Sensory Symptoms as an Early Manifestation of Active Vitiligo: A Case-Control Clinical and Molecular Study

Vitiligo pathogenesis is complex. There is some evidence in support of the neurohormonal pathways involved. Although considered a nonpruritic condition, some patients may experience itching, which can occur ahead of the appearance of the patches. We aimed to assess sensory symptoms in active and stable vitiligo patients and to measure 3 neuropeptide expressions in their lesional skin (neuropeptide Y [NPY], calcitonin gene-related peptide [CGRP], and nerve growth factors [NGF]) to correlate neuropeptide levels and sensory symptoms, with vitiligo activity. This case-control study included 85 patients, aged 18 years and older, analyzed into active or stable vitiligo groups. Patients were screened for itching or other abnormal neurological sensations such as paresthesia and numbness. The Vitiligo Disease Activity Score, Vitiligo Signs of Activity Score, and dermoscopic score were performed to assess disease activity. Three neuropeptides were quantified by enzyme-linked immunosorbent assay in skin biopsies from the edge of vitiligo lesions. A normal control group was also included. Results showed that 24.7% of patients had sensory symptoms: itching (18.8%), paresthesia (2.4%), and numbness (3.5%). The NGF, CGRP, and NPY levels were significantly higher in skin of normal controls compared to stable and active vitiligo patients. They were lowest in active vitiligo skin (p = 0.001, 0.016, and 0.01, respectively). NGF was the most relevant neuropeptide to vitiligo activity and sensory manifestations. In conclusion, almost one-third of the patients with active vitiligo reported sensory symptoms, predominantly itching, thus sensory manifestations may suggest a prodroma of activity and could be included in the screening tools for vitiligo activity. Trial Registration: www.clinicaltrials.gov (NCT05390164).