Advances in the function of traditional medicine for vitiligo treatment

Vitiligo has a significant impact on a substantial number of individuals worldwide.Traditional Chinese medicine has a long history of serving as a therapeutic treatment for vitiligo.Nevertheless,given the increasing volume of research on the utilization of traditional Chinese medicine for vitiligo treatment,it is imperative to conduct a comprehensive review that elucidates the efficacy of Chinese traditional medicine and other active ingredients in the treatment of vitiligo.This paper presents a comprehensive overview of the clinical preparations used to treat vitiligo,while also highlighting the potential monomers and extracts derived from traditional Chinese medicine for vitiligo treatment.A thorough analysis of the pharmacological effects of traditional Chinese medicine on vitiligo treatment will provide valuable insights and reliable information for the development of new treatment strategies.

Not Follicular but Dermal Melanocyte Precursors Are Histopathologically Retained in Vitiligo

Although perifollicular repigmentation in the vitiligo lesions is owing to activation of follicular melanocyte stem cells and/or precursor cells followed by supplying matured melanocytes, the underlying mechanism of diffuse repigmentation on the whole vitiligo surface remains still unknown. In addition to the presence of remaining melanocytes, it is conceivable that dermal melanocyte precursor cells contribute to induce diffuse repigmentation after treatment. Therefore, we investigated here whether dermal and follicular melanocyte precursor cells were reduced or not in vitiligo lesions. We performed an immunostaining for Nestin and p75NGFR as dermal melanocyte precursor cells and MITF/Fzd4 as follicular melanocyte precursor cells and compared the positive cells number between lesions and non-lesions (n = 11). Although MITF+/Fzd4+ cells in the hair follicle were significantly decreased in number in the lesions, Nestin+ and p75NGFR+ cells were not. This result indicates that dermal precursor cells could be retained in the vitiligo lesions but be disturbed to differentiate into matured melanocytes.

Comparative Study on Management of Vitiligo with Psoralen plus Steroid (Oxabet Formula) Alone VS Psoralen Formula plus Narrow Band of Ultraviolet B 311 nm in Khartoum Teaching Hospital of Dermatology and Venereology (KTHDV)

A comparative study and management has been conducted in (KTHDV). For some patients who attend the out patients clinic concern on treatment of the vitiligo with a new formula (Oxabet) alone VS Oxabet (oxpsolaren plus betamethasone) formula plus NB. UVB311 is during a period from (Jan 2011-Jan 2013). The study sample includes different age groups of both sexes. The study revealed that the formula alone gives good results. The localized vitiligo has a good response to the formula than generalized one. The early lesions have good responses than the old ones. The continuations of applying the treatment and the follow up of the patients enhance the efficacy of the treatment.

Highlights in pathogenesis of vitiligo

Vitiligo is a common pigmentary disorder. Many studies across decades and all over the world have attempted to illustrate the pathogenesis behind it; however, the pathogenesis of vitiligo remains elusive. This review article, we present the findings behind the most and updated theories behind this psychologically debilitating and disfiguring disease. The discussion begun with the role of genetic predisposition followed by neural theory first proposed in the 1950 s. Wehighlight the autoimmune hypothesis, followed by the reactive oxygen species model, zinc-α2-glycoprotein deficiency hypothesis, viral theory, intrinsic theory and biochemical, molecular and cellular alterations accounting for loss of functioning melanocytes in vitiligo. Many theories were elaborated to clarify vitiligo pathogenesis. It is a multifactorial disease involving the interplay of several factors. Future research is needed to clarify the interaction of these factors for better understanding of vitiligo pathogenesis and subsequent successful treatment.

CHARACTERIZATION OF VITILIGO BY IN VIVO SCATTERING COEFFICIENT OF HUMAN SKIN

Scattering coefficients of human skin in vivo with and without vitiligo were measured with optical coherence tomography(OCT).The experimental results show that there exist significant difference between the scattering coefficient of the epidermis of in vivo human skin with and without vitiligo disease.The results may be helpful for quantitatively diagnosing or evaluating the treatment of the disease.

