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Sharifzadeh A, Gochnauer H, Harris JE. Improvement in light tolerance with oral Polypodium leucotomos extract in a patient with nonsegmental vitiligo treated with narrow-band UV-B phototherapy. JAAD Case Rep 2024; 49:65-67. [PMID: 38883171 PMCID: PMC11179583 DOI: 10.1016/j.jdcr.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Affiliation(s)
- Afsheen Sharifzadeh
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Department of Dermatology, New York Medical College/Metropolitan Hospital Center, New York, New York
| | - Heather Gochnauer
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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2
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Speeckaert R, Bulat V, Speeckaert MM, van Geel N. The Impact of Antioxidants on Vitiligo and Melasma: A Scoping Review and Meta-Analysis. Antioxidants (Basel) 2023; 12:2082. [PMID: 38136202 PMCID: PMC10740621 DOI: 10.3390/antiox12122082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Reactive oxygen species (ROS) generated during melanogenesis make melanocytes particularly vulnerable to oxidative stress, influencing their survival and melanin synthesis. Oxidative stress, significantly present in vitiligo and recently also detected in melasma, triggers inflammatory cascades and melanogenesis, making antioxidants a promising therapeutic avenue. A systematic search was conducted on Embase and Pubmed to study the efficacy of antioxidants for treating vitiligo and/or melasma. Meta-analysis was performed to assess the difference in Melasma Severity Index (MASI) scores between baseline and follow-up. Various antioxidants like polypodium leucotomos, ginkgo biloba, catalase/superoxide dismutase, and vitamin E have potential in vitiligo. For melasma, vitamin C, silymarin, and niacinamide were among those showing promise in reducing pigmentation, with vitamin C displaying significant effects in meta-analysis. Different antioxidants improve both vitiligo and melasma, with an increased minimal erythema dose (MED) following UV exposure being significant for vitiligo and tyrosinase inhibition being crucial for melasma. However, the efficacy of individual antioxidants varies, and their exact mechanisms, especially in stimulating melanocyte proliferation and anti-inflammatory pathways, require further investigation to understand better and optimize their use.
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Affiliation(s)
- Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Vedrana Bulat
- Department of Dermatology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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3
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Białczyk A, Wełniak A, Kamińska B, Czajkowski R. Oxidative Stress and Potential Antioxidant Therapies in Vitiligo: A Narrative Review. Mol Diagn Ther 2023; 27:723-739. [PMID: 37737953 PMCID: PMC10590312 DOI: 10.1007/s40291-023-00672-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
Vitiligo is a chronic skin disorder characterised by the loss of melanocytes and subsequent skin depigmentation. Although many theories have been proposed in the literature, none alone explains the pathogenesis of vitiligo. Oxidative stress has been identified as a potential factor in the pathogenesis of vitiligo. A growing body of evidence suggests that antioxidant therapies may offer a promising approach to managing this condition. This review summarises the potential mechanisms of oxidative stress and the types of melanocyte death in vitiligo. We also provide a brief overview of the most commonly studied antioxidants. Melanocytes in vitiligo are thought to be damaged by an accumulation of reactive oxygen species to destroy the structural and functional integrity of their DNA, lipids, and proteins. Various causes, including exogenous and endogenous stress factors, an imbalance between prooxidants and antioxidants, disruption of antioxidant pathways, and gene polymorphisms, lead to the overproduction of reactive oxygen species. Although necroptosis, pyroptosis, ferroptosis, and oxeiptosis are newer types of cell death that may contribute to the pathophysiology of vitiligo, apoptosis remains the most studied cell death mechanism in vitiligo. According to studies, vitamin E helps to treat lipid peroxidation of the skin caused by psoralen ultra-violet A treatment. In addition, Polypodium leucotomos increased the efficacy of psoralen ultra-violet A or narrow-band ultraviolet B therapy. Our review provides valuable insights into the potential role of oxidative stress in pathogenesis and antioxidant-based supporting therapies in treating vitiligo, offering a promising avenue for further research and the development of effective treatment strategies.
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Affiliation(s)
- Aleksandra Białczyk
- Students' Scientific Club of Dermatology, Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, 85-094, Bydgoszcz, Poland.
| | - Adam Wełniak
- Students' Scientific Club of Dermatology, Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, 85-094, Bydgoszcz, Poland
| | - Barbara Kamińska
- Students' Scientific Club of Dermatology, Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, 85-094, Bydgoszcz, Poland
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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4
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Castillo E, González-Rosende ME, Martínez-Solís I. The Use of Herbal Medicine in the Treatment of Vitiligo: An Updated Review. PLANTA MEDICA 2023; 89:468-483. [PMID: 36379447 DOI: 10.1055/a-1855-1839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Vitiligo is a chronic disease of unknown etiology that causes progressive cutaneous depigmentation. Current pharmacological treatments have limited success and present significant risks. Many efforts have been made in recent years to explore new anti-vitiligo therapeutic strategies, including herbal-based therapies. The objective of the present review is to provide an updated overview on the most frequently used medicinal plants in the treatment of vitiligo. A bibliographical search was carried out in scientific databases Pubmed, Scifinder, Scopus, Google Scholar, and Medline up to October 2021 using the descriptors vitiligo, herbal, medicinal plants, and alternative therapies. In our search, the highest number of published studies comprise plants commonly used in traditional herbal medicine, highlighting the usefulness of ethnopharmacology in the discovery of new therapeutic agents. The review outlines current understanding and provides an insight into the role of psoralens and khellin (photosensitizing agents obtained from plants such as Cullen corylifolium or Ammi visnaga). The paper also describes other traditional herbs such as Ginkgo biloba, Phlebodium aureum, Piper nigrum, Picrorhiza kurroa, and Baccharoides anthelmintica that can likewise act as potential therapeutical agents. Based on our findings, photosensitizing agents in combination with phototherapy, the association of oral Phebodium aureum with phototherapies as well as oral G. biloba in monotherapy showed greater scientific evidence as therapeutic options. The research results emphasize that further investigation in this area is merited. More long-term follow up clinical trials and higher quality randomized trials are needed.
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Affiliation(s)
- Encarna Castillo
- Department of Pharmacy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, Alfara del Patriarca, Valencia (Spain)
| | - María Eugenia González-Rosende
- Department of Pharmacy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, Alfara del Patriarca, Valencia (Spain)
| | - Isabel Martínez-Solís
- Department of Pharmacy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, Alfara del Patriarca, Valencia (Spain)
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5
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Fatima S, Abbas T, Refat MA, Harris JE, Lim HW, Hamzavi IH, Mohammad TF. Systemic therapies in vitiligo: a review. Int J Dermatol 2023; 62:279-289. [PMID: 35133006 DOI: 10.1111/ijd.16114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/09/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
Vitiligo is characterized by the development of depigmented macules and patches. Autoimmunity has been established as a factor in disease pathogenesis, leading to utilization of immunosuppressive agents. Topical immunosuppressants are commonly used; however, this treatment modality is often cumbersome and inefficient, as many patients have active disease with extensive body surface area involvement. Prompt and aggressive treatment of vitiligo is important, as this may prevent progression and improve quality of life. To meet these challenges and improve patient outcomes, interest in systemic therapies has grown. Currently, oral therapies are rarely prescribed, likely due to concerns with systemic side effects and unclear efficacy. This article provides a brief overview on the use of systemic agents in treating vitiligo in order to provide additional therapeutic options to clinicians.
