PIGMENTARY DISORDERS AND VITILIGO 3521
A rapid assessment of vitiligo lesion stability in view of melanocyte
3281
Search for clinical and laboratory markers of severity and instability of
vitiligo: A cross-sectional observational hospital based study
Shreya Dass, H.B.T. Medical College and R. N. Cooper Hospital, Vile Parle (West),
Mumbai, Mumbai, India
Introduction: Vitiligo has always been troubling dermatologists due to unsatisfactory
results every now and then, in spite of many treatment options available; keeping
doctors on their toes in acquiring more and more knowledge about the disease.
Vitiligo has recently been found to be associated with atopic diathesis and proposed
explanations include melanocyte destruction by proinflammatory state of atopy,
Koebnerization of vitiligo by scratching in pruritic atopic dermatitis and common
genetic mutation(s) like vitamin D receptor polymorphisms in both vitiligo and
atopic diathesis. The association of vitiligo with increased serum homocysteine
(Hcy), decreased serum vitamin B-12 and decreased serum folic acid levels has also
been studied and mechanisms proposed for increased Hcy levels causing ‘pigmen-
tary dilution’ include melanocyte destruction, mutation in catalase gene and
inhibition of histidase and tyrosinase.
Materials and methods: A cross-sectional observational study was conducted on 40
vitiligo patients and 40 matched controls and criteria for atopic diathesis, serum Hcy,
vitamin B12, folic acid levels compared.
Results: History of atopy (47.5% vs 20%; P \.05) and clinical atopic diathesis were
significantly associated with vitiligo (42.5% vs 15%; P \.05). Out of the following
criteria: recurrent cough and cold, bronchial asthma, xerosis, chronically relapsing
dermatitis, pruritus and family history of atopy; 5% of controls and 20% of cases
fulfilled more than 3 criteria. Leukotrichia (P \.05) and early age of onset (22.4 vs
34.4 years; P \.05) were significantly found in patients of atopy. Mean Vitiligo Area
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
(72.5% vs 10%; P \.05) and reduced serum vitamin B-12 levels (70% vs 25%; P\.05)
were significantly associated with vitiligo. No significant association was found with
reduced serum folic acid levels. High VASI (39.47% vs 7.67%; P \.05) and larger
mean percentage BSA (43.5% vs 10.5%; P \.05), unstable disease (72.5% vs 27.5%;
P \.05); and leukotrichia were significantly associated with elevated Hcy levels.
Conclusion: Atopic diathesis, elevated serum Hcy and reduced serum vitamin B12
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.
3763
12-Hydroxystearic acid: A peroxisome proliferator-activated receptor
ligand that has antimelanogenic and antiinflammatory activity
Anita Damodaran, PhD, Unilever R&D, Bangalore, India; Rezwan Shariff, MS,
Unilever R&D, Shanghai; Manoj Joshi, Unilever R&D, Bangalore, India; Chen-liang
Guo, MS, Unilever R&D, Shanghai, China
Peroxisome proliferator-activated receptors (PPARs) have been pursued as biolog-
ical targets for skin rejuvenation, antiinflammation and antiaging benefits. The goal
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
confirm clinical efficacy in treating skin hyperpigmentation. 12-HSA reduced
melanogenesis in a melanoderm model. Our study of cocultures showed that 12-
HSA inhibited melanosome transfer from melanocyte to keratinocyte as measured by
flow cytometry using double immunofluorescence labelling. In human monocytes
stimulated with lipopolysaccharide (LPS), 12-HSA demonstrated moderate, yet dose
dependent antiinflammatory potential as indicated by reduction in PGE2 produc-
tion quantified by EIA. A half face, double blind, randomized IRB-approved clinical
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
changes in skin were recorded using spectrophotometer (CM2600d). In line with
the in vitro results and its role as a PPAR ligand, the formulation containing 12-HSA
significantly lightened facial pigment spots over vehicle control, in ITA (individual
typology angle) and L* (lightness) as measured by spectrophotometer. For the
underarm lightening study, female patients with skin types III or IV (Fitzpatrick
scale) exhibiting a moderate level of even darkening across their underarms were
enrolled in an IRB-approved clinical study. Impact of the product on hyperpigmen-
tation, erythema and dryness was measured over 4 weeks of application of cream
using expert visual assessment and expert underarm mapping. A significant
lightening benefit was demonstrated in the 12-HSA under arm compared to the
vehicle control after 10 days of application, which was maintained through the end
of the study. Our research clearly indicates that the PPAR pan-agonist 12-HSA inhibits
melanogenesis potentially through inhibition of melanosome transfer and/or
antiinflammatory activity. Furthermore, 12-HSA safely and effectively reduced
hyperpigmentation in as short a period as 3 weeks in both face and underarm in
vivo clinical studies.
