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Background Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. Objective To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. Methods A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. Results During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. Limitations Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. Conclusion The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

Background Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time. Objective The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography. Methods Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached. Results The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described. Conclusions This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment.

Background Patients with infantile nephropathic cystinosis have progressive accumulation of cystine in tissues leading to delayed extrarenal complications. No simple tool is available to evaluate the level of body cystine accumulation. Objective We sought to determine the value of in vivo reflectance confocal microscopy of the skin in patients with infantile nephrogenic cystinosis. Methods Nine patients and control subjects were recruited for this study. Images were acquired by means of a near-infrared reflectance confocal laser scanning microscope. Results Scattered bright particles within the papillary dermis were observed in all patients but not in control subjects. The density of particles ranged from numerous (+++) to very few (+/–) and their distribution was heterogeneous. Electron microscopy confirmed that these particles corresponded to cystine crystal deposits within dermal fibroblasts. The density of cystine crystals within the dermis was greater in older patients, in patients with a high leukocyte cystine concentration, and with delayed cysteamine therapy. There was no correlation between the density of cystine deposits and renal disease or hypopigmentation but high levels of deposition occurred in association with extrarenal manifestations. Limitations This is a preliminary study on a small sample of patients. Repeated examination and longer follow-up is necessary. Conclusion In vivo reflectance confocal microscopy of the skin appears to be a noninvasive means of assessing body cystine accumulation in infantile cystinosis and could be used as a complementary marker of treatment response in addition to leukocyte cystine measurement.

Background Nevus depigmentosus (ND) is known to be a rare congenital, nonprogressive disorder characterized by a hypopigmented lesion that remains stable over time. There have been only few studies of clinical and histopathologic characteristics of ND, and the etiopathogenesis is not fully established. Objective The purpose of this study was to investigate the clinical and histopathologic characteristics of ND. Methods A clinical survey was carried out with 60 patients given the diagnosis of ND. Punch biopsies (2 mm) from lesional and perilesional normal skin were performed. The sections were stained with hematoxylin-eosin, Fontana-Masson, antibodies to S-100 protein, MART-1, NKI/beteb, CD1a, CD3, CD20, and CD68. Results The lesions were usually present before the age of 3 years (68.3%), but some lesions appeared later in childhood (31.7%). In all, 27 patients (45%) had one lesion, but there were 14 patients (23.3%) who had more than 10 lesions. Fontana-Masson stain showed that the amount of melanin was significantly decreased in ND skin compared with perilesional normal skin. Melanocyte counts were significantly decreased in ND skin when stained with antibodies to GP-100 and MART-1. However, there were no significant differences in the number of melanocytes identified as S-100 protein–positive cells. There were no significant differences in histologic findings or dermal inflammatory infiltrates between ND skin and perilesional normal skin. Limitations Only 29 patients (48.3%) were followed up, and the average follow-up period after initial diagnosis was relatively short (68 months); therefore, these overall results may not be representative of the clinical course of the patients. Conclusion Only 18 patients (30.0%) presented with ND since birth and only 27 patients (45.0%) had one lesion. Both the amount of melanin and the number of melanocytes in ND skin were decreased in patients with ND. Therefore, both clinical and histologic findings should be considered together to make a diagnosis of ND.

Background Knowledge of the histopathology of melasma is a prerequisite for understanding its pathogenesis. However, the histopathological characteristics of male melasma are not well characterized. Objective We sought to investigate the histopathological characteristics of melasma in men compared with those of women with melasma and solar lentigo. Methods Biopsy specimens were obtained from both the lesional skin and the adjacent nonlesional skin in 8 men with melasma, 10 women with melasma, and 5 men and women each with solar lentigo. The samples were stained using Fontana-Masson and Verhoeff-van Gieson. Immunohistochemistry for melanocytes, the estrogen receptor, progesterone receptor, factor VIIIa–related antigen, stem cell factor, and c-kit was performed. Results Increased vascularity was found in the lesion of male melasma. The lesion to nonlesion ratio of the vessel area was increased in male melasma compared with lentigo groups. In the lesion of male melasma, there was a significant increase of stem cell factor and c-kit expression. In addition, the lesion to nonlesion ratio of stem cell factor was increased in male melasma compared with female melasma and lentigo groups. The lesion to nonlesion ratio of c-kit was also increased in male melasma compared with lentigo groups. Limitations This study did not include clinical data regarding social habits and was not confirmed by other molecular techniques. Conclusion The results suggest that chronic ultraviolet radiation associated with signaling of paracrine cytokines plays an important role in the mechanism associated with hyperpigmentation in male melasma.