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The German Vitiligo Association Engages Attendees and Participants at the Inviva Festival

The German Vitiligo Association enthusiastically participated in the recent Inviva Festival in an effort to raise awareness of the condition and inform the public about the value of therapy. Approximately 50 people visited the association’s stand, where they had educational conversations regarding vitiligo.

The organisation teamed together at the festival to have a significant impact since they wanted to help as many affected people as they could and educate festival attendees about vitiligo. The booth developed into a center for knowledge sharing, providing visitors with the chance to learn about vitiligo and the available treatments.

The booth attracted a lot of interest and was the topic of multiple conversations throughout the event. People in attendance avidly sought out information and interacted with the organization officials, both those who were intrigued and those who had directly experienced vitiligo. Many people expressed their amazement at learning that there was a vitiligo society in Germany and praised the volunteers’ helpfulness.

The exhibit offered a variety of vitiligo-related subjects and ideas. The future of vitiligo treatment was actively explored, with new alternatives like Opzelura and systemic therapies being highlighted. In addition, discussions focused on children’s vitiligo and the best ways to support young people who have the illness. The necessity of understanding vitiligo as a disease requiring treatment rather than merely a cosmetic concern—an significant distinction that has been highlighted in Germany since 2021—was one of the main messages delivered.

Despite the absence of significant announcements or outcomes from the event, the booth successfully achieved its primary objective of spreading awareness and fostering informative discussions. The positive reactions and feedback from attendees were unanimous, affirming the booth’s impact. Attendees expressed gratitude for the association’s presence and appreciated the valuable information shared. Many visitors were pleased to learn about the available resources and support networks, demonstrating the importance of events like the Inviva Festival in providing education and building connections.

While the booth encountered no major challenges during the event, the association acknowledged the need to secure sufficient volunteers for future endeavours. As they reflect on their participation, the German Vitiligo Association is considering the possibility of returning to the next Inviva Festival with a booth, but a final decision has yet to be made.

Although no key partnerships or collaborations were formed during the event, the association’s presence served as a reminder of the ongoing work being done to support individuals with vitiligo in Germany. By actively engaging with attendees, the booth contributed to fostering a sense of unity among those affected by vitiligo and other conditions.

The German Association for Vitiligo’s participation in the Inviva Festival was a resounding success. The booth became a platform for raising awareness, sharing information, and promoting dialogue about vitiligo and its treatment options. As the association continues its mission to support individuals with vitiligo, events like the Inviva Festival play a vital role in spreading awareness, combating stigmas, and fostering a more inclusive society.

 

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The History of Vitiligo Treatments

Vitiligo is a chronic skin disease that affects millions of people worldwide. It is characterized by the loss of pigment in the skin, resulting in white patches that can appear anywhere on the body. While the cause of vitiligo is not fully understood, it is believed to be an autoimmune disorder in which the body’s immune system attacks and destroys the melanocytes, the cells that produce skin pigment. Vitiligo affects about 1% of the world’s population, and there is currently no cure for the disease. However, there are several treatments available that can help control the spread of vitiligo and improve the appearance of the skin. Vitiligo can cause significant psychological distress and social stigma, especially in people with darker skin tones as it is more visible.

Historical Perspectives on Vitiligo Treatments:

Ancient texts from Egypt, India, and China describe various treatments for vitiligo, including the use of herbal remedies, sunlight exposure, and topical preparations made from animal products.

The earliest recorded treatments for vitiligo date back to ancient times. In ancient Egypt, for example, people with vitiligo were treated with a mixture of tar, honey, and oil. In India, vitiligo was treated with a combination of herbs, including psoralea corylifolia, which was believed to stimulate melanin production in the skin. In Ancient Greece, the physician Hippocrates recommended a mixture of ashes, wine, and honey to treat vitiligo.

However, it was not until the 20th century that more effective treatments for vitiligo were developed. In the early 1900s, doctors began experimenting with various topical treatments, such as corticosteroids and topical immunomodulators. In the 1950s, PUVA therapy was developed, which involves exposing the skin to a combination of psoralen and UVA light. This treatment can stimulate melanin production in the skin and is still used today. Other treatments for vitiligo included topical corticosteroids, topical calcineurin inhibitors, and phototherapy.

In the 1980s, a surgical procedure known as skin grafting was developed, which involves taking healthy skin cells from one part of the body and transplanting them to the affected area. This procedure can be effective but is expensive and can be associated with significant scarring.

In recent years, several new treatments for vitiligo have emerged, including targeted phototherapy, excimer laser therapy, and surgical treatments such as skin grafting and melanocyte transplantation. In 2019, the FDA approved a new treatment for vitiligo called Opzelura (ruxolitinib cream), which is a topical cream that works by inhibiting the Janus kinase (JAK) signalling pathway, a key pathway involved in the development of vitiligo. Opzelura was approved based on the results of two phase 3 clinical trials involving more than 500 patients with vitiligo. Read more about that here.

Opzelura is the first FDA-approved treatment specifically for non-segmental vitiligo, and it is also approved for use in the European Union. In clinical trials, Opzelura was shown to be effective in reducing the size and severity of vitiligo lesions, and it was well-tolerated by patients. However, like all medications, Opzelura may cause side effects, including skin irritation, itching, and redness.

While Opzelura represents a significant advance in the treatment of non-segmental vitiligo, it is not a cure for the disease. Vitiligo is a complex disease, and it is likely that a combination of treatments will be needed to effectively manage the spread of the disease. However, the approval of Opzelura is a promising development for people with vitiligo, and it is likely to be an important treatment option for many years to come.

 

Diverse Perspectives on Vitiligo Treatments:

Many people with vitiligo have tried multiple treatments with varying degrees of success. Some people report significant improvement with topical treatments, while others find them ineffective. PUVA therapy can be effective in some people, but it can also cause side effects, such as skin irritation and increased risk of skin cancer.

Many people with vitiligo also turn to alternative treatments, such as herbal remedies and dietary supplements. While some of these treatments may have anecdotal evidence of effectiveness, there is a lack of scientific evidence to support their use.

Vitiligo is a complex disease that can be challenging to manage. While there have been significant advances in the treatment of vitiligo over the years, there is still no cure for the disease. It is essential to consider diverse perspectives when evaluating the effectiveness of different treatments. What works for one person may not work for another, and it is important to work with a healthcare professional to find the most effective treatment for your individual needs.

The use of Janus kinase inhibitors and narrowband ultraviolet B combination therapy in non-segmental vitiligo

Abstract

Vitiligo is a depigmentation disorder of the skin that occurs secondary to the destruction of melanocytes by an immune-mediated process. Vitiligo clinically presents with depigmented macules and patches, most commonly on the face, acral sites, and genitalia. It can be characterized as generalized or localized based on distribution. The localized form can be further divided into segmental (linear, band-like, or Blaschkoid) and non-segmental vitiligo. The classical treatment of vitiligo includes topical steroids, pulsed oral steroids in unstable vitiligo, phototherapy, a combination of steroid therapy and phototherapy, surgical grafting, as well as intentional depigmentation therapy in severe cases. However, recent advances in understanding the immune mechanisms implicated in the pathogenesis of vitiligo have led to the use of an FDA-approved topical Janus kinase (JAK) inhibitors for vitiligo. Despite this novel therapy advancement, we recommend the addition of narrowband ultraviolet B (NB-UVB) to JAK inhibitors in patients with extensive and progressive lesions, or those not fully responsive to JAK inhibitor monotherapy.

