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A rapid assessment of vitiligo lesion stability in view of melanocyte

3281 Laila Benzekri, PhD, Mohammed V. University, Ibn Sina Hospital, Rabat, Morocco;
Search for clinical and laboratory markers of severity and instability of Yvon Gauthier, MD, Dermatology, Le Bouscat, France
vitiligo: A cross-sectional observational hospital based study
Background: The assessment of stability status is crucial in view of melanocytes
Shreya Dass, H.B.T. Medical College and R. N. Cooper Hospital, Vile Parle (West), grafting. Until now, a delayed evaluation of stability status of vitiligo lesions was
Mumbai, Mumbai, India judged by three imprecise indicators: history, Koebner’s phenomenon and test
Introduction: Vitiligo has always been troubling dermatologists due to unsatisfactory grafting. Therefore, it is important to discriminate active stage from stable stage.
results every now and then, in spite of many treatment options available; keeping Aim of the study: to introduce new and simple methodologies in order to develop a
doctors on their toes in acquiring more and more knowledge about the disease. rapid and not delayed accuracy of staging.
Vitiligo has recently been found to be associated with atopic diathesis and proposed
explanations include melanocyte destruction by proinflammatory state of atopy, Materials and method: Clinical assessment and disease activity: we proposed to
Koebnerization of vitiligo by scratching in pruritic atopic dermatitis and common separately identify the two more common clinical types of vitiligo: amelanotic with
genetic mutation(s) like vitamin D receptor polymorphisms in both vitiligo and sharply demarcated borders and hypomelanotic with poorly defined lesions
atopic diathesis. The association of vitiligo with increased serum homocysteine borders. Clinical pictures were taken at the time of the examination and a skin
(Hcy), decreased serum vitamin B-12 and decreased serum folic acid levels has also biopsy was performed concomitantly. All patients were examined one year after
been studied and mechanisms proposed for increased Hcy levels causing ‘pigmen- their first visit. The vitiligo was classified as stable if no new lesions had appeared
tary dilution’ include melanocyte destruction, mutation in catalase gene and and as spreading or active if there had been an increase in the number and/or size of
inhibition of histidase and tyrosinase. existing vitiligo lesions. Histologic assessment: Skin biopsies from 71 patients were
performed at the edge of vitiligo lesions. 8 to 10 sections from each patient were
Materials and methods: A cross-sectional observational study was conducted on 40 successively stained with hematoxylin-eosin and immunostained with HMB45,
vitiligo patients and 40 matched controls and criteria for atopic diathesis, serum Hcy, monoclonal antibodies against CD8 T-lymphocytes and E-cadherin. Statistical
vitamin B12, folic acid levels compared. analysis: Statistical analysis was performed with the Windows 13.0 version of SPSS
Results: History of atopy (47.5% vs 20%; P \.05) and clinical atopic diathesis were software (SPSS Inc, Chicago, IL, USA). P \.05 were regarded as significant.
significantly associated with vitiligo (42.5% vs 15%; P \.05). Out of the following Results: We have noticed a worsening in 46 patients and stability in 23 patients. The
criteria: recurrent cough and cold, bronchial asthma, xerosis, chronically relapsing stable lesions were statistically associated to an amelanotic aspect with sharply
dermatitis, pruritus and family history of atopy; 5% of controls and 20% of cases defined borders (P \ .001), and histologically by the lack of an inflammatory
fulfilled more than 3 criteria. Leukotrichia (P \.05) and early age of onset (22.4 vs infiltrate of CD8-T lymphocytes in the epidermis and the dermis (P ¼ .017) and a
34.4 years; P \.05) were significantly found in patients of atopy. Mean Vitiligo Area down-expression of E-cadherin at the membrane of keratinocytes (P ¼ .044).
Scoring Index (VASI) and mean percentage body surface area (BSA) involved was
more in patients of atopy, but not significantly (P [.05). Elevated serum Hcy levels Discussion: The clinical aspect of the vitiligo and particularly of the borders may
(72.5% vs 10%; P \.05) and reduced serum vitamin B-12 levels (70% vs 25%; P\.05) exactly reflect the depigmenting process in course. We demonstrated that
were significantly associated with vitiligo. No significant association was found with amelanotic aspect with sharply defined borders is associated to stability status of
reduced serum folic acid levels. High VASI (39.47% vs 7.67%; P \.05) and larger the vitiligo lesions.
mean percentage BSA (43.5% vs 10.5%; P \.05), unstable disease (72.5% vs 27.5%; Conclusion: A simple and careful clinical examination of perilesional skin with or
P \.05); and leukotrichia were significantly associated with elevated Hcy levels. without histopathologic study of the edge may allow reliable and immediate
Conclusion: Atopic diathesis, elevated serum Hcy and reduced serum vitamin B12 evaluation of the actual stability of vitiligo lesions.
levels may be used as markers of severity and instability of vitiligo and included in
work-up done on the first visit. There are no Indian studies on the same. Commercial support: None identified.

Commercial support: None identified.

