Blood endotyping distinguishes the profile of vitiligo from that of other inflammatory and autoimmune skin diseases

Tali Czarnowicki, Helen He, Alexandra Leonard, Hyun Je Kim, Naoya Kameyama, Ana B. Pavel, Randall Li, Yeriel Estrada, Huei Chi Wen, Grace W. Kimmel, Hee J. Kim, Margot Chima, Mark Lebwohl, James G. Krueger, Emma Guttman-Yassky

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Peripheral blood skin-homing/cutaneous lymphocyte antigen (CLA)+ T cells emerge as biomarkers of cutaneous immune activation in patients with inflammatory skin diseases (atopic dermatitis [AD] and alopecia areata [AA]). However, blood phenotyping across these subsets is not yet available in patients with vitiligo. Objective: We sought to measure cytokine production by circulating skin-homing (CLA+) versus systemic (CLA) “polar” CD4+/CD8+ ratio and activated T-cell subsets in patients with vitiligo compared with patients with AA, AD, or psoriasis and control subjects. Methods: Flow cytometry was used to measure levels of the cytokines IFN-γ, IL-13, IL-9, IL-17, and IL-22 in CD4+/CD8+ T cells in the blood of 19 patients with moderate-to-severe nonsegmental/generalized vitiligo, moderate-to-severe AA (n = 32), psoriasis (n = 24), or AD (n = 43) and control subjects (n = 30). Unsupervised clustering differentiated subjects into groups based on cellular frequencies. Results: Patients with Vitiligo showed the highest CLA+/CLA TH1/type 1 cytotoxic T-cell polarization, with parallel TH2/TH9/TH17/TH22 level increases to levels often greater than those seen in patients with AA, AD, or psoriasis (P < .05). Total regulatory T-cell counts were lower in patients with vitiligo than in control subjects and patients with AD or psoriasis (P < .001). Vitiligo severity correlated with levels of multiple cytokines (P < .1), whereas duration was linked with IFN-γ and IL-17 levels (P < .04). Patients and control subjects grouped into separate clusters based on blood biomarkers. Conclusions: Vitiligo is characterized by a multicytokine polarization among circulating skin-homing and systemic subsets, which differentiates it from other inflammatory/autoimmune skin diseases. Future targeted therapies should delineate the relative contribution of each cytokine axis to disease perpetuation.

Original languageEnglish
Pages (from-to)2095-2107
Number of pages13
JournalJournal of Allergy and Clinical Immunology
Issue number6
StatePublished - Jun 2019


  • T1
  • T17
  • T2
  • T22
  • Vitiligo
  • alopecia areata
  • atopic dermatitis
  • biomarkers
  • endotypes
  • psoriasis
  • regulatory T


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