Correlation between Plasma Level of Superoxide Dismutase and

Catalase with the Degree of Severity in Vitiligo

Sudarsa P., Karna R. V., and Adiguna M. S.

Department of Dermato-Venereology, Medical Faculty of Udayana University/Sanglah General Hospital, Denpasar-Bali

Keywords: superoxide dismutase, catalase, vitiligo, VASI

Abstract: Vitiligo is a common depigmentation disorders of the skin that can affecting all age and genders. This entity

has a complex pathogenesis, as one theory emphasize in the role of oxidative stress. Superoxide dismutase

(SOD) and catalase are thought as principal enzymatic antioxidant, but increased activity of SOD and lack

activity of catalase were thought to play a role in melanocyte damage by accumulation of hydrogen peroxide

). The aim of this study is to assess the correlation between SOD and catalase with the degree of severity

in vitiligo patients. This is a cross-sectional study involving 49 patients with vitiligo at Sanglah General

Hospital Denpasar Bali in period of August – November 2017. Superoxide dismutase and catalase level were

examined in blood plasma to assess its activity whereas degree of severity were determined clinically using

scoring system of Vitiligo Area Severity Index (VASI).This study found that the mean of SOD in plasma of

vitiligo patients was 0,638 U/ml with the lowest value was 0,49 U/ml and the highest value was 0,75 U/ml.

Whereas catalase level was 64,07 U/ml with the lowest value was 55,86 U/ml and the highest was 72,99 U/ml.

This study found significant positive correlation (r = 0,473; p < 0,01) between plasma SOD level and VASI

score and significant negative correlation (r = - 0,597; p < 0,01) between plasma catalase level and VASI

score. Superoxide dismutase catalyzes superoxide anion into oxygen and H

, in which H

subsequently

breaks into oxygen and water by the action of catalase. Increased activity of SOD with decreased activity of

catalase would lead to accumulation of hydrogen peroxide that could cause melanocyte death that seen

clinically as vitiligo.

1 INTRODUCTION

Vitiligo is still a challenge in Dermatology. It is the

most common depigmentation disorder that can be

ocurred in all ages and both gender (Alikhan et al.,

2011). Although not causing mortality, vitiligo came

with a big burden of morbidity because of the stigma

from uneven skin appearances. Chronically lasting

disease, prolong duration of therapy with unsatisfying

result, and unpredictable outcome had a huge impact

in the patient’s quality of life (Parsad et al., 2003).

The exact mechanism how selective damage of

melanocyte occur in vitiligo has not yet been

elaborated. One hypothesis is the imbalance of

oxidant and antioxidant that caused accumulation of

oxidative stress that in turn have impact in

melanocyte death (Arican & Kuruta, 2008). This

hypothesis arise based on the fact that melanin

synthesis process itself would generate abundant

amount of reactive oxygen species (ROS).

Superoxide anion (O

) and hydrogen peroxide

) are some ROS that produced during melanin

synthesis process that have destructive effect to cells,

specifically melanocytes (Denat et al., 2014).

Superoxide dimutase (SOD) and catalase are the main

antioxidant defense against radical superoxide in

order to reduce the toxicity to cells (Le Quere et al.,

2014).

The aim of this study is to determine the

correlation between plasma SOD and catalase with

severity of vitiligo using scoring system Vitiligo Area

Severity Index (VASI).

2 METHOD

This was a observational analytic study with cross-

sectional design that had been done in Dermato-

Venereology Outpatient Clinic at August-November

2017. Sampling of study subject were done using

consecutive technique sampling by taking all vitiligo

diagnosed patients that met the sample requirement

P., S., R. V., K. and M. S., A.

Correlation between Plasma Level of Superoxide Dismutase and Catalase with the Degree of Severity in Vitiligo.

DOI: 10.5220/0008151500920094

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 92-94

ISBN: 978-989-758-494-7

criteria that came to Dermato-Venereology

Outpatient Clinic during study period. Inclusion

criteria including vitiligo patients that came to

Dermato-Venereology Outpatient Clinic, Indonesian,

male and female under 60 years old, in good

condition, and willing to participate in this study.

Exclusion criteria including subject that already

received both topical and systemic treatment or

phototherapy 2 weeks before, smoking, pregnancy,

history of tuberculosis, cardiovascular disease,

rheumatoid arthritis, diabetes mellitus, asthma and

atopy, malignancy, and had history of taking

antioxidants or non-steroidal anti-inflammatory drugs

in 1 month before. Plasma SOD and catalase were

examined using spectrofotometric method.