Association between celiac disease and vitiligo:A review of the literature

Celiac disease(CD)is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes.Vitiligo is a commonly acquired depigmentation of the skin;its clinical manifestation are skin patches caused by localized or generalized melanin deficiency.Both diseases have similar global incidence rates(approximately 1%)and are associated to similar diseases,including autoimmune bullous disease,inflammatory bowel disease,autoimmune thyroiditis,autoimmune gastritis,and type 1 diabetes.The relationship between CD and vitiligo has been reported in several studies,but their conclusions are inconsistent.Further,it has also been reported that a gluten-free diet(GFD)can improve the symptoms of immunerelated skin diseases such as vitiligo.In this mini-review,we summarize and review the literature on the relationship between CD and vitiligo,assess the therapeutic significance of GFD for patients with vitiligo,and explore their possible physiopathology.We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo,thereby improving the prognosis.

Study of neuropeptide Y in the plasma and skin tissue of patients with vitiligo

Objective: To study the role of neuropeptide Y (NPY) in the pathogenesis of vitiligo. Methods: The levels of NPY in the plasma from patients with vitiligo and healthy volunteers were measured by 125I RIA Kit. The expression of NPY in normal skin tissues, uninvolved tissues and lesional tissues of vitiligo was detected by immunohistochemistry. Results: The levels of NPY in the patients with vitiligo of all types were significantly higher than that in the normal controls. In all types, the levels in active stage were significantly higher than those in stable stage. The expression of NPY was upregulated in lesions of patients with active vitiligo (P<0.01) compared with those in normal skin tissues and uninvolved tissues. There was significant difference of NPY expression between active stage and stable stage (P<0.01). Conclusion: These findings support the concept of neuropeptide involvement in vitiligo, especially in active vitiligo, and suggest that NPY may play a role in the pathogenesis of this disease.

Progressive Cribriform and Zosteriform Hyperpigmentation along with Vitiligo

Background: Progressive cribriform and zosteriform hyperpigmentation (PCZH) is a disorder of pigmentation. Although several cases of PCZH have been reported, cases that associated with vitiligo have not been published in the past. Aim: We report the case to reveal the interesting mosaicism reflecting on the skin. Case Presentation: This case presents a phenomenon of the coexistence of hyperpigmentation and depigmentation arranged in unilateral and symmetric distribution in one patient. Conclusion: The aetiology of the pigmental disorders is still unknown. The linear nature of the pigmented bands probably reflects the clonal migration and proliferation of embryonic melanoblasts, so somatic mosaicism that develops during embryogenesis appears to be the underlying aetiology, which is leading to proliferation and migration of two mixed populations of melanocytes with different potential for pigment production.

Treatment of Gray Hair in Vitiligo Patients by Direct Melanocytes Transplant Using Needling Micrografting and Dermabrasion Techniques

Background: Melanocytes transplant for treatment of vitiligo is a common therapy using different surgical procedures. But there was no interest in repigmentation of grayness of hair in the treated vitiliginous area. Objective: To do melanocytes transplant from donor area into the recipient vitiliginous area with associated gray hair. Patient and Methods: This is a case interventional study was done in Department of Dermatology/Baghdad Teaching Hospital from February 2011-March 2012. Eleven patients were enrolled in this study, six males and five females with vitiligo in association of gray hair. Their ages ranged from 8 - 35 years with a mean ±SD of 20.90 ± 7.006. Melanocytes transplant in patients with vitiligo using needling micrografting technique for twelve patches and direct melanocytes transplant from normal donor area into vitiliginous recipient area by dermabrasion technique for eleven patches. Dressing was applied and patients were seen every two weeks for the first month and monthly for one year. Results: Repigmentation of the vitiliginous area was started after two weeks and was obvious at one month that progressed over time. The repigmentation of hair appeared usually after few months and was obvious after four months and the repigmentation of gray hair was quicker in patients with micrografting technique than those with dermabrasion technique. The mean rate of repigmentation was 18.3% at six months and 37.5% at twelve months in micrografting technique while the mean rate of repigmentation was 9.15% at six months and 18.55 at twelve months in dermabrasion technique. Conclusions: Direct transplant of melanocytes from normal donor area into recipient vitiliginous area with associated white hair is an effective procedure to induce repigmentation of gray hair.

