Proefschrift Universiteit van Amsterdam. / Met lit. opg., bibliogr. - Met samenvatting in het Nederlands.

Made available in DSpace on 2015-12-06T23:46:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2007 / Objetivo: o vitiligo e doenca comum de etiologia desconhecida, cronica, capaz de determinar grave desfiguracao, podendo afetar significantemente a qualidade de vida dos pacientes. O presente estudo foi realizado com objetivo de pesquisar aspectos psicossociais em uma populacao de individuos com vitiligo, com enfase em sintomas de depressao e ansiedade e avaliacao da qualidade de vida, baseados em inventarios de investigacao, avaliando o impacto social da doenca sobre o individuo. Metodos: foram selecionados 60 voluntarios, de ambos os sexos, com idades entre 18 e 40 anos, sendo o primeiro grupo composto de 30 individuos sem vitiligo (grupo controle) e o segundo grupo composto de 30 individuos com vitiligo, em tratamento nos ambulatorios do Departamento de Dermatologia da Escola Paulista de Medicina ¬ Universidade Federal de São Paulo. Os voluntarios foram submetidos aos Inventarios Beck de ansiedade e depressao e Inventario de Qualidade de Vida da Organizacao Mundial da Saúde (WHOQOL - bref). Foram comparados os niveis de sintomas de depressao e ansiedade e parametros de qualidade de vida entre os dois grupos. Resultados: o grupo de individuos com vitiligo apresentou maiores escores medios de sintomas de depressao e ansiedade e menores escores medios dos Dominios Fisico, Psicologico e Social (WHOQOL), quando comparados com o grupo controle. Conclusoes: o vitiligo pode produzir impacto social significativo na vida dos individuos que o apresentam, justificando a instituicao de uma politica de abordagem mutidisciplinar visando melhora dos padroes de qualidade de vida. Estudos adicionais devem ser estimulados para aperfeicoar a compreensao dos aspectos psicossociais envolvidos / Purpose: vitiligo is a common chronic disease with an unknown etiology which can cause severe disfigurement and may significantly affect patient´s quality of life. The main purpose of this study was to evaluate psychosocial impact in a group of volunteers presenting vitiligo, emphasizing depression, anxiety and quality of life. Methods: inventories were given to sixty volunteers (thirty presenting vitiligo and a control group of thirty people with no disease), aged from 18 to 40, attending a public skin clinic (Federal University of Sao Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil). They were given the BDI (Beck Depression Inventory), the BAI (Beck Anxiety Inventory) and the WHOQOL (World Health Organization Quality of Life). Symptoms of depression and anxiety and parameters of quality of life were compared between both groups. Results: the group of volunteers presenting vitiligo disclosed higher medium scores of symptoms of depression and anxiety and lower medium scores in physical, psychological and social domains (WHOQOL), when compared to the control group. Conclusions: vitiligo may significanty affect various aspects of patient´s lives, producing considerable social impact. Multidisciplinary approach should be provided to improve quality of life. Further researches are necessary for a better understanding of psychosocial aspects involved in this matter. / BV UNIFESP: Teses e dissertações

Le vitiligo généralisé est une leucodermie acquise qui touche 0,5 à 1% de la population mondiale et qui résulte d’une perte progressive des mélanocytes.Le mécanisme à l’origine de la perte des mélanocytes au cours du vitiligo reste obscur et la destruction des mélanocytes n’a jamais été observée.De nombreuses hypothèses ont été avancées pour expliquer la disparition des mélanocytes : une susceptibilité génétique, l’auto-immunité, la théorie neurale et la théorie oxydative.Notre équipe a développé une théorie intégrée qui reprend ces différents mécanismes. Cette théorie considère que le vitiligo est lié au détachement des mélanocytes et à leur élimination à travers l’épiderme ou mélanocytorrhagie. Dans cette théorie, un défaut d’adhésion des mélanocytes est