Reduced Mortality Associated With Vitiligo

The chances of mortality could be low for patients with vitiligo, according to a recent study published in the Journal of Investigative Dermatology.

In the population-based cohort study, researchers explored the mortality of vitiligo as there is limited information about the risks of mortality among these patients. The researchers investigated all-cause and cause-specific mortality of patients with vitiligo compared with controls without vitiligo using a nationwide database.

Exploring vitiligo mortality in a national cohort would allow a greater understanding of the burden of the autoimmune disease and lead to a deeper understanding of its nature, the authors of the study claim.

The study included a total of 107,424 patients in Korea with vitiligo and 537,120 matched controls without vitiligo who were observed between 2002 and 2019. The mean age of included patients was ~48 years, and 39.61% were male.

Patients’ medical records were thoroughly analyzed and revealed that individuals with vitiligo experienced significantly reduced risks of mortality across a spectrum of diseases.

Of these findings, the risks associated with infectious, oncologic, hematologic, endocrine, neurologic, cardiovascular, respiratory, and renal/urogenital diseases were markedly lower in patients with vitiligo, the study revealed.

Previous studies have highlighted the co-occurrence of vitiligo with various autoimmune diseases, pointing to shared genetic alterations involved in immune activation and regulation. Specific immune responses have been identified as contributors to melanocyte destruction, authors shared.

What sets this study apart is that vitiligo seems to present a protective effect against mortality, particularly when it comes to infections, inflammation, and cancers.

Researchers suggest that the role of autophagy in vitiligo, a self-degradation process that regulates cellular homeostasis, could also relate to their findings.

Previous studies suggest that increased expression of autophagy markers in vitiligo skin may play a protective role against metabolic stress and external degenerative processes. In addition, autophagy's regulation of the innate immune system could provide defenses against viral infections.

The study also aligns with prior research indicating a reduced risk of malignancies in patients with vitiligo. In fact, the risk of internal malignancies, including cancers of the colon, rectum, ovary, and lung, was significantly decreased in individuals with vitiligo. The findings suggest that vitiligo may provide a form of immunity against cancer development.

Additionally, the study considers the role of treatments for vitiligo in contributing to reduced mortality. While there is no drug specifically approved for vitiligo, treatments such as phototherapy could have broader health implications.

For example, studies have suggested that ultraviolet B radiation, a component of phototherapy, may influence internal organs beyond the skin, offering benefits such as reducing the risk of atherosclerosis and improving blood pressure, the study mentioned.

However, there are certain limitations to the study which include the absence of information on disease severity and subtypes of vitiligo, potential unmeasured factors, and not having different populations observed.

The authors of the study believe the findings contribute toward the mortality risks associated with vitiligo, challenging previous beliefs about the outcomes of autoimmune conditions.

They added the unexpected protective effects observed in vitiligo patients open avenues for further research to unravel the underlying mechanisms and potential implications for patient management.

Reference

1. Ju HJ, Kang H, Han JH, Lee JH, Lee S, Bae JM. All-cause and cause-specific mortality among patients with vitiligo: a nationwide population-based study in Korea. J Invest Dermatol. 2023;S0022-202X(23)02481-8. doi:10.1016/j.jid.2023.07.007

Vitiligolularda Ölüm Riski Daha Düşük!

Kore'de yayınlanan yakın tarihli bir araştırmaya göre, vitiligolu hastalarda ölüm şansı düşük olabilir.

Nüfusa dayalı kohort çalışmasında, bu hastalar arasındaki ölüm riskleri hakkında sınırlı bilgi olduğundan araştırmacılar vitiligonun ölüm oranını araştırdı. Araştırmacılar, ülke çapında bir veri tabanı kullanarak vitiligolu hastaların tüm nedenlere ve nedene özel ölümlerini, vitiligosuz kontrollerle karşılaştırarak araştırdılar.