Vitiligo is a depigmentation disorder of the skin that occurs secondary to the destruction of melanocytes by an immune-mediated process. Vitiligo can be associated with various autoimmune diseases such as hypothyroidism, pernicious anemia, alopecia areata, autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED), among others.12 Vitiligo clinically presents with depigmented macules and patches, most commonly on the face, acral sites, and genitalia. It can be characterized as generalized or localized based on distribution. The localized form can be further divided into segmental (linear, band-like, or Blaschkoid) and non-segmental vitiligo.1 The diagnosis of vitiligo is made clinically, and examination with Wood’s Lamp shows “milky-white fluorescence” of the depigmented patches.1 This helps differentiate vitiligo from conditions with hypopigmentation rather than depigmentation such as pityriasis alba. The classical treatment of vitiligo includes topical steroids, pulsed oral steroids in unstable vitiligo, phototherapy, a combination of steroid therapy and phototherapy, surgical grafting, as well as intentional depigmentation therapy in severe cases.138 However, recent advances in understanding the immune mechanisms implicated in the pathogenesis of vitiligo have led to the use of an FDA-approved topical Janus kinase (JAK) inhibitors for vitiligo.9 JAK inhibitors are small molecules that disrupt the JAK–STAT (Signal Transducer and Activator of Transcription) signaling pathways, leading to inhibition of immune-mediated inflammatory pathways.4810In March of 2022, Opzelura™ (ruxolitinib), a topical JAK inhibitor was approved by the FDA for the treatment of non-segmental vitiligo in patients 12 and older.9 In the largest clinical trial for this medication, a total of 674 patients with non-segmental vitiligo were enrolled in phase 3 clinical trials of TRuE-V1 and TRuE-V2, (ClinicalTrials.gov Identifier: NCT04052425 and NCT04057573).9 Ruxolitinib therapy showed 75% improvement in Total Vitiligo Area Scoring Index (T-VASI) at 24 weeks posttreatment.9 Topical ruxolitinib addresses melanocyte dysfunction through inhibiting cytokines which lead to immune-mediated destruction of melanocytes by T cells.9 The safety profile of topical ruxolitinib has been studied in these trials and has been shown to have fewer adverse effects than the systemic route of administration.89 Patients with oral JAK inhibitors are at risk of developing serious bacterial, fungal, and viral infections that may result in hospitalization or death.4Despite this novel therapy advancement, we recommend the addition of narrowband ultraviolet B (NB-UVB) to JAK inhibitors in patients with extensive and progressive lesions, or those not fully responsive to JAK inhibitor monotherapy. In Opzelura clinical trials, 25% of patients did not respond to treatment.10 Subsequently, in the study by Leu et al, treatment with topical tofacitinib led only to re-pigmentation when there was concomitant light exposure.4 Topical JAK inhibitor monotherapy might not be an appropriate choice for extensive (>5%–10% of BSA) progressive non-segmental vitiligo, therefore we recommend the addition of an optimized aggressive NB-UVB regimen to topical ruxolitinib due to its paucity of side effects.3 In NB-UVB devices, the starting safe dose (200 mJ) 2–3 times per week can be increased by a 10%–20% dose increment to achieve light pink erythema or development of skin burning, sensitivity, peeling, or thickening.5 Furthermore, the 308-nm excimer laser therapy can be considered for smaller lesions.7 There have been several studies that have investigated the use of JAK inhibitors with various adjunctive therapy, including NB-UVB and excimer laser (Table 1).8 The maximum dose depends on Fitzpatrick’s skin phototype, photosensitive, and lesion location.6 After stabilization of progression and distribution of vitiligo through NB-UVB and topical ruxolitinib combination therapy, maintenance of regimentation may be achieved with JAK inhibitor monotherapy.

TABLE 1. Vitiligo treatment modalities with JAK inhibitors and various adjunctive therapy options in different studies
Investigator Number Of subjucts JAK inhibitor dosage and frequency Study duration Adjunct therapy Outcome Adverse events
Rothstein et al (2017) 11 Ruxolitinib 1.5% cream BID 20 weeks None Face: 76% VASI improvement

Non-acral upper extremity: 3.6% VASI improvement

Lower extremity/trunk (undefined): 0% VASI improvement

Erythema

Peripheral hyperpigmentation

Transient acne

Rothstein et al (2017) 8 Ruxolitinib 1.5% cream BID 32-week extension (52 weeks total) NB-UVB Face: 92% VASI improvement

Non-acral upper extremity: 12.6% VASI improvement

Trunk: 16.7% VASI improvement

Erythema Transient acne
McKesey et al (2019) 11 Tofacitinib 2% cream BID 8–16 weeks NB-UVB 3 times weekly 70% VASI improvement N/A
Rosmarin et al (2020) 1 Tofacitinib 2% cream BID 24 weeks NB-UVB (3 times weekly, home unit) Face:100 repigmentation None
Ferreira et al (2021) 2 Delgocitinib cream BID 36 weeks NB-UVB (3 times weekly) Face: Significant repigmentation, Erythema Transient acne

The psychosocial and cosmetic burden from this chronic autoimmune disease can lead to patients’ isolation. The cost and access of this recent FDA-approved topical JAK inhibitor for non-segmental vitiligo can pose a burden on patients to be compliant and receive appropriate treatment. Adjuvant light exposure treatment can overcome these challenges with effective targeted treatment. Topical JAK inhibitors found their place in the treatment of vitiligo after years of investigation. Prospective clinical trials are needed to further assess adjuvant light therapy and the future formulation of topical JAK inhibitors for the treatment of non-segmental rapidly progressive vitiligo.

References

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Image source: Envato Elements

 

VIPOC Represented at the German Dermatological Society

The 52nd conference of the German Dermatological Society (DDG) was held from the 26th to the 29th of April 2023 at the City Cube in Berlin. It is a highly anticipated event that offers advanced and continuing education at the highest level. It is an opportunity for professionals in the field of dermatology to stay up-to-date with the latest developments, connect with colleagues, and exchange ideas.

One of the most exciting aspects of the DDG conference is the inclusion of representatives from patient organizations. This year, the German vitiligo association was in attendance, and they were proud to have a VIPOC representative present. VIPOC is a global initiative that works to raise awareness of vitiligo and improve the lives of people living with the condition.

The presence of a VIPOC representative at the DDG conference highlights the growing recognition of vitiligo as a significant dermatological concern. It also underscores the importance of patient perspectives in guiding research and treatment efforts.

The conference featured a hybrid combination of lectures and symposia, which were also offered in digital form. This format allowed for a wider audience to participate and provided greater accessibility to the latest advancements in clinical dermatology. Attendees had the opportunity to learn about the latest findings from research, including new insights into the underlying causes of skin disorders, and suggestions for daily practice.

One of the most exciting developments discussed at the DDG conference was the latest approval of Opzelura in the EU. Opzelura is a topical cream that has been shown to be effective in reducing the size and severity of vitiligo lesions. The approval of Opzelura represents a significant advance in the treatment of vitiligo and offers new hope to people living with the condition.

The event provided an opportunity for healthcare professionals, researchers, and patient advocates to come together and collaborate in an effort to improve the lives of people living with skin disorders. It is a testament to the progress that has been made in the field and a sign of even greater advancements to come.

 

Incyte Announces European Commission Approval Of Opzelura® (Ruxolitinib) Cream For The Treatment Of Non-Segmental Vitiligo With Facial Involvement In Adults And Adolescents

April 20, 2023 at 10:21 AM EDT
  • Opzelura® (ruxolitinib) Cream is the first approved treatment in the European Union (EU) to address repigmentation in non-segmental vitiligo
  • Phase 3 data supporting the approval show treatment with Opzelura resulted in improved facial and total body repigmentation, sustained and continued improvements with longer duration of treatment

 

 

WILMINGTON, Del.–(BUSINESS WIRE)–Apr. 20, 2023– Incyte (Nasdaq:INCY) today announced that the European Commission (EC) has granted a marketing authorization for Opzelura® (ruxolitinib) cream 15mg/g for the treatment of non-segmental vitiligo with facial involvement in adults and adolescents from 12 years of age. Opzelura is the first and only approved treatment in the European Union (EU) to offer support for repigmentation in eligible patients with non-segmental vitiligo, a chronic autoimmune disease characterized by depigmentation of skin and reduced quality of life.