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Affiliation(s)
- Sakeena Fatima
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tazeen Abbas
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Maggi A Refat
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Tasneem F Mohammad
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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6
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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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Calzari P, Vaienti S, Nazzaro G. Uses of Polypodium leucotomos Extract in Oncodermatology. J Clin Med 2023; 12:jcm12020673. [PMID: 36675602 PMCID: PMC9861608 DOI: 10.3390/jcm12020673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/18/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
The effects of UV radiation on the skin and its damage mechanisms are well known. New modalities of exogenous photoprotection have been studied. It was demonstrated that Polypodium leucotomos extract acts as an antioxidant, photoprotectant, antimutagenic, anti-inflammatory, and immunoregulator. It is effective when taken orally and/or applied topically to support the prevention of skin cancers. It also has an important role in preventing photoaging. This review aims to report the mechanisms through which Polypodium leucotomos acts and to analyze its uses in oncodermatology with references to in vitro and in vivo studies. Additionally, alternative uses in non-neoplastic diseases, such as pigmentary disorders, photosensitivity, and atopic dermatitis, have been considered.
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Affiliation(s)
- Paolo Calzari
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Silvia Vaienti
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 30127 Verona, Italy
| | - Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Dermatology Unit, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
- Correspondence:
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1-Leitlinie: Diagnostik und Therapie der Vitiligo. J Dtsch Dermatol Ges 2022; 20:365-379. [PMID: 35304960 DOI: 10.1111/ddg.14713_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Jo Ana Schunter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Klaus Fritz
- Hautarztpraxis und Laserzentrum Landau, Landau, Deutschland
| | - Carmen Salavastru
- Universität Carol Davila, Pädiatrische Dermatologie, Bukarest, Rumänien
| | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges 2022; 20:365-378. [PMID: 35246935 DOI: 10.1111/ddg.14713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Vitiligo is a common skin disorder characterized by immune-mediated destruction of melanocytes. Non-segmental vitiligo, the most common clinical subtype, has usually a chronic course and often results in significant psychosocial consequences for the affected patient. Early recognition, awareness of comorbidity, precise assessment of disease extent and activity, evaluation of impairment of quality of life as well as rapid initiation of treatment based on currently available evidence-based therapies are crucial cornerstones in the management of vitiligo. This S1 guideline helps German dermatologists to better diagnose and treat vitiligo.
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Affiliation(s)
- Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Jo Ana Schunter
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Klaus Fritz
- Dermatology Office and Laser Center Landau, Landau, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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10
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Searle T, Al-Niaimi F, Ali FR. Polypodium leucotomos as an adjunct to the treatment of vitiligo. J Am Acad Dermatol 2021; 86:e65. [PMID: 34390787 DOI: 10.1016/j.jaad.2021.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tamara Searle
- University of Birmingham Medical School, Birmingham, UK
| | - Firas Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Faisal R Ali
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RS, UK; Vernova Healthcare Community Interest Company, Macclesfield, UK.
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11
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Jamgochian M, Alamgir M, Rao B. Diet in Dermatology: Review of Diet's Influence on the Conditions of Rosacea, Hidradenitis Suppurativa, Herpes Labialis, and Vitiligo. Am J Lifestyle Med 2021; 17:152-160. [PMID: 36636389 PMCID: PMC9830249 DOI: 10.1177/15598276211026592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The influence of dietary patterns on cutaneous disease has been an oft-posed question to dermatologists by patients in a clinical setting. Similarly, the popularity of nutritional supplementation with vitamins, minerals, and nutraceutical blends has been increasing. Dermatologists, primary care physicians, and other providers should be familiar with dietary interventions that are evidence-based and those that are more marketable than efficacious. In this review, the modification of diet, including dietary exclusion and dietary supplementation for the treatment of rosacea, hidradenitis suppurativa (HS), herpes labialis, and vitiligo was investigated. Despite abundant anecdotal evidence, the literature search found no high-quality evidence that an elimination diet for rosacea "trigger foods" improved rosacea symptoms though these elimination diets (of hot, spicy, alcohol-containing, or cinnamaldehyde-containing foods) had low risk of harm. There is evidence that zinc supplementation and vitamin D supplementation in deficient patients is helpful for treating HS. For herpes labialis, L-lysine supplementation was found to be effective for prophylaxis but not for decreasing duration of active lesions. For vitiligo, the use of the herb Polypodium leucotomos in conjunction with phototherapy was found to increase repigmentation, as well as vitamin D supplementation in deficient patients.
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Affiliation(s)
- Marielle Jamgochian
- Marielle Jamgochian, MBS, Rutgers Robert
Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA;
e-mail:
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12
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Hussain I. The Safety of Medicinal Plants Used in the Treatment of Vitiligo and Hypermelanosis: A Systematic Review of Use and Reports of Harm. Clin Cosmet Investig Dermatol 2021; 14:261-284. [PMID: 33790609 PMCID: PMC8001124 DOI: 10.2147/ccid.s298342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Vitiligo is disfiguring and devastating condition that can humans feel stigmatic and devalued. Melasma is a general condition of hyperpigmentation particularly involving the face. The pigmentation disorders of vitiligo (hypopigmentation or de-pigmentation) and melasma (Hypermelanosis) are common among the world's population (around 1% for vitiligo). OBJECTIVE The identification of medicinal plants used in the treatment of vitiligo and hypermelanosis. A systematic literature review on harms associated with the medicinal plants used in the treatment of vitiligo and hypermelanosis. To review and summarize information on reported adverse drug reactions (ADRs) associated with these medicinal plants contained in (where access is available) national and global individual case safety report databases. METHODS A systematic review of the literature with special reference to all types of clinical trial and case reports using biomedical databases including Medline, EMBASE, Scopus, International Pharmaceutical Abstracts and so forth to identify medicinal plants alone or as an adjuvant with other treatments and their safety/tolerability in the treatment of vitiligo and Hypermelanosis. Other sources of this search were medicinal plants text books, pharmacopoeias and authentic websites discussing possible treatments for vitiligo/hypermelanosis. It also included databases such as VigiAccess containing data from spontaneous reporting schemes for ADRs. RESULTS A total of 55 articles (47 clinical trials and 8 case reports) met the inclusion criteria. Some trials did not reported safety information, some did report, but not very well. Reports of blistering, erythema, acute hepatitis and mutagenesis with Psoralea corylifolia. Adverse effects of erythema (mild to severe), phototoxic reactions, mild raise in liver transaminases, gastrointestinal disturbances, burns, itching, scaling, depigmented macules, pruritis, and giddiness with the use of psoralens. Khellin-related erythema, perilesional hyperpigmentation, gastrointestinal disturbances, mild raise in liver transaminases and orthostatic complaints. Infrequent side effects with Ginkgo biloba. Lower grade of erythema and edema reported with the use of Polypodium leucotomos. CONCLUSION Primarily the retrieved clinical studies were efficacy oriented and safety parameters were secondary in priority whilst the general protocol of clinical trials requires the screening of drugs/medicinal plants on the basis of safety studies before testing the clinical aspects of efficacy. Thereby it is recommended that efficacy studies may be followed once the safety has been established for a particular medicinal plant in treating vitiligo and hypermelanosis.