Assessment of intraerythrocyte zinc levels in vitiligo patients
Bilal Dogan, MD, Gata Teaching Hospital, Istanbul, Turkey; Mustafa Bayram, MD,
3763 Gata Teaching Hospital, Istanbul, Turkey; Ercan Karabacak, MD, Gata Teaching
12-Hydroxystearic acid: A peroxisome proliferator-activated receptor Hospital, Istanbul, Turkey
ligand that has antimelanogenic and antiinflammatory activity Background: Vitiligo is a common pigmentary disorder. Many studies across decades
Anita Damodaran, PhD, Unilever R&D, Bangalore, India; Rezwan Shariff, MS, and all over the world have attempted to illustrate the pathogenesis behind it. The
Unilever R&D, Shanghai; Manoj Joshi, Unilever R&D, Bangalore, India; Chen-liang pathogenesis of vitiligo is not completely understood, although the disorder appears
Guo, MS, Unilever R&D, Shanghai, China to be resulted from the complex interaction between immune abnormalities,
otositotoxic and environmental factors. Trace elements are essential for normal
Peroxisome proliferator-activated receptors (PPARs) have been pursued as biolog- functioning of the immune system. In this study, we investigated the levels of zinc in
ical targets for skin rejuvenation, antiinflammation and antiaging benefits. The goal erythrocytes and their relationship with disease severity in patients with vitiligo.
of this research was to explore the cellular mechanisms of a new PPAR pan-agonist,
12-hydroxystearic acid (12-HSA), for its role in modulating melanogenesis and to Objectives: The aim of this study was to determine the zinc levels in serum and
confirm clinical efficacy in treating skin hyperpigmentation. 12-HSA reduced erythrocytes of patients with vitiligo by using atomic absorption spectrometric
melanogenesis in a melanoderm model. Our study of cocultures showed that 12- technique and to investigate the relationship between those levels and disease
HSA inhibited melanosome transfer from melanocyte to keratinocyte as measured by activity.
flow cytometry using double immunofluorescence labelling. In human monocytes Methods: Fifty-two (20 women and 32 men) vitiligo patients and age matched 52
stimulated with lipopolysaccharide (LPS), 12-HSA demonstrated moderate, yet dose controls were enrolled in the study. The diagnosis of vitiligo was determined
dependent antiinflammatory potential as indicated by reduction in PGE2 produc- according to physical examination and wood light. We measured zinc levels in
tion quantified by EIA. A half face, double blind, randomized IRB-approved clinical serum and erythrocytes by atomic absorption spectrophotometric technique.
study was conducted to evaluate 12-HSA in a cosmetic formulation for reducing the
appearance of pigmentation. Formulations were applied twice a day for 3 weeks and Results: Intraerythrocyte zinc levels of vitiligo patients and control group patients
changes in skin were recorded using spectrophotometer (CM2600d). In line with were found close to each other. Erythrocyte zinc levels of the control group were as
the in vitro results and its role as a PPAR ligand, the formulation containing 12-HSA 581.24 6 95.48 [280-924] mg/dL (standard deviation: 95.48) and of the vitiligo
significantly lightened facial pigment spots over vehicle control, in ITA (individual group were as 602.12 6 107.89 [400-872] mg/dL (standard deviation: 107.89 ).
typology angle) and L* (lightness) as measured by spectrophotometer. For the Serum zinc levels were additionally calculated as 88.94 6 13.43 [41-117] mg/dL
underarm lightening study, female patients with skin types III or IV (Fitzpatrick (standard deviation: 13) in the control group and 92.84 6 15.51 [60-134] mg/dL
scale) exhibiting a moderate level of even darkening across their underarms were (standard deviation: 16 ) in the vitiligo group (P \.001). 0.7% and 4% increases of
enrolled in an IRB-approved clinical study. Impact of the product on hyperpigmen- intraerythrocyte and serum zinc levels in the vitiligo group respectively were not
tation, erythema and dryness was measured over 4 weeks of application of cream statistically significant (P ¼ .15).
using expert visual assessment and expert underarm mapping. A significant Conclusions: We did our study to find out whether the assessment of zinc deficiency
lightening benefit was demonstrated in the 12-HSA under arm compared to the by intraerythrocyte zinc levels instead of serum zinc concentrations in patients with
vehicle control after 10 days of application, which was maintained through the end vitiligo could be more informative or not. But any measurement was not superior
of the study. Our research clearly indicates that the PPAR pan-agonist 12-HSA inhibits over each other’s according to the results of our study. Furthermore, the relationship
melanogenesis potentially through inhibition of melanosome transfer and/or between disease severity and erythrocyte zinc levels were also not correlated. Some
antiinflammatory activity. Furthermore, 12-HSA safely and effectively reduced other studies with intralesional or affected hair zinc levels in vitiligo may give us
hyperpigmentation in as short a period as 3 weeks in both face and underarm in different results to make a healthier interpretation about the association of vitiligo
vivo clinical studies. and zinc.

Supported 100% by Unilever R&D. Commercial support: None identified.