The EC decision follows the positive opinion received from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) earlier this year and is applicable to all 27 European Union Member States, Iceland, Norway and Liechtenstein.

“The approval of Opzelura by the European Commission represents a significant advancement for people living with non-segmental vitiligo with facial involvement who, until now, had no approved medical treatment to address repigmentation,” said Hervé Hoppenot, Chief Executive Officer, Incyte. “This approval wouldn’t have been possible without the support of the vitiligo patient and medical community, and the efforts of our research and development teams. We will now work across individual countries in Europe to bring this much awaited therapy to eligible patients seeking to treat their vitiligo.”

The EC decision is based on data from two pivotal Phase 3 clinical trials (TRuE-V1 [NCT04052425] and TRuE-V2 [NCT04057573]), evaluating the efficacy and safety of Opzelura versus vehicle (non-medicated cream) in more than 600 people with non-segmental vitiligo, age 12 and older. Results from the TRuE-V program showed that treatment with Opzelura resulted in significant improvements in facial and total body repigmentation versus vehicle as shown by the number of patients reaching the facial and total body Vitiligo Area Scoring Index (F-VASI-T-VASI) endpoints at Week 24 compared to vehicle and in an open-label extension at Week 521.

Results at Week 24, which were consistent across both studies, showed that 29.8% and 30.9% of patients treated with Opzelura achieved ≥75% improvement from baseline in the facial Vitiligo Area Scoring Index (F-VASI75), the primary endpoint, compared to 7.4% and 11.4% of patients treated with vehicle in TRuE-V1 and TRuE-V2, respectively. At Week 52, approximately one in two of Opzelura-treated patients achieved F-VASI751.

Additionally, at Week 24, more than 15% of patients treated with Opzelura achieved ≥90% improvement from baseline in F-VASI (F-VASI90), compared to approximately 2% of patients treated with vehicle. At Week 52, approximately one in three of Opzelura-treated patients achieved F-VASI90.

There were no serious treatment-related adverse events related to ruxolitinib cream and the most common adverse reaction was application site acne1.

Pivotal Phase 3 data supporting the European Commission decision were also published in The New England Journal of Medicine.

“The approval of Opzelura is welcome news for dermatologists and eligible patients in Europe who often face challenges managing vitiligo,” said Prof. Dr. Markus Böhm, Department of Dermatology, University of Münster Germany. “TRuE-V is the first large-scale clinical trials program in vitiligo and its results clearly demonstrate the clinically meaningful improvements in facial and total body repigmentation seen with Opzelura and its potential to further optimize patient care and outcomes.”

Vitiligo is a chronic autoimmune disease characterized by depigmentation of skin that results in patchy loss of skin color from the progressive destruction of pigment-producing cells known as melanocytes. Over-activity of the JAK signaling pathway is believed to drive inflammation involved in the pathogenesis and progression of vitiligo. In the European Union, EEA countries and UK diagnosed vitiligo prevalence is estimated to be ~1.5 million patients2,3, with approximately 8 in 10 patients suffering from non-segmental vitiligo4, and a subset of whom has facial involvement and seeking treatment. Vitiligo can occur at any age, although many patients with vitiligo will experience initial onset before the age of 305.

“Vitiligo is a chronic autoimmune disease that impacts many aspects of a person’s life,” said Jean-Marie Meurant, Vice-President of the Vitiligo International Patient Organizations Committee (VIPOC). “The arrival of new treatment options are important for our community as it gives people with vitiligo something they have long been hoping for: the choice to treat their disease.”

About Opzelura® (ruxolitinib) Cream 15mg/g
Opzelura, a novel cream formulation of Incyte’s selective JAK1/JAK2 inhibitor ruxolitinib, is the first and only topical JAK inhibitor approved for use in the European Union (EU), indicated for the treatment of non-segmental vitiligo with facial involvement in adults and adolescents from 12 years of age.

In patients with non-segmental vitiligo with facial involvement, Opzelura is approved for topical use twice daily to the depigmented skin areas up to a maximum of 10% body surface area. Satisfactory repigmentation may require treatment with Opzelura for more than 24 weeks.

Opzelura is approved in the U.S. for the topical treatment of non-segmental vitiligo in patients 12 years of age and older and for the topical short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis (AD) in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies, or when those therapies are not advisable.

Incyte has worldwide rights for the development and commercialization of Opzelura. In April 2022, Incyte entered into a strategic alliance agreement with Maruho Co., Ltd. for the development, manufacturing, and exclusive commercialization of ruxolitinib cream for treatment of autoimmune and inflammatory dermatology indications in Japan.

Opzelura is a trademark of Incyte.

About Incyte Dermatology
Incyte’s science-first approach and expertise in immunology has formed the foundation of the company. Today, we are building on this legacy as we discover and develop innovative dermatology treatments to bring solutions to patients in need.

Our research and development efforts in dermatology are initially focused on leveraging our knowledge of the JAK-STAT pathway. We are exploring the potential of JAK inhibition for a number of immune-mediated dermatologic conditions with a high unmet medical need, including atopic dermatitis, vitiligo, lichen planus, lichen sclerosus and prurigo nodularis.

About Incyte
Incyte is a Wilmington, Delaware-based, global biopharmaceutical company focused on finding solutions for serious unmet medical needs through the discovery, development and commercialization of proprietary therapeutics.

Source

____________________
1 Opzelura® (ruxolitinib) cream 15mg/g. Summary of Product Characteristics (SmPC). Incyte; April 2023.
Mohr N, et al. Epidemiology of Vitiligo – A Dual Population-Based Approach. Clinical Epidemiology. 2021 May 26; 13:373-382.
3 Bibeau K, et al. Vitiligo prevalence and quality of life among adults in Europe, Japan and the USA. Journal of the European Academy of Dermatology and Venerology. 2022; V36(10), P 1831-1844.
4 Gandhi K, et al. Prevalence of Vitiligo Among Adults in the United States. JAMA Dermatol. 2022 Jan 1;158(1):43-50.
Frisoli M, et al. Vitiligo: mechanisms of pathogenesis and treatment. Annual. Review of Immunology. 2020; 38(1):621-648.

As you know, 2023 is a special year for all of us and the start of vitiligo treatment journeys.

Yes, very special indeed, because this is the year of the arrival of a new drug.

Other molecules as anti-jak, topical creams, systemic treatments are under clinical trials/reviews in Europe by big pharma industries with interesting first results.

 

To get the drug prescribed by doctors, each drug should be validated by the EMA (European Medicines Agency located in Amsterdam, The Netherlands) before being distributed in EU countries after local specific access and price regulations. Patient organizations need to be involved in every step and ready to advocate through meetings, contribution files, etc.

Your patient organization will have to inform, advocate and raise awareness about vitiligo… so all the patients will be able to have same level of knowledge about the new drugs/trials and have access to treatment. The Patient organization roles are crucial, and our commitments are important.

 

With such good news, and tremendous steps (thanks to the researchers and the patients willing to participate to all the clinical trials) we have to learn together and to celebrate.

 

With the support of VIPOC and our sponsors,  we have organized an amazing event in Brussels (Belgium), during the World Vitiligo Day (WVD) celebration (25th June). The first meeting will be with the representatives of the European vitiligo organizations. The celebration will consist of 2 days for patient leaders’ meetings and one day for EU advocacy.

