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In This Issue

Message From the
Executive Director

Diagnostic Tests for Vitiligo:
Which Tests and Why

Micropigmentation
to Cover Vitiligo

Medical News Updates

  • Ginkgo Biloba found helpful for vitiligo
  • NB-UVB more effective when
    combined with Tacrolimus
  • Children with Vitiligo: Increased
    Incidence of Autoimmune Thyroiditis
Research & Clinical Trials

What's on your Mind?

  • How do I treat vitiligo around my eyes?
  • Will Protopic make my
    vitiligo stop spreading?
  • What will new pigment look like?
    How will it start?
Support Groups

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VSI Medical and Scientific
Advisory Committee

Pearl E. Grimes, M.D., Committee Chair
Ted A. Grossbart, Ph.D.
Sancy A. Leachman, M.D.
I. Caroline Le Poole Ph.D.
Mauro Picardo, M.D.
Nanette B. Silverberg, M.D.
Richard A. Spritz, M.D.
Alain Taieb, M.D., Ph.D.
Wiete Westerhof MD, PhD.

For more information
on VSI's MSAC Click Here

 
 

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VSI wishes to express our deepest sympathy to all those whose lives have been affected by the devastation of the tornadoes and floods.


Message From the Executive Director

Dear Members and Friends of VSI,

Progress can come in many forms, as illustrated by our two lead articles. One focuses on the adaptation of an established procedure, tattooing, to the treatment of vitiligo.  The other describes our recently-evolved understanding that certain autoimmune disorders are linked to vitiligo, and what tests may help determine whether these other disorders are affecting your health or that of family members. Our greater understanding of vitiligo and what drives it is giving us new and more effective strategies to control vitiligo. Until a permanent method of control is found, improvements in treatment are important and need to be promoted.

If you have vitiligo on your lips, eyes, or other small but visible areas, our lead article on a special form of tattooing might be of particular interest. This form of tattooing, different from that used in off-the-street tattoos, has its critics, but due to a recent medical journal article citing its benefits in treating lip vitiligo, we thought it worthy of our attention in this issue.

For the broader audience, we wanted to highlight why some blood tests are important, not only for those with vitiligo, but for close family members as well.  Though vitiligo is a skin disease, it is a disease that is driven by the immune system and, as a result, is linked to other immune-related disorders.  This linkage increases the chances for people with vitiligo to develop one or more of several other related autoimmune disorders.

VSI, through its recruitment of patient volunteers, has supported basic research that has confirmed these autoimmune links.  We thank all of our VSI volunteers for their participation and for helping to advance our understanding.  We will continue to support this important research and hope that all of you will as well, through your participation in this and other studies posted on VSI’s website.

Thanks also to all of you who recently donated in support of our newsletter. We depend on your donations.  Thank you for helping our community to stay informed and connected.

Let us know if we can help

Sincerely,

Jackie Gardner


Please consider a donation to VSI. Our newsletter service is supported entirely by donations.  VSI’s mission of education and advocacy is enabled by the generous support of the vitiligo community and its partners.  With your donation, you will be supporting the only comprehensive reporting on scientific and medical events in vitiligo for the public.
You can make your gift today by clicking here.

 

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Diagnostic Tests for Vitiligo:

Which Tests and Why


Why did my dermatologist give me a blood test when he diagnosed my vitiligo? I thought vitiligo was just a disease of the skin.

While vitiligo is an autoimmune disease of the skin, it has been observed over the years to be potentially linked to certain other disorders, primarily other autoimmune disorders. This suspected association has prompted dermatologists to be alert to the potential for these disorders in their vitiligo patients. Recent genetics research further confirms this association and the increased risk for a person with vitiligo of developing one of the several autoimmune diseases listed in Table 1 below.

 

Table 1.  Reported coexisting disorders

Thyroid disease (Graves’ disease & Hashimoto’s thyroiditis)
Diabetes mellitus
Adrenal insufficiency
Lupus erythematosus
Alopecia areata
Myasthenia gravis
Pernicious anemia
Rheumatoid arthritis
Sarcoidosis
Chronic active hepatitis
Vogt Koyanagi Harada syndrome
Autoimmune polyglandular syndrome
Psoriasis

 

Genetics research confirms vitiligo’s autoimmune link

A 2010 genetics research study, led by Dr. Richard Spritz of the University of Colorado, studied more than 5,000 individuals, both with and without vitiligo. The study determined that vitiligo is in fact an autoimmune disease and found that several genes linked with vitiligo also had associations with other autoimmune disorders. According to the researchers, this indicates that persons with vitiligo have an increased risk of developing other autoimmune diseases, as do their close relatives - even those without vitiligo.