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Affiliation(s)
- Irshad Hussain
- Institute of Pharmacy, Shaheed Mohtarma Benazir Bhutto (SMBB) Medical University, Larkana, Pakistan
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13
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Pacifico A, Damiani G, Iacovelli P, Conic RRZ, Gonzalez S, Morrone A. NB-UVB plus oral Polypodium leucotomos extract display higher efficacy than NB-UVB alone in patients with vitiligo. Dermatol Ther 2021; 34:e14776. [PMID: 33433041 DOI: 10.1111/dth.14776] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
Polypodium leucotomos displayed a synergic effect with NB-UVB in psoriasis, but its application on vitiligo remains understudied. The aim of this study was to investigate whether oral supplementation with leaves extract of Polypodium leucotomos (PL) improves narrow band (NB) UVB phototherapy-induced repigmentation. Forty-four patients with generalized vitiligo were enrolled in this randomized, prospective, placebo controlled study. Twenty-three patients were randomly selected to receive combined treatment with NB-UVB phototherapy and 480 mg oral PL twice daily while 21 patients received NB-UVB phototherapy combined with placebo. All subjects were treated with NB-UVB twice weekly for 6 months. Our results demonstrated that oral PL combined with NB-UVB improved repigmentation as well as increased the response rate compared with patients treated with NB-UVB alone (47.8% vs 22%). Our study suggests that oral supplementation of PL and NB-UVB phototherapy enhance the extent of repigmentation.
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Affiliation(s)
- Alessia Pacifico
- Clinical Dermatology Department, S. Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences University of Milan, Milan, Italy.,PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Paolo Iacovelli
- Clinical Dermatology Department, S. Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Rosalynn R Z Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Salvador Gonzalez
- Department of Medicine and Medical Specialties, Alcalà University and Ramon y Cajal Hospital, Ctra, De Colmenar Viejo, Madrid, Spain
| | - Aldo Morrone
- Clinical Dermatology Department, S. Gallicano Dermatological Institute, IRCCS, Rome, Italy
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15
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Shakhbazova A, Wu H, Chambers CJ, Sivamani RK. A Systematic Review of Nutrition, Supplement, and Herbal-Based Adjunctive Therapies for Vitiligo. J Altern Complement Med 2020; 27:294-311. [PMID: 33337930 DOI: 10.1089/acm.2020.0292] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Vitiligo is an autoimmune skin condition that affects people globally anywhere, from <0.1% to more than 8% of individuals. The disease destroys skin melanocytes, resulting in a patchy depigmentation of the skin. About 50% of all patients develop the disease before their 20s. Methods: We systematically searched the literature and reviewed the evidence for the use of nutritional supplements and diet in the management of vitiligo. Embase and Medline were searched for diet, herbal, and nutrition-based clinical studies. Additional filters were applied that looked for controlled trial or randomized controlled trial and article or article in press or letter and English and clinical study. We selected clinical studies in humans that showed how diet or natural supplements can improve the symptoms of vitiligo in all of our searches. Results: There were 62 manuscripts that resulted from the PubMed search and 259 from the Embase search. A final of 26 studies were reviewed, and other supplemental case and case-control studies were used to introduce diet components that may influence either exacerbation or amelioration of vitiligo. Possible mechanisms of action are introduced for natural and supplemental interventions. Conclusion: Some of the supplements reviewed include Gingko biloba, oral Polypodium leucotomos, alpha lipoic acid, vitamins B12, D, and E, folic acid, phenylalanine, canthaxanthin, Nigella sativa oil, and other combined herbal bio-actives. Overall, the growing evidence is promising, but more studies are needed in this area to further explore the impact that supplements and diet can have on vitiligo management. The most promising therapies included oral phenylalanine as adjuvant therapy with UVA therapy, oral G. biloba as monotherapy, both of which can be used with other traditional therapies, and oral P. leucotomos with phototherapy or photochemotherapy.
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Affiliation(s)
| | - Hera Wu
- College of Medicine, California Northstate University, Elk Grove, CA, USA.,Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Cindy J Chambers
- College of Medicine, California Northstate University, Elk Grove, CA, USA.,Pacific Skin Institute, Sacramento, CA, USA.,Zen Dermatology, Sacramento, CA, USA
| | - Raja K Sivamani
- College of Medicine, California Northstate University, Elk Grove, CA, USA.,Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,Pacific Skin Institute, Sacramento, CA, USA.,Zen Dermatology, Sacramento, CA, USA.,Department of Biological Sciences, California State University, Sacramento, Sacramento, CA, USA
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16
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Lin X, Meng X, Song Z, Lin J. Nuclear factor erythroid 2-related factor 2 (Nrf2) as a potential therapeutic target for vitiligo. Arch Biochem Biophys 2020; 696:108670. [PMID: 33186606 DOI: 10.1016/j.abb.2020.108670] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
Vitiligo is an autoimmune disease of the skin which causes loss of melanocytes from the epidermis. Recently, it is demonstrated that oxidative stress (OS) plays a significant role in the immuno-pathogenesis of vitiligo. A major mechanism in the cellular defense against OS is activation of the nuclear factor erythroid2-related factor (Nrf2)-Kelch-like ECH-associated protein 1(Keap1)-antioxidant responsive element (ARE) signaling pathway. Recently it has been shown that vitiligo melanocytes have impaired Nrf2-ARE signaling. A number of drugs including those known as Nrf2 activators and those known to possess effects to activate Nrf2, have been used in treating vitiligo with certain therapeutic effects. Also, studies have shown that a number of compounds can protect melanocytes against OS via activating Nrf2. These compounds may be considered as candidates for developing new drugs for vitiligo in the future. Nrf2 can be considered as a potential therapeutic target for vitiligo.
