mmj

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

2148-8118 2618-6020

Muğla Sıtkı Koçman Üniversitesi

Internal Diseases

İç Hastalıkları

Vitiligo Hastalarında Topikal Kortikosterid Kulanımının Serum IL-17 Düzeyine Etkisi

The Effect of Topical Corticosteroids on Serum IL-17 Level in Vitiligo Patients

https://orcid.org/0000-0003-0505-7850

Karakaş Çelik

Sevim

Bülent Ecevit Üniversitesi Moleküler Biyoloji ve Genetik Bölümü, Zonguldak

https://orcid.org/0000-0002-6572-9615

Solak

Nilgün

Bülent Ecevit Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıklar Anabilim Dalı, Zonguldak

https://orcid.org/0000-0002-9300-9324

Edgünlü

Tuba

Muğla Sıtkı Koçman Üniversitesi, Tıp Fakültesi, Tıbbi Biyoloji Anabilim Dalı, Muğla

https://orcid.org/0000-0003-2244-7965

Özel Türkçü

Ümmühani

Muğla Sıtkı Koçman Üniversitesi, Tıp Fakültesi, Tıbbi Biyokimya Anabilim Dalı, Muğla

12 04 2018

5 3 11 15 07 27 2018 10 22 2018

2014

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

Vitiligo edinsel depigmentasyonhastalıklarının en sık görüleni olup prevelansı %1-2’dir. Hastalıkmelanositlerin kaybı ile oluşmaktadır. Yıllardır vitiligo patogeneziniaçıklamaya yönelik biyokimyasal, immünolojik, genetik ve biyolojik çalışmalaryapılmaktadır. Ancak bugüne kadar, vitiligonun etyopatogenezi ve mekanizmalarıtam olarak anlaşılamamıştır. Yakın zamana kadar vitiligo Th1 odaklıotoimmuninflamatuar bir hastalık olarak kabul edilmekteydi. Ancak yapılan sonçalışmalar Th17’nin de vitiligo patogenezinde önemli bir rol aldığını ortayakoymuştur. Vitiligo hastalarında IL-17 düzeyinin arttığı birçok çalışmadagösterilmekle birlikte vitiligo hastalarında topikal kortikosteroidkullanımının IL-17 düzeyine etkisini araştıran bir çalışma yapılmamıştır. Buçalışmada vitiligo hastalarında topikal kortikosteroid kullanımının IL-17 serumdüzeyine etkisinin belirlenmesi amaçlanmıştır. Çalışma kapsamında Bülent EcevitÜniversitesi Tıp Fakültesi Hastanesi Dermatoloji bölümünde kortikosteroidtedavisi gören 68 vitiligo hastası ile herhangi bir tedavi almayan 16 vitiligohastasında serum IL-17 düzeyleri belirlenmiştir. Serum IL-17 düzeyleri topikalkortikosteroid tedavisi alan ve almayan hastalar arasında karşılaştırıldığındatopikal kortikosteroid kullanımı ile serum IL-17 düzeyleri arasında anlamlı birilişki bulunamamıştır (p>0.05). Daha önceki çalışmalarda vitiligohastalarında serum IL-17 düzeyinde farklılık görülmesi bu sitokinin vitiligopatogenizinde rol oynadığını göstermekle birlikte çalışmamızda topikalkortikosteroid kullanımının serum IL-17 düzeyine etki etmediği gösterilmiştir.

Vitiligo isone of the most common acquired depigmenting disorders with a prevalence of1-2% of population. Vitiligo is causedby the destruction of melanocytes. Over the years, the role of biochemical,immunological, genetic, and other biological aspects in the pathogenesis ofvitiligo has been studied. So far, the exact etiopathogenesis and mechanisms ofvitiligo are not fully understood. Until recently vitiligo has been consideredmainly to be a Th1-driven autoimmune inflammatory disease defined but recentfindings have revealed a potential role for Th17 responses in the pathogenesisof vitiligo. However, the results obtained in studies on serum levels of IL-17are contradictory. In some studies, it has been found that increasing levels ofIL-17 in vitiligo patients but some studies decreased. The aim of our study isto investigate serum levels of IL-17 in vitiligo patients in the Turkishpopulation. In the study, serum levels of IL-17 were determined in 68 vitiligopatients who were treated with corticosteroids and 16 vitiligo patients withoutany treatment in Dermatology department of Bülent Ecevit University MedicalFaculty Hospital. When serum IL-17 levels were compared between patientsreceiving and not receiving topical corticosteroid treatment, no significantcorrelation was found between serum IL-17 levels and topical corticosteroid use(p>0.05). Although previous studies have shown that the difference in IL-17serum levels that cytokine plays a role in the pathogenesis of vitiligo, butour study indicates that topical steroid use in therapy has no effect on IL-17levels.

İnterlökin IL-17 Serum Düzeyi Sitokin Vitiligo

Cytokine IL-17 Interleukin Serum Levels Vitiligo

1. Dunn JF. Vitiligo. Am Fam Physician. 1986;33(5):137-43.

2. Schwart RA. Vitiligo. Cutis 1997;60(5):239-44.

3. Mosher DB, Fitzpatrick TB, Ortanne JB. Disorders of Pigmentation, Hipomelanoses and Hypermelanoses. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine, 5th ed. New York, Mc Graw Hill, 1999:936-45.

4. Bahadır S, Yaylı S. Childhood vitiligo: epidemiology and etiology. Türkderm. 2006; 40(3):81-6.

5. Schallreuter KU, Bahadoran P, Picardo M, et al. Vitiligo pathogenesis: autoimmune disease, genetic defect, excessive reactive oxygen species, calcium imbalance, or what else? Exp Dermatol. 2008;17(2):139-40.

6. Taïeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009;360(2):160-9.

7. Kyriakis KP, Palamaras I, Tsele E, Michailides C, Terzoudi S. Case detection rates of vitiligo by gender and age. Int J Dermatol. 2009;48(3):328-9.

8. Plettenberg H, Assmann T, Ruzicka T. Childhood vitiligo and tacrolimus: immunomodulating treatment for an autoimmune disease. Arch Dermatol. 2003;139(5):651-4.

9. Puel A, Döffinger R, Natividad A, et al. Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I. J Exp Med. 2010;207(2):291–7.

10. Miossec P, Korn T, Kuchroo VK. Interleukin-17 and type 17 helper T cells. N Engl J Med. 2009;361(9):888–98.

11. Kovacs OS. Vitiligo. J Am Acad Dermatol. 1998;38(5):647-66.

12. Bhatnagar A, Kanwar AJ, Parsad D, De D. Psoralen and ultraviolet A and narrow- band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score: an open prospective comparative study. JEADV. 2007;21(10):1381-5.

13. Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Köbner Phenomenon With Disease Activity and Therapeutic Responsiveness in Vitiligo Vulgaris. Arch Dermatol. 1999;135(4):407-13.

14. Speeckaert R, Speeckaert MM, van Geel N. Why treatments do(n't) work in vitiligo: An autoinflammatory perspective. Autoimmun Rev. 2015;14(4):332-40.

15. Jin Y, Birlea SA, Fain PR, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med. 2010;362(18):1686-97.

16. Jin Y, Birlea SA, Fain PR, et al Genome-wide analysis identifies a quantitative trait locus in the MHC class II region associated with generalized vitiligo age of onset. J Invest Dermatol. 2011;131(6):1308-12.

17. Quan C, Ren YQ, Xiang LH, et al. Genome-wide association study for vitiligo identifies susceptibility loci at 6q27 and the MHC. Nat Genet. 2010;42(7):614-8.

18. Cheong KA, Kim NH, Noh M, Lee AY. Three new single nucleotide polymorphisms identified by a genome-wide association study in Korean patients with vitiligo. J Korean Med Sci. 2013;28(5):775-9.

19. Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res. 2003;16(3):208-14.

20. Peters EM, Handjiski B, Kuhlmei A, et al. Neurogenic inflammation in stress-induced termination of murine hair growth is promoted by nerve growth factor. Am J Pathol. 2004;165(1):259-71.

21. Khan R, Satyam A, Gupta S, Sharma VK, Sharma A. Circulatory levels of antioxidants and lipid peroxidation in Indian patients with generalized and localized vitiligo. Arch Dermatol Res. 2009;301(10):731-7.

22. Basak PY, Adiloglu AK, Ceyhan AM, Tas T, Akkaya VB. The role of helper and regulatory T cells in the pathogenesis of vitiligo. J Am Acad Dermatol. 2009;60(2):256-60.

23. Dwivedi M, Laddha NC, Imran M, Shah BJ, Begum R. Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) in isolated vitiligo: a genotype-phenotype correlation. Pigment Cell Melanoma Res. 2011;24(4):737-40.

24. Kotobuki Y, Tanemura A, Yang L, et al. Dysregulation of melanocyte function by Th17-related cytokines: significance of Th17 cell infiltration in autoimmune vitiligo vulgaris. Pigment Cell Melanoma Res. 2012;25(2):219-30. 25. Bassiouny DA, Shaker O. Role of interleukin-17 in the pathogenesis of vitiligo. Clin Exp Dermatol. 2011;36(3):292-7.

26. Ortonne J-P. Vitiligo and other disorders of hypopigmentation. In: Bolognia JL, Jorrizzo JL RR, ed. Dermatology. New York: Mosby 2008. 913–38.

27. Mahmoud BH, Hexsl CL, Hamzavi IH. An update on new and emerging options for the treatment of vitiligo. Skin Therapy Lett. 2008;13(2):1-6.

28. Zhou L, Shi YL, Li K, et al. Increased circulating Th17 cells and elevated serum levels of TGF-beta and IL-21 are correlated with human non-segmental vitiligo development. Pigment Cell Melanoma Res. 2015;28(3):324-9.

29. Khan R, Gupta S, Sharma A. Circulatory levels of T-cell cytokines (interleukin [IL]-2, IL-4, IL-17, and transforming growth factor-β) in patients with vitiligo. J Am Acad Dermatol. 2012;66(3):510-1.

30. Elela MA, Hegazy RA, Fawzy MM, Rashed LA, Rasheed H. Interleukin 17, interleukin 22 and FoxP3 expression in tissue and serum of non-segmental vitiligo: a case- controlled study on eighty-four patients. Eur J Dermatol. 2013;23(3):350-5. 31. Tembhre MK, Sharma VK, Sharma A, Chattopadhyay P, Gupta S. T helper and regulatory T cell cytokine profile in active, stable and narrow band ultraviolet B treated generalized vitiligo. Clin Chim Acta. 2013;424:27-32.

32. Esmaeili B, Rezaee SA, Layegh P, et al. Expression of IL-17 and COX2 gene in peripheral blood leukocytes of vitiligo patients. Iran J Allergy Asthma Immunol. 2011;10(2):81-9.

33. Habeb AM, Al Hefnawy AM, Elsayed SB, Abo Bkr AA, Elhefnawy AM. Expression of interleukin-17 mRNA in vitiligo patients. Egypt J Dermatol Venerol. 2013;33(2):67–70.

34. Hegazy RA, Fawzy MM, Gawdat HI, Samir N, Rashed LA. T helper 17 and Tregs: a novel proposed mechanism for NB-UVB in vitiligo. Exp Dermatol. 2014;23(4):283-6.