In autoimmune diseases, multiple genes are involved. What is inherited is not one specific gene that causes one specific disease; rather, several genes increase vulnerability or susceptibility to get autoimmune disease in general and certain diseases or groups of diseases in particular.

Autoimmune diseases tend to occur in families. If there’s one case of an autoimmune disease in the family, there is an increased risk of those in the family developing other autoimmune disorders. However, it is often not risk for the same autoimmune disease; rather, it is a more general tendency toward autoimmunity, particularly to certain diseases within a group of related diseases. Thus, one family member may have hypothyroidism, another family member may have vitiligo, a third member of the family may have rheumatoid arthritis, and a fourth family member might have none at all, another condition, or two or more of those diseases.

Since vitiligo tends to occur more often with certain other autoimmune diseases (see Table 1), this suggests that these different autoimmune diseases probably share at least some predisposing genetic or environmental causal factors, although these remain mostly unknown.

What should a person with vitiligo do?

There are routine tests available that can put one’s mind at ease about the risk of autoimmune disease. If you have been to a dermatologist for your vitiligo, the doctor may have already tested you for the presence of autoimmune disorders linked to vitiligo. The tests are aimed at identifying antibodies and other markers that are symptomatic of autoimmune disease. What are these tests?

Complete thyroid panel including the following tests:

  • TSH
  • TPO  
  • Free T3
  • Free T4

A thyroid panel is a group of tests that are often ordered together to help evaluate thyroid gland function and to help diagnose hypo (deficient activity) and hyper (excessive activity) thyroidism, due to thyroid disorders. The tests measure the amount of thyroid hormones and enzymes in the blood. These hormones are TSH (thyroid stimulating hormone), free T4, and free T3. TSH is produced by the pituitary gland and helps to maintain stable amounts of the thyroid hormones T4 and T3. When the system is functioning normally, thyroid production turns on and off to maintain constant blood thyroid hormone levels.

Thyroid peroxidase (TPO) is an enzyme made in the thyroid gland that is important in the production of thyroid hormone. The thyroid panel should also include the TPO test, which detects and measures antibodies directed against thyroid peroxidase (TPO).

The presence of thyroid peroxidase autoantibodies (TPOAb) in the blood reflects a prior attack on the thyroid tissue by the body's immune system and suggests that the cause of thyroid disease is due to an autoimmune disorder such as Hashimoto’s disease or Graves’ disease.  Hashimoto’s thyroiditis occurs when the thyroid produces too little hormone (hypothyroidism), and Graves’ disease is when the thyroid produces excessive hormone (hyperthyroidism), both due to an autoimmune attack on the thyroid gland.

The reported evidence is strongest for a link between vitiligo and autoimmune thyroid dysfunction.  Many researchers have reported the propensity of people with vitiligo to develop thyroid dysfunction, which may be at the subclinical (not symptomatic) or clinical level. As vitiligo often precedes thyroid disease, it is recommended that the person with vitiligo be regularly screened for thyroid dysfunction and thyroid-related antibodies.

 

Antinuclear Antibody (ANA) test:

An ANA test detects antinuclear antibodies associated with other autoimmune diseases, especially connective tissue diseases. Examples of these diseases include lupus, rheumatoid arthritis and scleroderma. A positive ANA test doesn't definitely prove the presence of a connective tissue disease. However, it helps narrow the range of possible diagnoses if there are other factors or symptoms.

 

Complete Blood Count (CBC)

The CBC is one of the most common blood tests. It's often done as part of a routine check-up. The CBC can help detect blood diseases and disorders, such as anemia, infections, clotting problems, blood cancers, and immune system disorders. This test measures many different parts of your blood.

WBC White Blood Cell May be increased as a result of infections, inflammation, cancer, leukemia; or decreased due to some medications (such as methotrexate), chemotherapy, radiation therapy, or diseases of the immune system.
RBC, Hgb, Hct Red Blood Cell, Hemoglobin & Hematocrit Decreased with anemia (blood has a lower than normal number of red blood cells). (Pernicious anemia is a condition in which the body can’t make enough healthy red blood cells because it doesn’t have enough vitamin B12.  It is one of the autoimmune conditions closely associated with vitiligo.)

MCV

MCH


MCHC

Mean Corpuscular Volume
Mean Corpuscular Hemoglobin

Mean Corpuscular Hemoglobin Concentration

The MCV measures the average size of the red blood cell.
MCH measures the amount of hemoglobin in a single red blood cell.
MCHC concentration measures the average hemoglobin concentration per unit volume of packed red cells.