Çalışmanın yazarları, ulusal bir kohortta vitiligo mortalitesinin araştırılmasının, otoimmün hastalığın yükünün daha iyi anlaşılmasına olanak sağlayacağını ve doğasının daha iyi anlaşılmasına yol açacağını iddia ediyor.

Çalışmaya Kore'de 2002 ile 2019 yılları arasında gözlemlenen vitiligolu toplam 107.424 hasta ve vitiligosuz 537.120 eşleştirilmiş kontrol dahil edildi. Dahil edilen hastaların ortalama yaşı ~48 idi ve %39,61'i erkekti.

Hastaların tıbbi kayıtları kapsamlı bir şekilde analiz edildi ve vitiligosu olan bireylerin çeşitli hastalıklarda ölüm risklerinin önemli ölçüde azaldığını ortaya çıkardı.

Çalışma, bu bulgulardan enfeksiyöz, onkolojik, hematolojik, endokrin, nörolojik, kardiyovasküler, solunum ve böbrek/ürogenital hastalıklarla ilişkili risklerin vitiligo hastalarında belirgin şekilde daha düşük olduğunu ortaya çıkardı.

Önceki çalışmalar, vitiligonun çeşitli otoimmün hastalıklarla birlikte ortaya çıktığını vurgulamış ve bağışıklık aktivasyonu ve düzenlenmesinde yer alan ortak genetik değişikliklere işaret etmiştir. Yazarlar, melanosit yıkımına katkıda bulunanlar olarak spesifik bağışıklık tepkilerinin tanımlandığını paylaştı.

Bu çalışmayı farklı kılan şey, vitiligo'nun özellikle enfeksiyonlar, iltihaplanma ve kanserler söz konusu olduğunda ölüm oranlarına karşı koruyucu bir etki göstermesidir.

Araştırmacılar, hücresel homeostazı düzenleyen bir kendi kendine bozulma süreci olan vitiligodaki otofajinin rolünün de bulgularıyla ilişkili olabileceğini öne sürüyorlar.

Önceki çalışmalar, vitiligo derisinde artan otofaji belirteçlerinin ekspresyonunun, metabolik strese ve dış dejeneratif süreçlere karşı koruyucu bir rol oynayabileceğini öne sürüyor. Ayrıca otofajinin doğuştan gelen bağışıklık sistemini düzenlemesi viral enfeksiyonlara karşı savunma sağlayabilir.

Çalışma aynı zamanda vitiligosu olan hastalarda malignite riskinin azaldığını gösteren önceki araştırmalarla da uyumludur. Aslında vitiligosu olan kişilerde kolon, rektum, yumurtalık ve akciğer kanserleri de dahil olmak üzere iç malignitelerin riski önemli ölçüde azalmıştır. Bulgular vitiligo'nun kanser gelişimine karşı bir tür bağışıklık sağlayabileceğini düşündürmektedir.

Ek olarak, çalışma vitiligo tedavilerinin mortalitenin azaltılmasına katkı sağlamadaki rolünü de değerlendirmektedir. Vitiligo için özel olarak onaylanmış bir ilaç bulunmamakla birlikte, fototerapi gibi tedavilerin sağlık üzerinde daha geniş etkileri olabilir.

Örneğin çalışmalar, fototerapinin bir bileşeni olan ultraviyole B radyasyonunun derinin ötesindeki iç organları etkileyebileceğini, ateroskleroz riskini azaltmak ve kan basıncını iyileştirmek gibi faydalar sağlayabileceğini ileri sürdü.

Ancak çalışmanın, hastalığın ciddiyeti ve vitiligo alt tipleri hakkında bilgi bulunmaması, potansiyel ölçülemeyen faktörler ve farklı popülasyonların gözlemlenmemesi gibi bazı sınırlamaları vardır.

Araştırmanın yazarları, bulguların vitiligo ile ilişkili ölüm risklerine katkıda bulunduğunu ve otoimmün durumların sonuçları hakkındaki önceki inançları çürüttüğüne inanıyor.

