Microbial community profiling shows dysbiosis in the lesional skin of Vitiligo subjects

Healthy human skin harbours a diverse array of microbes that comprise the skin microbiome. Commensal bacteria constitute an important component of resident microbiome and are intricately linked to skin health. Recent studies describe an association between altered skin microbial community and epidemiology of diseases, like psoriasis, atopic dermatitis etc. In this study, we compare the differences in bacterial community of lesional and non-lesional skin of vitiligo subjects. Our study reveals dysbiosis in the diversity of microbial community structure in lesional skin of vitiligo subjects. Although individual specific signature is dominant over the vitiligo-specific microbiota, a clear decrease in taxonomic richness and evenness can be noted in lesional patches. Investigation of community specific correlation networks reveals distinctive pattern of interactions between resident bacterial populations of the two sites (lesional and non-lesional). While Actinobacterial species constitute the central regulatory nodes (w.r.t. degree of interaction) in non-lesional skin, species belonging to Firmicutes dominate on lesional sites. We propose that the changes in taxonomic characteristics of vitiligo lesions, as revealed by our study, could play a crucial role in altering the maintenance and severity of disease. Future studies would elucidate mechanistic relevance of these microbial dynamics that can provide new avenues for therapeutic interventions.

Láser Excimer en Vitiligo. ¿Tratamiento efectivo y seguro para esta enfermedad? Revisión sistemática de la literatura

Introducción: El vitíligo es una enfermedad prevalente en nuestro medio con una prevalencia del 2% de la población mundial. Los síntomas de esta enfermedad son principalmente estéticos al manifestarse como máculas acrómicas, simétricas en las extremidades y en rostro donde genera la mayor estigmatización de los pacientes. Actualmente ningún tratamiento provee mejoría pronta y permanente de los síntomas. Objetivo: Determinar la efectividad del Láser Excimer 308 nm en el tratamiento del vitíligo por medio de una revisión sistemática de la literatura. Métodos: Búsqueda sistemática de ensayos clínicos y estudios cuasiexperimentales en las bases de datos más importantes acerca de la efectividad del Láser Excimer 308 nm en la repigmentación de los pacientes adultos con vitíligo. Se evaluó su calidad metodológica. Resultados: De 862 artículos encontrados se escogieron 40 artículos potenciales de los cuales dos fueron incluidos en esta revisión. El láser Excimer 308 nm como monoterapia presenta una pigmentación efectiva (≥50%) en 28.03% de las áreas tratadas, de los cuales 72.9% se localizaron en áreas sensibles a radiación ultravioleta y 27.02% en zonas no sensibles. Inicio de pigmentación a la sesión número 13 (un mes post inicio del tratamiento). El láser fue seguro y bien tolerado. Conclusión: La evidencia sugiere que el tratamiento con Láser Excimer 308 nm, como monoterapia, es una alternativa terapéutica para lograr repigmentación pronta de las máculas acrómicas del vitíligo en áreas sensibles a radiación ultravioleta. Deben considerarse estudios que evalúen combinaciones de fármacos y Láser en el tratamiento de vitíligo.

Imuno-histoquímica para o diagnóstico precoce de vitiligo

O vitiligo é uma doença de pele freqüente que acomete 1% da população e é caracterizada por máculas despigmentadas conseqüentes à perda progressiva e localizada dos melanócitos da epiderme. Na maioria dos pacientes, o diagnóstico é feito por exame clínico. A biópsia da pele é realizada quando há necessidade de diagnóstico diferencial com doenças hipocromiantes. O diagnóstico histopatológico de vitiligo é difícil nos preparados corados por hematoxilina e eosina (HE). Há poucos estudos sobre a melhoria da qualidade diagnóstica no vitiligo. OBJETIVO: Avaliar a utilidade dos marcadores imuno-histoquímicos proteína S-100, human melanoma black-45 (HMB-45) e Melan-A para o diagnóstico precoce em casos clinicamente suspeitos ou duvidosos de vitiligo. Material e métodos: Lâminas histológicas de biópsias de pele sã e lesada de 10 pacientes com suspeita clínica de vitiligo coradas pelos métodos de HE, proteína S-100, HMB-45 e Melan-A. Utilizou-se contracoloração com Giemsa como modificação técnica para diferenciar a melanina da imunomarcação. RESULTADOS: Seis casos, com manifestação clínica recente, apresentaram infiltrado linfocitário, do tipo dermatite de interface, na pele lesada na HE. As colorações por S-100, HMB-45 e Melan-A marcaram os melanócitos da camada basal da pele sã, e a proteína S-100 evidenciou as células de Langerhans. Na pele lesada, os melanócitos estavam ausentes ou diminuídos quando comparados com a pele normal. A proteína S-100 demonstrou maior número de células de Langerhans, o que é característico das lesões de vitiligo. CONCLUSÃO: A imuno-histoquímica pode ser utilizada como método auxiliar no diagnóstico dos casos duvidosos de vitiligo.