From June 23rd (arrival of the participants) to the 26th of June, the provisional program will be:

  • Saturday 24th and Sunday 25th: Vitiligo patient representatives meeting (workshop, advocacy, implementation of joint projects, training, etc.)
  • Monday 26th: advocacy meeting with EU representatives.

Conditions :

  • Transportation and accommodation costs (flight/train, hotel recommended by VIPOC will be supported by VIPOC and sponsors.)
  • One delegate per patient organization.
  • Saturday 24th and Sunday 25th are strongly recommended for participation. Monday 26th is also important to meet Country/EU representatives if delegates are available.

 

To make this meeting a success, we are counting on your participation. Please don’t hesitate to contact us for more information at  nicolle.maquignon@vipoc.org  .

Body Care Tips for Vitiligo Patients

Body Care Tips for Vitiligo Patients

Vitiligo is a condition that causes the loss of skin pigmentation, leading to white patches on the skin. While it is not a life-threatening condition, it can have a significant impact on a person’s quality of life. Taking care of your body with vitiligo is essential to manage the condition and maintaining good health. In this article, we will discuss some  body care tips for Vitiligo Patients.

  1. Protect your skin: Wear sunscreen every day, even on cloudy days, and wear protective clothing when spending time outdoors. UV rays from the sun can cause further changes in your skin colour and worsen your vitiligo.
  2. Moisturize: Keeping your skin hydrated is important in preventing further skin changes. Use a moisturizer regularly to keep your skin healthy and supple.
  3. Avoid stress: Stress can cause further changes in your skin color, so it’s important to find ways to reduce stress in your life. Exercise, meditation, and other relaxation techniques can help reduce
  4. Avoid harsh chemicals: Certain chemicals, such as those found in hair dyes and bleaches, can irritate the skin and trigger vitiligo. Use gentle, natural products whenever possible.
  5. Stay hydrated: Drinking plenty of water can help keep the skin hydrated and reduce dryness..
  6. Talk to your doctor: Your doctor can help develop a treatment plan that works for you, including topical creams, light therapy, or other treatments. Regular check-ups with your doctor can also help monitor your condition and adjust your treatment plan as needed.

In conclusion, taking care of your body with vitiligo is crucial to managing the condition and maintaining good overall health. Body Care Tips for Vitiligo Patients include protecting your skin from the sun, staying hydrated, avoiding harsh chemicals, and consulting your doctor. Proper skin care can help reduce the risk of developing new patches and may even help some patches repigment over time. By following these tips, you can manage the condition and improve your quality of life.

GET THE INFOGRAPHIC HERE:

 

The first step for a medicinal product for vitiligo has been authorized in Europe

On February 23, 2023, the European Medicines Agency (EMA) published a positive opinion for the use of the molecule Ruxolitinib™ in cream form (Opzelura™ from Laboratories Incyte Biosciences) as part of a non-segmental vitiligo for adults and adolescents over 12 years of age.

Decision extract published by the EMA

 

Read the full version here: Opzelura: Pending EC decision | European Medicines Agency (europa.eu)

By 1 May 2023, the European Union will have to publish a marketing authorisation in one, several or all EU member countries.
Following this decision, each member country will be able to define the principles of coverage and reimbursement of the medicine by the health system in the country concerned.
The process to get the medicine at a pharmacy counter takes many months and sometime several years. In each country processes are complex. Therefore, patient organizations advocacy is crucial to speed the process and to get the right access and reimbursement for all vitiligo patients.
The more we will be united in Europe in all steps of the process, the more we will be getting advantages for all vitiligo sufferers.
Building patient impacts contributions, looking for combined advocacy files, etc. will make patient defense more effective and robust.

For  example:
In France, after obtaining a marketing authorisation, a pharmaceutical company can freely set the price of a medicine.
For it to be reimbursed by Social Security, the laboratory must submit an application to the High Authority of Health (HAS). The opinion issued by the HAS Transparency Commission is on the SMR (Medical Service Rendered) or the ASMR (Improvement of the Medical Service Rendered). Which in the context of vitiligo in the absence of a drug approved today should only concern the Medical Service Rendered.
This opinion is then sent to the Economic Committee for Health Products (CEPS) and the National Union of Health Insurance Funds (UNCAM). A negotiation phase then opens on the amount of the coverage (price and percentage of reimbursement).
The final decision to include a medicinal product for reimbursement falls within the competence of the Ministers responsible for Health and Social Security and is published in French Official Journal.

 

Current Status of Cell-Based Therapies for Vitiligo

Abstract

Vitiligo is a chronic pigmentary disease with complex etiology, the signs of which are caused by the destruction of melanocytes in the epidermis, leading to the lack of melanin pigment responsible for skin coloration. The treatment of vitiligo, which aims at repigmentation, depends both on the clinical characteristics of the disease as well as on molecular markers that may predict the response to treatment. The aim of this review is to provide an overview of the clinical evidence for vitiligo cell-based therapies taking into account the required procedures and equipment necessary to carry them out as well as their effectiveness in repigmentation, assessed using the percentage of repigmentation of the treated area. This review was conducted by assessing 55 primary clinical studies published in PubMed and ClinicalTrails.gov between 2000 and 2022. This review concludes that the extent of repigmentation, regardless of the treatment method, is highest in stable localized vitiligo patients. Moreover, therapies that combine more than one cell type, such as melanocytes and keratinocytes, or more than one method of treatment, such as the addition of NV-UVB to another treatment, increase the chances of >90% repigmentation. Lastly, this review concludes that various body parts respond differently to all treatments.

1. Background

Vitiligo is a chronic pigmentary disease that affects approximately 1% of the world’s population. This dermatological condition affects skin and hair and manifests itself by characteristic white macules and patches. The disease can be segmental, localized in one area of the body, or generalized, affecting a broader area. It can also be stable or unstable, depending on the appearance of new decoloration. Non-segmental vitiligo is prone to reactivation but, as in many of the studies, patients are required to have stable vitiligo, those with the segmental type of the disease are more likely to be selected for treatment. The loss of skin pigmentation is caused by the destruction of melanocytes in the epidermis, leading to the lack of melanin pigment responsible for skin coloration. The published data suggest that the causes of melanin deficiency are multifactorial; mostly, it has an autoimmune origin with an underlying genetic tendency.
The disease has vast deleterious consequences beyond the aesthetical aspect, negatively affecting the patient’s emotional well-being and self-esteem. It is reported that around 75% of vitiligo patients have a psychological disorder, and female vitiligo patients experience significantly more significant impairment of general and psychological health, intimate relationships, and sexual function compared to healthy women.
The standard treatment for vitiligo varies based on the patient’s tolerance and consists of topical steroid therapy, immunosuppressant, sun protection, phototherapy, vitamin D, or narrow-band ultraviolet B (UVB) phototherapy (Figure 1). While these treatment options can be successful for certain patients, for others, they do not bring satisfactory results. Moreover, some patients are resistant to conventional medical treatments, probably due to polymorphisms in the genes involved in the immune response and melanogenesis , which motivates the search for novel combination therapy.
Figure 1. Standard and cell-based therapies for vitiligo. The figure was created with Biorender.com, accessed on 3 November 2022.
Therefore, there is a great interest in introducing other novel therapies that are effective and safe for vitiligo patients (Figure 1).
This narrative literature review aims to bring a comprehensive knowledge of cell-based therapies in the treatment of vitiligo. In the present study, we discuss the development of these methods in recent years and point out various technical aspects affecting the effectiveness of the given methods for a better understanding of which procedure could be recommended, taking into account the characteristics of vitiligo and the patient’s age as well as facilities available in the clinic. Different transplantation approaches using keratinocytes and melanocytes or both cell types are presented with a description of the most applicable techniques such as hair follicle cell transplantation, the ReCell system, the Jodhpur Technique, and an approach where cell transplantations are combined with narrowband ultraviolet B (NB-UVB) or autologous platelet-rich plasma.
This literature review aims to bring knowledge of cell-based therapies by assessing 55 of the most effective primary clinical studies published in PubMed (https://pubmed.ncbi.nlm.nih.gov/, accessed on 20 November 2022)  and ClinicalTrails.gov (https://clinicaltrials.gov, accessed on 20 November 2022)  between 2000 and 2022 with the oldest studies being discussed for historical relevance. Moreover, this review aims to give an indication of the therapies depending on the vitiligo type and location. Only human-based clinical studies and case reports were included in this review.
This review is divided into five sections, each considering a different cell-based therapy, its background, studies, and effects. It should be stated that the studies presented here have been conducted on several different ethnic groups. It is known that people of varying skin colors respond differently to vitiligo treatment; thus, this must be kept in mind when analyzing the results of clinical trials.

