Postgraduate Program in Translational Medicine, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Arch Dermatol Res. 2024 Nov 1;316(10):737. doi: 10.1007/s00403-024-03443-w.
Vitiligo is an autoimmune skin disease that can be influenced by stress, including that resulting from sleep deprivation and sleep disturbances. Sleep is essential in the regulation of several hormonal, metabolic and autoimmune pathways that may have important roles in vitiligo. This study aimed to investigate the potential interplay between hormonal, metabolic, and autoimmune markers in vitiligo patients, and the possible influence of sleep quality in these vitiligo pathways. A cohort of 30 vitiligo patients and 26 healthy controls were assessed for various laboratory markers, including thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium, 1.25(OH)2D, 25(OH)D, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and antinuclear antibodies (ANA). The study evaluated sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Positive anti-TPO were found in the vitiligo group, but did not in the control group. Vitamin D 25(OH)D mean levels were clinically insufficient in both groups (< 30 mg/dL). Reactive ANA was analyzed with 2 variables related to vitiligo: phototherapy and skin activity. No statistical correlation was found in the chi-square test on this relationship. Descriptive findings have shown that the positivity to anti-TPO and anti-TG, associated or not with reactive ANA, was higher in vitiligo group. Great part (85.7%) of vitiligo group were "poor sleepers" (PSQI > 5), which has increased (88.2%) when considering only individuals with signs of vitiligo activity. Autoimmune hypothyroidism and positive anti-TPO are expected in vitiligo, although this marker is not usually measured in the first laboratory screening to this disease. Adequate vitamin D levels may be a key adjuvant in skin pigmentation, and be related to sleep quality and immune regulation, as this vitamin can be related to better sleep and immunomodulation in autoimmune diseases. Evaluating ANA before phototherapy can be controversial, but it should be considered in cases with a poor response to this treatment, or when there is a higher risk of other autoimmune diseases. Poor sleep predominated in the vitiligo group, based on PSQI scores that reported worse subjective sleep in these patients. Worse sleep predominated in individuals with signs of skin activity and reactive autoimmune markers. Screening these components could be important in the management of vitiligo, as maintaining body homeostasis can help to improve the disease course. Sleep should be considered as a potential modulator of several multidirectional vitiligo pathways.
白癜风是一种自身免疫性皮肤病，可受压力影响，包括睡眠不足和睡眠障碍引起的压力。睡眠对于调节多种激素、代谢和自身免疫途径至关重要，这些途径可能在白癜风中起着重要作用。本研究旨在探讨白癜风患者中激素、代谢和自身免疫标志物之间的潜在相互作用，以及睡眠质量对这些白癜风途径的可能影响。研究人员评估了 30 名白癜风患者和 26 名健康对照组的各种实验室标志物，包括促甲状腺激素（TSH）、甲状旁腺激素（PTH）、血清钙、1,25(OH)2D、25(OH)D、抗甲状腺过氧化物酶（anti-TPO）、抗甲状腺球蛋白（anti-TG）和抗核抗体（ANA）。研究人员使用匹兹堡睡眠质量指数（PSQI）评估睡眠质量。白癜风组中发现了阳性的抗 TPO，但对照组中没有。两组维生素 D 25(OH)D 平均水平均低于临床正常值（<30 mg/dL）。ANA 分析采用了与白癜风相关的 2 个变量：光疗和皮肤活动。在这个关系的卡方检验中没有发现统计学相关性。描述性研究结果表明，白癜风组中抗 TPO 和抗 TG 的阳性率（与反应性 ANA 相关或不相关）更高。白癜风组中有 85.7%的人（PSQI>5）是“睡眠不佳者”，而仅考虑有白癜风活动迹象的个体时，这一比例增加到 88.2%。自身免疫性甲状腺功能减退症和阳性抗 TPO 预计会在白癜风中出现，尽管这种标志物通常不在对这种疾病的首次实验室筛查中进行测量。适当的维生素 D 水平可能是皮肤色素沉着的关键辅助因素，与睡眠质量和免疫调节有关，因为这种维生素与自身免疫性疾病中更好的睡眠和免疫调节有关。在进行光疗之前评估 ANA 可能存在争议，但在这种治疗反应不佳或存在更高患其他自身免疫性疾病风险的情况下，应考虑进行评估。根据 PSQI 评分，白癜风组中较差的主观睡眠占主导地位，提示这些患者睡眠较差。在有皮肤活动迹象和反应性自身免疫标志物的个体中，较差的睡眠更为常见。筛查这些成分在白癜风的管理中可能很重要，因为维持身体的内环境平衡有助于改善疾病进程。睡眠应被视为多个多向性白癜风途径的潜在调节剂。