Excimer Laser no tratamento do vitiligo em 123 pacientes: estudo retrospectivo

Introduction: Vitiligo is cosmetically disfiguring and can cause significant psychological morbidity. Most therapies require protracted treatments and can lead to disappointing results. More recently, 308 nm Excimer laser has proven to be effective in treating vitiligo. Objective: To analyze the effectiveness and patient satisfaction of 308 nm Excimer treatment for vitiligo patches in a variety of locations on the body. Methods: Patients with generalized or localized vitiligo (n = 123, 321 lesions), were studied. The patients were treated at a private practice between 2007 and 2010. Two independent examiners analyzed the response to the therapy by comparing clinical and photographic records before and after treatment. Results: More than half (n = 77) of the patients presented repigmentation greater than 60%, 26 presented 40-59%, and 20% had levels less than 39%. Facial lesions responded better to treatment than those in other body parts. Elbows, hands and feet were the less sensitive areas. In general, the patients were satisfied with the treatment. Conclusion: The use of Excimer laser for treating vitiligo was effective and safe, producing satisfactory cosmetic results and improving patients' self esteem.

Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review

Vitiligo is a relatively common acquired disorder, characterized by progressive loss of melanocytes from the epidermis and the epidermal appendages. The disease is associated with considerable morbidity because of a major impact on the quality of life. The treatment for vitiligo is generally unsatisfactory and challenging. There are a variety of therapeutic possibilities including topical corticosteroids, topical calcineurin inhibitors, as well as phototherapy with Psoralen plus UVA (PUVA), narrow-band UVB, and a 308-nm excimer laser and/or lamps. Furthermore, surgical methods encompass grafting and transplantation while depigmentation treatments and psychological support may also be considered. The objective is to assess the effect of the 380-nm excimer laser in the treatment of vitiligo based on the available studies and case series. We searched the relevant literature about vitiligo and excimer laser published between 1990 and 2012 using the MEDLINE database. We reviewed all relevant articles about 308-nm excimer laser and light sources assessing their efficacy in the management of vitiligo as well as their side effects. The value of combination treatment methods was also analyzed. The available studies provide strong evidence that the excimer laser represents the most effective approach to treat vitiligo compared to ordinary phototherapy. Excimer laser is relatively safe and effective for localized disease. UV-sensitive areas respond best as well as a short duration of the disease. More frequent treatments achieve better results. Compared to other treatment modalities, the excimer laser most likely constitutes the treatment of choice for localized vitiligo. Its efficacy can be further improved in combination with other therapies such as corticosteroids, pimecrolimus, or tacrolimus.

Repigmentation by outer-root-sheath-derived melanocytes: proof of concept in vitiligo and leucoderma

BACKGROUND: Treatment of depigmented skin is an unmet medical need. OBJECTIVE: Melanocytes or stem cells thereof residing in the outer root sheath (ORS) of hair follicles might be used to repigment skin. METHODS: After de-epidermisation, autologous ORS cell solutions were applied to 5 patients with vitiligo and 1 with leucoderma. RESULTS: Stable repigmentation in a variable percentage was documented in all the patients. CONCLUSION: Applying ORS-derived melanocytes is a promising technology to improve autologous melanocyte transplantation.