B12 and/or folic acid deficiency (conditions associated with vitiligo) can increase MCV, MCH, and MCHC indicating that further testing may be necessary. 
Platelet Platelets Platelets are cell fragments that participate in clotting. They initiate repair of blood vessel walls. Platelet counts can be decreased or increased for a number of conditions that affect platelet production, including anemia, B12 and/or folic acid deficiency and systemic lupus erythematosus, diseases associated with vitiligo.

 

Comprehensive Metabolic Panel (CMP)

A comprehensive metabolic panel is a group of chemical tests performed on the blood serum (the part of blood that doesn't contain cells).

These tests include total cholesterol, total protein, and various electrolytes such as sodium, potassium, chlorine, and many others.

This test helps provide information about your body's metabolism, providing information about how your kidneys and liver are working, and can be used to evaluate blood sugar, cholesterol, and calcium levels, among other things.

Abnormal test results can indicate underlying medical conditions.

 

Folate/B12

B12 and/or folate (folic acid) deficiencies are often found in those with vitiligo. B12 and folate are B complex vitamins that are necessary for normal red blood cell formation, tissue and cell repair, and DNA synthesis. Over time, a deficiency in either B12 or folate can lead to a variety of health problems, including pernicious anemia, a condition reported to be associated with vitiligo. High doses of these supplements are recommended by some vitiligo experts. There have been isolated reports that repigmentation was achieved in vitiligo patients with B12 and/or folate deficiencies after prolonged administration of folic acid and vitamin B12.

It is recommended that these two nutrients always be supplemented together. If there is a B12 deficiency and only folic acid is taken, it can mask some of the blood changes and clues that a B12 deficiency exists, and vice versa. Such masking can allow progressive and irreversible damage to take place in the brain, spinal column, and peripheral nerves. Further, folic acid must be present for the proper use of B12.

No supplement should ever be taken alone or in combination without first consulting a doctor. Some supplement combinations can be dangerous when combined or when taken out of balance with one another. This information is provided so that you may research on your own to determine with your doctor the best approach to your treatment.

 

25-Hydroxy-Vitamin D

There have been reports of low levels of vitamin D in vitiligo patients. One study found that people with darker skin tones had a greater risk of vitamin D deficiency.  In addition, the investigators noted that patients with very low levels of vitamin D faced a 10-fold higher risk of having another autoimmune disease, including systemic lupus erythematosus, Sjögren's syndrome, Hashimoto's thyroiditis, Graves' disease, alopecia areata, or inflammatory bowel disease.

 

Going Forward:

While we do not know the exact or specific causes of vitiligo, we do know that it is a chronic condition in which melanocytes (the cells that make pigment) in the skin are destroyed. Why and how these melanocytes disappear we do not fully understand, but we now know that there is an autoimmune component as well as genetic and biological factors not yet understood.

Vitiligo is a complex syndrome, involving multiple causative factors, some of them necessarily working in concert. Until we know more about the cause and nature of this disease which affects as many as 40 million people around the world, the best strategy is for each of us with vitiligo to stay informed so that we are in the best possible position to make the decisions that protect our skin and health. We will report on any future findings that may shed more light on these and other autoimmune disease linkages with vitiligo and what this means for us.

Micropigmentation
to Cover Vitiligo

Researchers Report Cosmetic Tattoo Procedure
Effective in Treating Lip Vitiligo


Vitiligo on the lips is difficult to treat and can cause embarrassment and self-consciousness.  Melanocytes, the cells that produce the pigment that gives skin its color, reside in our hair follicle reservoir and migrate from there when stimulated by pigmenting treatments. As there are no hair follicles on the lip, traditional repigmenting therapies are often not effective.

Surgery and micropigmentation (cosmetic tattoo) are two procedures being used for repigmenting areas like this. Surgical procedures transplant melanocytes to the lips to restore pigment, while micropigmentation uses a tattoo process and very fine needles to deposit tiny bits of pigment to the area. Both are especially useful for sites that have a poor rate of repigmentation with other therapies.  In addition to the lips, such sites can include fingers, toes, hands, wrists, armpits, elbows, hairline, anal area, lower legs, and mucosa and mucocutaneous (lubricating membrane lining an inner surface or organ) junctions. Extensive mucosal (usually the inside of the mouth) depigmentation in vitiligo may involve gingival (gum) tissues, which may also be tattooed to obtain near normal gingival color. Besides vitiligo, micropigmentation is a useful adjunctive therapy for camouflaging other discolorations and a variety of scars.

Micropigmentation has had mixed reviews from both vitiligo patients and medical professionals.  Some report satisfaction with the procedure; others question whether it is worth the effort.  This is why the very positive results of a small-scale study of micropigmentation therapy caught our eye. The results were published by researchers from the Department of Plastic and Reconstructive Surgery at Chhatrapati Shahuji Maharaj Medical University in Uttar Pradesh, India in a recent 2010 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery.

