Archives of Dermatological Research

, Volume 304, Issue 10, pp 823–830 | Cite as

Over-expression of tumor necrosis factor-α in vitiligo lesions after narrow-band UVB therapy: an immunohistochemical study

  • Enayat AttwaEmail author
  • Hend Gamil
  • Magda Assaf
  • Sohair Ghonemy
Original Paper


There is a growing evidence that cytokines are important in the depigmentation process of vitiligo, however, the exact mechanism is not fully understood. The aim of this work was to study the possible role of the tumor necrosis factor-α (TNF-α) cytokine in the depigmentation process of the disease. Twenty patients with generalized vitiligo were exposed to narrow-band ultraviolet B (NB-UVB) therapy thrice weekly for a total of 60 sessions. Immunohistochemical examination was done, to assess the TNF-α expression in lesional and perilesional skin as compared to normal control skin, before and after therapy. At baseline, positive lesional TNF-α expression was detected in 60 % of patients which was significantly higher as compared to perilesional skin (20 %) and negative expression in healthy control skin. Post-treatment, a statistically significant increase in TNF-α expression was detected in both lesional (90 %) and perilesional skin (70 %) as compared to baseline (P < 0.05). The significant increase of TNF-α in vitiligo lesions compared with perilesional and healthy skin suggests a possible involvement of this cytokine in the depigmentation of vitiligo. The increase in TNF-α expression after NB-UVB phototherapy suggests another role in repigmentation.


Narrow-band ultraviolet B Tumor necrosis factor-α Vitiligo 


Conflict of interest

None declared.