Clinical Experience in the Treatment of Vitiligo by the Method of Invigorating Qi,Promoting Blood Circulation and Detoxification

Studies have shown that traditional Chinese medicines have clear curative effects in the treatment of vitiligo with few side effects.Through literature research and clinical observation,the study summarized the etiology and pathogenesis of vitiligo in traditional Chinese medicine as"deficiency,toxin,and stasis",formulated the method of invigorating qi,promoting blood circulation and detoxification,and prescribed Fuse Hexue Jiawei Decoction for the treatment of vitiligo.

A systemic review on vitiligo(baraṣ)&role of Unani medicines towards its treatment

Vitiligo is not only a cosmetic problem,but also a social and psychological problem with the prevalence rate between 1–2%and being highest in India.As far as etiopathogenesis of the disease is concerned,out of various theories put forward,some accepted hypothesis is the autoimmune destruction of melanocytes,melanocytes adhesion,neurogenic damage,auto-toxicity.Disease is mainly classified in two forms i.e.segmental vitiligo and non-segmental vitiligo.Treatment of this disease is usually cumbersome and time taking,causing significant impact on quality of life.Moreover,modern treatment is only suppressive but not curative.Medicinal plants are the base of many traditional medicine systems throughout the world for thousands of years and continue to provide new remedies to mankind.If used appropriately,they are comparatively more effective,less toxic and easily available at affordable prices.Detailed management consisting of single herbs and compound formulations along with other regimes has been mentioned to treat this disease in the classical Unani literature which is safe and effective.Aim of this paper was to delineate the vitiligo disease and search for evidence in the management of the disease through Unani and herbal medicines.

Treatment of Patients with Vitiligo by Intradermal Pricking of Vitiligenous Skin Using Sharp and Blunt Needle

Background: Vitiligo is a well known autoimmune disease, both cell mediated and humeral reaction are implicated in its etiopathogensis. Pricking of marginal pigmented of vitiligo skin to stimulate normal melanocytes to migrate into vitiligenous area and induce new melanogenesis and this is well known mechanism to induce repigmentation and supported by publications. Objective: To use needling technique by using blunt and sharp needle by doing pricking completely white vitiligo skin in order to stimulate residual melanocytes of basal layer and or the melanocytes of outer root sheath of hair follicles to proliferate and induce active melanogenesis. Patients and Methods: This is an interventional, therapeutic, comparative, study that was done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq from April 2014-March 2015. Thirty five patient with vitiligo were enrolled in this study, their ages ranged from 5 - 55 (22.28 ± 12.09) years;15 patients treated with sharp needle, 2 males and 13 females and 20 patients treated with blunt needle, 4 males and 16 females. All clinical types of vitiligo including the generalized, localized and segmental were treated. The number of vitiligo patches varied between patients and the treated patches by sharp needle were 22 and by blunted needle were 20 patches. In both groups, needling was done geometrically, softly and rapidly in systemic horizontal rows away from pigmented margin and pigmented spot inside the patches and was not repeated. In Group A needle gauge 18 hold at 45° to skin surface and the distance between each pricking was 5 - 10 mm and similarly was done in Group B by using blunt needle. Each patient was advised to have daily sun light exposure for at least 15 min. Measuring the surface area of the lesions and calculating the reduction rate was done by using transparent with square paper and this was carried out every month till the end of the 4th month period of the treatment. All patients in both groups were evaluated every 2 weeks for the 1st month and then monthly for 3 months and the rate of reduction in surface area was measured. Also to record any side effects and complications. Results: After 2 week, 2 months, and 4 months of treatment, there was 0.5%, 4.31%, and 10% respectively reduction in the surface area of lesions in Group A, while in Group B, there was 7%, 18.42%,and 13.5% respectively reduction in the surface area. Conclusions: Pricking the vitiligo skin by needle, gauge 18 gave success rate 10% and 13.5% at four months after therapy and needling could be repeated once a week to accelerate melanogenesis and until get complete repigmentation.

