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Dr. Steppie Attends FSDDS Annual Meeting; Vitiligo Study Cited

July 27, 2021

Vitiligo is a common but chronic skin disorder characterized by loss of epidermal melanocytes (pigment cells) and progressive depigmentation. Four years ago, when invited to participate in a research study at Sanford Burnham Prebys Medical Discovery Institute, Dr. Michael Steppie was eager to collaborate with the distinguished list of professionals assembled to review the molecular mechanisms of vitiligo development and progression.

The original article titled “MicroRNA-211 Regulates Oxidative Phosphorylation and Energy Metabolism in Human Vitiligo” received ethical approval from the Sanford Burnham Prebys Medical Discovery Institute's Institutional Review Board Committee and was published in Journal of Investigative Dermatology (Volume 137, Issue 9) in Sept. 2017.

Optimistic Tone at 2021 FSDDS Annual Meeting

Michael Steppie, M.D., clinical professor of Dermatology at Florida State University College of Medicine and the President and Medical Director of Associates in Dermatology, attended the 2021 Annual Meeting of the Florida Society of Dermatology & Dermatologic Surgery conducted at Palm Beach July 16th thru 18th. Dr. Steppie was pleased to learn more about promising new vitiligo treatments and treatment combinations. “It was exciting to hear such an optimistic tone at this year’s presentations,” remarked Dr. Steppie. “Anyone who suffers from skin depigmentation should follow our links to learn more about treatment options and therapies to help stabilize their condition. Here at Associates in Dermatology, we are dedicated to delivering the most effective treatments to help patients better manage their skin condition regardless of the cause or severity.”

The Florida Society of Dermatology and Dermatologic Surgery (FSDDS) was established in 1930 to serve as an advocate for all Florida dermatologists and their patients, to promote excellence in dermatologic care, to ensure the highest standards for dermatologic medical education, and to enhance the quality and availability of dermatologic healthcare to all Floridians. The group’s annual meeting was conducted over the weekend with an in-depth presentation on new approaches to stabilize vitiligo by Seemal R. Desai, MD, FAAD. Dr. Seemal is a Clinical Assistant Professor at University of Texas Southwestern Medical Center’s Department of Dermatology, and the founder and Medical Director of Innovative Dermatology, PA in Dallas, TX.

New Treatment Options and Combinations

“Sadly, there is currently no cure for vitiligo,” said Dr. Steppie. “So any hope of a treatment to cure the disease is particularly exciting.” As a chronic skin disorder, hypopigmentation is typically seen on sun-exposed areas of the face, lips, hands, and feet, however, blotches can appear on other body parts including the genitalia, mouth, lips, eyeballs, and even facial hair. Dr. Steppie also recommends that those interested in keeping up with the latest news on vitiligo visit the Skin of Color Society to access the website’s resource library.

A number of optimistic new treatment options and treatment combinations were presented and discussed at the annual meeting, including the use of antioxidants. Several new studies support the use of antioxidants containing Alpha Lipoic Acid, Vitamin E and Vitamin C, especially in combination with phototherapy (NBUVB) twice weekly. Plus, another study published by National Center for Biotechnology Information about Janus Kinase Inhibitors (JAK) containing Ruxolitinib 1.5% cream reported highly positive results in 11 out of 12 patients over a 20 week period. For anyone who would like to learn more about the latest findings in vitiligo treatments should visit the Skin of Color Society as well as American Academy of Dermatology, International League of Dermatological Societies, and Global Vitiligo Foundation.

Advancing the Science through Collaborative Research

More noticeable in people with darker skin, a loss of skin color can affect any skin type causing lighter patches on any part of the body. Although vitiligo is not life threatening, the exact cause of skin blotches is still somewhat unclear, which is precisely why Ranjan Perera, Ph.D., the scientific director of Analytical Genomics and Bioinformatics at Sanford Burnham Prebys, Michael Steppie, M.D., and their colleagues were eager to examine new evidence, such as abnormal miRNA expression in the skin and serum in patients with vitiligo. The pathoetiology of vitiligo is multifactorial and has genetic, immunological, and environmental components. Moreover, there appears to be strong epidemiological and genetic evidence implicating an autoimmune pathogenesis. For years, vitiligo has been associated with multiple immune disorders. As a result of their collaborative efforts, the group may have identified a genetic culprit of the skin disease.

Sanford Burnham Prebys is dedicated to discovering the fundamental molecular causes of disease and takes a unique collaborative approach to medical research and identifying new therapeutic approaches. The Medical Discover Institute is especially known for its world-class capabilities in stem cell research and drug discovery technologies. A group of Associate in Dermatology out patients that consisted of seven (7) men and four (4) women, chose to participate in the original study. Since a microRNA called miR-211 is not found vitiligo cells, it is believed the messenger RNAs may prevent gene expression by turning off several genes linked to mitochondria creation. Rarely does the skin get its color back but some patients have had limited color return following his or her treatment regimen. That’s why identifying miR-211 as a possible cause means this microRNA could be a promising therapeutic target. In hopes of identifying a cure or preventing the skin disorder, both Dr. Steppie and Dr. Perera have encouraged large-scale studies to validate the group’s findings.