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Affiliation(s)
- Xiran Lin
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Lu, Dalian, 116011, China.
| | - Xianmin Meng
- Department of Pathology and Laboratory Medicine, Axia Women's Health, 450 Cresson BLVD, Oaks, PA, 19456, USA.
| | - Zhiqi Song
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Lu, Dalian, 116011, China.
| | - Jingrong Lin
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Lu, Dalian, 116011, China.
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Zare F, Parvizi MM, Saki N, Jaladat AM. Applications of Ma'aljobon, a natural remedy from traditional Persian medicine, in dermatology: A journey from past to modernity. Dermatol Ther 2020; 33:e13931. [PMID: 32662602 DOI: 10.1111/dth.13931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/21/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023]
Abstract
Ma'aljobon, a handmade substance, is the liquid portion of coagulated milk after adding vinegar to the heated milk. In traditional Persian medicine (TPM) it has been known as a useful remedy for the treatment of some skin disorders. The aim of this study was to review the applications of Ma'aljobon for skin diseases according to the sages of TPM and modern medicine. Main TPM sources were reviewed with the keyword of "Ma'aljobon." Furthermore, electronic databases including Scopus, PubMed, SID, and Google Scholar were searched with the keyword "Whey protein" during 2000 to 2018. According to TPM sources, Ma'aljobon was used by Iranian sages as a safe and effective remedy to treat a wide range of skin diseases, such as pimples, and ulcers. Meantime, recent evidence has also shown the effectiveness of whey protein in treating some skin disorders such as atopic dermatitis. Gastrointestinal discomfort was the most adverse effect of Ma'aljobon mentioned in TPM sources. In conclusion, there were several applications for Ma'aljobon in treatment of dermatologic disease according to TPM, as well as modern medicine. These finding could be the basis of future clinical trials on the effects of Ma'aljobon in the treatment of skin problems.
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Affiliation(s)
- Farzaneh Zare
- Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Saki
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mohammad Jaladat
- Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Parrado C, Nicolas J, Juarranz A, Gonzalez S. The role of the aqueous extract Polypodium leucotomos in photoprotection. Photochem Photobiol Sci 2020; 19:831-843. [PMID: 33856681 DOI: 10.1039/d0pp00124d] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
Abstract
Solar radiation in the ultraviolet (UV), visible (VIS), and infrared (IR) ranges produces different biological effects in humans. Most of these, particularly those derived from ultraviolet radiation (UVR) are harmful to the skin, and include cutaneous aging and increased risk of cutaneous diseases, particularly skin cancer. Pharmacological photoprotection is mostly topical, but it can also be systemic. Oral photoprotectives constitute a new generation of drugs to combat the deleterious effects of solar radiation. Among these, an extract of Polypodium leucotomos (PL/Fernblock®, IFC Group, Spain) contains a high content of phenolic compounds that endow it with antioxidant activity. PL can administered orally or topically and is completely safe. PL complements and enhances endogenous antioxidant systems by neutralizing superoxide anions, hydroxyl radicals, and lipoperoxides. In addition to its antioxidant activity, PL also improves DNA repair and modulates immune and inflammatory responses. These activities are likely due to its ability to inhibit the generation and release of reactive oxygen species (ROS) by UVR, VIS, and IR radiation. PL also prevents direct DNA damage by accelerating the removal of induced photoproducts and decreasing UV-induced mutations. Oral PL increases the expression of active p53, decreases cell proliferation, and inhibits UV-induced COX-2 enzyme levels. PL has been used to treat skin diseases such as photodermatoses and pigmentary disorders and recently as a complement of photodynamic phototherapy in actinic keratoses. The photoprotective capability of PL has been proven in a multitude of in vitro and in vivo studies, which include animal models and clinical trials with human subjects. Based on this evidence, PL is a new generation photoprotector with antioxidant and anti-inflammatory properties that also protects DNA integrity and enhances the immune response.
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Affiliation(s)
- Concepción Parrado
- Department of Histology and Pathology, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Jimena Nicolas
- Department of Biology, Faculty of Sciences, Autónoma University of Madrid, Spain
| | - Angeles Juarranz
- Department of Biology, Faculty of Sciences, Autónoma University of Madrid, Spain
| | - Salvador Gonzalez
- Medicine and Medical Specialties Department, Alcala University, Madrid, Spain.
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Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
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Application of medicinal plants in several dermatovenerological entities. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2019; 69:525-531. [PMID: 31639095 DOI: 10.2478/acph-2019-0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2019] [Indexed: 01/19/2023]
Abstract
Treatment of skin conditions with medicinal plants has been an ongoing human activity lasting over thousands of years. The use of specific plant species developed regionally, based on local flora. Commonly used medicinal plants for dermatological complaints are: Phlebodium aureum (L.) J. Sm., Ginkgo biloba L., Rosmarinus officinalis L., Panax ginseng C.A.Mey., Allium cepa L., Aloe vera (L.) Burm.f., Capsicum annuum L., Berbe ris aquifolium Pursh, Camellia sinensis (L.) Kuntze, and Podophyllum peltatum L. The demand for complementary therapeutics is an emerging trend due to the awareness of potential side effects that synthetic drugs might cause. More scientific evidence and better documentation are needed before advising dermatologic patients on herbal medicinal treatment. Standardised extracts and formulations with proven clinical efficacy should be developed for this cause. Here provided review entails the use of herbal medicinal products in the treatment of frequent chronic skin diseases, such as vitiligo, alopecia, psoriasis and genital warts.
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Di Nardo V, Barygina V, França K, Tirant M, Valle Y, Lotti T. Functional nutrition as integrated approach in vitiligo management. Dermatol Ther 2018; 32:e12625. [DOI: 10.1111/dth.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/16/2018] [Indexed: 01/29/2023]
Affiliation(s)
| | - Victoria Barygina
- Department of Biomedical Experimental and Clinical Sciences; University of Florence; Florence Italy
| | - Katlein França
- Department of Dermatology & Cutaneous Surgery, Institute for Bioethics & Health Policy; University of Miami Miller School of Medicine; Miami Florida
- Department of Psychiatry & Behavioral Sciences, Institute for Bioethics & Health Policy; University of Miami Miller School of Medicine; Miami Florida
| | | | - Yan Valle
- University of Rome “G. Marconi”; Rome Italy
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Speeckaert R, Dugardin J, Lambert J, Lapeere H, Verhaeghe E, Speeckaert MM, van Geel N. Critical appraisal of the oxidative stress pathway in vitiligo: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2018; 32:1089-1098. [PMID: 29341310 DOI: 10.1111/jdv.14792] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The pathogenesis of vitiligo remains a topic of extensive debate. This is partly due to the moderate efficacy of current treatments. The role of the oxidative stress pathway in vitiligo is a popular although controversial research topic. OBJECTIVE To clarify the role of the oxidative stress pathway in vitiligo compared to other inflammatory skin disorders and to assess the therapeutic role of antioxidants. METHODS We conducted a systematic search of the existing literature on the aberrancies of the oxidative stress pathway in vitiligo. Subsequently, the efficacy of both topical and oral antioxidants in clinical trials was investigated. RESULTS A deregulated oxidative pathway is clearly evident with elevated superoxide dismutase, decreased catalase and increased lipid peroxidation. However, similar results have been obtained in other inflammatory skin diseases such as psoriasis, atopic dermatitis, lichen planus and urticaria. This questions the unique role of oxidative stress in the development of vitiligo. Some isolated successes have been reported with oral ginkgo biloba, polypodium leucotomos and vitamin C and E preparations, while other clinical trials have failed to show reproducible results. The use of topical antioxidants delivers in general no beneficial results. CONCLUSION The oxidative pathway is affected in vitiligo, but its unique initiating or contributory role in the pathogenesis is less evident. Interesting data support the added value of oral antioxidants in vitiligo although confirmatory studies are missing.