To explore the potential vitiligo treatment mechanism of Piperine in Piperis Longi Fructus via network pharmacology and bioinformatics strategies

Objective:To explore the mechanism of Piperine of Piperis Longi Fructus in the treatment of vitiligo based on network pharmacology and transcriptome.Methods:Piperine,the active component of Piperis Longi Fructus,was screened from Traditional Chinese Medicine Systems Pharmacology,and the target network and protein interaction network of piperine-vitiligo were constructed.PPI analyzed the cross targets,GO function,and KEGG pathway analysis.In the GEO database,vitiligo gene expression profile chips GSE65127 and GSE75819 were selected for differential gene screening and gene set enrichment analysis.The potential key signal pathways of piperine in the treatment of vitiligo were identified by transcriptome microarray data verification.Results:31 potential targets of piperine in the treatment of vitiligo were found,of which 9 targets such as ESR1,AKT1,and IGF1 were closely related to the treatment of vitiligo.Enrichment analysis showed that signal pathways such as PI3K-Akt,MAPK,and Melanogenesis were related to piperine's mechanism in treating vitiligo.The cross-validation of chip analysis results confirmed that Melanogenesis is a potential key signal pathway for piperine in vitiligo treatment.Conclusion:This study discusses the potential targets and signal pathways of piperine in the treatment of vitiligo,which helps clarify the mechanism of piperine in the treatment of vitiligo and provides a theoretical basis for the clinical treatment of vitiligo.It also provides direction for the research and development of new drugs for vitiligo.

Oral Use of an Infusion of Leaves of <i>Solanum paniculatum</i>L., </i>Jacaranda brasiliensis</i>and </i>Sonchus oleraceus</i>for Treatment of Vitiligo

Background: A healthy normal skin is essential for a person’s physical and mental well being. It is an important aspect of their sexual attractiveness, a sense of well being and a sense of self confidence. Vitiligo is an acquired depigmentation disorder of skin affecting 1% - 4% of the world population. Neither life threatening nor symptomatic (except that depigmented patches burn easily when exposed to the sun) the effects of vitiligo can be cosmetically and psychologically devastating. Because the disease is still not understood, there is a plethora of different treatments approaches, but they are largely unsatisfactory from patient’s perspective. Objective: To report the outcomes from oral use of an infusion of leaves of Solanum paniculatum L., Jacaranda brasiliensis and Sonchus oleraceus for treatment of vitiligo. Ethical issues: Study approved by the Research Ethics Committee of Hospital Federal dos Servidores do Estado do Rio de Janeiro (CAAE: 32143314.9.0000.5252). All participants confirmed the condition of volunteer by signing the Informed Consent Form. Methods: From October 2014 to October 2015 twelve subjects consumed daily four glasses (800 ml) of proposed phytotherapeutic preparation. Results: All subjects were highly satisfied about their outcomes. Total depigmentation was considered as a positive outcome because it is cosmetically acceptable. Total depigmentation was observed in presence of 80% or more of depigmenteted patches. Conclusions: The phytotherapeutic preparation proposed is effective on treatment of depigmenteted patches in vitiligo.

Preliminary Colorimetric Assessment of Progressive Nonsegmental Vitiligo under Short-Term Intravenous Methylprednisolone Pulse Therapy

Although the administration of systemic steroid for nonsegmental vitiligo in the progressive stage is a recommended treatment according to guidelines, the clinical efficacy of this regimen has not been fully established. In this study, we evaluated the clinical efficacy of half-dose steroid treatment and stratified the evidence regarding its usefulness in progressive vitiligo patients. Half-dose steroid pulse therapy (500 mg/day of methylprednisolone for three sequential days) was administered intravenously three times monthly in five vitiligo patients. The visual changes in vitiligo lesions were evaluated on photographs and quantified using a spectrophotometer. As results, all patients completed three cycles of treatment without severe adverse events. Three of the five patients achieved disease arrest with decrease in white contrast. Therefore, short-term and halfdose steroid therapy is well tolerated and effective for achieving disease arrest in progressive nonsegmental vitiligo. The whiteness assessed by a spectrophotometer is possibly associated with therapeutic response to steroid therapy.