Documenting Progress with Scientific Citation

Instead of using footnotes, citations are used in scientific writing to credit the author and source even if the new study or work does not include exact quotes or content exactly as it was written in the original document. This allows the reader to identify the publications referenced and to better understand the scope of the author'(s) research. Listed below are the most recent Doximity notifications (updated on November 3, 2021) that confirm citation and application of the vitiligo research conducted at Sanford Burnham Prebys:

  • Publication cited in Indian Journal of Dermatology, Venereology and Leprology – January 11, 2022 Effects of keratinocyte-derived and fibroblast-derived exosomes on human epidermal melanocytes.
  • Publication cited in Frontiers in Pharmacology - October 15, 2021 Development of Multi-Target Strategy for the Treatment of Vitiligo via Machine Learning and Network Analysis Methods.
  • Publication cited in Genes and Diseases - October 15, 2021 SFRP5 inhibits melanin synthesis of melanocytes in vitiligo by suppressing the Wnt/β-catenin signaling.
  • Publication cited in Metabolomics - September 25, 2021 Metabolomic signature of amino acids in plasma of patients with non-segmental Vitiligo.
  • Publication cited in Medicinal Research Reviews – July 23, 2021 Mechanisms of melanocyte death in vitiligo.
  • Publication cited in Frontiers in Immunology – July 23, 2021 Targeting Innate Immunity to Combat Cutaneous Stress: The Vitiligo Perspective.
  • Publication cited in Journal of Investigative Dermatology – July 4, 2021 Analysis of Matched Skin and Gut Microbiome of Vitiligo Patients Reveals Deep skin Dysbiosis: Link with Mitochondrial and Immune Changes.
  • Publication cited in Frontiers in Genetics – July 4, 2021 Identification of a Potentially Functional circRNA-miRNA-mRNA Regulatory Network in Melanocytes for Investigating Pathogenesis of Vitiligo.
  • Publication cited in Stem Cell Research & Therapy – July 3, 2021 Mesenchymal stem cell-derived microvesicles improve intestinal barrier function by restoring mitochondrial dynamic balance in sepsis rats.
  • Publication cited in Pigment Cell & Melanoma Research - June 15, 2021 Alterations of the pigmentation system in the aging process.
  • Publication cited in Journal of Dermatology – June 5, 2021 Vitiligo: A focus on pathogenesis and its therapeutic implications.
  • Publication cited in British Journal of Dermatology – June 4, 2021 Regulatory noncoding RNAs help protect keratinocytes from ultraviolet-mediated damage in vitiligo.
  • Publication cited in Frontiers in Immunology – June 4, 2021 The Role of the NKG2D in Vitiligo.
  • Publication cited in Frontiers in Immunology – June 3, 2021 Targeting Innate Immunity to Combat Cutaneous Stress: The Vitiligo Perspective.
  • Publication cited in Advances in Experimental Medicine and Biology – May 2, 2021 Mass Spectrometry-Based Shotgun Lipidomics for Cancer Research.
  • Publication cited in Journal of Dermatological Science – April 25, 2021 Serum levels of miRNA-21-5p on SOX5, beta-catenin, CDK2 and MITF protein expression in normal human melanocytes.
  • Publication cited in Pigment Cell & Melanoma Research – April 25, 2021 An update on Vitiligo pathogenesis.
  • Publication cited in Medicinal Research Reviews – April 25, 2021 Mechanisms of melanocyte death in vitiligo.
  • Publication cited in Journal of Investigative Dermatology – April 24, 2021 MicroRNA-211 Modulates the DUSP6-ERK5 Signaling Axis to Promote BRAFV600E-Driven Melanoma Growth In Vivo and BRAF/MEK Inhibitor Resistance.
  • Publication cited in Journal of Investigative Dermatology – April 18, 2021 Molecular Hydrogen Protects Human Melanocytes from Oxidative Stress by Activating Nrf2 Signaling.
  • Publication cited in Pigment Cell Melanoma Research – November 3, 2020 The enigma and challenges of vitiligo pathophysiology and treatment.
  • Publication cited in Molecular Biology Reports – February 21, 2020 Current insight into the roles of microRNA in vitiligo.
  • Publication cited in International Journal of Molecular Medicine – January 27, 2020 Role of the p53–TRPM1/miR–211–MMP9 axis in UVB–induced human melanocyte migration and its potential in repigmentation.

In summary, the results of the Sanford Burnham Prebys study suggests miR-211 may play an important role in regulating the pathophysiology of human vitiligo, which makes it not only an immunological disorder but also a disease of abnormal cellular metabolism. Ultimately, a better and more thorough understanding of intracellular metabolism in vitiligo cells will be required so these pathways can be targeted for therapeutic purposes.

Diagnosing and Treating Vitiligo: Today & Tomorrow

Dyschromia is a common condition that results in skin blotching. In most cases, the person’s skin has either too much pigment or not enough pigment, which results in patches of uneven skin tone. Most often, darker spots are caused by hyperpigmentation (melasma), while lighter blotches are due to hypopigmentation (vitiligo). In the past, patients suffering from vitiligo and lighter patches of skin were warned by dermatologists that they could be at a higher risk for skin cancer. At the time, it seemed to be a reasonable warning as sufferers lack the natural protection of the skin pigment melanin. However, more recent studies into the genetics of vitiligo revealed the same genes that increase the risk of vitiligo may simultaneously decrease the person’s risk for melanoma.

­­IMPORTANT NOTE: Having vitiligo does not mean you cannot get skin cancer, so it is very important for those with the disorder to use recommended forms of sun protection and visit his or her dermatologist for regular checkups. In addition to increasing the risk of all forms of skin cancer, sunburn can make vitiligo worse.

Not all cases of hypopigmentation are diagnosed as vitiligo. Only after a clinical examination and review of the person’s medical history, can a dermatologist make an accurate diagnosis. Lighter patches of skin can also be related to eczema (pityriasis alba) as well as a fungal infection (tinea versicolor). Moreover, each condition may require a different treatment protocol. Nonetheless, since damaged vitiligo skin cells are void of the microRNA called miR-211, it appears vitiligo is a disease involving abnormal cellular energy metabolism. While going from target to treatment could take time, identifying the regulated genes through collaborative studies offers significant hope for the future. 

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