODS: A prospective observational color Doppler ultrasound study was performed in nonsegmental face and/or neck vitiligo patients without a history of previous treatments. Two sites, a lesional area and a contralateral clinically healthy region, were ultrasonographically studied and compared in the same patient. All cases were studied in high-frequency (24 MHz) and ultra-high-frequency (70 MHz) ultrasound devices with the highest axial spatial resolution available in the market. Demographic data of the sample, ultrasound grayscale, and color Doppler features were recorded and analyzed. RESULTS: Ten patients met the study criteria (60% females; mean age 49 years). All cases presented ultrasonographic undulation of the epidermis in the affected zones vs 50% in the healthy control regions, being more prominent in the vitiligo areas. Eighty percent demonstrated intense hypoechoic thin plaques in the upper dermis (subepidermal). All vitiligo areas presented thickening and hypoechogenicity of the regional hair follicles and/or pilosebaceous units. Ninety percent showed prominent sebaceous glands, and 20% demonstrated a hypoechoic cap surrounding the sebaceous glands in the lesional areas. Dermal hypervascularity was detected in 100% of the affected regions and 40% of the clinically healthy areas. CONCLUSION: Ultrasound can identify subclinical inflammatory cutaneous patterns in the epidermis, dermis, hair follicles, pilosebaceous units, and sebaceous glands in vitiligo. This noninvasive information can support early detection, monitoring, and research, including the clinical trials of drugs used to manage this devastating disease.

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INTRODUCTION: Vitiligo is an autoimmune dermatosis that affects quality of life, which englobes sleep quality. Sleep regulates the immune system, including inflammatory cytokines, and other pathways, which may influence vitiligo pathogenesis. OBJECTIVES: To analyze levels of immune serum components (cytokines) in a vitiligo group, and assess whether there was any association with sleep. METHODS: This study comprised 30 vitiligo patients and 26 control individuals. Quality of life and sleep questionnaires were completed [Dermatology Life Quality Index (DLQI), Short-Form Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI)]. Seven cytokines have been measured: IFN-γ, interleukin (IL)-4, IL-6, IL-10, IL-17A, IL-12 p40 and TNF-α. RESULTS: The mean age of the vitiligo group was 47.7 years-old, with prevalence of females (66.7 %). Mucosal (70 %), acral (60 %) and focal subtype (53.3 %) predominated. Signs of vitiligo activity were identified in 63.3 % of the disease sample. Total PSQI scores and scores for domain 4 (sleep efficiency) were statistically worse in vitiligo group. The SF-36 and ISI total scores were worse in the vitiligo group, although not statistically significant compared with controls. Four SF-36 domains were statistically worse in vitiligo sample, and the DLQI mean score was mild to moderate (5.57). Cytokine levels were not different between groups, or when associated with PSQI. Higher ISI scores (more severe insomnia) were related to increased IL-17A. Higher IL-4, IL-6 and IL-10 levels were associated with previous phototherapy. CONCLUSIONS: Poor sleep and impaired aspects of quality of life predominated in the vitiligo sample. Insomnia was related to IL-17A increase in vitiligo. Increased levels of IL-4, IL-6 and IL-10 were related to previous ultraviolet B narrow band (UVB-NB) phototherapy, suggesting an interaction of this treatment on immune system. Sleep disruption and the course of vitiligo may have common pathways in respect of circadian cytokines, which may represent an important subject in vitiligo management.

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Skin disorders affect millions of people all over the world. There are limited options to treat dermal illnesses such as vitiligo, psoriasis, and atopic dermatitis (eczema). Central American ferns are a potential source of bioactive metabolites against those diseases. Currently, Polypodium leucotomos Poir. is the only one being commercially utilized for this purpose. In this work, we evaluated the concentration of the skin bioactive compounds: quinic and chlorogenic acid, in the extract of 20 wild ferns from Costa Rica. We also evaluated the antimicrobial capabilities of the crude extracts of wild ferns and the sun protection factor (SPF) of the extracts. We found 19 out of 20 have either an important concentration of the compounds mentioned above or antimicrobial properties. Also, most samples result in higher SPF than P. aureum's rhizome. We also have studied the fern acclimatization, at different shading conditions, finding a significant influence of the culturing conditions on metabolite production. After acclimatization. So far, we demonstrate that various ferns included in this study are a potential source of treatments for skin conditions.