Connective tissue panniculitis in a child with vitiligo and Hashimoto's thyroiditis

A 9-year-old girl presented with a 6-month history of inflamed tender nodules in the pretibial area. These eventually healed leaving depressed areas of atrophy and loss of subcutaneous tissue. Histology showed a predominantly lymphocytic lobular panniculitis, consistent with connective tissue panniculitis. Investigations revealed an elevated thyroid stimulating hormone, elevated thyroid antiperoxidase antibody and a weakly positive antinuclear antibody (titre 1 in 40). She was commenced on hydroxychloroquine 300 mg daily, which resulted in resolution of the pannictulitis. She developed focal Vitiligo oil the thighs. This gradually improved with 0.1% mometasone furoate ointment. The hydroxychloroquine dose was tapered to 200 mg daily after 12 months, then to 100 mg daily after 18 months therapy. Her thyroid autoantibody levels continued to rise and the hydroxychloroquine was increased again to 300 mg daily. She became borderline hyothyroid. Hashimoto's thyroiditis was diagnosed. Thyroxine was instituted with a resultant improvement in her thyroid blood tests. The lipoatrophy has not developed further during 2-year follow up.

Increased numbers of circulating polyfunctional Th17 memory cells in patients with seronegative spondylarthritides

OBJECTIVE: A distinct subset of proinflammatory CD4+ T cells that produce interleukin-17 was recently identified. These cells are implicated in different autoimmune disease models, such as experimental autoimmune encephalomyelitis and collagen-induced arthritis, but their involvement in human autoimmune disease has not yet been clearly established. The purpose of this study was to assess the frequency and functional properties of Th17 cells in healthy donors and in patients with different autoimmune diseases. METHODS: Peripheral blood was obtained from 10 psoriatic arthritis (PsA), 10 ankylosing spondylitis (AS), 10 rheumatoid arthritis (RA), and 5 vitiligo patients, as well as from 25 healthy donors. Synovial tissue samples from a separate group of patients were also evaluated (obtained as paraffin-embedded sections). Peripheral blood cells were analyzed by multiparameter flow cytometry and immunohistochemistry. Cytokine production was examined by enzyme-linked immunosorbent assay and intracellular cytokine staining using specific monoclonal antibodies. Synovial tissue was examined for infiltrating T cells by immunohistochemical analysis. RESULTS: We found increased numbers of circulating Th17 cells in the peripheral blood of patients with seronegative spondylarthritides (PsA and AS), but not in patients with RA or vitiligo. In addition, Th17 cells from the spondylarthritis patients showed advanced differentiation and were polyfunctional in terms of T cell receptor-driven cytokine production. CONCLUSION: These observations suggest a role of Th17 cells in the pathogenesis of certain human autoimmune disorders, in particular the seronegative spondylarthritides.

Genotoxicity of Brosimum gaudichaudii measured by the Salmonella/microsome assay and chromosomal aberrations in CHO cells

The root bark of Brosimum gaudichaudii Trecul (Moraceae) is popularly used for treatment of vitiligo. In the present study the mutagenic activity of the aqueous and methanolic extract as well as of the n-butanolic fraction of this medicinal plant were evaluated using Salmonella typhimurium assays, TA100, TA98, TA102 and TA97a strains, while the clastogenic effect in Chinese hamster ovary (CHO) cells in the G(1)/S, S and G(2)/S phases of the cell cycle. The results showed mutagenic activity of the aqueous extract against TA102 in the presence of S9, and of methanolic extract, with and without metabolic activation. TA100 mutagenicity was only observed for the methanolic extract in the absence of S9. The n-butanolic fraction did not present mutagenic activity. In CHO cells only the methanolic extract induced a significant increase of chromosomal aberrations in the G(1)/S and S phases, whereas a decrease in the mitotic index was observed in the G(1)/S and G(2)/S phases. No clastogenicity was observed for the aqueous extract. The furocoumarins (psoralen and bergapten) presented in the extracts might contribute to the mutagenicity. The lower activity of the aqueous extract was probably due to the presence of smaller amount of furocoumarins compared to the methanolic extract. (C) 2002 Elsevier B.V. Ireland Ltd. All rights reserved.

