10.5826/dpc.1401a27
Introduction: Vitiligo is thought to be an autoimmune disorder caused by melanocytes dysfunction and depigmentation. Among different executors of the immune system in developing the disease, the role of various cytokines has been defined.
Objectives: We have focused on IL-38, the tenth member of IL-1 cytokine family with a proposed anti-inflammatory role, which has not hitherto been introduced as an anti-inflammatory factor in vitiligo.
Methods: Sixty-nine generalized vitiligo patients and 72-year-old- and sex-matched healthy individuals were included in this study. IL-38 level was evaluated in sera of all participants using ELISA assay. The relation of IL-38 level to patients characteristics was evaluated.
Results: IL-38 serum level in vitiligo patients (159.5±39.7 pg/ml) was lower than the healthy controls (166.7±34.8pg/ml) (P = 0.039). A weak negative correlation between the age of male patients and their IL-38 serum levels was identified (r = 0.38, P = 0.058). Evaluation of the IL-38 serum levels relationship with patients clinical characteristics showed no correlation with disease onset, stage of depigmentation, and disease activity status.
Conclusions: The lower levels of IL-38 as an anti-inflammatory cytokine support the inflammatory nature of vitiligo. It indicates the difference of IL-38 in sera of vitiligo patients and healthy controls, as the first report of the lower level of this cytokine in the context of vitiligo. The reason of this difference remains to be clarified; as there are not sufficient study reports revealing the role of gender, ethnicity and inflammation on the cytokine network in the context of vitiligo.
text/xml
2160-9381
3520
en
Roya Radanfar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
skin
Evaluation of IL-38, a Newly-Introduced Cytokine, in Sera of Vitiligo Patients and Its Relation to Clinical Features 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2024-01-31
2023-05-09
2024-01-31
2024-02-21
e2024027
Dermatol Pract Concept
Introduction: Vitiligo is thought to be an autoimmune disorder caused by melanocytes dysfunction and depigmentation. Among different executors of the immune system in developing the disease, the role of various cytokines has been defined.
Objectives: We have focused on IL-38, the tenth member of IL-1 cytokine family with a proposed anti-inflammatory role, which has not hitherto been introduced as an anti-inflammatory factor in vitiligo.
Methods: Sixty-nine generalized vitiligo patients and 72-year-old- and sex-matched healthy individuals were included in this study. IL-38 level was evaluated in sera of all participants using ELISA assay. The relation of IL-38 level to patients characteristics was evaluated.
Results: IL-38 serum level in vitiligo patients (159.5±39.7 pg/ml) was lower than the healthy controls (166.7±34.8pg/ml) (P = 0.039). A weak negative correlation between the age of male patients and their IL-38 serum levels was identified (r = 0.38, P = 0.058). Evaluation of the IL-38 serum levels relationship with patients clinical characteristics showed no correlation with disease onset, stage of depigmentation, and disease activity status.
Conclusions: The lower levels of IL-38 as an anti-inflammatory cytokine support the inflammatory nature of vitiligo. It indicates the difference of IL-38 in sera of vitiligo patients and healthy controls, as the first report of the lower level of this cytokine in the context of vitiligo. The reason of this difference remains to be clarified; as there are not sufficient study reports revealing the role of gender, ethnicity and inflammation on the cytokine network in the context of vitiligo.
Roya Radanfar
2024/01/31
10.5826/dpc.1401a27
e2024027
Department of dermatology, Shiraz University of Medical Sciences, Shiraz, Iran 
2160-9381
skin
en
e2024027
Mahmoud Marie RE, Adel AM, Abd El-Fadeal NM, Eyada MMK. Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity. J Cosmet Dermatol. 2022;21(8):3515-3521. DOI: 10.1111/jocd.14612. PMID: 34783147.
Evaluation of IL-38, a Newly-Introduced Cytokine, in Sera of Vitiligo Patients and Its Relation to Clinical Features 
https://dpcj.org/index.php/dpc/article/download/3520/2424
  Evaluation of IL-38, a Newly-introduced Cytokine,
     in Sera of Vitiligo Patients and Its Relation
                  to Clinical Features
                         Maryam Zarrabi1, Nasser Gholijani1, Zahra Amirghofran1,2,
                                 Maryam Sadat Sadati3, Roya Radanfar4