Researchers in this study found that this form of tattooing, in their opinion, worked well in treating vitiligo in the lip area, particularly in dark skin, and better than surgery.

What exactly is micropigmentation?

Micropigmentation uses equipment similar to devices used in specialized tattooing methods. However, the pigments used are metabolically inert and are different from any kind of tattooing ink. It generally involves the use of a non-allergenic iron oxide pigment to cover recalcitrant areas of vitiligo.  The artificial pigment is implanted into the skin by means of a cluster of needles attached to a high-speed apparatus. It is an adaptation of the technique of permanent eyeliner tattooing.

The iron oxide pigments are available in a variety of colors and shades from various manufacturers. There is a fading of the dye by about 20% within the first few weeks.  Additional 2-3 treatments may be required to refresh the color to make it more closely match the uninvolved skin.  (Micropigmentation or cosmetic tattooing may also be called permanent cosmetics, permanent make-up, Derma-Pigmentation, or camouflage tattooing.)

A technician is commonly the person doing the micropigmentation procedure. However, there are board-certified plastic surgeons and dermatologists who perform micropigmentation as well.

How well does it work?

In the Indian study, 15 patients with localized stable lip vitiligo were treated by cosmetic tattooing. Of these 15, 11 experienced excellent color matching, two had good color matching, and two experienced minimal fading and required repeat tattooing – one after 18 months, the other after two years. These patients were all followed up for 2-3 years.

The patients required 2-3 sessions of tattooing in the lips to achieve the most aesthetically pleasing result. Though there have been side effects reported in the literature such as leaching, color mismatch, change in shade over time, and hypertrophy, the study did not report any of these complications or adverse effects with the exception of the minimal fading in 2 of the patients in the study mentioned above.

The benefits cited by the study’s authors were that there was (1) lack of postoperative pain, (2) minimal patient inconvenience, and (3) limited expense.  The authors further reported that the results are considered permanent, although some fading will occur with time, requiring an occasional touch-up within a period of 2-3 years.

The study authors concluded that tattooing was a better option for stable vitiligo of the lips than any of the surgical procedures that have been used and reported on.  It was simpler, more effective, safer and less costly.

On VSI’s forums, a number of vitiligo patients have reported dissatisfaction with micropigmentation, often saying that their color did not last after undergoing this procedure.  A few others reported being very satisfied. The discrepancy between these experiences may lie in the skill of the provider applying the pigment, whether the pigment was inserted deeply and evenly enough, and if there were touch-ups done after the initial application. (At the end of this article, we have provided more detail on what is involved in the procedure, and how to find a skilled practitioner.)

Fading does occur to a degree after the procedure is done. Follow-up treatments are generally required to touch-up the color.  Generally, the most precipitous loss of pigment occurs within 1 week of the procedure, with maximum fading occurring within 6 weeks.  For the majority of cases, only a moderate degree of fading occurs. In some cases, especially those involving the fingertips, there is a significant loss of pigment.

It should be expected that lip tattoos will fade over time as do all tattoos and permanent makeup applications.  Estimates have been made that the tattoos will look good for 2-4 years, maybe even longer. (At the end of this article, we have provided some additional facts about side effects and precautions that should be exercised in undertaking this procedure.)

Who is a good candidate for micropigmentation?

People with non-progressive vitiligo where new white spots or patches have ceased to surface and the existing patches aren’t gaining in size are considered the best candidates. People of a darker skin color may be more likely to have the best result.

Who is not a good candidate for cosmetic tattooing?

There are several situations which pose risk to people when using micropigmentation.  The people who should not use micropigmentation include:

  • Those who are prone to developing keloids – scars that grow beyond normal boundaries – are at risk of keloid formation from a tattoo.
  • People using blood thinners, antihistamine prescriptions, beta blockers for blood pressure control, painkillers or any form of narcotic medication. 
  • People with a history of herpes simplex virus infection, unless they are being treated with prophylactic antiviral drugs.
  • People who have tested positive for HIV.
  • People with a medical history of skin problems like psoriasis are likely to be refused this treatment.
  • Allergies may also preclude someone from having this treatment.

 

Conclusion

Micropigmentation seems to have the potential to be an effective treatment option for those select people who are good candidates, who are being treated by a skilled and experienced practitioner, and who know what to expect.  Though the procedure provides a more long-lasting and waterproof improvement in the skin than make-up and dyes, it is important to realize the improvement is not necessarily “permanent.”

As there are no large-scale, double-blind trials of the procedure, we do not know precisely how long the improvement lasts or what type of person has the best experience. To be safe, if you consider this treatment, you should approach it assuming a possibility that you will experience ultimate fading in years ahead and that additional treatment would be needed to maintain the camouflage tattoo.