Dysregulation of Circular Antigen-Specific T Cells Anergy in Autoimmune Vitiligo

Background: Vitiligo is an autoimmune disorder related to melanocyte loss;however, the exact interplay between antigen-specific autoimmunity and local oxidative stress remains unclear. Recently, the migration ability and number of Foxp3-expressing regulatory T cells (Tregs) in lesional skin was found to be reduced in vitiligo patients. Objectives: We aimed to clarify the T cell anergy status of melanocytes by focusing on the impaired equivalence of peripheral melanocyte-specific cytotoxic T cells and functional Tregs in patients with progressive vitiligo. Materials and methods: Ten progressive vitiligo patients and 10 age-matched healthy individuals were enrolled in this study. We analyzed the number of functional Tregs in progressive vitiligo patients and compared the findings with those of controls. Next, to assess the suppressive activity of Tregs on melanocyte-specific T lymphocytes, we strictly purified the functional Tregs fraction and Melan-A-specific CD8+ T cells and co-cultured these cells with each other. The number of Melan-A-specific CD8+ T cells was then counted by FACS. In addition, the expression of the representative exhaustion markers PD-1 and CTLA-4 on functional Tregs was assessed in vitiligo patients and normal controls. Results: The number of functional Tregs itself was not significantly decreased in the blood of vitiligo patients compared to healthy controls. However, the cytotoxic T cell (CTL) proliferation was significantly decreased after cultivation with Tregs from healthy individuals (p < 0.01), and this decrease in CTLs was less marked after cultivation with Tregs from vitiligo patients. Conclusions: We demonstrated a reduced suppressive function of activated Tregs on Melan-A-specific CTLs in the circulating cells of vitiligo patients compared with healthy controls. This result suggests that T cell anergy with Tregs dysfunction may participate in the immune response to melanocytes in vitiligo patients.

Review of narrowband ultraviolet B radiation in vitiligo

Vitiligo is a common, acquired pigmentary disorder of unknown etiology with great impact on patient's appearance and quality of life. It presents a therapeutic challenge to many dermatologists. Photochemotherapy using psoralen and ultraviolet A(UVA) therapy, topical and oral immunosuppresants, as well as cosmetic camouflage are also commonly employed with varying clinical efficacy. Phototherapy is a popular treatment option, which includes both of the generalized ultraviolet B(UVB) therapies, broadband UVB and narrowband UVB(NB-UVB). It has been used favorably, both alone as well as in combination with other agents like topical calcineurin inhibitors, vitamin-D analogs. Combination therapies are useful and may provide quicker regimentation and treat vitiligo with an additive mechanism of action than UVB phototherapy. Advances in technology may lead to the continuing use of UVB phototherapy as a treatment for vitiligo through the development of sophisticated devices and delivery systems as well as innovative application methods. These will provide increased therapeutic options for all vitiligo patients, particularly those with refractory disease. In this article, I have reviewed the available data pertaining to efficacy and safety issues for NB-UVB as monotherapy, its comparison with psoralen plus UVA and other modes of phototherapy, combination regimens that have been tried and future prospects of NB-UVB in vitiligo.

Treatment of Localized Vitiligo with 1% Pimecrolimus Cream versus 0.05% Clobetasol Propionate Cream—Single, Blinded, Comparative Therapeutic Trial

Background: Calcineurin inhibitors like tacrolimus and pimecrolimus are new modality of treatment of localized vitiligo. Objective: To compare the effectiveness and side effects of 1% pimecrolimus cream in comparison with 0.05% clobetasol propionate cream as a treatment of localized type of vitiligo. Patients and Methods: Fifty two patients with localized vitiligo were included in this single, blind, comparative therapeutic trial. Full history and examination for each patient was done. Wood’s light was used when needed to confirm the diagnosis. Thirty (57.7%) were females and 22 (42.3%) males, female to male ratio of 1.36:1. Their ages ranged between 3 - 40 (13.15 ± 7.9) years, while disease duration ranged from 6 - 84 (29.62 ± 20.56) months. Total numbers of lesions were 114 lesions with a mean of 2.2 lesions per patient. The surface area of the lesions ranged between 1 - 31 (7.15 ± 6.98) cm2. Vitiliginous patches were most commonly located on face 48 (42.1%) lesions, and lower limbs 35 (30.7%) lesions. Patients were divided in to two groups according to the type of therapeutic modality.?Group?A?consisted of 25 patients (52 lesions) receiving 1% pimecrolimus cream and?Group?B?27 patients (62 lesions) treated with 0.05% clobetasol propionate cream, both used twice daily. The amount of cream per area was applied according to rule of fingertip unit. Measuring the surface area of the lesions and calculating the reduction rate were done every month till the end of the 6th?month. Then patients were asked to stop the use of medication to be re-evaluated again after 3 months without any treatment and to record any local or systemic side effects. Results: After 6 months of treatment there was 79.67% reduction in the surface area of lesions in?Group?A, while inGroup?B?there was 82.59% reduction in the surface area with no statistically significant difference between the two groups. The reduction rate was early as there was statistically significant reduction for both groups after one month of treatment (p value < 0.01). The reduction rates for facial lesions were more than other parts of the body. There was no significant relapse after 3 months of stopping treatment for both groups. Side effects were minimal and tolerable. Conclusions: Topical 1% pimecrolimus is as effective as clobetasol propionate in treatment of localized vitiligo affecting less than 5% of the body surface area but pimecrolimus was more preferred as the side effects of topical steroid could be avoided.