Vitiligo hastalarında gözlemlenen beklenmedik koruyucu etkilerin, altta yatan mekanizmaların ve hasta yönetimine yönelik potansiyel sonuçların ortaya çıkarılması için daha fazla araştırmaya açık yollar olduğunu eklediler.

Referans

1. Ju HJ, Kang H, Han JH, Lee JH, Lee S, Bae JM. All-cause and cause-specific mortality among patients with vitiligo: a nationwide population-based study in Korea. J Invest Dermatol. 2023;S0022-202X(23)02481-8. doi:10.1016/j.jid.2023.07.007

Newly Discovered Genes Could Change Vitiligo Treatment

 

A recent study has revealed 135 previously unknown genes that play important roles in regulating melanin production in humans—and that could lead to melanin-modifying drugs for vitiligo and other pigmentation diseases.

The research team was led by Vivek Bajpai, assistant professor in the School of Sustainable Chemical, Biological and Materials Engineering at the University of Oklahoma, with collaborators from Stanford University, where Bajpai did postdoctoral work.

Melanin synthesis is compartmentalized within the melanosome, in specialized pigment cells (melanocytes). The synthesis of melanin within the melanosomes varies, which is why human skin, hair, and eye color vary. Pigmentation-related diseases are associated with disruptions in melanogenesis.

Melanin’s particular physicochemical properties, such as high refractive index, determine its optical properties, the researchers wrote in their article, published in Science on Aug. 11. “We reasoned that an accumulation of melanin within melanosomes would change melanocytes’ light-scattering properties.”

Bajpai developed a novel method to detect and quantify the melanin-producing activity of melanocytes: Passing light through the melanocytes, he could record whether the light was absorbed or scattered by the melanin. “If there are a lot of melanin-producing melanosomes,” he said in a University of Oklahoma press release, “the light will scatter much more than in cells with little melanin.”

The team measured light scattering through flow cytometry, capturing “dynamic shifts” in melanin levels within melanosomes. They used CRISPR-Cas9 technology to genetically engineer cells, and conducted a genome-wide genetic screen, systematically removing more than 20,000 genes from hundreds of millions of melanocytes.

Their screen identified 169 genes, including some that were previously known and 135 new melanin-promoting genes whose deletion was associated with reduced light scattering—in other words, loss of melanin.

The melanin-promoting genes are involved in diverse biological pathways, such as transcription regulation, RNA processing, and endosomal transport, the researchers say. “Consistent with their melanin-promoting role, the expression of the majority of our screen hits is elevated in darkly pigmented, compared with lightly pigmented, human melanocytes. Our analyses revealed that select melanin-promoting genes are associated with skin color variation and show evidence of local adaptation in human populations.”

By focusing on specific previously unidentified candidates, the researchers say, “we implicated a new cargo recycling pathway in melanosome function and identified a transcription factor involved in melanosome maturation. Our work provides a rich resource for further studies of melanogenesis and its relationship with skin color variation and human diseases.”

Their findings are also meaningful to a broad swath of science beyond dermatology. Bajpai’s method of targeting melanin-producing genes could lead to prevention of fungi- and bacteria-related diseases in humans and crops.

Reference: https://www.managedhealthcareexecutive.com/view/newly-discovered-genes-could-change-vitiligo-treatment

Cilt rengiyle ilişkili 135 yeni gen tespit edildi

 

İnsanlara cilt rengini veren pigmentasyonla ilgili 135 yeni gen tanımlandı. ABD'de yapılan araştırmadaki bulguların cilt kanseri ve vitiligo tedavilerinde yeni ilaç ve yol arayışına yön vermesini bekleniyor.

