الفهرس 
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Abstract
V
itiligo is a chronic acquired depigmentary disorder of the skin, hair and mucous membrane characterized by asymptomatic well-circumscribed white macules and patches that can affect any part of the body with no certain predilection of sex or race.
Vitiligo is a complex multifactorial disease, different mechanisms of pathogenesis had been suggested including genetic, immunological, neural and environmental factors. Neither one mechanism can account for the pathogenesis of the disease, rather interlacement between these different factors in genetically susceptible individuals are proposed as a unifying approach to understand the pathogenesis of the disease. It’s a life-altering disease with a tremendous effect on the patient’s quality of life.
Oxidative stress had been implicated as a major contributor to the vitiligo pathogenesis, as the imbalance between ROS and the antioxidant defense mechanisms were widely observed among the vitiligo patients.
Total oxidant status (TOS) level was considered to be reflecting the global status of oxidative stress in the serum, as it determines the cumulative oxidative effects of various oxidant reagents generated in biological systems.
Albumin acts as a main buffering agent for toxic molecules within the circulation. It undergoes structural changes when exposed to ischemia or oxidative stress and ischemia modified albumin (IMA) is produced under these conditions with high levels. It can be considered as a marker of oxidative stress and ischemia in different clinical conditions.
Our study aimed to evaluate the serum level of ischemia modified albumin (IMA) in vitiligo patients and its relation to total oxidant status and disease activity.
This study was done on 48 patients with vitiligo, 24 were considered active cases while the other 24 were non-active cases. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. The study also included 48 age-and sex-matched healthy adults as a control group. The vitiligo activity and tensity were assessed by VIDA and VETI scores respectively, while serum TOS and IMA levels were assessed by using ELISA kits.
We excluded pregnant and lactating women, cases with segmental vitiligo, cases using topical treatment in the past month or using systemic treatment in the past three months prior to enrollment, cases with other dermatological or systemic diseases which may affect IMA or TOS levels.
Our study revealed a significant increase in serum total oxidant status (TOS) and serum ischemia-modified albumin (IMA) levels in vitiligo patients compared to controls. We also found a highly significant positive correlation between oxidative stress levels expressed by TOS levels and both the IMA levels and vitiligo disease activity represented by VIDA score. The levels of TOS and IMA were significantly elevated in active vitiligo patients compared to the non-active cases. However, there was no association between TOS or IMA levels with the tensity of the vitiligo represented by VETI score.
In conclusion, this finding points to the pivotal role played by oxidative stress during the active state of the disease. The serum IMA levels are also a good representative for oxidative stress levels in vitiligo patients and they are positively linked to the disease activity. So, IMA may act as a potential new marker of vitiligo activity with a promising results. We recommend further studies with larger sample size to provide a detailed assessment of serum IMA role in vitiligo pathogenesis.
8. CONCLUSION AND RECOMMENDATION
Based on our study, we can conclude the following:
• The oxidative stress plays an important role in vitiligo pathogenesis and disease activity.
• The serum IMA levels are elevated in vitiligo patients compared to controls and they are directly correlated to the oxidative stress state in vitiligo patients.
• The serum IMA levels correlate positively to the disease activity of vitiligo and they may work as a potential new marker for disease activity.
Based on our findings, we can recommend the following:
• Larger scale studies with enrollment of more patients are recommended.
• Studying the role of IMA and TOS in segmental vitiligo patients.
• To perform studies estimating the effect of different lines of vitiligo treatment on serum TOS and IMA levels.
• To study the effect of antioxidant supplements on the TOS, IMA levels, and disease activity in vitiligo patients
• To compare the accuracy of the serum levels of TOS and IMA in detecting disease activity with other markers of vitiligo activity like CXCL10.