Pityriasis Alba versus Vitiligo Clinical and Histopathological Study

Background: Most recently there was a well established study showed that pityriasis alba of ten progresses into vitiligo (Sharquie et al.). These findings were considered a new thought that might support a new hypothesis regarding the pathogenesis of vitiligo. Objective: In order to do further work on hypothesis which is in favor that pityriasis alba might progress into vitiligo, so the present research including clinical and histopathological study to confirm that pityriasis alba might progress to vitiligo. Patients and method: This is a descriptive clinical and histopathological comparative study carried out in Department of Dermatology, Baghdad Teaching Hospital during the period from January 2015 to August 2016. Thirty eight patients with pityriasis alba (group A) and twenty eight patients with vitiligo stage I (group B) and twelve patients with both pityriasis alba and vitiligo (group C) were included in this study. All patients were fully interviewed and full history was taken from all the patients. Also careful asking about personal and family history of vitiligo was taken. Blunt trauma was done to induce Koebner’s phenomenon. Punch biopsies were taken from skin lesion of all patients and ten biopsies from 10 persons were taken from normal skin. Each biopsy specimen was processed and stained with Hematoxylin-eosin (H & E) and Fontana-Masson (FM) for histological evaluations. Results: Clinical study-Group A: Pityriasis alba patients: The mean of age of patients in pityriasis alba ± SD was 8.68 ± 5.94 years including 33 (86.84%) males and 5 (13.16%) females. Koebner’s phenomenon was positive in 2 (5.26%) patients and family history of vitiligo was positive in 17 (44.74%) patients. Group B: stage I vitiligo patients: The mean of age ± SD was 15.46 ± 12.50 years with 15 (57.14%) male patients and 12 (42.86%) female patients. A Koebner’s phenomenon was positive in 11 (39.28%) patients and family history of vitiligo was found in 11 (39.29%) patients. Group C: pityriasis alba and vitiligo patients: The mean of age ± SD was 8.33 ± 2.78 years including 9 (75%) male patients and 3 (25%) female patients. Koebner’s phenomenon was positive in 6 (50%) patients and family history of vitiligo was positive in 7 (58.33%) patients. Histopathological study: Group A: pityriasisalba: </

Therapeutic Comparison between Sun Irradiation vs. Narrowband UVB Phototherapy along with Concomitant Topical Tacalcitol for Vitiligo Vulgaris

In addition to therapeutic options such as steroid ointment, immunosuppressive drug and ultraviolet phototherapy, recent reports have demonstrated the clinical efficacy of topical vitamin D3 for vitiligo vulgaris. However, there seems to be little clinical effect of vitamin D3 without UV exposure. In the present study, we evaluated the clinical difference of sun irradiation vs. narrowband UVB in combination with tacalcitol assessing the change of lesion size and color tone by a spectrophotometer. Thirty-three vitiligo patients were composed of 19 treated with sun illumination and 14 treated with narrowband UVB in combination with topical use of tacalcitol. The mean % size reduction was higher in the group of sunbathing than narrowband UVB (29% vs. 23%). Delta L score, which represented the difference of whiteness between lesional and perilesional skin, was significantly improved after treatment in the group of sun irradiation instead of narrowband UVB (p = 0.0023). Therefore, we consider that sun illumination along with tacalcitol may be able to induce natural repigmentation and be an alternative therapeutic option for vitiligo vulgaris.