2. Melanocytes and Keratinocytes as the Targets for Vitiligo Therapy

Neural crest cell-derived melanocytes are the melanin-producing cells of the skin; several melanocyte cell death mechanisms have been proposed to explain the origin of vitiligo. As such, the transplantation of healthy cells shows great promise for treating vitiligo patients. Several methods for the delivery of non-cultured melanocytes into the affected skin areas of patients have been attempted , including transplantation onto dermabraded or laser-abraded areas. In this approach, the skin sample is shortly incubated with trypsin and centrifuged before spreading on the recipient area. As the number of melanocytes in this method is not increased in culture, its efficacy might be lower compared to cultured melanocyte transplantation. This is suggested by the relatively low (57.4%) number of patients achieving >50% repigmentation in the study by Ghorbani et al. Melanocytes only account for up to 10% of skin cells and thus should be amplified in vitro prior to transplantation to maximize the chances of success .
Therefore, there are numerous approaches for transplanting pure cultured melanocytes. For example, in the Chen et al. study, 25 segmental vitiligo patients were treated with cultured autologous melanocytes. The cells were transplanted into laser-denuded areas at a density of 70,000 to 100,000 melanocytes per cm2. Complete repigmentation was seen in most patients in less than one month, although in some cases, a thin vitiliginous line at the junction between normal skin and the transplant was visible. Hair follicles, the outer root sheath, are rich in melanocytes with potential proliferative ability. Thus, this offers a potential donor site for autologous cell transplants and was recently explored in several studies. In the study by Shi et al. [23], the occipital area was used to obtain a scalp specimen containing at least 15 hair follicles. Following the removal of adipose tissue, the remaining hair follicles and dermal papillae were incubated, and a single-cell suspension was created. The sterilized recipient area was then abraded superficially using a motorized dermabrader or a CO2 laser and covered with the cell suspension and a hyaluronic acid dressing. In the nine months following treatment, 22 of the 26 patients achieved >75% repigmentation, and of those, 9 individuals achieved >90% repigmentation. Moreover, hair follicle transplantation using the hair follicular unit transplantation (FUT) technique is a cheap, simple method requiring minimal infrastructure, which makes it suitable for small stable lesions affecting hairy body parts [24].
Melanocytes can also be transplanted using dermarolling treatment, which involves microneedles piercing the epidermis for cell delivery. Melanocytes can be obtained with superficial shaving of scalp skin, as this is another area known to be particularly rich in these cells. Following incubation in a trypsin solution, the epidermis can easily be separated from the dermis using forceps. The epidermis is then centrifuged, the supernatant removed, and the pellet suspended in plasma. Following cleaning with an antiseptic spray, the recipient site can be dermarolled to deliver the melanocytes. Benzekri and Gauthier [25] have shown that after 24 h, nearly all holes had closed up without signs of infection, and melanocytes had been observed in the basal layer of the epidermis. After six months, 40% of the patients had an excellent response (76–100%) to the treatment. Autologous melanocytes can also be obtained from the thigh or buttock areas with normal skin color, which was explored in generalized vitiligo patients. The autologous material was incubated with trypsin then mixed with patients’ serum and centrifuged. The cell suspension mixed with hyaluronic acid was then evenly spread on recipient areas, previously injected with lidocaine, and shaved with a curate device. The success of the treatment was highly dependent on the recipient area, with the highest proportion of excellent and good results achieved in various areas of the face (57.4% on the face compared to the overall success of 50%) [14]. Using eyelid skin to harvest melanocytes and subsequent transplantation of the autologous melanocytes yielded similar results, with >80% repigmentation in 56% of the cases. The high success rate could be in part due to the selective growth of melanocytes while inhibiting fibroblasts and keratinocyte cells, as their faster growth and high proportion prevent the growth of melanocytes. The best results and even coloration were achieved in the legs, trunk, and face, and it was observed that sunlight could promote pigment production of transplanted cells [26]. Even though the results of the three latter studies are satisfactory, using hair root melanocytes appears to be the most effective solution. Moreover, it is clear that the choice of melanocyte donor area for melanocytes should be influenced by the recipient area affected by vitiligo, as the different methods showed varying success in various locations on the body [27]. Interestingly, Zhu et al. [26] found a higher level of anti-melanocyte antibodies in the vitiligo patients’ serum, indicating that humoral immunological mechanisms could play a role in the development of the disease.
The clinical characteristic of vitiligo is another important aspect determining the effectiveness of transplantation. One hundred and twenty cases of vitiligo patients were studied, and it was investigated whether stable localized vitiligo, stable generalized vitiligo, and active generalized vitiligo show different outcomes after cultured autologous pure melanocytes transplantation. In this study, similar to previous work of this group [16], 60,000 to 100,000 melanocytes/cm2 were applied on the skin after carbon dioxide laser abrasion of the vitiligous areas. The best outcome was observed in the stable localized vitiligo group, where 84% of patients achieved 90% to 100% repigmentation. An excellent percentage of coverage was shown in 54% of patients in the stable generalized vitiligo group and none in patients suffering from active generalized vitiligo. This study proved the validity of the treatment of stable vitiligo with cultured autologous pure melanocytes [28]. The clinical applications of melanocyte cell transplantation in vitiligo are summarized in Table 1 and Figure 2. However, most clinical trials attempt to transplant keratinocytes in co-culture with melanocytes [29,30].
Figure 2. CT-cell therapy. The highest percentage of repigmentation depending on the cell-based therapy used (based on papers presented in Table 1).