1 Autoimmune Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Immunology Department, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
4 Dermatology department, Shiraz University of Medical Sciences, Shiraz, Iran



Key words: vitiligo, interleukin38, cytokine, skin
Citation: Zarrabi M, Gholijani N, Amirghofran Z, Sadati MS, Radanfar R. Evaluation of IL-38, a Newly-Introduced Cytokine, in Sera
of Vitiligo Patients and its Relation to Clinical Features. Dermatol Pract Concept. 2024;14(1):e2024027. DOI: https://doi.org/10.5826
/dpc.1401a27
Accepted: July 24, 2023; Published: January 2024
Copyright: ©2024 Zarrabi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Maryam Sadat Sadati. Department of dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.
E-mail: msadati63@yahoo.com




  ABSTRACT              Introduction: Vitiligo is thought to be an autoimmune disorder caused by melanocytes dysfunction
                        and depigmentation. Among different executors of the immune system in developing the disease, the
                        role of various cytokines has been defined.
                        Objectives: We have focused on IL-38, the tenth member of IL-1 cytokine family with a proposed
                        anti-inflammatory role, which has not hitherto been introduced as an anti-inflammatory factor in
                        vitiligo.
                        Methods: Sixty-nine generalized vitiligo patients and 72-year-old- and sex-matched healthy individu-
                        als were included in this study. IL-38 level was evaluated in sera of all participants using ELISA assay.
                        The relation of IL-38 level to patients characteristics was evaluated.
                        Results: IL-38 serum level in vitiligo patients (159.5±39.7 pg/ml) was lower than the healthy controls
                        (166.7±34.8pg/ml) (P = 0.039). A weak negative correlation between the age of male patients and
                        their IL-38 serum levels was identified (r = 0.38, P = 0.058). Evaluation of the IL-38 serum levels
                        relationship with patients clinical characteristics showed no correlation with disease onset, stage of
                        depigmentation, and disease activity status.




Original Article | Dermatol Pract Concept. 2024;14(1):e2024027                                                                          1
                      Conclusions: The lower levels of IL-38 as an anti-inflammatory cytokine support the inflammatory
                      nature of vitiligo. It indicates the difference of IL-38 in sera of vitiligo patients and healthy controls, as
                      the first report of the lower level of this cytokine in the context of vitiligo. The reason of this difference
                      remains to be clarified; as there are not sufficient study reports revealing the role of gender, ethnicity
                      and inflammation on the cytokine network in the context of vitiligo.