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Affiliation(s)
- R Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - J Dugardin
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - J Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - E Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - M M Speeckaert
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Cao H, Chai TT, Wang X, Morais-Braga MFB, Yang JH, Wong FC, Wang R, Yao H, Cao J, Cornara L, Burlando B, Wang Y, Xiao J, Coutinho HDM. Phytochemicals from fern species: potential for medicine applications. PHYTOCHEMISTRY REVIEWS : PROCEEDINGS OF THE PHYTOCHEMICAL SOCIETY OF EUROPE 2017; 16:379-440. [PMID: 32214919 PMCID: PMC7089528 DOI: 10.1007/s11101-016-9488-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023]
Abstract
Ferns are an important phytogenetic bridge between lower and higher plants. Historically they have been used in many ways by humans, including as ornamental plants, domestic utensils, foods, and in handicrafts. In addition, they have found uses as medicinal herbs. Ferns produce a wide array of secondary metabolites endowed with different bioactivities that could potentially be useful in the treatment of many diseases. However, there is currently relatively little information in the literature on the phytochemicals present in ferns and their pharmacological applications, and the most recent review of the literature on the occurrence, chemotaxonomy and physiological activity of fern secondary metabolites was published over 20 years ago, by Soeder (Bot Rev 51:442-536, 1985). Here, we provide an updated review of this field, covering recent findings concerning the bioactive phytochemicals and pharmacology of fern species.
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Affiliation(s)
- Hui Cao
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, 350002 China
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau
| | - Tsun-Thai Chai
- Department of Chemical Science, Faculty of ScienceUniversiti Tunku Abdul Rahman, 31900 Kampar, Malaysia
| | - Xin Wang
- Department of Biology, Shanghai Normal University, 100 Guilin Rd, Shanghai, 200234 China
| | | | - Jing-Hua Yang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, School of Chemical Science and Technology, Yunnan University, Kunming, 650091 China
| | - Fai-Chu Wong
- Department of Chemical Science, Faculty of ScienceUniversiti Tunku Abdul Rahman, 31900 Kampar, Malaysia
- Centre for Biodiversity Research, Universiti Tunku Abdul Rahman, 31900 Kampar, Malaysia
| | - Ruibing Wang
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau
| | - Huankai Yao
- School of Pharmacy, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Jiangsu, 221004 China
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jianguo Cao
- Department of Biology, Shanghai Normal University, 100 Guilin Rd, Shanghai, 200234 China
| | - Laura Cornara
- Dipartimento di Scienze della Terra dell’Ambiente e della Vita, Polo Botanico, Università degli Studi di Genova, Corso Dogali 1M, 16136 Genoa, Italy
| | - Bruno Burlando
- Dipartimento di Scienze e Innovazione Tecnologica, Università del Piemonte Orientale “Amedeo Avogadro”, Viale Teresa Michel 11, 15121 Alessandria, Italy
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Via De Marini 6, 16149 Genoa, Italy
| | - Yitao Wang
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau
| | - Jianbo Xiao
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou, 350002 China
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau
| | - Henrique D. M. Coutinho
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri–URCA, Crato, CE Brazil
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Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, Delamere FM, Eleftheriadou V, Evans N, Firkins L, Greenlaw N, Lansbury L, Lawton S, Layfield C, Leonardi-Bee J, Mason J, Mitchell E, Nankervis H, Norrie J, Nunn A, Ormerod AD, Patel R, Perkins W, Ravenscroft JC, Schmitt J, Simpson E, Whitton ME, Williams HC. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundSkin diseases are very common and can have a large impact on the quality of life of patients and caregivers. This programme addressed four diseases: (1) eczema, (2) vitiligo, (3) squamous cell skin cancer (SCC) and (4) pyoderma gangrenosum (PG).ObjectiveTo set priorities and reduce uncertainties for the treatment and prevention of skin disease in our four chosen diseases.DesignMixed methods including eight systematic reviews, three prioritisation exercises, two pilot randomised controlled trials (RCTs), three feasibility studies, two core outcome initiatives, four funding proposals for national RCTs and one completed national RCT.SettingSecondary care, primary care and the general population.ParticipantsPatients (and their caregivers) with eczema, vitiligo, SCC and PG, plus health-care professionals with an interest in skin disease.InterventionsOur three intervention studies included (1) barrier enhancement using emollients from birth to prevent eczema (pilot RCT); (2) handheld narrowband ultraviolet light B therapy for treating vitiligo (pilot RCT); and (3) oral ciclosporin (Neoral®, Novartis Pharmaceuticals) compared with oral prednisolone for managing PG (pragmatic national RCT).ResultsSystematic reviews included two overarching systematic reviews of RCTs of treatments for eczema and vitiligo, an umbrella review of systematic reviews of interventions for the prevention of eczema, two reviews of treatments for SCC (one included RCTs and the second included observational studies), and three reviews of outcome measures and outcome reporting. Three prioritisation partnership exercises identified 26 priority areas for future research in eczema, vitiligo and SCC. Two international consensus initiatives identified four core domains for future eczema trials and seven core domains for vitiligo trials. Two pilot RCTs and three feasibility studies critically informed development of four trial proposals for external funding, three of which are now funded and one is pending consideration by funders. Our pragmatic RCT tested the two commonly used systemic treatments for PG (prednisolone vs. ciclosporin) and found no difference in their clinical effectiveness or cost-effectiveness. Both drugs showed limited benefit. Only half of the participants’ ulcers had healed by 6 months. For those with healed ulcers, recurrence was common (30%). Different side effect profiles were noted for each drug, which can inform clinical decisions on an individual patient basis. Three researchers were trained to PhD level and a dermatology patient panel was established to ensure patient involvement in all aspects of the programme.ConclusionsFindings from this programme of work have already informed clinical guidelines and patient information resources. Feasibility studies have ensured that large national pragmatic trials will now be conducted on important areas of treatment uncertainty that address the needs of patients and the NHS. There is scope for considerable improvement in terms of trial design, conduct and reporting for RCTs of skin disease, which can be improved through wider collaboration, registration of trial protocols and complete reporting and international consensus over core outcome sets. Three national trials have now been funded as a result of this work. Two international initiatives to establish how best to measure the core outcome domains for eczema and vitiligo are ongoing.Trial registrationCurrent Controlled Trials Barrier Enhancement for Eczema Prevention (BEEP) (ISRCTN84854178 and NCT01142999), Study of Treatments fOr Pyoderma GAngrenosum Patients (STOP GAP) (ISRCTN35898459) and Hand Held NB-UVB for Early or Focal Vitiligo at Home (HI-Light Pilot Trial) (NCT01478945).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tessa Clarke