3. Melanocyte–Keratinocyte Cell Transplantation (MKCT)

It should be clarified that MKCT is the complete clinical grafting procedure which includes harvesting epithelium from the donor site, preparing the recipient site, and applying the suspension and dressing the wound, whereas non-cultured epidermal suspension (NCES) refers to a prepared cell suspension used in MKCT. The first introduction of non-cultured epidermal cellular grafting in the treatment of stable vitiligo took place in 1992 [31] after several successful attempts under experimental conditions on piebald guinea pig skin [32]. In this treatment, both melanocytes and keratinocytes are transferred, as melanocytes grow better in the presence of keratinocytes and produce better repigmentation. For instance, Phillips et al. [33] demonstrated the significance of improving the method of maintaining melanocyte numbers by introducing a feeder layer. The use of a hyaluronic acid-enriched cellular graft gave a repigmentation rate of over 70% in the vitiligous areas in 77% of patients after 12 months compared to a placebo in a double-blind study [1]. For a change, Khodadadi et al. [34] replenished the missing melanocytes and keratinocytes using a different route of their administration: the cell suspension was injected intraepidermally into vitiligous lesions. In the 6-month follow-up, 4 out of 10 patients had achieved moderate repigmentation (76–100%) and one patient’s patch was fully repigmented. The authors found no correlation between the number of transplanted cells and the outcome. Further development of this technique gave a repigmentation rate of over 50% in 32.2% of treated patches, whereas acquired repigmentation remained stable in 79.3% of treated patches during the 30-month-long follow-up period. Observing 300 patients, the first pigmentation loss in treated patches started around 9 months post-transplantation and mostly occurred during the first year (68.5%, n = 150) after treatment [35]. It is worth mentioning the results of the study by Budania et al. [34] and Bao et al. [36] which compared the NCES method with suction blister epidermal grafting (SPEG) and showed a better extent of repigmentation after NCES. Interestingly, in the study by Budania et al. [37], no melanocyte culture media, trypsin inhibitor, or hyaluronic acid was used, and only simple syringe-base suction was applied. Moreover, a comparison between an autologous non-cultured extracted hair follicle outer root sheath cell suspension (NCORSHFS) and NCES showed comparable efficacy in repigmentation [38,39], although, patients in the NCES group were significantly more satisfied than the patients in the NCORSHFS group [38]. However, there is also a study that suggests that cultured melanocyte transplantation (CMT) may give better repigmentation as compared with NCES in the case of stable generalized and segmental vitiligo [40]. Interestingly, a superior repigmentation to NCES or NCORSHFS alone was achieved when those two techniques were combined. The authors suggested that this approach may be a good alternative for the more resistant-to-treatment acral vitiligo [41].
The MKCT grafting procedure was also substantially developed since its discovery by Olsson and Juhlin in 1998 [42]. Initially, the sample of superficial skin was removed, and cells were isolated, separated, and cultured in a melanocyte growth medium. To carry out this procedure in one day, the next step was to apply the melanocyte-enriched epidermal cell suspension directly on dermabraded depigmented skin. Some of the changes proposed by Mulekar [43] concern the use of Dulbecco’s Modified Eagle’s Medium (DMEM) and Ham’s F-12 Nutrient Mixture for cell separation procedure and CO2 incubator substitution with an ordinary incubator. The CO2 incubator helps to maintain the pH in the cell cultures; however, it makes the procedure more expensive. Currently, melanocyte–keratinocyte cell transplantation (MKCT) involves obtaining a skin biopsy from the donor site one-tenth of the recipient area size. This is followed by soaking it in trypsin-EDTA solution, separating the dermis from the epidermis, and disposing of the dermis. The sample is then centrifuged, and the stratum corneum is discarded. Finally, the cell suspension is transplanted onto the deep epidermis of the dermabraded recipient area, which is then covered with a dry collagen sheet. The whole treatment can be conducted as a 2 to 4 h outpatient procedure.
In this technique, repigmentation can be seen between 2 weeks and 2 months after surgery . Many patients show hyperpigmentation, but it usually blends with the surrounding skin in 6 to 8 months, and the likelihood increases when patients expose the transplanted areas to sunlight. This method is most effective in segmental and focal vitiligo patients, for whom a scarring or cobblestone appearance is unlikely. Interestingly, the only post-operative pain that can be observed is in the feet and ankles. Six months following the surgery, 84% of the patients showed good to excellent repigmentation, and in the long term, six years after the surgery, the treatment results remained positive for patients with segmental, stable vitiligo with the absence of fingertip involvement. Mulekar et al also evaluated the effects of this treatment in 49 patients with segmental vitiligo and 15 patients with focal vitiligo who were followed up for up to 5 years. Overall, 95% to 100% of repigmentation was achieved in 84% of patients with segmental vitiligo and 73% of those with focal vitiligo, while a poor outcome was observed in 10% and 20%, respectively. Another study using MKCT reported that in the 12 to 72 months post-treatment, good to excellent repigmentation remained in 71% and 54% of patients with stable and non-stable vitiligo, respectively, confirming the success of this treatment for stable vitiligo patients. Interestingly, at 12 months, 62% of patients showed additional repigmentation that was not present before, and only 26% showed partial or complete regression. It was noted that improvement peaked at 10 months post-surgery and stabilized by up to a year, plateauing at around 18–24 months. In another paper by Mulekar et al, 142 patients were followed up to 6 years after autologous, non-cultured melanocyte-keratinocyte cell transplantation. Complete repigmentation was shown in 56% of patients, while poor pigmentation was observed in 24%. Another group presented data concerning three cases of patients with stable genital vitiligo. A 26-year-old male with the loss of pigmentation on the penis glans and neck, and 24- and 39-year-old males with depigmentation of the glans and shaft of the penis, all of whom were treated with autologous, non-cultured MKCT. All of the patients achieved almost complete repigmentation. In another study, patients with stable vitiligo were treated using the same method as Mulekar and co-workers.  The outcome of the treatment of eight vitiligous patches treated with autologous non-cultured melanocyte–keratinocyte transplantation was compared to six control lesions, which were only dermabraded. The results were evaluated after 4 months. Over 95% repigmentation was observed in 50% and 0% to 24% repigmentation in 37% of patients treated with MKT. Five out of six control patches failed to show repigmentation, and one patch resulted in hyperpigmentation following inflammation.
Vazques-Martinez et al and Quezada et al compared the efficacy of the transplantation of melanocyte and keratinocyte (MKCT) cell suspension after dermabrasion (DA) or with dermabrasion only. In the 12-month follow-up period in Vazquez-Martinez’s study there was no statistically significant difference between MKCT + DA and DA alone in the area of depigmentation but clinically MKCT + DA showed slightly better results. Quezada et al analyzed the results 3 months after transplantation and observed no significant differences between the treatments. It should be noted that the two latter studies indicate that MKCT + DA and DA alone are similar in terms of efficacy, whereas Mulekar and co-workers have found MKCT to be significantly better. This highlights the differences between methods and samples used in different studies even when, in principle, the technique used is the same.
Huggins et al performed 29 MKCT procedures in 23 patients with focal, generalized, or segmental vitiligo with no control group. Overall, 52% of the vitiligous lesions were localized on the extremities. Patients were evaluated monthly between the 3rd and 6th month after the procedure. Excellent repigmentation was achieved in 17% and poor in 41% of patients. The presence of vitiligo on the face/neck was associated with a better response to the treatment, with 19% of patients showing excellent repigmentation and 50% good.
Ebadi et al conducted a study where patients with stable generalized vitiligo, with a total of 39 patches, were divided into four groups. Nine patches were treated with MKCT alone, ten patches with MKCT and excimer laser, ten patches with excimer laser alone, and ten patches served as controls and did not receive any treatment. The authors reported that excimer laser combined with non-cultured MKCT improves the repigmentation rate, with an average of 41.9% reduction in the depigmented area surface. For comparison, it was only 4.7% for patients treated with excimer laser alone, 15.9% for those treated with MKCT alone, and 0.1% for the control group.
Lastly, it has been observed that the ethnicity of patients must be considered in the choice of MKCT treatment, for instance, Asian patients are more prone to hypertrophic scarring. Even though vitiligo affects all ethnic groups similarly, it may be more noticeable in people with darker skin, and some treatments may show varying efficacy between the different groups.
It is worth mentioning that the response to NCES treatment may depend on the location of the lesions. The best results were observed in face and neck lesions (88% of satisfactory responses) and the worst in the extremity lesions (33% of satisfactory responses). However, based on their results, Mulekar et al. concluded that the concept of a “difficult-to-treat site” is a relative term and depends upon the technique used. The non-cultured MKCT seems to be favorable as this technique does not require special precautions to treat these anatomical sites. According to some authors, using a higher density of melanocytes in the suspension , a strict immobilization procedure for the treated areas, and post-operative phototherapy in the form of sun exposure might improve the results in such a “difficult-to-treat site”. Others reported that a better response was achieved in segmental vitiligo patients compared to non-segmental ones (84% compared to 63%). Moreover, NCES was also successfully used in the repigmentation of leucotrichia in vitiliginous patches. The proposed mechanism of this process is a retrograde migration of transplanted melanocytes or interfollicular epidermal stem cells to the hair bulb and/or their production of cytokines, which stimulates melanogenesis in the follicular bulbs. It should also be mentioned that skin grafting may be considered to treat localized vitiligo in children In this group of patients, an MKTP is favorable as it does not require a long surgical time, and there is no need for absolute immobility and any special precautions to treat ‘‘difficult-to-treat’’ sites. The clinical applications of MKCT in vitiligo are summarized in Table 1 and Figure 2.