Where do I find a professional who does this treatment?

A knowledgeable physician is the best person to help decide
if micropigmentation is an advisable choice for you.

Selecting a medical professional who is experienced and knowledgeable
in the procedure is critical to ensure the best cosmetic and safe result.
It could make the difference between a good result and an unsatisfactory one.

Ideally, the practitioner should be licensed (if required by the state) and board-certified by the American Academy of Micropigmentation and the Society of Permanent Cosmetics Professionals.

States vary as to whether they require a license to perform micropigmentation treatment. Some states may only require registration with the local health office or have regulations only in county or city jurisdictions. Others prohibit the procedure entirely.

To find the regulations for your state, consult: http://www.state.xx.us

NOTE: You must first replace the “xx” with the two-letter
            abbreviation for the state you are researching.

Search for “micropigmentation” or “permanent cosmetic tattooer” (or permanent cosmetic tattooing) from the home page of your state’s web site or in section for licensing or regulations.

Get references through friends, your doctor, the treatment provider, the   American Academy of Micropigmentation, and the Society of Permanent Cosmetic Professionals. Online chat rooms may be another source of    references.

Review the treatment provider’s credentials and make certain that they are current. Ask about the type and length of training. Also, ask how many times the provider has performed the micropigmentation treatment you are considering.

Review the provider’s portfolio of before-and-after photos of micropigmentation patients, in order to help set reasonable expectations. Bring a photo of the result you would like to have.

Inquire about the type of equipment used, where the procedure will be     performed, and the extent of the procedure.

Ask about possible side effects.

 


 

Additional Facts

  •  A slight bluish hue has been noted to occur in the treated micropigmented skin. One medical expert recommends not using colors that contain black or grey pigments in order to avoid this “bluish hue.”

  • To prolong the life of the tattoo, limiting exposure to the sun, wind, salt and chlorine will help. Also, keeping the lips moisturized will help sustain the vibrancy of the tattoo.

  • It can be difficult to match the patient’s skin perfectly. Because the dye is being applied to a completely colorless area, the color will appear darker than the surrounding normal skin upon initial application. It is best to choose a color that actually closely matches the surrounding normal skin.

  • The color also does not adjust to seasonable changes of uninvolved sites. (If the surrounding area tans or fades with the seasons, the micropigmented area may no longer match.)

  • Aging can create discoloration.

  • Micropigmentation is generally considered a safe and inexpensive procedure without significant adverse effects. Short-term side effects are few, mild, localized, and generally occur immediately after the procedure with complete resolution within one week. They include oozing from scattered points of puncture, usually lasting several hours. Moderate swelling of the lips invariably occurs, however, with resolution within 24 hours.

  • Micropigmentation can lead on occasion to infection, allergic reactions to the pigments, granulomas (a type of inflammatory tumor or growth),
    keloid (scar) formation and MRI complications (temporary burning and swelling of treated area following MRI exposure.)

  • The few immediate adverse effects of micropigmentation are usually believed to result from improper technique and lack of adherence to sterile practices.

  • Koebnerization (trauma induced loss of pigment) can occur at the site of micropigmentation.

  •  If the person desires to have the color removed, it can be difficult.

 


 

What can I expect during the procedure?

  1. The area of skin to be treated is carefully prepared with an antiseptic solution. Sterile towels are draped around it.

  2. The skin is anaesthetized by infiltrating with a 1% - 2% lidocaine solution with or without epinephrine subcutaneously.

  3. The pigments are then applied by repeated gentle jabbing motions with the needle perpendicular to the skin surface. An antibiotic ointment is used as needed to wipe away the excess pigment during the procedure.  Freshly micropigmented areas are either dressed with the antibiotic ointment and sterile nonadherent dressings or, for the lips, application of antibiotic ointment alone is sufficient.

  4. Written instructions are given to keep the dressing clean and dry and to remove it after 24 hours. Thereafter, the micropigmented areas are left exposed while keeping them as dry as possible for the next 5 days, except for the application of antibiotic ointment twice a day.

  5. Patients will return for weekly follow-up and then monthly if no complications occur.

  6. Costs of the procedure will vary depending on your specialist and the area where you live. Roughly, the costs of the procedure run between $700 and $1,000. This fee generally will include a certain number of appointments, including those for touch-ups and aftercare.

Medical News Updates

Highlights of recently-published medical
articles on vitiligo and its treatments


Ginkgo biloba taken twice daily was found to be
helpful in treating vitiligo in a pilot trial.


