Vitiligo is an idiopathic, non-contagious and often familial depigmentation disorder affecting both sexes equally. The mostly progressive and patchy loss of the inherited skin colour is not only a cosmetical problem, it has a profound impact on the patient's well-being. Stigmatisation and rejection often causes depression, self-consciousness, sexual problems and an impaired quality of life. To further substantiate earlier investigations and to introduce new aspects, we utilised the Dermatology Life Quality Index (DLQI), the Beck Depression Inventory (BDI) and the Adjustment to Chronic Skin Disorders Questionnaire (ACS) with its sub-scales on Social anxiety/avoidance, Helplessness and Anxious-depressive Mood in 422 patients and 55 healthy controls. We also included 103 children, their parents and 18 controls by using the Children's Dermatology Life Quality Index (CDLQI) and an adapted version of the ACS. We found that patients with vitiligo experience high levels of stigmatisation. They have an impaired quality of life and are more socially anxious/avoidant, helpless and (anxious-) depressive compared to healthy controls. The results correlate with disease severity, avoidant behaviour/hiding of vitiligo and the belief that psychological stress influences the disease. Female patients are generally more affected. Treatment with pseudocatalase PC-KUS improves quality of life and reduces anxious-depressive mood. Children also suffer from stigmatisation and an impaired quality of life. Parents are more socially anxious and helpless compared to the control group.

no / Nonsegmental vitiligo (NSV) is characterized by loss of inherited skin color. The cause of the disease is still unknown despite accumulating in vivo and in vitro evidence of massive epidermal oxidative stress via H2O2 and peroxynitrite (ONOO−) in affected individuals. The most favored hypothesis is based on autoimmune mechanisms. Strictly segmental vitiligo (SSV) with dermatomal distribution is a rare entity, often associated with stable outcome. Recently, it was documented that this form can be associated with NSV (mixed vitiligo). We here asked the question whether ROS and possibly ONOO− could be players in the pathogenesis of SSV. Our in situ results demonstrate for the first time epidermal biopterin accumulation together with significantly decreased epidermal catalase, thioredoxin/thioreoxin reductase, and MSRA/MSRB expression. Moreover, we show epidermal ONOO− accumulation. In vivo FT-Raman spectroscopy reveals the presence of H2O2, methionine sulfoxide, and tryptophan metabolites; i.e., N-formylkynurenine and kynurenine, implying Fenton chemistry in the cascade (n=10). Validation of the basic data stems from successful repigmentation of skin and eyelashes in affected individuals, regardless of SSV or segmental vitiligo in association with NSV after reduction of epidermal H2O2 (n=5). Taken together, our contribution strongly supports H2O2/ONOO-mediated stress in the pathogenesis of SSV. Our findings offer new treatment intervention for lost skin and hair color.—Schallreuter, K. U., Salem, M. A. E. L., Holtz, S., Panske, A. Basic evidence for epidermal H2O2/ONOO−-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS.

Vitiligo is an idiopathic, non-contagious and often familial depigmentation disorder affecting both sexes equally. The mostly progressive and patchy loss of the inherited skin colour is not only a cosmetical problem, it has a profound impact on the patient¿s well-being. Stigmatisation and rejection often causes depression, self-consciousness, sexual problems and an impaired quality of life. To further substantiate earlier investigations and to introduce new aspects, we utilised the Dermatology Life Quality Index (DLQI), the Beck Depression Inventory (BDI) and the Adjustment to Chronic Skin Disorders Questionnaire (ACS) with its sub-scales on Social anxiety / avoidance, Helplessness and Anxious-depressive Mood in 422 patients and 55 healthy controls. We also included 103 children, their parents and 18 controls by using the Children¿s Dermatology Life Quality Index (CDLQI) and an adapted version of the ACS. We found that patients with vitiligo experience high levels of stigmatisation. They have an impaired quality of life and are more socially anxious / avoidant, helpless and (anxious-) depressive compared to healthy controls. The results correlate with disease severity, avoidant behaviour / hiding of vitiligo and the belief that psychological stress influences the disease. Female patients are generally more affected. Treatment with pseudocatalase PC-KUS improves quality of life and reduces anxious-depressive mood. Children also suffer from stigmatisation and an impaired quality of life. Parents are more socially anxious and helpless compared to the control group. / German Vitiligo Association (Deutscher Vitiligo Verein)