4. ReCell System in Vitiligo Therapy

ReCell is a robust point-of-care autologous therapy designed to treat skin defects such as small and large thermal burn wounds using a patient’s regenerative cells. The ReCell system enables the harvesting of autologous cells, processing them, and delivering them using a spray applicator. Three clinical trials analyzed the results of treating patients with stable vitiligo with ReCell (a cell suspension with keratinocytes, melanocytes, dermal papillary fibroblasts, and Langerhans cells sprayed over the wound). Mulekar et al compared the efficacy of the ReCell system and melanocyte–keratinocyte transplantation 4 months after the procedure. In both methods, the cell suspension was spread to previously dermabraded areas, and the results of the treatments were comparable.
Due to efficacy, time, and cost, surfaces that can be covered with cultured melanocytes are larger than those that can be covered with non-cultured cells. Cervelli et al treated 15 patients, and 12 of them (80%) achieved more than 75% repigmentation. The authors observed an excellent color match in 66% of patients.
In 2010, the same group presented a case report of a 30-year-old man suffering from stable vitiligo on his hands. Before undergoing ReCell therapy, he had vitamin A, C, E, and UVB therapy, none of which were beneficial. Treatment with the ReCell system gave excellent results, both in the extent of repigmentation and the skin color match. The clinical applications of the ReCell system in vitiligo are summarized in Table 1 and Figure 2.

5. Autologous Non-Cultured, Non-Trypsinized Epidermal Cell Grafting

This method is also known as the Jodhpur Technique (JT) (the first time was carried out in the Medical College in Jodhpur in India) and is a modification of the autologous non-cultured, non-trypsinized keratinocyte–melanocyte cellular graft technique. The grafting material is rich in melanocytes and is obtained following the dermabrasion of the donor area. The epidermal particles fragmented during dermabrasion become entangled in an ointment, and a paste-like material is obtained. This material is laid out over the recipient lesion area using a graft spreader. This technique is very low-cost and does not need any sophisticated equipment.
The study by Tyagi et al with the use of the JT technique revealed that in both epidermal cell suspension and epidermal curettes, over 75% repigmentation was achieved in 60% of lesions. Moreover, the color matching with surrounding skin and yield of grafts was not significantly different between these techniques. Even better results were presented in the study by Lamoria et al, where excellent repigmentation (>75%) was observed in 70% of lesions. In terms of the repigmentation rate, side effects, patient satisfaction, and dermatology life quality index reduction, this method was superior to FUT. The clinical applications of non-cultured epidermal cell grafting in vitiligo are summarized in Table 1 and Figure 2.

6. Cell Transplantations in Combination Therapy with a Narrowband Ultraviolet B (NB-UVB) or Autologous Platelet-Rich Plasma

Narrowband ultraviolet B (NB-UVB) is one of the treatment options for patients suffering from active vitiligo. It promotes the proliferation and migration of cultured melanocytes. Zhang et al collected a group of 473 patients and investigated the effect of NB-UVB in combination with autologous melanocyte transplantation. The patients were divided into four groups: group 1 underwent NB-UVB sessions before melanocyte transplantation, group 2 was NB-UVB treated after transplantation, group 3 received NB-UVB before and after transplantation, while group 4 did not undergo NB-UVB sessions and received only transplantation. The best results were observed in group 3, where ≥90% repigmentation was achieved in 81% of patients, which suggests that NB-UVB given before and after transplantation of the melanocytes gives the best chance of repigmentation in active vitiligo patients. Interestingly, Yao et al. demonstrated more than 90% repigmentation at the 1-year follow-up in all patients treated with low-density cultured autologous melanocytes combined with NB-UVB treatment after cell transplantation. Excellent repigmentation (85–100%) was also achieved in the small four-patient study where the non-cultured autologous melanocytes and keratinocytes transplantation was combined with UVA or UVB therapy after grafting .
Platelet-rich plasma (PRP) originates from the collection of venous blood, which is then centrifuged in the presence of anticoagulants. After centrifugation, autologous platelets are suspended in a small amount of plasma. Topical application using an intradermal injection of PRP through the secretion of platelet’s alpha granules increases the release of growth factors (especially basic fibroblast growth factor, bFGF), adhesion molecules, and chemokines, which, by interacting with the local environment, stimulate melanocyte migration along with the stimulation of keratinocyte and fibroblast proliferation. Moreover, PRP promotes the release of inflammatory mediators and modulators through the release of numerous anti-inflammatory cytokines, such as interleukins (IL-4, IL-10, IL-13), IL-1 receptor antagonist (IL-1ra), soluble tumor necrosis factor (TNF) receptor (sTNF-R) I, and interferon-gamma (IFN-γ). Although intralesional injection of PRP alone did not induce repigmentation, a combination of PRP with NB-UVB induced statistically significant repigmentation in a series of 60 patients from Egypt  An interesting and promising study was performed with NCES suspended in PRP. Parambath et al compared the extent of repigmentation achieved using the transplantation of NCES in PRP and NCES in phosphate-buffered saline (PBS) in 21 patients with stable vitiligo. After 6 months, the repigmentation was 75.6% after NCES in PRP and 65% after NCES and PBS treatment (p = 0.0036). Moreover, the suspension in PRP was better assessed by patients in the visual analog scale. The clinical applications of combination therapy for vitiligo are summarized in Table 1 and Figure 2.

7. Are Cell-Based Therapies Appropriate for All Vitiligo Patients? Limitations and Challenges

Although vitiligo cell-based therapy is safe, well-tolerated, and effective at repigmentation with matching color and texture in appropriate candidates, it is still an underperformed treatment. There are several reasons for this: a limited number of practitioners know the technique details, a lack of awareness on the part of physicians, and a lack of insurance coverage for vitiligo because many consider it a cosmetic disease. Moreover, not all patients are willing to undergo this type of therapy. Parambath et al found that 11 out of 38 patients screened for the study were not willing to undergo surgery. When asked about the reasons for refusal, patients indicated the desire to receive a trial of medical therapy from a tertiary care center, fear of surgery, unwillingness for follow-up visits, and high costs. It should also be noted that not every vitiligo patient is eligible for surgical therapy. Depending on the clinical practice, most patients must have clinically stable vitiligo for 6 months to one year to qualify. Clinically stable vitiligo is determined by the non-appearance of new lesions and by the absence of changes in the existing ones. Patients with segmental or focal vitiligo are better candidates because they tend to achieve greater repigmentation than those with generalized disease. Higher rates of repigmentation were also reported in young patients compared to older ones.
It is also very important to note that it is difficult to estimate the overall percentage of people who have recovered from vitiligo, as only a fraction of them undergo treatment. Moreover, even though combination therapy is more effective than monotherapy, recurrence affects up to 40% of patients.
Patients are excluded from surgery if they had a history of koebnerization, hypertrophic scarring, keloids, or are susceptible to poor wound healing. According to Ramos et al., isolated scalp leukotrichia is an adverse prognostic sign, and the presence of significant distal fingertip, periorificial, or acrofacial involvement is also an exclusion criterion because these disease variants typically respond poorly to the melanocyte–keratinocyte transplantation procedure . However, as we discuss below, patients with leucotrichia in vitiliginous patches may also have a chance for successful treatment. Recently, molecular markers were suggested for better predictions of vitiligo diagnosis and response to treatment. The RNA sequencing in vitiligo patients showed differences in expression levels of 470 genes between the skin specimens of responder versus non-responder patients. Two hundred sixty-nine upregulated genes were involved in processes, such as fatty acid omega oxidation, whereas down-regulated genes (two hundred and one) were related to PPAR and estrogen signaling pathways.