Morfoanatomia e histoquímica de Brosimum gaudichaudii Trécul (Moraceae)

Brosimum gaudichaudii, conhecida como mamacadela, é espécie comum nos cerrados, com grande valor na medicina popular e na indústria de medicamentos. A casca da raiz e do caule é empregada no tratamento do vitiligo, sendo o bergapteno e psoraleno, duas furanocumarinas, responsáveis pela ação farmacológica. Neste trabalho são apresentadas a caracterização morfoanatômica e a histoquímica de órgãos vegetativos de B. gaudichaudii, com informações sobre o embrião e o desenvolvimento pós-seminal. Amostras foram processadas segundo técnicas usuais em anatomia e ultra-estrutura vegetal. O embrião é do tipo total e invaginado, a plântula cripto-hipogéia e o sistema radicular do tirodendro é composto por raiz primária pouco desenvolvida em relação às raízes laterais. Plantas adultas apresentam raízes gemíferas longas, plagiotrópicas originando ramos caulinares aéreos; tais raízes possuem periderme com súber desenvolvido e floema secundário abundante em relação ao xilema, sendo facilmente destacados quando manipulados. O caule jovem e a folha apresentam epiderme unisseriada, grande densidade de tricomas tectores unicelulares e tricomas glandulares. Laticíferos não-articulados ramificados ocorrem em todos os órgãos, podendo invadir os elementos de vaso. Idioblastos fenólicos ocorrem em abundância em todos tecidos e órgãos analisados. O valor das características anatômicas observadas no controle de qualidade da droga é discutido.

Avaliação do potencial genotóxico do extrato bruto de Pyrostegia venusta (Ker Gawl.) Miers, Bignoneaceae, em medula óssea de camundongos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Rapid determination of furanocoumarins in creams and pomades using SPE and GC

A solid-phase extraction and chromatography-flame ionization detection (GC-FID) method has been developed for the routine analysis of psoralen, bergapten, isopimpinellin and pimpinellin in creams and pomades employed in Brazil for the treatment of vitiligo. The calibration curve for psoralen was linear in the range 10-100 mu g ml(-1), for bergapten 5-90 mu g ml(-1), for pimpinellin 10-90 mu g ml(-1) and for isopimpinellin 5-100 mu g ml(-1). The best recoveries of the furanocoumarins in the creams analysed were 94-97%, whereas in the pomades, recoveries were 94-96%. The R.S.D. of the quantitative analysis of the furanocoumarins in the products analyses were within 5%. (C) 2000 Elsevier B.V. B.V. All rights reserved.

Simultaneous determination of furanocoumarins in infusions and decoctions from Carapia (Dorstenia species) by high-performance liquid chromatography

The use of furanocoumarins, which are photosensitizing compounds, combined with exposure to UV-A radiation is a common treatment for vitiligo, psoriasis, and a number of other skin diseases. Although furanocoumarins plus UV-A treatment is highly effective, several studies have shown that exposure to high doses increases the risk to development of cutaneus carcinoma. Several Dorstenia species are used in folk medicine, mainly against skin diseases, because of the presence of biologically active compounds. We present here analysis of the chemical composition of furanocoumarins from infusion and decoction of Carapia (Dorstenia species), which is used in Brazil against several diseases. We have employed high-performance liquid chromatography (HPLC) procedures for the quantitative determination of psoralen, bergapten, and isopimpinellin. The contents of furanocoumarins revealed an insignificant difference between infusion and decoction. Dorstenia tubicina and D. asaroides contained psoralen and bergapten only in the rhizomes, whereas D. vitifolia shows solely isopimpinellin in both rhizomes and aerial parts.

Biodegradable Nanoparticles Containing Benzopsoralens: An Attractive Strategy for Modifying Vascular Function in Pathological Skin Disorders

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Morfoanatomia e histoquímica de órgãos vegetativos e reprodutivos de Brosimum gaudichaudii Trecul (Moraceae)

Pós-graduação em Ciências Biológicas (Botânica) - IBB