le facteur prédisposant au vitiligo.L’interaction des mélanocytes avec les kératinocytes environnants et avec la membrane basale est médiée par les intégrines et les cadhérines. L’expression de l’intégrine et de la E-cadhérine n’est pas modifiée dans le vitiligo généralisé.En 2006, Fukunaga-Kalabis et al. montrent que l’attachement des mélanocytes à la membrane basale est en partie dû à DDR1 qui est sous le contrôle de la protéine CCN3. Ils ont observé que l’inhibition de CCN3 induit le détachement des mélanocytes.Récemment, des variants génétiques de DDR1 ont été observés chez des patients d’origine ethnique différente atteints de vitiligo. Nous avons décidé d’étudier d’une part l’expression de CCN3 au niveau de la peau lésionnelle et non lésionnelle de patients atteints de vitiligo et d’autre part l’impact de l’inhibition de CCN3 et de DDR1 au niveau de mélanocytes utilisés pour des reconstructions épidermiques. Nos résultats in vitro et in vivo suggèrent que CCN3 est impliqué dans la physiopathologie du vitiligo. / Common generalized vitiligo is an acquired hypopigmentation which is found in 0, 5-1% of individuals world-wide and which results in progressive loss of melanocytes.The mechanism underlying the elimination of melanocytes in vitiligo remains unclear and melanocyte destruction has never been clearly demonstrated in non segmental vitiligo. Various hypotheses have been put forward to explain the disappearance of melanocytes in vitiligo: genetic susceptibility, autoimmunity, neural and impared redox status. We previously proposed a new theory that integrates those pathomechanisms. This theory considers vitiligo as a disease caused by the chronic detachment and transepidermal loss of melanocytes named melanocytorrhagy. In this theory, the defective adhesion of melanocytes is the predisposing factor.Interactions between melanocytes and the basement membrane are mediated by integrins and interactions between melanocytes and keratinocytes are mediated by cadherins in association with β-catenin. But integrin expression is not affected in NSV and a normal expression of E-cadherin in lesional and non lesional vitiligo skin is observed.In 2006, Fukunaga-Kalabis et al. reported that attachment of melanocytes to basal lamina is in part due to DDR1, which is under control of CCN3. They have observed that inhibition of CCN3 induces the detachment of melanocytes.Recently, DDR1 genetics variants have been associated with vitiligo in patients of different ethnic origin. We have decided to study in parallel the expression of CCN3 and DDR1 in lesional and non lesional skin of vitiligo patients and the impact of inhibition of CCN3 and DDR1 in melanocytes on their behaviour in reconstructed epidermis.In conclusion, our in vivo and in vitro data suggest that CCN3 is implicated in vitiligo etiology.

Orientador : Maria Beatriz Puzzi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T15:10:26Z (GMT). No. of bitstreams: 1 Issa_ClaudiaMariaBernardinoMagro_D.pdf: 1672562 bytes, checksum: bc1e3d1155c8de63a5b20760c0745d9e (MD5) Previous issue date: 2003 / Resumo: Foram apresentados os resultados de um estudo com 12 pacientes portadores de vitiligo estável, tratados com quatro diferentes técnicas cirúrgicas, aplicadas em cada paciente de forma concomitante; num total de 48 áreas tratadas e seguidas ao longo de 90 dias. Efetuaram-se os seguintes tratamentos: tratamento apenas com crioterapia (AC); crioterapia mais meio de cultura para melanócitos (CM); crioterapia mais transplante de melanócitos e queratinócitos não em cultura (QM); crioterapia mais transplante de melanócitos em cultura (CC). Acompanhou-se o aparecimento e evolução da repigmentação ao longo do tempo. Não houve repigmentação em AC e CM. Houve repigmentação progressiva em QM e CC, ao longo dos 90 dias. O nível de redução da área acrômica em ambos foi significativa ao longo dos 90 dias. Não houve, porém, diferença significativa entre ambos / Abstract: This study presents the results of a clinical trial study, conducted on 12 patients with stable vitiligo at the vitiligo outpatient