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Nicholas Evans
- Trust Headquarters, West Hertfordshire Hospital NHS Trust, Hemel Hempstead, UK
| | - Lester Firkins
- Strategy and Development Group, James Lind Alliance, Oxford, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Nunn
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Ramesh Patel
- Radcliffe-on-Trent Health Centre, Nottingham, UK
| | - William Perkins
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane C Ravenscroft
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Parrado C, Mascaraque M, Gilaberte Y, Juarranz A, Gonzalez S. Fernblock (Polypodium leucotomos Extract): Molecular Mechanisms and Pleiotropic Effects in Light-Related Skin Conditions, Photoaging and Skin Cancers, a Review. Int J Mol Sci 2016; 17:ijms17071026. [PMID: 27367679 PMCID: PMC4964402 DOI: 10.3390/ijms17071026] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/02/2016] [Accepted: 06/20/2016] [Indexed: 12/20/2022] Open
Abstract
Healthier life styles include increased outdoors time practicing sports and walking. This means increased exposure to the sun, leading to higher risk of sunburn, photoaging and skin cancer. In addition to topical barrier products, oral supplementations of various botanicals endowed with antioxidant activity are emerging as novel method of photoprotection. Polypodium leucotomos extract (PL, commercial name Fernblock®, IFC Group, Spain) is a powerful antioxidant due to its high content of phenolic compounds. PL is administered orally, with proven safety, and it can also be used topically. Its mechanisms include inhibition of the generation and release of reactive oxygen species (ROS) by ultraviolet (UV) light. It also prevents UV- and ROS-induced DNA damage with inhibition of AP1 and NF-κB and protection of natural antioxidant enzyme systems. At the cellular level, PL decreases cellular apoptosis and necrosis mediated UV and inhibits abnormal extracellular matrix remodeling. PL reduces inflammation, prevents immunosuppression, activates tumor suppressor p53 and inhibits UV-induced cyclooxygenase-2 (COX-2) enzyme expression. In agreement with increased p53 activity, PL decreased UV radiation-induced cell proliferation. PL also prevents common deletions mitochondrial DNA damage induced by UVA, and MMP-1 expression induced Visible Light and Infrared Radiation. These cellular and molecular effects are reflected in inhibitions of carcinogenesis and photoaging.
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Affiliation(s)
- Concepcion Parrado
- Pathology Department, School of Medicine, Universidad de Málaga, Malaga 29071, Spain.
| | - Marta Mascaraque
- Biology Department, Sciences School, Universidad Autónoma de Madrid, Madrid 28049, Spain.
| | | | - Angeles Juarranz
- Biology Department, Sciences School, Universidad Autónoma de Madrid, Madrid 28049, Spain.
| | - Salvador Gonzalez
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
- Medicine Department, Alcalá University, Madrid 28805, Spain.
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Cohen BE, Elbuluk N, Mu EW, Orlow SJ. Alternative Systemic Treatments for Vitiligo: A Review. Am J Clin Dermatol 2015; 16:463-74. [PMID: 26329814 DOI: 10.1007/s40257-015-0153-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact quality of life. It often represents a therapeutic challenge, which has resulted in interest in alternative treatments such as herbal and vitamin supplements. In this review, we provide an overview of the most commonly studied complementary agents, describe proposed mechanisms of action, identify potential adverse effects, and discuss the primary evidence supporting their use. Our discussion focuses on L-phenylalanine, Polypodium leucotomos, khellin, Ginkgo biloba, and vitamins and minerals, including vitamins B12, C, and E, folic acid, and zinc used as monotherapy or in combination with other treatments for the management of vitiligo.
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Affiliation(s)
- Brandon E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA.
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Murbach TS, Béres E, Vértesi A, Glávits R, Hirka G, Endres JR, Clewell AE, Szakonyiné IP. A comprehensive toxicological safety assessment of an aqueous extract of Polypodium leucotomos (Fernblock(®)). Food Chem Toxicol 2015; 86:328-41. [PMID: 26585922 DOI: 10.1016/j.fct.2015.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 12/01/2022]
Abstract
A battery of toxicological studies was conducted in accordance with internationally accepted standards to investigate the genotoxicity and repeated-dose oral toxicity of Fernblock(®), a commercial aqueous extraction of the leaves of the tropical fern Polypodium leucotomos used for its oral and topical photoprotective properties. No evidence of mutagenicity was observed in a bacterial reverse mutation test or in vitro mammalian chromosomal aberration test nor was any genotoxic activity observed in an in vivo mouse micronucleus test. Two repeated-dose oral toxicity studies were conducted in male and female Wistar rats. In the first study, no mortality or toxic effects were observed and no target organs were identified at doses administered for 14 days by gavage up to the maximum dose of 5000 mg/kg bw/day. Based on these results, a 90-day study was conducted at 0, 300, 600, and 1200 mg/kg bw/day. No mortality or treatment-related adverse effects were observed and no target organs were identified. The NOAEL from the 90-day study was determined to be 1200 mg/kg bw/day, the highest dose tested.
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Affiliation(s)
- Timothy S Murbach
- AIBMR Life Sciences, Inc., 4117 South Meridian, Puyallup, WA 98373, USA.
| | - Erzsébet Béres
- Toxi-Coop Zrt., Deres u. 10/A, H-1124 Budapest, Hungary.
| | - Adél Vértesi
- Toxi-Coop Zrt., Deres u. 10/A, H-1124 Budapest, Hungary.
| | - Róbert Glávits
- Toxi-Coop Zrt., Deres u. 10/A, H-1124 Budapest, Hungary.
| | - Gábor Hirka
- Toxi-Coop Zrt., Deres u. 10/A, H-1124 Budapest, Hungary.
| | - John R Endres
- AIBMR Life Sciences, Inc., 4117 South Meridian, Puyallup, WA 98373, USA.
| | - Amy E Clewell
- AIBMR Life Sciences, Inc., 4117 South Meridian, Puyallup, WA 98373, USA.