Supported 100% by Unilever R&D.
AB230 J AM ACAD DERMATOL
grafting
Laila Benzekri, PhD, Mohammed V. University, Ibn Sina Hospital, Rabat, Morocco;
Yvon Gauthier, MD, Dermatology, Le Bouscat, France
Background: The assessment of stability status is crucial in view of melanocytes
grafting. Until now, a delayed evaluation of stability status of vitiligo lesions was
judged by three imprecise indicators: history, Koebner’s phenomenon and test
grafting. Therefore, it is important to discriminate active stage from stable stage.
Aim of the study: to introduce new and simple methodologies in order to develop a
rapid and not delayed accuracy of staging.
Materials and method: Clinical assessment and disease activity: we proposed to
separately identify the two more common clinical types of vitiligo: amelanotic with
sharply demarcated borders and hypomelanotic with poorly defined lesions
borders. Clinical pictures were taken at the time of the examination and a skin
biopsy was performed concomitantly. All patients were examined one year after
their first visit. The vitiligo was classified as stable if no new lesions had appeared
and as spreading or active if there had been an increase in the number and/or size of
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
successively stained with hematoxylin-eosin and immunostained with HMB45,
monoclonal antibodies against CD8 T-lymphocytes and E-cadherin. Statistical
analysis: Statistical analysis was performed with the Windows 13.0 version of SPSS
software (SPSS Inc, Chicago, IL, USA). P \.05 were regarded as significant.
Results: We have noticed a worsening in 46 patients and stability in 23 patients. The
stable lesions were statistically associated to an amelanotic aspect with sharply
defined borders (P \ .001), and histologically by the lack of an inflammatory
infiltrate of CD8-T lymphocytes in the epidermis and the dermis (P ¼ .017) and a
down-expression of E-cadherin at the membrane of keratinocytes (P ¼ .044).
Discussion: The clinical aspect of the vitiligo and particularly of the borders may
exactly reflect the depigmenting process in course. We demonstrated that
amelanotic aspect with sharply defined borders is associated to stability status of
the vitiligo lesions.
Conclusion: A simple and careful clinical examination of perilesional skin with or
without histopathologic study of the edge may allow reliable and immediate
evaluation of the actual stability of vitiligo lesions.
Commercial support: None identified.
2738
Assessment of intraerythrocyte zinc levels in vitiligo patients
Bilal Dogan, MD, Gata Teaching Hospital, Istanbul, Turkey; Mustafa Bayram, MD,
Gata Teaching Hospital, Istanbul, Turkey; Ercan Karabacak, MD, Gata Teaching
Hospital, Istanbul, Turkey
Background: Vitiligo is a common pigmentary disorder. Many studies across decades
and all over the world have attempted to illustrate the pathogenesis behind it. The
pathogenesis of vitiligo is not completely understood, although the disorder appears
to be resulted from the complex interaction between immune abnormalities,
otositotoxic and environmental factors. Trace elements are essential for normal
functioning of the immune system. In this study, we investigated the levels of zinc in
erythrocytes and their relationship with disease severity in patients with vitiligo.
Objectives: The aim of this study was to determine the zinc levels in serum and
erythrocytes of patients with vitiligo by using atomic absorption spectrometric
technique and to investigate the relationship between those levels and disease
activity.
Methods: Fifty-two (20 women and 32 men) vitiligo patients and age matched 52
controls were enrolled in the study. The diagnosis of vitiligo was determined
according to physical examination and wood light. We measured zinc levels in
serum and erythrocytes by atomic absorption spectrophotometric technique.
Results: Intraerythrocyte zinc levels of vitiligo patients and control group patients
were found close to each other. Erythrocyte zinc levels of the control group were as
581.24 6 95.48 [280-924] mg/dL (standard deviation: 95.48) and of the vitiligo
group were as 602.12 6 107.89 [400-872] mg/dL (standard deviation: 107.89 ).
Serum zinc levels were additionally calculated as 88.94 6 13.43 [41-117] mg/dL
(standard deviation: 13) in the control group and 92.84 6 15.51 [60-134] mg/dL
(standard deviation: 16 ) in the vitiligo group (P \.001). 0.7% and 4% increases of
intraerythrocyte and serum zinc levels in the vitiligo group respectively were not
statistically significant (P ¼ .15).
Conclusions: We did our study to find out whether the assessment of zinc deficiency
by intraerythrocyte zinc levels instead of serum zinc concentrations in patients with
vitiligo could be more informative or not. But any measurement was not superior
over each other’s according to the results of our study. Furthermore, the relationship
between disease severity and erythrocyte zinc levels were also not correlated. Some
other studies with intralesional or affected hair zinc levels in vitiligo may give us
different results to make a healthier interpretation about the association of vitiligo
and zinc.
Commercial support: None identified.
MAY 2016