University of Toronto researchers treated 12 vitiligo patients with 60 mg of standardized Ginkgo biloba two times per day for 12 weeks. Eleven participants completed the trial with 85% or greater adherence to the protocol. The progression of vitiligo stopped in all patients. The vitiligo lesions averaged 15% repigmentation. At least 25% of the participants achieved a clinically significant 30% repigmentation. There was a lack of serious adverse reactions. Of the 11 participants who completed the trial, two experienced no change and one experienced a very small improvement. Two participants achieved greater than 30% improvement, with another achieving 27% and three more 11 to 18% improvement.

They felt their findings were consistent with a previous report showing effectiveness in treating vitiligo with Gingko biloba in a double-blind, randomized trial conducted in India. The 2003 Indian study reported that 40 mg of Ginkgo biloba three times per day for 6 months arrested the spread of vitiligo in 20 out of 25 participants in the active group, and induced marked (75% or greater) repigmentation in 10 of these participants.

The Toronto researchers were not sure why the Indian study had better results but they speculated on a number of things. The Indian study was longer; they did not use the exact same Ginkgo biloba extract; the dosage was different and delivered in an alternate method. They said the genetic variations in the population might have made a difference, as well as diet and social differences. In the Toronto study, some of the participants did not complete the study until November, thus experiencing substantially less sun exposure in the later months of their treatment. Because sun exposure can stimulate the proliferation of melanocytes and vitamin D, this factor could also explain the deviation in results.

There were no identifiable differences in gender, location or type of vitiligo, duration of vitiligo, or skin type between the participants who improved the greatest and those who did not improve at all. Of the three participants who improved the greatest, two had progressive vitiligo, while one had non-progressive.

The researchers said they did not know why the Ginkgo biloba worked, but it is an antioxidant, affects the immune system and has anxiety-relieving properties. They felt that the ease of taking an oral pill, the relatively low cost, and the low frequency of adverse reactions with Ginkgo biloba makes its use for vitiligo tempting. They felt their initial results did provide preliminary evidence that Ginkgo may have a role in the management of vitiligo.

The pilot study was focused on determining the feasibility of a future large, randomized, controlled trial of Ginkgo for the treatment of vitiligo. They felt their findings indicated that a larger, double-blind, placebo-controlled randomized study was feasible. Though the Gingko study’s 15% improvement after 3 months of treatment is much smaller than can be achieved with other therapies over a longer duration, the researchers believed Ginkgo was worth investigating further as a potential treatment of vitiligo. Ginkgo biloba is available over-the-counter and is widely-used for a variety of purposes.

Editor’s Note:  A third study with oral Ginkgo biloba and narrow band UVB is now being done by King Saud University Hospital as a vitiligo treatment. We will report on the results of this study when its findings are published.

 



Study finds that NB-UVB is more effective for vitiligo patients
when used with tacrolimus ointment (0.1%) than UV treatment alone.

In a randomized double-blind trial, patients with stable symmetrical vitiligo were treated half-side with tacrolimus ointment (0.1%) and half-side with placebo ointment. Whole body NB-UVB was given twice or thrice weekly for at least 3 months.  Of the 40 patients, 27 had a better effect on the tacrolimus side. The degree of improvement was significantly better on the tacrolimus side. There was a correlation between the effect and the number of topical tacrolimus applications, but there was no correlation with the number of UV treatments given; nor was there any difference based on gender, age, skin type, duration of disease, familial occurrence of vitiligo, nor presence of other autoimmune disease or allergy.

 



Children with vitiligo show an increased
incidence of autoimmune thyroiditis.

Researchers in the Department of Dermatology at Karadeniz Technical University in Turkey studied the thyroid functions of 50 children and adolescents with vitiligo (26 boys, 24 girls; mean age 9.5 years) and 50 control children (25 boys, 25 girls; mean age 8.8 years) who did not have vitiligo and were otherwise healthy.  The purpose of the study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. They found a significant association between autoimmune thyroiditis and sex and disease duration.  Autoimmune thyroiditis was identified in four subjects with vitiligo (all girls; one child, three adolescents).  Vitiligo disease duration in these patients was significantly longer than in the other patients. No one in the control group was found to have thyroiditis.  Although all vitiligo patients with thyroiditis had vulgaris-type disease, there was no significant association between thyroiditis and clinical types of vitiligo.

They recommended that children with vitiligo, especially girls and subjects with generalized/vulgaris-type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis. Neither overt hypothyroidism nor hyperthyroidism were detected.