News Medical Life Sciences; Oklahoma Üniversitesi'nden Vivek Bajpai ve Stanford Üniversitesi'nden araştırmacılar tarafından yapılan çalışmada, insanlara cilt rengini veren pigmentasyonla ilişkili 135 yeni gen tanımlandığını yazdı. Araştırmacılar, cilt pigmenti de olarak da tanımlanan melanin üretimini etkileyen, işlevsel olarak farklı 169 gen bulurken bunlardan 135'inin daha önce pigmentasyon ile ilişkili olmadığı tespit edildi.

Araştırmaya göre, yeni keşfedilen KLF6 ve COMMD3 isimli iki genden KLF6 isimli DNA bağlayıcı protein, insanlarda ve hayvanlarda melanin üretimi kaybına yol açarken diğer türlerde ise melanin üretiminde rol oynuyor. COMMD3 ise, melanozomların asitliğini kontrol ederek melanin sentezini düzenliyor.

Cilt kanseri araştırmalarını etkileyecek

Bajpai, çalışmayla ilgili "Melanini neyin düzenlediğini anlayarak daha açık tenli insanları melanomdan veya cilt kanserinden korumaya yardımcı olabiliriz. Bu yeni melanin genlerini hedefleyerek vitiligo ve diğer pigmentasyon hastalıkları için melanin değiştiren ilaçlar da geliştirebiliriz" açıklamasında bulundu. Araştırmacılar, bu tür melanin üreten genleri keşfederek mikroplara ve hastalıklara karşı etkili müdahaleler geliştirebilir. Araştırma, Journal Science  adlı dergide yayımlandı.

Kaynak: Gazete Oksijen

FDA approves first topical treatment for vitiligo

The U.S. Food and Drug Administration has approved Opzelura (ruxolitinib) as the first topical treatment for vitiligo.

The 1.5 percent cream is approved for continuous topical use twice daily to affected areas of up to 10 percent of body surface area in patients aged 12 years and older. More than 24 weeks of treatment may be needed for satisfactory patient response.

The approval was based on results from the TRuE-V clinical trials, in which more than 600 patients were randomly assigned to Opzelura or placebo. At week 24, 30 percent of patients treated with Opzelura achieved ≥75 percent improvement from baseline in the facial Vitiligo Area Scoring Index (F-VASI75) versus 8 to 13 percent of patients treated with placebo. Approximately half of Opzelura-treated patients achieved F-VASI75 at week 52.

"There have been no FDA-approved therapies available to date and the approval of Opzelura therefore marks a significant milestone," David Rosmarin, M.D., from Tufts Medical Center in Boston, said in a company press release. "I welcome a medical treatment that helps my patients with nonsegmental vitiligo who are interested in potentially reversing the depigmentation caused by their disease."

Approval was granted to Incyte.

Referance:

https://medicalxpress.com/news/2022-07-fda-topical-treatment-vitiligo.html

Multimodal analyses of vitiligo skin identify tissue characteristics of stable disease

Vitiligo is an autoimmune skin disease characterized by the destruction of melanocytes by autoreactive CD8+ T cells. Melanocyte destruction in active vitiligo is mediated by CD8+ T cells, but the persistence of white patches in stable disease is poorly understood. The interaction between immune cells, melanocytes, and keratinocytes in situ in human skin has been difficult to study due to the lack of proper tools. We combine noninvasive multiphoton microscopy (MPM) imaging and single-cell RNA-Seq (scRNA-Seq) to identify subpopulations of keratinocytes in stable vitiligo patients. We show that, compared with nonlesional skin, some keratinocyte subpopulations are enriched in lesional vitiligo skin and shift their energy utilization toward oxidative phosphorylation. Systematic investigation of cell-to-cell communication networks show that this small population of keratinocyte secrete CXCL9 and CXCL10 to potentially drive vitiligo persistence. Pseudotemporal dynamics analyses predict an alternative differentiation trajectory that generates this new population of keratinocytes in vitiligo skin. Further MPM imaging of patients undergoing punch grafting treatment showed that keratinocytes favoring oxidative phosphorylation persist in nonresponders but normalize in responders. In summary, we couple advanced imaging with transcriptomics and bioinformatics to discover cell-to-cell communication networks and keratinocyte cell states that can perpetuate inflammation and prevent repigmentation.