clinic of The Clinical Hospital of the University of Campinas, between March 2000 and December 2001. This study was in accordance with the ethical standards of the Institutional Review Board. The patients were concomitantly treated with four different types of surgical techniques in 48 areas randomly chosen. There was a 90-day follow-up period. The following treatments were carried out: only cryotherapeutic treatment (OC); cryotherapy plus melanocyte culture medium (CM); cryotherapy plus transplantation of non-cultured melanocytes and keratinocytes (KM); and cryotherapy plus transplantation of cultured melanocytes (CC). The appearance of repigmentation and its evolution were followed all along the treatments. In the case of OC and CM no repigmentation occurred. Progressive repigmentation was observed over a period of 90 days in the case of KM and CC. In these two groups there was a significant reduction in the achromic areas during this time but no significant difference was found between the two treatments / Doutorado / Clinica Medica / Doutor em Clínica Médica

46 Patienten, davon 15 Melanompatienten mit erworbenen Hypopigmentierungen und 31 Patienten mit typischer Vitiligo, wurden klinisch und histologisch untersucht, mit dem Ziel, Gemeinsamkeiten und Unterschiede der beiden Erkrankungen zu erkennen. Untersucht wurden ferner assoziierte Erkrankungen wie Atopie und Autoimmunkrankheiten in Eigen- und Familienanamnese. Daneben erfolgten HLA-Typisierungen und Autoantikörpernachweise. Routinehistologisch und immunhistologisch unterscheiden sich beide Vitiligoformen nicht. Unterschiede fanden sich im Ausbreitungstyp. Während die Vitiligo häufig akral begann und sich zentripetal ausbreitete, fand sich die Melanom-assoziierte-Hypopigmentierung (MAH) primär häufig am Stamm, auch in der Umgebung des Primärmelanoms oder der Metastasen und breitete sich teilweise zentrifugal aus. In der Vitiligogruppe überwogen Frauen (77%), bei den MAH-Patienten war die Geschlechterverteilung etwa ausgeglichen. Die Melanompatienten waren signifikant älter als die Patienten mit klassischer Vitiligo. Bei drei Melanompatienten trat die Hypopigmentierung vor der Melanomdiagnose auf, eine 38-jährige Melanompatientin hatte bereits in der Kindheit eine Vitiligo. Eine positive Familienanamnese bezüglich Vitiligo fand sich bei 13 Vitiligopatienten und bei einer Patientin mit MAH. Die Familienanamnese für Atopie war bei 15 Vitiligopatienten (knapp 50 %), in der MAH-Gruppe nur in zwei Fällen positiv. Eigen- und Familienanamnese für Autoimmunerkrankungen waren in der Vitiligogruppe signifikant häufiger als im MAH-Kollektiv; auch ein positiver Antikörpernachweis war wesentlich häufiger in der Patientengruppe mit klassischer Vitiligo als bei den MAH-Patienten. Bei zehn MAH-Patienten und 30 Vitiligopatienten wurden HLA-Typisierungen durchgeführt. Ein signifikanter Unterschied fand sich bei HLA-A2. Die MAH-Patienten schienen trotz makroskopischer Metastasierung in zehn Fällen eine ungewöhnlich lange Lebensdauer zu haben. (Median neun Jahre) Zusammenfassung: Die Melanom-assoziierte-Hypopigmentierung zeigt klinische Unterschiede zur klassischen Vitiligo. Ob eine klassische Vitiligo einen Schutzfaktor für eine Melanomerkrankung darstellt, muss durch größere Studien geklärt werden. / Background: Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented macules resulting from the loss of cutaneous melanocytes. Approximately five percent of patients suffering from melanoma also develop various degrees of skin hypomelanosis. Objective: This study was accomplished in order to evaluate the different and common signs between classic Vitiligo and melanoma-associated-hypopigmentation. Methods: 15 patients affected with melanoma-associated-hypopigmentation (MAH) and 36 patients affected with typical Vitiligo were studied. Histology techniques, HLA-typing, laboratory findings (autonuclear antibody, TSH) and associated diseases like autoimmunity, atopy, in auto- and family- anamnesis were included in the research. Results: Histology and Immunhistology showed no difference between both forms of hypopigmentation. However, we can observe distinguish spreading pattern of depigmented lesions. Classically, Vitiligo, the hypopigmentation, mainly started acral then expanded centripetally. MAH was frequently found on the trunk, close to primary melanoma or metastasis then spread centrifugal. The number of female patients affected with Vitiligo was dominant opposed to the male’s. The MAH male/female ratio was equal. Three MAH patients suffered from Vitiligo before Melanoma. 