Introduction                                                         whereas this homology is significantly lower (14%-30%)
                                                                     with the other members of IL-1 cytokine family [14]. Because
Vitiligo is an acquired and progressive disorder, caused by          of its structural resemblance with IL-36Ra, IL-38 is supposed
melanocytes dysfunction and chronic depigmentation, re-              to function through IL-36R downstream signaling pathways
sulting in the formation of demarcated white macules in the          such as nuclear factor (NF)-κB and mitogen-activated protein
epidermis [1]. The prevalence of vitiligo estimated to be in         kinase (MAPK) inhibition [15,16]. In line with these findings
the range of 0.4% to 2.0 % worldwide [2] with a reported             about the biological functions of IL-38, several studies have
greater predilection to arise in childhood and based on some         focused on the specific role of this cytokine in some disorders,
studies in females [1, 3]. This disease is classified into three     typically immune-mediated diseases. IL-38 gene polymor-
main clinical types according to international consensus;            phisms have been studied in ankylosing spondylitis, rheu-
namely, non-segmental or generalized vitiligo, segmental             matoid arthritis (RA), psoriatic arthritis and heart diseases
vitiligo and mixed vitiligo [4]. These subtypes are distin-          [17-20]. Moreover, the levels of this cytokine have been raised
guished based on their onset and distribution patterns [4].          in sera of patients with systemic lupus erythematosus (SLE),
The mechanisms underlying the etiopathogenesis of vitiligo           RA, myocardial infarction and childhood asthma [21-24].
are not clearly identified; however, in genetically susceptible
individuals, several phenomena have been supposed to be
associated with the disease onset and development. Autoim-           Objectives
munity, oxidative stress, impairment of melanocytes growth
                                                                     According to the role of various cytokines in the pathogen-
and development, viral infections and neurological damages
                                                                     esis of vitiligo, focusing on those with the unknown effects
are among the main theories proposed in the etiology of
                                                                     in this disease would come into consideration. Therefore, we
vitiligo [4]. Autoimmune theory implicates the remarkable
                                                                     aimed to investigate the role of IL-38 in vitiligo as the first
presence of immune system footprints in the context of the
                                                                     report of the lower level of this cytokine in the context of
disease, as high serum levels of autoantibodies against ty-
                                                                     vitiligo pathogenesis.
rosine hydroxylase (TH) which cause the melanocytes and
keratinocytes destruction are detectable in vitiligo patients [5].
Moreover, it has been found that skin-homing cytotoxic               Methods
T-cells specific for some peptides of melanocytic proteins gp-
100 and melan A or melanoma antigen recognized by T cells            Subjects
(MART)-1, are related to vitiligo disease activity [6]. Also,        A total of 76 patients with vitiligo (69 generalized and
a significant rise in serum levels of cytokines such as tumor        7 localized) who referred to Dermatology Outpatient Clinic
necrosis factor (TNF)-α , interferon (IFN)-γ, interleukin            of Shahid Faghihi Hospital, Shiraz, Iran, were included in
(IL)-1β, IL-2, IL-6, IL-17, IL-22, IL-8 and IL-10 was ob-            this study. Of 69 patients with generalized vitiligo, 43 and
served in these patients [7-11].                                     26 patients were females and males, respectively (mean
    IL-38, with the previous name, IL-1HY2 is a member of            age 36.00±14.88 years; range 13-74 years). The study pro-
IL-1 cytokine family (IL-1α, IL-1β, IL-1 receptor antagonist         tocol was approved by Elite Researcher Grant Committee
[IL-1Ra], IL-18, IL-36 receptor antagonist [IL-36Ra], IL-36α,        under award number [971223] from the National Institute
IL-37, IL-36β, IL-36γ, IL-38 and IL-33) [12]. This cytokine is       for Medical Research Development (NIMAD), Tehran. In-
expressed in a variety of organs and tissues including heart,        formed consent was obtained from all patients. Information
placenta, skin, spleen, thymus, fetal liver and proliferating B      from the patients was recorded using a special questioner
cells of the tonsil [12]. The genomic position of IL-38 is near      with respect to demographic, paraclinical and clinical pre-
the IL-1Ra and IL-36Ra locus on human chromosome                     sentation of the cases. Subjects with other autoimmune or
2p13 [13]. Furthermore, the structural homology of IL-38             inflammatory diseases, current infections and pregnant
with IL-1Ra and IL-36Ra is about 41% and 43%, respectively,          women were excluded from the study.