 

Editor’s Note: Autoimmune thyroiditis has two forms: Hashimoto’s thyroiditis and Graves disease. With Hashimoto’s thyroiditis, the thyroid gland is gradually destroyed by a variety of cell- and antibody-mediated immune processes and causes the production of too little thyroid hormone (hypothyroidism). Symptoms of the disease are varied and several, but include fatigue, weight gain, elevated blood cholesterol level, depression, sensitivity to cold, and muscle cramps. Graves’ disease causes the thyroid to produce too much thyroid hormone (hyperthyroidism). Symptoms may include anxiety, irritability, weight loss, sensitivity to heat, goiter, and bulging eyes. Treatment can control these diseases. Few data have been reported about the association between vitiligo and autoimmune thyroiditis in pediatric populations. Data from the few available studies has been conflicting; however, in the opinion of this study’s authors, some of these studies either did not have a control group or there were limitations in the methodology used. The risk for thyroid disease in childhood vitiligo is being debated, but authors of this study feel their research shows increased risk in children with vitiligo for this form of thyroid disease.

Research & Clinical Trials

VSI would like to extend its “Congratulations” to
Pearl Grimes M.D.

Dr Grimes was recently awarded:

The “Practitioner of the Year” from the Dermatology Foundation
And
The “Mentor of the Year” from the Women’s Dermatologic Society

Dr. Grimes is the Chairman of
VSI’s Medical and Scientific Advisory Committee



Clinical Trial Enrolling for New Vitiligo Treatment

Dr. Pearl E. Grimes: Medical Director
Vitiligo & Pigmentation Institute of Southern California

Is Nationally and Internationally Recognized
For Her Work on Pigmentary Disorders.

The Institute is conducting a Clinical Study
for a New Vitiligo Treatment:

An Experimental Drug to be Used in Combination
With Narrowband Ultraviolet B (NB-UVB) Phototherapy.

For More Information:  Click here to visit VSI's Clinical Trial page

 


Clinical Trial Enrolling for New Vitiligo Treatment

The Department of Dermatology at
Henry Ford Hospital in Detroit, Michigan
 

Is Conducting a Clinical Study for a New Vitiligo Treatment:
An Experimental Drug to be Used in Combination
With Narrowband Ultraviolet B (NB-UVB) Phototherapy.

For More Information:  Click here to visit VSI's Clinical Trial page

 


Major Expansion of Vitiligo Genetics Project

University of Colorado Health School of Medicine

Update!

International Study to Find Vitiligo Genes

Additional USA and Canadian Patient Volunteers Needed

Scientists with the international VitGene Consortium project spanning 18 countries are working to understand the biology of vitiligo so that more effective vitiligo treatments can be designed. Thanks to your involvement, the first phase of this research project has been very successful, discovering many vitiligo genes, resulting in real breakthroughs in our understanding and opening new doors to developing potential new treatments.

We now plan to expand these studies to discover additional vitiligo genes, giving us even more targets for treatment. That means we need to double the number of patients. Our new goal is to enroll 3000 additional Caucasian (white) vitiligo patients over the next two years. Your help is essential.

If you are from the USA or Canada and have not previously taken part, your participation is vitally needed. Please complete the questionnaire below then email directly to Dr. Richard Spritz at the University of Colorado School Of Medicine using the email address provided at the end of the questionnaire.

Your personal information, by law, will be kept private and will not be sold or disclosed. Join with us to work for a vitiligo-free future!

Click here to download the questionnaire

Click Here to Read Research Updates on this Study

 


Patients Invited to Participate in Online Vitiligo Survey

Sponsored by Nanette B. Silverberg, MD
Departments of Dermatology,
St. Luke's-Roosevelt and
Beth Israel Medical Centers, New York, NY

Dr. Silverberg is conducting a survey to review medical, genetic,
psychological and nutritional factors that may
cause or exacerbate vitiligo.

  • Individuals with vitiligo that have been previously diagnosed by a physician are welcome to contribute to this survey.

  • Friends and family without vitiligo are also encouraged to respond as control subjects. Just answer the questions that are applicable

  • The survey will not include any personal information that may identify you to the public.

Click Link to Select the Appropriate Survey Below

Participate in this Survey as an Adult with Vitiligo
Adult Vitiligo Survey

OR

To Participate in this Survey For Your Child
Survey For Your Child

What's On Your Mind?


Q.  Is it OK to put the topical ointments around the eyes?

A.  If you are trying to treat depigmented areas around the eyes, you need to be careful not to get the ointment or cream too close to the side of the eye where it could get warm and possibly leach into the eye. It is better to sparingly apply the ointment or cream just below the eyebrow. When you blink it will spread onto the lower part of the eyelid, but shouldn’t get into the eye.


Q.  I am using NB-UVB light, but wearing goggles.  Is it safe to remove the goggles to expose my eyelids to the light?

A.  As long as the patient is old enough to understand they must keep their eyes closed at all times, and has an annual eye exam, it is safe to expose the eyelid to NB-UVB light.

