Vitiligo is a skin disease that is caused by selective destruction of melanocytes and is characterized by white spots. Melanocytes and keratinocytes seem to exhibit a functional close relationship, mediated at least in part by keratinocyte-derived cytokines, which seem important for survival and activity of melanocytic cells. We wanted to investigate the hypothesis that in vitiligo the expression of epidermal cytokines may be modified compared with normal skin. In 15 patients with active, non-segmental vitiligo, biopsies were obtained from lesional, perilesional and non-lesional skin; normal skin from five healthy donors was also tested. Tissue sections were tested using immunohistochemistry for the expression of keratinocyte-derived cytokines with stimulating activity, such as granulocyte-monocyte colony stimulating factor (GM-CSF), basic fibroblastic growth factor (bFGF), and stem cell factor (SCF) or with inhibiting activity, such as interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) on melanocytes. Cytokine receptors and specific melanocytic markers were also investigated. No melanocyte was identified in lesional skin by means of specific markers or c-kit receptor, whereas in perilesional, non-lesional and healthy skin, melanocytes were found in similar number. In vitiligo skin a significantly lower expression of GM-CSF, bFGF and SCF was found, and a significantly higher expression of IL-6 and TNF-alpha was detected, compared with perilesional, non-lesional and healthy skin. In conclusion, we provided evidence that a significant change of epidermal cytokines exists in vitiligo skin compared with perilesional, non-lesional and healthy skin, suggesting that the cytokine production of epidermal microenvironment may be involved in vitiligo.

Case description: A 67 years old man presented to the clinic complaining of an itchy blistering skin rash over elbows, knees and buttocks for the past 2 months that is not responding to antihistamines. Itching has no diurnal variation. Patient has no chronic comorbidities a nd is not on regular medications. On examination, symmetrical vesicular lesions with erythema, crusting and itch marks are seen over both elbows, knees and back with-ve Nicolsky's sign. General examination reveals pallor, patient BMI 17.5, abdominal diste ntion, and peripheral neuropathy. Investigations showed microcytic hypochromic anemia with HGB 9.8 mg/dl, MCV 68, HCT 29.8, WBCs and platelets are normal. K 3.1 mg/dl, Na 135 meq/dl , Ca 8.5mg/dl, albumin 3 g/dl. Skin biopsy and direct immunofluorescence of t he skin around the lesions was taken that was diagnosed as dermatitis herpetiformis. Endoscopy was done and it confirmed the diagnosis of celiac disease.Treatment: Patient was advised to follow a gluten free diet plan and dapsone was started at a dose of 1 00 mg/day. Patient rash resolved gradually over a period of 3 weeks.

Our findings suggest that etanercept is more effective than acitretin in the treatment of psoriasis and that it is able to affect Th17 system.

Long-term treatment with 0.1% tacrolimus ointment is significantly more efficacious than a corticosteroid ointment regimen in adults with moderate to severe AD.

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