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Immunological Parameters Associated With Vitiligo Treatments: A Literature Review Based on Clinical Studies. Autoimmune Dis 2015; 2015:196537. [PMID: 26457199 PMCID: PMC4589577 DOI: 10.1155/2015/196537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/26/2015] [Indexed: 12/04/2022] Open
Abstract
Vitiligo, a depigmentary disorder, caused by the loss of melanocytes, affects approximately 1% of the world population, irrespective of skin type, with a serious psychological impact on the patient quality of life. So far, the origin of vitiligo has not been traced and the pathogenesis is complex, involving the interplay of a multitude of variables. Although there is no treatment that ensures the complete cure of the disorder, there are some pharmacological, phototherapy, and surgical therapies available. A series of variables can affect treatment outcome, such as individual characteristics, emotional issues, type of vitiligo, stability of the lesions, and immunological status. The present literature review identified the main immunological parameters associated with treatments for vitiligo. Cytotoxic CD8+ T lymphocytes are the main cell type involved in treatment success, as fewer cells in skin lesions are associated with better results. Other parameters such as cytokines and regulatory T cells may also be involved. Further clinical scientific studies are needed to elucidate the complex mechanisms underlying vitiligo and its treatments, in order to expand the range of therapeutic approaches for each individual case.
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Abstract
As the understanding of the immune system pathways, cytokine balances, and cellular interactions continues to expand, so must the potential applications of therapies that can impact the process of diseases instead of just controlling their symptoms. In the case of Polypodium leucotomos extract, which is derived from a tropical fern of the Polypodiaceae family, the future potential of applications in dermatology and beyond will be better understood as its incorporation into daily routines gives rise to the development of new regimens. Clinicians may position this agent as an option for daily maintenance, accept its use in combinations, or use it as a template for further development of oral supplementation that may evolve into a true immunomodulator. The antioxidant activity of P. leucotomos extract is primarily driven by caffeic acid and ferulic acid, resulting in the control of cutaneous responses to ultraviolet-induced erythema, in the interception of inflammatory mechanisms, and the promotion of other cytotoxic responses. Histologically, the impact of P. leucotomos extract induces an effect on the overall reduction of angiogenesis, photocarcinogenesis, and solar elastosis, while on the cellular level there are improvements in cell membrane integrity and elastin expression. Future applications for P. leucotomos extract could include the potential for photoprotective effects, and subsequent research efforts should focus on determining the optimal dosage regimen, duration of action, and utility of combinations with sunscreens, among other outcomes. Recently published data have also demonstrated how the antioxidant effects of oral P. leucotomos extract can delay tumor development in mice models, suggesting there might be a protective role that could be described with further clinical research. In addition, it is important to recognize the distinction between photoprotection and chemoprevention, in that there has yet to be any in vivo or controlled clinical trial data in human subjects that show a role for P. leucotomos extract in the prevention of carcinogenesis.
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Affiliation(s)
- Neal Bhatia
- Director of Clinical Dermatology, Therapeutics Clinical Research, San Diego, CA, USA,
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Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K. Interventions for vitiligo. Cochrane Database Syst Rev 2015; 2015:CD003263. [PMID: 25710794 PMCID: PMC10887429 DOI: 10.1002/14651858.cd003263.pub5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Around 1% of the world's population has vitiligo, a disease causing white patches on the skin. Several treatments are available. Some can restore pigment but none can cure the disease. OBJECTIVES To assess the effects of all therapeutic interventions used in the management of vitiligo. SEARCH METHODS We updated our searches of the following databases to October 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 10), MEDLINE, Embase, AMED, PsycINFO, CINAHL and LILACS. We also searched five trials databases, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effects of treatments for vitiligo. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and methodological quality, and extracted data. MAIN RESULTS This update of the 2010 review includes 96 studies, 57 from the previous update and 39 new studies, totalling 4512 participants. Most of the studies, covering a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, however only five reported on all of our three primary outcomes which were quality of life, > 75% repigmentation and adverse effects. Of our secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation resulting from treatment at two years follow-up.Most of the studies assessed combination therapies which generally reported better results. New interventions include seven new surgical interventions.We analysed the data from 25 studies which assessed our primary outcomes. We used the effect measures risk ratio (RR), and odds ratio (OR) with their 95% confidence intervals (CI) and where N is the number of participants in the study.We were only able to analyse one of nine studies assessing quality of life and this showed no statistically significant improvement between the comparators.Nine analyses from eight studies reported >75% repigmentation. In the following studies the repigmentation was better in the combination therapy group: calcipotriol plus PUVA (psoralen with UVA light) versus PUVA (paired OR 4.25, 95% CI 1.43 to 12.64, one study, N = 27); hydrocortisone-17-butyrate plus excimer laser versus excimer laser alone (RR 2.57, 95% CI 1.20 to 5.50, one study, N = 84); oral minipulse of prednisolone (OMP) plus NB-UVB (narrowband UVB) versus OMP alone (RR 7.41, 95% CI 1.03 to 53.26, one study, N = 47); azathioprine with PUVA versus PUVA alone (RR 17.77, 95% CI 1.08 to 291.82, one study, N = 58) and 8-Methoxypsoralen (8-MOP ) plus sunlight versus psoralen (RR 2.50, 95% CI 1.06 to 5.91, one study, N = 168). In these three studies ginkgo biloba was better than placebo (RR 4.40, 95% CI 1.08 to 17.95, one study, N = 47); clobetasol propionate was better than PUVAsol (PUVA with sunlight) (RR 4.70, 95% CI 1.14 to 19.39, one study, N = 45); split skin grafts with PUVAsol was better than minipunch grafts with PUVAsol (RR 1.89, 95% CI 1.25 to 2.85, one study, N = 64).We performed one meta-analysis of three studies, in which we found a non-significant 60% increase in the proportion of participants achieving >75% repigmentation in favour of NB-UVB compared to PUVA (RR 1.60, 95% CI 0.74 to 3.45; I² = 0%).Studies assessing topical preparations, in particular topical corticosteroids, reported most adverse effects. However, in combination studies it was difficult to ascertain which treatment caused these effects. We performed two analyses from a pooled analysis of three studies on adverse effects. Where NB-UVB was compared to PUVA, the NB-UVB group reported less observations of nausea in three studies (RR 0.13, 95% CI 0.02 to 0.69; I² = 0% three studies, N = 156) and erythema in two studies (RR 0.73, 95% CI 0.55 to 0.98; I² = 0%, two studies, N = 106), but not itching in two studies (RR 0.57, 95% CI 0.20 to 1.60; I² = 0%, two studies, N = 106).Very few studies only assessed children or included segmental vitiligo. We found one study of psychological interventions but we could not include the outcomes in our statistical analyses. We found no studies evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high- quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR. .