2                                                                        Original Article | Dermatol Pract Concept. 2024;14(1):e2024027
    Vitiligo disease activity score (VIDA) was used to eval-      the rest of analysis was performed only on generalized pa-
uate vitiligo activity [25]. In addition, according to the Vit-   tients. The beginning of the disease was around 27 years old.
iligo European Task Force (VETF) system, the extent, stage        Family history of vitiligo was seen in 26.2% of the patients.
­(cutaneous and hair pigmentation in vitiligo patches) and        More than 95% of the patients had generalized bilateral
progression of the disease was determined for each patient.       symmetrical vitiligo. Most patients (85.5%) had complete
The patients were classified into progressive, stable or re-      depigmentation with less than 30% hair whitening, and
gressive according to the spreading of the lesions or white       86.8% were categorized in type III skin type. The disease
macules at the time of blood sampling [26]. Skin type of the      was progressive in 25 (36.2%) patients, stable in 20 (29%)
patients was also determined according to Fitzpatrick clas-       cases and regressive in 24 patients (34.8 %).
sification [27]. Seventy-two age- and sex-matched healthy
subjects (42 females and 30 males; mean age 39.54±10.35           IL-38 Serum Level Differences Between Patients
years; range 24-62 years) were considered as the control          and Healthy Controls
group. Controls were healthy individuals who had no his-          We found a significant difference in IL-38 serum levels be-
tory of autoimmune disease themselves or in their relatives.      tween patients (159.5±39.7 pg/ml) with range of 122.1-
    Sample preparation and cytokine measurement through           331.6 pg/ml and healthy control group (166.7±34.8 pg/ml)
enzyme-linked immunosorbent assay (ELISA)                         with range of 113.1-293.0 pg/ml (P = 0.039) (Figure 1).
    Three milliliters of blood were taken from each patients         We did not find any significant difference in IL-38 levels
and controls. In order to isolate sera, the samples were cen-     between the female (163.8±46.5 pg/ml) and male (152.5±23.6
trifuged at 4000 rpm for 15 minutes. Sera were stored at          pg/ml) patients (P = 0.31) or female (169.5±40.4 pg/ml) and
-70ºC until used.                                                 male (162.8±24.3 pg/ml) controls (P = 0.92).
    Serum level of IL-38 in all individuals was measured
through a specific ELISA kit (R&D SystemsCat. No.                 Correlation Between IL-38 Serum Levels and
DY9110-05) according to the manufacturer instructions.            Patients Characteristics
Briefly, anti-IL-38 monoclonal antibodies were pre-coated         IL-38 serum levels showed no correlation with the age of
on to ELISA microplates. Serum samples (100 μl) were added        patients, however when patients were evaluated according
to each well. Afterwards, 100 μl of the working solution of       to the sex, IL-38 serum levels showed a weak negative cor-
streptavidin-horseradish peroxidase (HRP) conjugated anti-        relation with the age of male patients (P = 0.058, r = -0.38)
bodies were added and after addition of substrate the opti-       (Figure 2). This correlation was not observed in relation to
cal density of each well was determined using a microplate        male healthy controls (P = 0.21, r = -0.233).
reader (Biotech) at 450 nm.                                          As the next step, analysis of the relation of IL-38 serum
                                                                  levels to other patients characteristics showed no significant
Statistical Analysis                                              correlation with disease onset, disease duration. And the
Statistical analysis was performed using SPSS v. 25 ­software     Comparison of IL-38 serum levels in patients with positive
(SPSS, Inc.) and GraphPad Prism v.8 software. Data were           family history of vitiligo and patients with negative family
presented as mean ± standard deviation (SD). Mann-­Whitney        history showed no significant differences. We did not find
U test was used to evaluate IL-38 serum level differences be-     any difference in IL-38 level in patients with generalized
tween the groups. Spearman correlation test (rho) was done        bilateral symmetrical vitiligo (160.32±40.38 pg/ml) com-
to assess any correlation between two quantitative variables      pared to other types (142.23±4.13 pg/ml, P = 0.41). Stage of
with no normal distribution. P < 0.05 was regarded as statis-     depigmentation also showed no significant effect on IL-38
tically significant value.                                        level (P = 0.85). IL-38 did not differ between patients with
                                                                  progressive (148.83±21.50 pg/ml), stable (160.90±44.79 pg/
                                                                  ml) or regressive (169.54±47.75 pg/ml) disease, P = 0.23).
Results                                                           VIDA score had no effects on the level of cytokine. How-
                                                                  ever, evaluation of the relationship between skin type and
Demographic and Clinical Data                                     IL-38 serum levels, showed significant differences in both
The participant clinical and demographic data are summa-          male and female patients. As, comparison of IL-38 serum
rized in Table 1. A total of 76 patients were included in this    levels between two skin type groups of male patients, ie type
study. Among them, 69 cases presented with generalized and        III (24 patients) and type IV (2 patients) resulted in the evi-
7 cases with localized type of vitiligo. Comparison of IL-38      dence of a difference between these two groups (P = 0.045)
serum levels in generalized (159.53±39.66 pg/ml) and local-       (­Figure 3). The level of this cytokine was lower in male pa-
ized (158.99±31.42 pg/ml) patients showed no significant          tients with type III (149.4±21.7 pg/ml) than those with type
differences. Due to limited number of the localized patients,     IV (190.2±5.45 pg/ml). We compared the IL-38 serum levels