Reference:

https://pubmed.ncbi.nlm.nih.gov/35653192/ 

Vitiligo, Causes,Symptoms, and Treatment

 

Vitiligo is a skin disorder in which smooth white areas called macules and patches appear on a person's skin. Generally starts on the hands for arms feet and face. Globally about 1% or so of the population has Vitiligo most people who have. Vitiligo will develop the condition prior to age 40 about half develop it before age 20. Vitiligo I may have a genetic component as the condition 10 Cimarron in families. Vitiligo is sometimes associated with other medical conditions including thyroid dysfunction.There is no way to determine if it'll I will spread or remain confined to one location. Types of Vitiligo do I go can be generalized which is the most common type when macules appear in various places on the body.

Segmental which is restricted to one side of the body or one area such as the hands or face mucosal what's your fax mucous membranes of the mouth and or the genitals. 

Focal which is a rare type in which the macros are in a small area and do not spread in a certain pattern within 1 to 2 years. Tricone which means that there is a white or color lacentre been an area of lighter pigmentation and then an area of normally colored skin.

Symptoms white patches on the skin are the main side of vitiligo these patches are more common in areas where the skin is exposed to the Sun the patches maybe on the hands feet arms face and lips other common areas for white patches are the armpits and groin where the leg meets the body around the mouth eyes nostrils Naval genitals rectal areas.

Causes although the causes of Vitiligo aren't completely understood there are a number of different theories autoimmune disorder the infected person's immune system May develop antibodies that destroyed their on a science genetic factors certain factors that may increase the chance of getting Vitiligo can be inherited.

About 30% of Vitiligo cases run in families neurogenic factors a substance that is toxic to melanocytes may be released at nerve endings in the skin self-destruction a defect in the Milana size causes them to destroy themselves Google are you I may also be triggered by certain events such as physical or emotional stress because none of the explanation seemed to completely account for the condition it's possible that a combination of these factors is responsible for vitiligo.

Diagnosis usually the white patches are easily visible on the skin but Healthcare Providers can use a Wood's lamp which shines ultraviolet or UV light onto the skin to help differentiate from other skin conditions. 

     Treatment repigmentation therapy therapy camouflage therapy surgery counseling prevention since no one knows for certain what causes Vitiligo no one can tell you how to prevent it in general it is smart forever to practice safe sun exposure habits and to take good care of your skin.

Jak Inhibitors

 

Disease where the immune system attacks of pigment cells are melanocytes in the body switch to white spots open and exposed areas such as the face and hands. Patient experienced increased quality of life despite affecting about 25 to 2% of the world's. Population know medications are FDA-approved to repigment in a liger who helped evaluate. 

What's the weather in cream to see if patients maybe were pigmented. About half the patients who received the highest dose of the Medicine Group Higgins 75% or more on the face significant number of patients also repugnant at on the body as well. He should serve as smart as early as 8 weeks after starting treatment. At the top of this medicine was well-tolerated with the table for safety profile it is currently being tested in a phase 3 Program. Hopefully become the first medicine that will be approved to treat vitiligo.

What is Vitiligo

 

Vitiligo likely meaning blemish is a non contagious skin condition that is defined by patches of Discoloration or deep pigmentation. The vitiligo can affect any race or ethnicity. It tends to be more noticeable in people with darker skin Like Canadian fashion model Winnie Harlow. 

Given the effect on a person's appearance, pigment loss can really impact a person's quality of life. Which is made of a single layer of small cuboido to low column stem cells that continually divide and produce new caratinosites They continue to mature is they migrate up through the epidermal layers but the straighten baseley also contains another group of cells Melanosites which secrete the protein pigment or coloring substance called melanin Melanin is actually a broad term that constitutes several types of melanin found in people of differing skin color.

