Generalized vitiligo is an autoimmune disorder characterized by patchy loss of pigmentation due to autoimmune destruction of melanocytes in the involved areas. Vitiligo is a polygenic, multifactorial disorder involving multiple genes and unknown environmental triggers. Recently, genetic variation in NALP1 (also called NLRP1), encoding a key regulator of the innate immune response, has been associated with generalized vitiligo in Caucasians of northern European origin. Here, we have investigated whether NALP1 is also associated with generalized vitiligo in Jordanian Arab patients. We genotyped 8 NALP1 single-nucleotide polymorphisms (SNPs) in 26 generalized vitiligo patients and 61 matched controls unaffected by vitiligo or any other autoimmune disorder. We found that two SNPs in the NALP1 extended promoter region, rs1008588 and rs2670660 were significantly associated with generalized vitiligo in our cohort of Arab vitiligo patients, and several other SNPs in the NALP1 region were at the margin of significant association. These results indicate that NALP1 is associated with susceptibility to generalized vitiligo in Arabs, as in Caucasians. Whether the casual variants are the same of not is yet to be identified by functional analysis.

FM is infrequently seen in north Jordan. We believe that repeated frictional trauma from clothing or scrub pads against the skin overlying the bony protuberances is fundamental in its pathogenesis. Other factors, such as scrub pads made of rough material (loofah), dark skin type, and individual variability, may also play a role in the pathogenesis. We advise patients not to use rough scrub pads during bathing, to avoid rubbing the skin overlying the bony prominences, to avoid rubbing vigorously, and to use a soft cotton pad instead.

Microneedling is an effective treatment for both acne scars and associated pigmentation in patients with dark skin color. The treatment appears to be safe apart from transient redness, mild dryness, and small hematomas, however additional treatments may be needed in some patients to achieve more improvement in pigmentation.

Although the PTPN22 1858C/T variant has been reported to play a role in increasing the risk of vitiligo in Caucasian patients, it does not appear to play a similar role in the Jordanian population, though a larger cohort of patients might be needed to confirm such a conclusion.