Original Article | Dermatol Pract Concept. 2024;14(1):e2024027                                                                 3
                           Table 1. Demographic and clinical data of the vitiligo patients.
                                                                      Patients with
                           Characteristics                          generalized vitiligo               Healthy controls
 Number of subjects                                                           69                                72
 Age (year), mean±SD                                                    36.00±14.88                       39.54±10.35
 Gender (Female/Male), N(%)                                           43/26 (62.3/37.7)                 42/30 (58.3/41.7)
 Disease onset (year) ), mean±SD                                        27.01±15.76
 Disease duration (year) ), mean±SD                                      8.98±7.93
 Family history of vitiligo, N(%)                                         18 (26.1)
 Family history of other Autoimmune disease, N(%)                          5 (7.2)
 Smoking, N(%)                                                            17 (24.6)
 Generalized type, N(%):
  Acrofacial                                                               2 (2.9)
  Vulgaris                                                                66 (95.7)
   Mixed                                                                   1 (1.4)
 Stage of depigmentation, N(%)
   -0 (N1)                                                                2 (2.9 %)
   -Incomplete                                                            6 (8.7 %)
   -Complete with <30%hair whitening                                     59 (85.5 %)
   -Complete with >30%hair whitening                                      2 (2.9 %)
 Skin type, N(%)
   -I                                                                          -
   -II                                                                    2 (2.9 %)
   -III                                                                  60 (87.0 %)
   -IV                                                                   7 (10.1 %)
   -V                                                                          -
   -VI                                                                         -
 Spreading, N(%)
   -Progressive                                                          25 (36.2 %)
   -Stable                                                               20 (29.0 %)
   -Regressive                                                           24 (34.8 %)
 Vitiligo disease activity score (VIDA), N(%)
 +4 activity of 6 weeks or less                                          13 (19.1 %)
 +3 activity of 6 weeks to 3 months                                      14 (20.6 %)
 +2 activity of 3-6 months                                               12 (17.6 %)
 +1 activity of 6-12 months                                              14 (20.6 %)
 0: stable for 1 year                                                    15 (22.1 %)
 -1: Stable at least 1 year with spontaneous repigmentation                   -

SD = standard deviation.




among female skin type groups. We could find a IL-38 se-         pg/ml), phototherapy along with topical steroids (162.9±46.1
rum level difference between two groups of female patients,      pg/ml), and only topical steroids (149.7±20.9 pg/ml).
those 36 patients with skin type III (168.29±49.43 pg/ml)
and 5 patients with type IV (135.97±9.68 pg/ml, P = 0.018)
                                                                 Conclusions
(Figure 3). Regardless of the differences in IL-38 level ob-
served between male and female patients with type IV and III     Interleukin (IL)-38, the tenth member of IL-1 cytokine fam-
due to quite low number of type IV patients, statistically, no   ily, was discovered in 2001 [12]. Because of its sequential
correlation has been detected, in patients with skin type III,   homology with IL-1Ra and IL-36Ra, IL-38 has been sup-
IL-38 levels in male patients (149.4±21.73 pg/ml) were less      posed to exert anti-inflammatory properties [14]. Various
than in female patients (168.29±49.43 pg/ml) (P = 0.046).        studies have focused on the investigation of IL-38 exact
    The IL-38 serum level did not differ among patients with     role in different disorders particularly autoimmune diseases.
various treatments. Patients under phototherapy (154±26.2        Gou et al have shown that IL-38-related polymorphisms