Reference: Prystowsky JH et al, J Am Acad Dermatol 1992; 26:607
http://www.ncbi.nlm.nih.gov/pubmed/1597547

(Source: Amit G. Pandya, MD, Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas)


Q. Will Protopic make my vitiligo stop spreading?

A.  Protopic is a topical treatment and only treats the area that it is applied to.  If your vitiligo is actively spreading on the body, Protopic cannot stop the spreading; you would need to ask the doctor about a systemic treatment to stabilize your vitiligo so that you do not continue to lose pigment on areas of the body not being treated. If applied to an area that is in the beginning stages of depigmentation, Protopic can sometimes stop the area from developing further and/or restore it to the original color.


Q. What will new pigment look like? How will it start?

A.  New pigment comes from the hair follicle where the melanocytes reside. It usually begins as a small dot or freckle. It will continue to grow until it gets bigger and bigger and eventually fills in the depigmented area.

Sometimes the new pigment (freckle) will show up inside a depigmented area, with one or more freckles that grow bigger. Other times you won’t see any freckles inside the area, but instead the depigmented area gets smaller and smaller because the new pigment is migrating from the outside edges of the depigmented area.

Tip:  It’s a good idea to take pictures when you first begin treating, then again every 3 months or so to compare for progress.

To View Summer Newsletter Bibliography: Click Here

Support Groups

One of the most often asked questions VSI receives is:
Can you tell me where the nearest support group is?


VSI recognizes that the need is great for this type of personal resource, but to date we have not had the funding or manpower to offer physical support groups.

We began surveying other small nonprofit organizations for ideas of alternate ways to implement personal support on a smaller scale that would not exceed our current capacity.

If you have vitiligo, you have most likely at some point, experienced the feeling of being alone in a world where no one understands. Vitiligo can seemingly pull the rug completely out from under even the most well-adjusted person, leaving feelings of insecurity and helplessness.

We talk with people daily who find it hard to believe they could ever regain the emotional stability they once knew and enjoyed. The road back to a full and happy life is paved with small stepping stones. Sure, there will be bumps in the road, but learning to recognize the bumps and how to move around them will put most people back on track.

Along with a supportive family and medical professional, what better help to get back on your feet, than someone who’s been down the same bumpy road and has successfully emerged on the other side? As a result, we’d like to recruit a group of people who would be willing to talk personally, by phone or email, to those who need some emotional support. VSI would screen those requesting assistance to make sure that professional help is not required.

Contact information must be complete and verifiable in order for VSI to proceed with the process.

If you’re interested in becoming a volunteer, please click below and fill out the online application as completely as possible.  Click here to complete application.

Earn funding for VSI when you Shop!
Please keep VSI in mind when you do any of your online shopping


Amazon.com has all kinds of items in addition to books. As long as shopping is done through this link, Amazon.com, or from the Amazon box on our Community Home Page, Amazon returns a portion of the sale to VSI. The more items members buy, the higher the percentage!

Our Vitiligo Library and Store is also powered by Amazon. It contains books, articles and products for those with vitiligo.

Our other program is iGive.com. The iGive shopping mall has over 700 stores where you can shop and VSI gets a percentage. Let friends and family know about iGive, so they can support VSI, too. You do have to register for iGive. Once you've registered, you can either shop directly through their "mall" on iGive's website or by downloading their toolbar, which makes it even easier. iGive also has a search function powered by Yahoo at isearchigive.com that earns VSI a penny per search. The power of numbers makes this also an effective way to support VSI.

You Can Make a Difference Today,
For Someone in the Vitiligo Community

There is no other source available that offers the comprehensive   vitiligo education and patient support as VSI

By making a donation to VSI as a Supporting Member; your gift will make a difference in the life of another person living with vitiligo. Over 100,000 people with vitiligo contacted VSI last year for help. We respond daily to hundreds of people coming to us for information and support. As we depend on donations from the public to serve vitiligo patients, your gift is critically needed.

When you join as a Supporting Member, you will have the satisfaction of knowing you are helping others whose lives have been affected by vitiligo.

You will also gain additional Supporting Member Benefits.
If you are already a Supporting Member, an additional gift is welcome and gratefully appreciated. Thank you for your support and for enabling us to provide critically-needed services to this community.

 

Copyright © 2011 Vitiligo Support International Inc. All rights reserved.
Reproduction or republication strictly prohibited without prior written permission


A Vitiligo Support International, Inc. financial statement is available upon written request from the Virginia Office of Consumer Affairs.
Mail requests to: Virginia Department of Agriculture and Consumer Services, Office of Consumer Affairs, P.O. Box 1163, Richmond, Virginia 23218.