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BACKGROUND: Vitiligo is the most common pigmentary disorder and is considered a chronic, cumulative, multifactorial disease. The crucial role of cytotoxic CD8+ T lymphocytes and the IFNγ/CXCL10 axis has been demonstrated in its pathogenesis. OBJECTIVE: To evaluate the clinical profile and immuno-inflammatory markers in patients with vitiligo in a reference medical center. METHODS: Cross-sectional study in which all patients with vitiligo seen at the medical center the from 2019 to 2022 were evaluated, to outline the clinical profile. Moreover, cardiovascular risk biomarkers (neutrophil/lymphocyte ratio and C-reactive protein levels) were measured, as well as cytokines and chemokines (TNFα, IFNγ, IL10, IL15 and CXCL10) in the serum of a subgroup of 30 patients. RESULTS: There was a predominance of females, with a mean age of 43 years. Most were phototypes IV or V (71.3%), without comorbidities (77.55%), and without a family history of vitiligo (70.41%). Higher levels of neutrophil/lymphocyte ratio, C-reactive protein, and inflammatory cytokines/chemokines were documented in vitiligo patients when compared to the control group (non-significant). As relevant data, the highest values of CXCL10 were detected in patients with vitiligo versus controls, as well as in patients with disease of shorter duration (p<0.05). STUDY LIMITATIONS: The number of assessed patients was small due to recruitment difficulties caused by the COVID-19 pandemic. CONCLUSION: The present data contribute to confirming the relevant role of the IFNγ/CXCL10 axis in the pathogenesis of vitiligo, highlighting CXCL10 as a possible activity marker.

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OBJECTIVE: This systematic review provides a comprehensive analysis of the efficacy of autologous cell transplant as a therapeutic approach for stable segmental vitiligo. Vitiligo poses significant challenges for healthcare professionals in terms of treatment selection. Autologous cell transplant has emerged as a promising modality for managing vitiligo, with cultured and noncultured transplants being considered when determining the patient's treatment approach. There is little knowledge and literature on the subject, so we analyze the different studies. METHOD: Using online medical literature databases and the PRISMA guidelines, six out of 60 articles met the acceptance criteria to be analyzed, emphasizing the lack of current literature on this subject. RESULTS: Autologous cell transplant achieves excellent pigmentation rates for many body parts. We found that cultivated cells had better results than noncultivated ones. Both types of treatments could pigment 80% or more where needed. CONCLUSION: This review highlights the importance of autologous cell transplant as a new and reliable tool for the treatment of stable segmental vitiligo, cultured transplants being the most effective. By employing autologous cell transplant, the repigmentation rate is notably high and consistently achievable. Although its cost and logistical complexities hinder the current accessibility to this therapy, efforts are being made to enhance its availability, and its scope is expected to expand further. More studies are needed to understand this therapy method in other kinds of vitiligo.

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Previous studies found conflicting results about associations of vitiligo with different autoimmune diseases. To evaluate associations of vitiligo with multiple autoimmune diseases. A cross-sectional study representative of 612,084,148 US patients from the Nationwide Emergency Department Sample (NEDS) 2015-2019 was performed. Vitiligo and autoimmune diseases were identified using International Classification of Diseases-10 codes. The most frequent autoimmune disorders in patients with vitiligo were type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus (SLE), autoimmune thyroiditis, Addison's disease, and systemic sclerosis (SSc). Vitiligo was associated with any autoimmune disorder (adjusted odds ratio [95% confidence interval] 1.45 [1.32-1.58]). Cutaneous disorders with largest effect-sizes were alopecia areata (186.22 [115.31-300.72]) and SSc (32.13 [25.28-40.82]). Non-cutaneous comorbidities with largest effect-sizes were primary sclerosing cholangitis (43.12 [18.98-97.99]), pernicious anemia (41.26 [31.66-53.78]), Addison's disease (33.85 [26.68-42.9]), and autoimmune thyroiditis (31.65 [26.34-38.02]). Vitiligo is associated with multiple cutaneous and non-cutaneous autoimmune diseases, especially in females and older age.

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The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.

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OBJECTIVE AND DESIGN: The discovery of new inflammatory pathways and the mechanism of action of inflammatory, autoimmune, genetic, and neoplastic diseases led to the development of immunologically driven drugs. We aimed to perform a narrative review regarding the rising of a new class of drugs capable of blocking important and specific intracellular signals in the maintenance of these pathologies: the small molecules. MATERIALS/METHODS: A total of 114 scientific papers were enrolled in this narrative review. RESULTS: We describe in detail the families of protein kinases-Janus Kinase (JAK), Src kinase, Syk tyrosine kinase, Mitogen-Activated Protein Kinase (MAPK), and Bruton Tyrosine Kinase (BTK)-their physiologic function and new drugs that block these pathways of intracellular signaling. We also detail the involved cytokines and the main metabolic and clinical implications of these new medications in the field of dermatology. CONCLUSIONS: Despite having lower specificity compared to specific immunobiological therapies, these new drugs are effective in a wide variety of dermatological diseases, especially diseases that had few therapeutic options, such as psoriasis, psoriatic arthritis, atopic dermatitis, alopecia areata, and vitiligo.

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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.

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