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Objectives: Vitiligo is the most prevalent acquired leukoderma. It has a profound psychological impact, especially in people with skin of color. It might be difficult to diagnose vitiligo early since it resembles nevus depigmentosus, pityriasis alba, idiopathic guttate hypomelanosis and post-tinea versicolor hypopigmentation.

Materials / method: Published literature discussing dermoscopic criteria of vitiligo as well as other common hypopigmented lesions was revised from 2000 till 2023. The criteria with their definitions were tabulated. 168 patients with hypopigmented skin lesions namely vitiligo, depigmented nevi, mycosis fungoides, idiopathic guttate hypomelanosis, pityriasis alba, pityriasis versicolor, lichen sclerosis et atrophicus, or ash leaf macule of tuberous sclerosis were diagnosed clinically and confirmed pathologically. Dermoscopic images of their lesions were obtained.

Results: Statistical analysis was used to calculate the sensitivity and specificity of diagnosis of dermatoscopic images of lesions in comparison to confirmed clinicopathological diagnosis. White structureless areas, well-defined borders, and absent pigment network were the most frequent findings in lesions of vitiligo in 35/38, 31/38, and 30/38 patients, respectively.

Conclusion: Dermoscopy enhanced the diagnosis of 36 cases of vitiligo out of 38 patients with a sensitivity of 94.7% and 98.5% specificity. Thus dermoscopic criteria are valid in identifying cases of vitiligo and differentiating it from other hypopigmented disorders.

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Objectives: We examined whether any nuclearus and cell fusion associated with a positive immunolabelling of varicella-zoster virus (VZV) and VZV mature virions could be found in segmental vitiligo (SV) skin samples as in herpes zoster (HZ)

Introduction: Segmental vitiligo (SV) is a unilateral subtype of vitiligo which is clinically characterized by a cutaneous depigmentation and histologically by a melanocyte loss from the epidermis and hair follicle reservoirs. To date, its pathogenesis remains a mystery. In many cases, this skin depigmentation shares several clinical features and dysfunctions with herpes zoster (HZ).

Materials / method: A total of 40 SV samples were used for histological and immunochemical studies. Control samples were obtained from three HZ, and 10 generalized vitiligo lesions. For ultrastructural study, three recent SV and one HZ as controls were recruited.

Results: We report that nuclear fusion in epidermal cells were statistically associated with recent SV (p<0.001) whereas, syncytia formation was associated with long-lasting SV (p= 0.001). A positive detection of VZV antigen was statistically associated in the epidermis with recent SV and in the dermis with long-lasting SV (p=0.001). Finally, the discovery of mature virions in 3/3 recent SV samples provides additional arguments for our viral hypothesis.

Conclusion: We hypothesize that in SV, an occult, brief and non-contagious VZV reactivation could be the first step of a cascade of events leading to a local depigmentation, and possibly to an autoimmune process. In this hypothesis, we could consider SV as a chronic depigmented sequelae developed in a localized area, following unique or successive viral reactivations of brief duration and low-grade intensity occurring in anatomically corresponding autonomic ganglia.

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Objectives: Recently, the monochromatic excimer light (MEL) has been used to treat vitiligo. The radiation wavelength of 308-nm can be delivered by the xenon-chloride excimer laser in a targeted form, or by an excimer lamp in an incoherent form.

Introduction: Vitiligo is the most common cause of depigmentation, with a prevalence of around 0.1% to 2%. In a 2020 randomized placebo-controlled trial, ruxolitnib cream resulted in substantial repigmentation of vitiligo lesions and was well tolerated amongst subjects.6 Both topical ruxolitnib and MEL have shown efficacy for the treatment of vitiligo, while being well tolerated amongst patients. Thus, we report a case of segmental vitiligo treated with ruxolitnib and the 308nm MEL delivered with an excimer lamp.

Materials / method: A 43-year-old Black male presented to our office with a 3-month history of white patches on the right maxilla region of the face. The patient was started on ruxolitnib 1.5% topical cream twice daily to the affected areas. At 4 month follow-up, mild improvement was observed (Figure 2). The patient received 308nm MEL with an excimer lamp, with an energy of 100mj/cm2 for 2 seconds for each lesion. Ruxolitnib cream twice daily was continued, and he received the 308-nm excimer light twice weekly with increasing energies as tolerated.

Results: As noted in the materials and methods, the depigmented macules and patches on the right nasal labial fold and lower cheek before treatment with ruxolitinib cream twice daily were unchanged. The patient achieved mild improvement after four months of the introduction of ruxolitinib. Significant repigmentation was not observed until the 308nm excimer lamp was added for 10 months. Complete repigmentation of the lower cheek, greater than 50% improvement of the right nasal labial fold, and 50% improvement of the right ala of nose.

Conclusion: Ruxolitnib in combination with the MEL delivered with a 308nm excimer lamp resulted in significant repigmentation in the lesions of segmental vitiligo. Given the difficulty in treating segmental vitiligo, in combination with the safety and tolerability of these modalities, this treatment could be an effective therapy for such patients. Clinical trials to determine long term safety data are needed.

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Objectives: Know better V.R. Foundation

Introduction: The Vitiligo Research Foundation
Firmly committed to curing vitiligo, the VR Foundation is a 501(c)3 non-profit, focused research organization. Our mission is to accelerate the end of suffering for millions of people who live with vitiligo through research, support and education.

VR Foundation is a consultative member of the United Nations Economic and Social Council (UN ECOSOC).

Results: The Vitiligo Research Foundation
Firmly committed to curing vitiligo, the VR Foundation is a 501(c)3 non-profit, focused research organization. Our mission is to accelerate the end of suffering for millions of people who live with vitiligo through research, support and education.

VR Foundation is a consultative member of the United Nations Economic and Social Council (UN ECOSOC).

Conclusion: The Vitiligo Research Foundation
Firmly committed to curing vitiligo, the VR Foundation is a 501(c)3 non-profit, focused research organization. Our mission is to accelerate the end of suffering for millions of people who live with vitiligo through research, support and education.

VR Foundation is a consultative member of the United Nations Economic and Social Council (UN ECOSOC).

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