13 patients in classic Vitiligo but only one MAH-patient had a positive family history of Vitiligo. Significant differences were detected in age, autoimmune diseases, atopy, autoantibodies and HLA2. MAH patients seemed to have a better prognosis in spite of macroscopic metastasis. Conclusion: In this study, clinical and immunological differences between melanoma-associated-hypopigmentation and classic Vitiligo were investigated. Further studies are necessary to examine the clinical relevance of Vitiligo-like alterations from melanoma patients.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the discipline of Dermatology Johannesburg, 2017 / Introduction: Vitiligo is a skin pigmentation disorder and has an estimated global prevalence of around one to two percent. Vitiligo can significantly affect patients’ Quality of life (QoL). It is cosmetically and psychologically devastating, and can affect anyone irrespective of race, skin type or ethnicity. There is a paucity of research evaluating the QoL amongst vitiligo patients in Africa and Sub-Saharan Africa in particular. The objectives of this study were to demonstrate how vitiligo has altered the QoL of vitiligo patients treated at the skin outpatients’ clinics in Johannesburg, South Africa. Methods: Our research was a prospective cross-sectional study of all individuals who were diagnosed with vitiligo at the three dermatology outpatients’ clinics in three academic public hospitals, and the phototherapy daycare centre in Johannesburg. All patients fulfilling the inclusion criteria were requested to take part in the study. Data was obtained from enrolled individuals using a data collection sheet and the Dermatology Life Quality index questionnaire. This information was analysed using statistical software (STATA version 12). Results: A total of ninety-five (n=95) respondents were included as per inclusion criteria in our study. Our cohort comprised of sixty-two females (n=62, 65.26%), thirty-three males (n=33, 34. 74%). DLQI scores were in the ranges of 0 to 28 and the mean was 10.06±6.52, which indicates a moderate Quality of life (QoL) impairment in our cohort. Conclusion: Our study has shown that vitiligo moderately affects the QOL life of adult South African vitiligo patients. Therefore, treatment measures should be directed towards medical and psychological aspects of our patients for better treatment outcomes and improved QoL. This would be an argument for establishment of psychodermatology clinics at our referral hospitals. / MT2017

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Objective: To conduct an open label clinical pilot trial using Ginkgo biloba in the treatment of vitiligo in Toronto to test the feasibility of recruitment, patient retention, variability of outcome measures, identify safety concerns, and magnitude of treatment effect ahead of a full randomized clinical trial. Methods: 12 participants 12 to 35 years old were recruited to a prospective nonrandomized open-label pilot trial and treated with 60 mg of standardized G. biloba BID for 12 weeks. The primary outcome was the validated Vitiligo European Task Force (VETF). Secondary outcomes included the Vitiligo Area Scoring Index (VASI), photographs, and adverse reactions. Results: Ingestion of Ginkgo biloba was associated with a trend towards improvement on VETF measures of vitiligo lesion area and staging, and significant improvement in VETF spread and total VASI vitiligo measures. Conclusions: By achieving full recruitment, showing benefit, and indicating no adverse reactions the pilot study shows that a future RCT is feasible.