  1. 1.
    Arca E, Tastan HB, Erbil AH et al (2006) Narrow band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol 33:338–343PubMedCrossRefGoogle Scholar
  2. 2.
    Birol A, Kisa U, Kurtipek GS et al (2006) Increased tumour necrosis factor alpha (TNF-α) and interleukin 1 alpha (IL-1α) levels in the lesional skin of patients with nonsegmental vitiligo. Int J Dermatol 45:992–993PubMedCrossRefGoogle Scholar
  3. 3.
    Brazzelli V, Antoninetti M, Palazzini S et al (2007) Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with NB-UVB phototherapy. J Eur Acad Dermatol Venereol 21:1369–1374PubMedCrossRefGoogle Scholar
  4. 4.
    Brink N, Szamel M, Young AR et al (2000) Comparative quantification of IL-1β, IL-10, TNF-α and IL-7 mRNA levels in UV irradiated skin in vivo. Inflamm Res 49:290–296PubMedCrossRefGoogle Scholar
  5. 5.
    Cui J, Shen LY, Wang GC (1991) Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol 97:410–416PubMedCrossRefGoogle Scholar
  6. 6.
    Eves PC, Bullett NA, Haddow D et al (2008) Simplifying the delivery of melanocytes and keratinocytes for the treatment of vitiligo using a chemically defined carrier dressing. J Invest Dermatol 128(6):1554–1564PubMedCrossRefGoogle Scholar
  7. 7.
    Fitzpatrick TB (1997) Mechanisms of phototherapy in vitiligo. Arch Dermatol 133:1591–1592PubMedCrossRefGoogle Scholar
  8. 8.
    Goktas EO, Aydin F, Senturk N et al (2006) Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol 20:553–557PubMedCrossRefGoogle Scholar
  9. 9.
    Grimes PE, Morris R, Avaniss-Aghajani T et al (2004) Topical tacrolimus therapy for vitiligo. Therapeutic responses and skin messenger RNA expression of proinflammatory cytokines. J Am Acad Dermatol 51(1):52–61PubMedCrossRefGoogle Scholar
  10. 10.
    Hamzavi I, Jain H, McLean D et al (2004) Parametric modeling of narrow band UV-B phototherapy for vitiligo using a novel quantitative tool. Arch Dermatol 140:677–683PubMedCrossRefGoogle Scholar
  11. 11.
    Hino R, Kobayashi T, Mori H et al (2007) Inhibition of T helper 2 chemokine production by narrow-band ultraviolet B in cultured keratinocytes. Br J Dermatol 156:830–837PubMedCrossRefGoogle Scholar
  12. 12.
    Joshi PG, Nair N, Begum G et al (2007) Melanocyte-keratinocyte interaction induces calcium signalling and melanin transfer to keratinocytes. Pigment Cell Res 20(5):380–384PubMedGoogle Scholar
  13. 13.
    Kang HY, Kang WH (2004) Leukomelanoderma following acute cutaneous graft-versus-host disease. Eur J Dermatol 14(3):146–149PubMedGoogle Scholar
  14. 14.
    Kawaguchi M, Mitsuhashi Y, Kondo S (2005) Over expression of tumor necrosis factor α-converting enzyme in psoriasis. Br J Dermatol 152(5):915–919PubMedCrossRefGoogle Scholar
  15. 15.
    Köck A, Shwarz T, Kirnbauer R et al (1990) Human keratinocytes are a source for tumour necrosis factor α: evidence for synthesis and release upon stimulation with endotoxin or ultraviolet light. J Exp Med 172:1609–1614PubMedCrossRefGoogle Scholar
  16. 16.
    Leverkus M, Yaar M, Eller MS et al (1998) Post transcriptional regulation of UV induced TNF-alpha expression. J Invest Dermatol 110:353–357PubMedCrossRefGoogle Scholar
  17. 17.
    Lowry OH, Rosebrough NJ, Farr AL et al (1951) Protein measurement with Folin phenol reagent. J Biol Chem 193:265–275PubMedGoogle Scholar
  18. 18.
    Martinez-Esparzo M, Jimenez-Cervantes C, Solano F et al (1998) Mechanisms of melanogenesis inhibition by tumour necrosis factor-α in melanoma cells. Eur J Biochem 255:139–146CrossRefGoogle Scholar
  19. 19.
    Moretti S, Spallanzani A, Amato L et al (2002) New insights into the pathogenesis of vitiligo: imbalance of epidermal cytokines at sites of lesions. Pigment Cell Res 15:87–92PubMedCrossRefGoogle Scholar
  20. 20.
    Njoo MD, Bos JD, Westerhof W (2000) Treatment of generalized vitiligo in children with narrow band (TL-01) UVB radiation therapy. J Am Acad Dermatol 42:245–253PubMedCrossRefGoogle Scholar
  21. 21.
    Scherschun L, Kim JJ, Lim HW (2001) Narrow band ultraviolet-B is a useful and well tolerated treatment for vitiligo. J Am Acad Dermatol 44(6):999–1003PubMedCrossRefGoogle Scholar
  22. 22.
    Schwarz A, Maeda A, Wild MK et al (2004) Ultraviolet radiation induced regulatory T cells not only inhibit the induction but can suppress the effector phase of contact hypersensitivity. J Immunol 172:1036–1043PubMedGoogle Scholar
  23. 23.
    Schwarz T (2002) Photoimmunosuppression. Photodermatol Photoimmunol Photomed 18:141–145PubMedCrossRefGoogle Scholar
  24. 24.
    Seité S, Colige A, Deroanne C et al (2004) Changes in matrix gene and protein expressions after single or repeated exposure to one minimal erythemal dose of solar-stimulated radiation in human skin in vivo. Photochem Photobiol 79:265–271PubMedCrossRefGoogle Scholar
  25. 25.
    Shang J, Eberle J, Geilen CC et al (2002) The role of nuclear factor-kappa B and melanogenesis in tumor necrosis factor-alpha-induce. Skin Pharmacol Appl Skin Physiol 15:321–329PubMedCrossRefGoogle Scholar
  26. 26.
    Shintani Y, Yasuda Y, Kobayashi K et al (2008) Narrow band UVB radiation suppresses contact hypersensitivity. Photodermatol Photoimmunol Photomed 24:32–37PubMedCrossRefGoogle Scholar
  27. 27.
    Skov L, Hansen H, Allen M et al (1998) Contrasting effects of ultraviolet A1 and ultraviolet B exposure on the induction of tumour necrosis factor alpha in human skin. Br J Dermatol 138:216–220PubMedCrossRefGoogle Scholar
  28. 28.
    Wallace ML, Smoller BR (1996) Immunohistochemistry in diagnostic dermatopathology. J Am Acad Dermatol 34(2):163–183PubMedCrossRefGoogle Scholar
  29. 29.
    Westerhof W, d’ Ischia M (2007) Vitiligo puzzle, the pieces fall in place. Pigment Cell Res 20(5):345–359PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Enayat Attwa
    • 1
    Email author
  • Hend Gamil
    • 1
  • Magda Assaf
    • 1
  • Sohair Ghonemy
    • 1
  1. 1.Departments of Dermatology, Venereology and Pathology, Faculty of MedicineZagazig UniversityZagazigEgypt

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