4                                                                    Original Article | Dermatol Pract Concept. 2024;14(1):e2024027
                                                                         are associated with the increased risk of ankylosing spon-
                                                                         dylitis [17]. Moreover, an association of IL-38 rs7570267
                                                                         and rs3811058 single nucleotide polymorphism with RA
                                                                         susceptibility has been shown [18]. In another study on RA
                                                                         patients, elevated levels of IL-38 was reported in plasma of
                                                                         patients compared to healthy controls [28]. Rudloff et al
                                                                         measured the IL-38 serum level in patients with SLE. They
                                                                         found that IL-38 may play a protective role in this disorder [21].
                                                                         However, the probable role of this newly identified cytokine
                                                                         in other autoimmune disorders has not been clarified yet.
                                                                         Accordingly, we have focused on vitiligo, a disease with an
                                                                         auto-immune background and no published report on the
Figure 1. IL-38 serum level differences between generalized vitil-       anti-inflammatory role of IL-38 in its pathogenesis. We mea-
igo patients and healthy controls; *P<0.05. Data are represented as      sured IL-38 level in a group of patients with vitiligo and
mean± standard deviation.                                                healthy subjects to evaluate the probable role of IL-38 in
                                                                         disease development. The results showed that the cytokine
                                                                         level in patients was significantly lower than the healthy in-
                                                                         dividuals. It should be noted that. This result was in contrary
                                                                         to the result from previous study where Radwa El- Sayed et
                                                                         al measured the IL-38 serum level in 21 patients with vitiligo
                                                                         and 21 healthy controls. They found that IL-38 serum level
                                                                         was higher in patients with vitiligo than in healthy controls
                                                                         and was related to vitiligo severity and signs of activity [29].
                                                                         The reasons for these differences may be due to sample size
                                                                         and genetic background, and also our result was different
                                                                         with the results reported from some other studies in RA [28]
                                                                         and SLE [21] patients. The reason for these differences is not
                                                                         exactly clear but may be due to variation in the biological
                                                                         nature of the diseases as type and the extent of inflamma-
                                                                         tion established in various disorders may be different. In this
                                                                         regard, we could state the increased serum levels of autoan-
Figure 2. Correlation between the age of vitiligo male patients and      tibodies such as anti-dsDNA, anti-Ro, antinuclear antibody
their IL-38 serum levels; P = 0.058, r = -0.38
                                                                         (ANA) and low serum levels of complement components, ie
                                                                         C3 and C4 and high serum erythrocyte sedimentation rate
                                                                         (ESR) as the indicators of inflammatory condition in SLE,
                                                                         whereas these factors are not considerable in the context of
                                                                         vitiligo. Moreover, the contribution of genetic background
                                                                         and sample size should not be ignored as these are also im-
                                                                         portant factors that might influence such differences.
                                                                            It should be noted that, the current finding is similar to
                                                                         our previous study about the role of IL-38 in Bechet disease
                                                                         (unpublished data) in which a significant lower IL-38 levels
                                                                         in patients compared to controls was found. In addition, in
                                                                         various studies the elevated levels of several inflammatory cy-
                                                                         tokines such as IL-1β, IL-8, IL-17 and IFN-γ in sera of vitiligo
                                                                         patients compared to healthy controls have been shown [7-10].
                                                                         According to these data vitiligo is proposed as an auto-­
                                                                         inflammatory disease. Thus, lower levels of IL-38 which seems
                                                                         to be an anti-inflammatory cytokine, in these patients would be
Figure 3. IL-38 serum level differences between female and male          expected and support the inflammatory nature of this disease.
patients with skin types III and IV. *: P < 0.05. Data are represented      On evaluation of the relation of IL-38 level to patients
as mean ± standard deviation.                                            characteristics, we found a weak negative correlation



Original Article | Dermatol Pract Concept. 2024;14(1):e2024027                                                                           5
between the age of male patients and their IL-38serum levels,              8. Ezzedine S, El Rewiny EM, Abozied AA, Samna ASM. Evaluation
so that this cytokine showed a decreased level with increased                 of Serum Interferon-gamma Level in Vitiligo Patients. Egyptian
                                                                              Journal of Hospital Medicine. 2018;73(10):7806-7813. DOI:
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                                                                           9. Levandowski CB, Mailloux CM, Ferrara TM, Gowan K, Ben S,
    We investigated the relation of IL-38 level to patients                   Jin Y, McFann KK, et al. NLRP1 haplotypes associated with vitil-
disease activity and found no significant result. Analysis of                 igo and autoimmunity increase interleukin-1β processing via the
IL-38 level in patients with various stages of depigmentation                 NLRP1 inflammasome. Proc Natl Acad Sci U S A. 2013;110(8):
and VIDA score did not also reach to be significant. These                    2952-2956. DOI: 10.1073/pnas.1222808110. PMID: 23382179.
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                                                                          10. Farag AG, Marae AH, Habib MSE, Mahfouz RZ, Elnaidany
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                                                                              NF, Youssef SI, et al. IL-8 mRNA and Serum Levels in Vitiligo
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in sera of vitiligo patients and healthy controls, as the first               tiTaher ZA, Lauzon G, Maguiness S, Dytoc MT. Analysis of
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                                                                          11. Lin H, Ho AS, Haley-Vicente D, et al. Cloning and charac-
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Original Article | Dermatol Pract Concept. 2024;14(1):e2024027                                                                                  7