Objective: To conduct an open label clinical pilot trial using Ginkgo biloba in the treatment of vitiligo in Toronto to test the feasibility of recruitment, patient retention, variability of outcome measures, identify safety concerns, and magnitude of treatment effect ahead of a full randomized clinical trial. Methods: 12 participants 12 to 35 years old were recruited to a prospective nonrandomized open-label pilot trial and treated with 60 mg of standardized G. biloba BID for 12 weeks. The primary outcome was the validated Vitiligo European Task Force (VETF). Secondary outcomes included the Vitiligo Area Scoring Index (VASI), photographs, and adverse reactions. Results: Ingestion of Ginkgo biloba was associated with a trend towards improvement on VETF measures of vitiligo lesion area and staging, and significant improvement in VETF spread and total VASI vitiligo measures. Conclusions: By achieving full recruitment, showing benefit, and indicating no adverse reactions the pilot study shows that a future RCT is feasible.

Made available in DSpace on 2014-06-11T19:35:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:24:27Z : No. of bitstreams: 1 lourenco_mv_dr_araiq.pdf: 869109 bytes, checksum: 309d6c297b12fceb302c8b5c561de256 (MD5) / Brosimum gaudichaudii Trécul é uma planta medicinal utilizada na medicina tradicional no tratamento de doenças de pele, assim como o vitiligo. As furanocumarinas lineares psoraleno e bergapteno são os principais compostos responsáveis por esse efeito. O medicamento “V” produzido a partir do vegetal Brosimum gaudichaudii é usado pela população no tratamento do vitiligo, por ser alegado que o mesmo contém bergapteno. Entretanto, nada é conhecido a respeito do conteúdo de bergapteno nesse medicamento. Além disso, o uso de furanocumarinas tem sido relacionado ao aumento na incidência de câncer de pele e outras desordens assim como mutação gênica e aberrações cromossômicas em humanos. Este trabalho reporta análises qualitativas e quantitativas do vegetal B. gaudichaudii e do medicamento “V” por CLAE-DAD e CG-EM. As análises mostraram que as furanocumarinas estão presentes em maiores quantidades no córtex das raízes do vegetal, e que o medicamento “V” contém derivados de ácidos graxos e apenas pequenas quantidades de psoraleno e bergapteno. De acordo com a composição do extrato polar de B. gaudichaudii e do medicamento “V”, os flavonóides 5,7,3’,4’-tetraidroxi-6-C-glucopiranosilflavona e 5,7,3’,4’-tetraidroxi-3-O-β-D-galactopiranosilflavonol foram identificados no extrato metanólico das folhas de B. gaudichaudii, mas estão ausentes no medicamento “V”. Ensaios biológicos para mutagenicidade mostraram que os extratos aquoso e metanólico do córtex das raízes do vegetal são mutagênicos enquanto que os do medicamento não apresentam mutagenicidade... / Brosimum gaudchaudii Trécul is a medicinal plant that has been used in traditional medicine to treat skin diseases such as vitiligo. The linear furanocoumarins psoralen and bergapten are the main compounds responsible for this effect. Drug “V” produced from B. gaudichaudii has been used by the population for the treatment of vitiligo because its alleged content of bergapten. However, nothing is known about the bergapten content in drug V. Furthermore, the use of furanocoumarins has been linked to a higher incidence of skin cancer and other disorders such as gene mutations and chromosomal aberrations in humans. This work reports the qualitative and quantitative analyses of B. gaudichaudii and drug “V” by HPLC and CG-MS. The analyses showed that furanocoumarins are present in large amounts in the root bark of the plant, and that drug “V” contains fatty acid derivatives and only small amounts of psoralen and bergapten. Concerning the polar composition of B. gaudichaudii and drug V, the flavonoids 5,7,3’,4’-tetrahydroxy-6-C-glucopyranosyl flavone and 5,7,3’,4’- tetrahydroxy-3-O-β-galactopyranosyl flavonol were identified in the methanolic extract of B. gaudichaudii leaves, but are absent in drug “V”. . Biological assays showed that the aqueous and methanolic extracts of the root bark of the plant are mutagenic, while drug “V” does not show mutagenicity. Preliminary cytotoxic assays showed that methanolic extracts of the root bark and of drug “V” are more cytotoxic than their respective aqueous extracts. In conclusion, B. gaudichaudii and drug “V” seems to present several differences not only in their chemical composition but also in the biological properties evaluated in this study.