The skin is divided into three layers the epidermis dermis and hypodermis The hypodermist is made of fat and connective tissue that anchors the skin to the underlying muscle Just above is the dermis which contains hair follicles, nerves, and blood vessels and just above that the outer most layer of skin is the epidermis. The epidermis itself has multiple cell layers that are mostly caratinosites which are named for the keratin protein that they're filled with. Keratin is a strong fibers protein that allows caratinocytes to protect themselves from getting destroyed when you rub your hands through the sand at the beach Current assights start their life at the deepest layer of the epidermis called the straight and baseley or basil layer.

These sub types of melanin range in color from black to redish. To reddish yellow and their relative quantity and rate at which their metabolised define a person's skin color When karate sites are exposed to the sun they send a chemical signal to the melanosites which stimulates the melanosites into making more melanin The melanosites move the melanin into small sax called malanosomes and these get taken up by newly formed caratinocytes Which will later metabolize the melanin as they migrate into higher layers of the epidermis melanin then axes in natural sunscreen.

Because it's protein structure dissipates or scatters the UVB light which if left unchecked can damage the DNA in the skin cells inly to skin cancer. Melanice can also be found in the dermis at the base of the hair follicle And in the eye where the help color hair and the iris respectively. There's a loss of melanocytes or the absence of their function. Histologically having less melanin in the epidermis result in white deep pigmented patches these patches are classified by type There's nonsegmental vitiligo which is the more common type that affects any age group. And it occurs at various locations that are mirrored on both sides of the body.

There's also segmental vitiligo which mostly affects children And occurs in segments along a single spinal nerve typically only on one side of the body without crossing the midline The exact cause of melanocyte destruction isn't known But it does seem to be linked to both genetic and environmental triggers. In non-segmental vitilgo there seems to be an autoimmune element where immune cells attack the melanosites. Insegmental vitiligo there seemed to be neural factors. Where nerves released neurochemicals that damage the melanocytes. 

Other causes maybe that the melanosites get damaged by a build up of toxic metabolites Is they make melanin or in other metabolic pathways one interesting observation is called the cubner phenomenon. And that's when Vitiligo develops in skin soon after there's been a trauma like a cut abrasion or burn The main symptom of it a ligo is the irregular round or oval shaped patches of depigmentation appearing within normally pigmented skin The patches can range in size from millimeters to centimeters and can sometimes expand and merge with other patches over time The body hair and the iris may also be depigmented in affected areas Non-segmental vitiligo tends to affect the hands forearms, neck, scalp, feet, and face while segmental vitilgo tends to affect areas of skin near dorsal roots from the spinal cord.

Particularly in the face following the trigeminal nerve. The diagnosis of it a ligo is based on the appearance of D pigmented patches but a skin biopsy can also be done There are two main treatments. When the affected area is small, cosmetic cover up and topical immune suppressants can be applied directly to the skin. When the affected area is large systemic immune suppressant UV photo therapy skin bleaching Skin bleaching and in severe cases skin grafts can all be tried. Whatever the course of therapy sunscreen is recommended to prevent darkening of the skin areas immediately surrounding And contrasting the deep pigmentation areas and to reduce the risk of skin cancer.

Alright it's a quick vitiligo is a non contagious condition where destruction of melanosites and loss of melanin Leads to areas of deep pigmentation on the skin tends to affect the hands Arms, neck, scalp, feet, and face. Well, segmental vitiligo tends to affect the areas of skin near dorsal roots from the spinal cord Particularly in the face following the trigeminal nerve. For small areas, cosmetic cover up and topical immune suppressants can be used Areas systemic immune suppressants UV photo therapy skin bleaching and even skin grafts can be used as well Thanks for watching. If you're interested in a deeper dive on this topic take a look at us most.org where we have flashcards, question Gins and other awesome tools to help you learn medicine.