Correlation were analyzed using analysis software

SPSS Ethical clearance for study protocol was

obtained from Ethical Study Comission Faculty of

Medicine Udayana/Sanglah Hospital before the study

begin. Subject fulfilled inclusion and exclusion

criteria will be explained about the goal and

procedure of the study before the informed consent

signed. Subject have full right to refuse to participate

in this study.

Table 1. Characteristic Distribution of Study Subject

No Characteristic Vitiligo (n=49) Percentage (%)

1. Gender

Male

female

2. Age (years)

≤ 15

16 – 25

26 – 35

36 – 45

46 – 55

56 – 65

> 66

8,2

6,1

18,4

22,4

18,4

24,5

2,0

3. Diagnosis Vitiligo

Non Segmental

Segmental

83,7

16,3

Family History

Yes

14,3

85,7

3 RESULT

This study involved 49 vitiligo patients consist of

49% male and 51% female. Based on age distribution,

the youngest subject was 15 years old and the oldest

was 66 years old with the mean age 42,31 years old.

Characteristic of the study subject were listed in table

This study found the mean of plasma SOD level

from the study subject was 0,638 U/ml with the lowest

value was 0,49 U/ml and the highest was 0,75 U/ml.

Whereas for plasma catalase level, the mean was

64,07 U/ml with lowest value was 55,86 U/ml and the

highest value was 72,99 U/ml. Correlation analysis

using Spearman’s rho test because the VASI score

data were not normally distributed. From this

statistical analysis significant positive correlation (r =

0,473; p < 0,01) between plasma SOD level and

severity based on VASI score and significant negative

correlation (r = - 0,597; p < 0,01) between plasma

catalase level and severity based on VASI score were

found.

4 DISCUSSION

This study found significant positive correlation

between plasma SOD level and VASI score and

significant negative correlation between plasma

catalase level and VASI score. This result implied

that the higher plasma SOD level and the lower

plasma catalase level, the more severe vitiligo would

be. Previous study showed similar result. Study by

Sravani in 2009 about activity of SOD and catalase in

skin tissues showed a significant increase of SOD

activity and decrease of catalase activity both on

lesional and normal skin of vitiligo patients (Sravani

et al., 2009). Briganti et al in 2012 found an increase

of SOD activity on depigmented skin tissue that

correlate with the increase of SOD in mononuclear

Correlation between Plasma Level of Superoxide Dismutase and Catalase with the Degree of Severity in Vitiligo

cells of peripherally circulating blood which indicate

a functional relation among endogen antioxidants and

the occurrence of systemic oxidative stress (Briganti

& Picardo, 2002). Arican et al in 2008 and Agrawal

et al in 2014 also found the mean of catalase level in

erythrocytes on vitiligo patients were significantly

lower than normal controls (Arican et al., 2008;

Agrawal et al., 2004).

Superoxide dismutase is the first line enzymatic

antioxidant transforming a reactive superoxide anion

•-

to become hydrogen peroxide H

that

subsequently will turned into H

O and O

with the

activity of catalase that act as the second line

enzymatic antioxidant (Le Quere et al., 2014, Sravani

et al., 2009).

The accumulation of H

can cause

inactivation of catalase enzyme that will result in

more H

excess and damage to the cells (Hazneci

et al., 2004; Dammak et al., 2009). This disturbed

antioxidant activity showed by increase of SOD and

decrease of catalase had been proved both in the

lesional and non-lesional skin of vitiligo patients and

also in melanocytes in vitro (Schallreuter et al., 1999;

Maresca et al., 1997).Accumulation of H

will

undergo a Fenton and Haber-Weiss reaction to

produce a very reactive hydroxyl radical (OH

•

) that

very toxic to melanocytes and considered as the cause

of melanocyte deaths so that the increase of SOD and

decrease of catalase are related to the progressivity

and severity of vitiligo (Laddha et al., 2014).

5 CONCLUSIONS

There were significant positive correlation between

plasma SOD level and severity of vitiligo based on

VASI score and significant negative correlation

between plasma catalase level and severity of vitiligo

based on VASI score.

ACKNOWLEDGEMENTS

This study is funded by Study and Development Unit

of Medical Faculty Udayana University on 2017.

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