8. Conclusion

In conclusion, cell therapies undergo continuous improvements both toward better re-pigmentation effects and simplifying the methods, making them more accessible to dermatological clinics. Modifications of procedures involving simplifying cell collection, ensuring their good transplantation potential, as well as using less sophisticated laboratory equipment, reduce the cost of the procedure and make it more accessible to patients. Another important factor when considering cell-based vitiligo treatment is the selection of appropriate candidates. In the meta-regression analyses by Ju et al, the successful outcome (>90% repigmentation) was associated with younger age, segmental vitiligo, and a non-acral area.
It should also be mentioned that repigmentation after cell therapy progresses gradually and may continue beyond 12 months following the procedure. Thus, there is a great need for more extended follow-up studies (minimum 6 months) for evaluation of the effectiveness and real cost that the patients must undertake on their way along the treatment of vitiligo.

 

 

 

 

 

 

Types of Sun Protective Clothing

It’s important for vitiligo patients to protect their skin from the sun’s harmful UV rays. Sun-protective clothing is an effective way to shield the skin from the sun and can be particularly beneficial for people with vitiligo.

We all have our favorite outdoor activity. Whether it’s heading out for a day hike, or grabbing your gear for a morning of fishing. However, being outside in the sun for long periods of time can take its toll on your skin as you age. Without applying (and reapplying) the proper SPF sunscreen and utilizing shaded areas, your skin can absorb enough direct sunlight to cause a sunburn in as little as five minutes.

Unfortunately, people who work outdoors may not have time to reapply sunscreen or take long breaks in the shade as often as they should. Others may have traits that make them more susceptible to skin cancer so they require additional sun protection on top of sunscreen. The answer to these common problems is easier than you may think—sun protective clothing!

Clothing brands are now offering new lines that have one extremely beneficial feature—material that is designed to protect you from the sun. Read on to learn more about sun protective clothing and to find the brand that is right for you and your lifestyle.

What is sun protective clothing?

Sun protective clothing is made of tightly woven fabric that minimizes the space between each individual strand, which in turn minimizes the amount of sunlight that can reach the skin. Despite the tightly woven nature of the fabrics, sun protective clothing is lightweight, breathable, and dries quickly to wick sweat away from your body and help keep you cool.

Where to purchase sun protective clothing.

REI

REI has a wide selection of sun protective clothing. The company sells pants, shirts, skirts, and hats to fit practically any style. Some items are made for camping and hiking, while others are more fashion-forward for a casual day out in the town. REI carries multiple brands of sun protective clothing as well as its own line of items, so you are bound to find something that works for you.

Columbia

Columbia’s OMNI-Shade line of fabric is designed to block both UVA and UVB rays. The brand sells clothing options for men, women, and even the kids! Columbia also offers a variety of styles to protect you in various weather conditions for those of you that enjoy extreme outdoor activities.

For additional sun protection on hard to cover areas, visit Columbia for patterned arm sleeves and neck wraps in store or online.

Coolibar

If you’re looking for stylish protective clothing you can wear out to a nice lunch, Coolibar is for you. Coolibar is a one-stop shop for all things sun protection. The online retailer sells clothing, hats, and sun accessories for men, women, children, and babies.

At Coolibar you can find perfect dresses, pants, everyday tees, fitness clothing, and swimwear to fit both your lifestyle and personal style. Coolibar has a large selection of basic colors and stylish prints to mix and match, allowing you to create a variety of outfits that are both stylish and protective.

Coolibar doesn’t stop at clothing. The online retailer also sells sun accessories such as umbrellas, hats, gloves, and sunscreen to help protect you even more.

Solumbra by Sun Precautions

If you are serious about protecting your skin, Solumbra by Sun Precautions is the brand for you. The Solumbra line was designed for men, women, and children who are medically sensitive to the sun. Unlike ordinary shirts that have only 5 to 9 SPF protection, the Solumbra line provides a long lasting solution to sun protection with all products having a 100 or higher SPF protection. That’s more than sunscreen! The material in each item blocks 98% of UVA and UVB radiation from reaching your skin and causing severe skin damage.

You will find clothing for active sports like hiking, biking, and running, in addition to leisure sports like golf and boating. Solumbra also has an extensive line of swimwear, which includes swim shirts, rash guards, and swim leggings to keep you protected while in the water.

What does UPF mean?

Now that you understand why sun protective clothing is important and where you can find it, you may find yourself asking, “How do I measure the effectiveness of one piece of clothing to another?” Well you have probably heard of SPF, or Sun Protection Factor, which measures how protective sunscreen is, but sun protective clothing is rated using the UPF, or Ultraviolet Protection Factor, scale.

The UPF scale is broken down as follows:

  • Good protection: 15-24 UPF
  • Great protection: 25-39 UPF
  • Excellent protection: 40-50+ UPF

If you wear a shirt with a UPF rating of 50, it translates to only 2% (1/50) of the sun’s UV radiation reaching your skin. Compare that to standard clothing which typically has a low UPF rating of about 6, and you can see how beneficial clothing with a higher SPF rating can be.

Keep in mind that specific dyes and chemical treatments can also be added to clothing to increase their UPF rating. Generally, the more vivid the color of your clothing, the higher the UPF rating is.

Different activities require different levels of UPF protection. A typical day of running errands may only call for a rating of 15 to 24, but a long hike or a full day of golf may require a UPF rating of 50 or higher for more protection since you’ll be outdoors for a longer time period.

Benefits of wearing sun protective clothing.

Extra protection

In addition to your sunscreen, sun protective clothing can help prevent sunburns. If you don’t have a chance to reapply sunscreen while you are outdoors, your clothes have got your back.

Covers exposed skin

The tightly woven fabric of sun protective clothing often covers more skin than a regular item of clothing, lessening the risk of sun exposure. Modern day fabrics also provide long sleeve shirts and pants for people to wear while in hot weather conditions for a protective, yet comfortable fit.

Solution for Fair Skin

People of all ages with fair or pale skin can rest easy knowing that their skin is protected. For these skin types, sunscreen is often not enough to prevent a sunburn. By wearing sun protective clothing, people with traits that are more susceptible to skin cancer can enjoy the outdoors without suffering a painful sunburn afterward.

People with darker skin tones may not burn as easily, but that does not eliminate them from potential sun damage and skin cancer risk. Everyone should consider sun protective clothing when they are exposed to the sun for any length of time.

Enjoy sunny days, free of sunburns! Purchase sun protective clothing for yourself and your family and enjoy being outdoors without worrying about sun damage to the skin. Take that longer hike you have always wanted to try, spend a day out on the lake, or play all 18 holes of golf. Sun protective clothing will make the outdoor lifestyle you have always wanted a reality.

 

SOURCE 

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By Armin Rimoldi