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Parrado C, Juarranz A, Gilaberte Y, Philips N, Gonzalez S. Fern Extract, Oxidative Stress, and Skin Cancer. Cancer 2014. [DOI: 10.1016/b978-0-12-405205-5.00025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eleftheriadou V, Thomas KS, Whitton ME, Batchelor JM, Ravenscroft JC. Which outcomes should we measure in vitiligo? Results of a systematic review and a survey among patients and clinicians on outcomes in vitiligo trials. Br J Dermatol 2013; 167:804-14. [PMID: 22591025 DOI: 10.1111/j.1365-2133.2012.11056.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relevant and reliable outcomes play a crucial role in the correct interpretation and comparison of the results of clinical trials. There is a lack of consensus around methods of assessment and outcome measures for vitiligo, which makes it difficult to compare results of randomized controlled trials (RCTs) and perform meta-analysis. OBJECTIVES To describe the heterogeneity in outcome measures used in published RCTs of vitiligo treatments, and to report the most desirable outcomes from patients' and clinicians' perspectives. METHODS We conducted a systematic review of outcome measures used in RCTs as well as a survey of the most desirable outcomes identified by patients and clinicians as part of a Vitiligo Priority Setting Partnership. RESULTS Outcomes from 54 eligible trials were analysed and compared with outcomes suggested by patients and clinicians. In the systematic review, 25 different outcomes were reported. Only 22% of trials had clearly stated primary outcome measures. Repigmentation was the most frequently reported outcome in 96% of trials and was measured using 48 different scales. Only 9% of trials assessed quality of life. Thirteen per cent measured cessation of spreading of the disease and 17% of studies reported patients' opinions and satisfaction with the treatment. In contrast, out of 438 suggestions made by patients and clinicians, cosmetically acceptable repigmentation (rather than percentage of repigmentation) was the most desirable outcome (68%), followed by cessation of spread of vitiligo (15%), quality of life (8%) and maintenance of repigmentation (4%). CONCLUSIONS We propose that future vitiligo trials should include repigmentation, cosmetic acceptability of results, global assessment of the disease, quality of life, maintenance of repigmentation, stabilization of vitiligo and side-effects. International consensus among clinicians, researchers and patients is needed to establish an agreed core outcome set for future vitiligo trials.
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Affiliation(s)
- V Eleftheriadou
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham NG7 2NR, UK.
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Tippisetty S, Goudi D, Mohammed AW, Jahan P. Repair efficiency and PUVA therapeutic response variation in patients with vitiligo. Toxicol In Vitro 2012; 27:438-40. [PMID: 22921987 DOI: 10.1016/j.tiv.2012.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/04/2012] [Accepted: 08/02/2012] [Indexed: 11/17/2022]
Abstract
Vitiligo is an acquired depigmentation disorder affecting 0.1% to >8.8% in Indian population. Psoralen and ultraviolet A radiation (PUVA) is a gold standard treatment for vitiligo, however, response is still empirical. In order to investigate whether drug response variation is influenced by the repair ability of PUVA treated vitiligo subjects, single cell gel electrophoresis (SCGE) for genotoxicity and serum malonaldehyde (MDA) for cytotoxicity were performed on 107 subjects (77 cases and 30 healthy controls) in South Indian population. In vitro repair ability was assessed by considering the residual damage. A significant difference was observed between the patients and controls with regard to their mean values of DNA damage and MDA levels (p<0.05). On categorization to fast and slow responders based on the time of response, patients exhibited a significant deviation in residual DNA damage, suggestive of variation with respect to DNA repair efficiency (p<0.05). This is the first study to our knowledge with respect to PUVA drug response variation in vitiligo in relation to DNA repair. Large systematic studies on DNA repair may help in a better understanding of the mechanisms involved in the PUVA drug response variation.
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Fernblock, a nutriceutical with photoprotective properties and potential preventive agent for skin photoaging and photoinduced skin cancers. Int J Mol Sci 2011; 12:8466-75. [PMID: 22272084 PMCID: PMC3257081 DOI: 10.3390/ijms12128466] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 10/31/2011] [Accepted: 11/21/2011] [Indexed: 12/29/2022] Open
Abstract
Many phytochemicals are endowed with photoprotective properties, i.e., the capability to prevent the harmful effects of excessive exposure to ultraviolet (UV) light. These effects include photoaging and skin cancer, and immunosuppression. Photoprotection is endowed through two major modes of action: UV absorption or reflection/scattering; and tissue repair post-exposure. We and others have uncovered the photoprotective properties of an extract of the fern Polypodium leucotomos (commercial name Fernblock). Fernblock is an all-natural antioxidant extract, administered both topically (on the skin) or orally. It inhibits generation of reactive oxygen species (ROS) production induced by UV including superoxide anion. It also prevents damage to the DNA, inhibits UV-induced AP1 and NF-κB, and protects endogenous skin natural antioxidant systems, i.e., CAT, GSH, and GSSR. Its photoprotective effects at a cellular level include a marked decrease of UV-mediated cellular apoptosis and necrosis and a profound inhibition of extracellular matrix remodeling. These molecular and cellular effects translate into long-term inhibition of photoaging and carcinogenesis that, together with its lack of toxicity, postulate its use as a novel-generation photoprotective nutriceutical of phytochemical origin.
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Abstract
BACKGROUND Around one per cent of the world's population has vitiligo, a disease which causes white patches on the skin. There are a variety of treatments available, most of which are unsatisfactory. OBJECTIVES To assess all interventions used to manage vitiligo. SEARCH STRATEGY In November 2009 we updated searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2009), MEDLINE, EMBASE, AMED, PsycINFO, LILACS and ongoing trials databases. SELECTION CRITERIA Randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS At least 2 review authors independently assessed study eligibility and methodological quality, and carried out data extraction. Two of the 57 included studies could be combined for meta-analysis. MAIN RESULTS In this update, 57 trials, including 19 from the original review, were assessed with 3139 participants. Most of the RCTs, which covered a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, 6 measured cessation of spread, and 5 investigated the effect of treatment on quality of life.Most of the studies assessed combination therapies which generally reported better results. New interventions include monochromatic excimer light (MEL), Polypodium leucotomos, melanocyte transplantation, oral antioxidants, Chinese zengse pill, and pimecrolimus. We analysed the data from 28 studies that met our outcome criteria of improvement in quality of life and greater than 75% repigmentation.Fifteen analyses from studies comparing various interventions showed a statistically significant difference between the proportions of participants achieving more than 75% repigmentation. The majority of analyses showing statistically significant differences were from studies that assessed combination interventions which generally included some form of light treatment.Topical preparations, in particular corticosteroids, reported most adverse effects. However, in the combination studies it was difficult to ascertain which treatment caused these effects. None of the studies was able to demonstrate long-term benefits. Very few studies were conducted on children or included segmental vitiligo. We found one study of psychological interventions and none evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR
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Gonzalez S, Gilaberte Y, Philips N. Mechanistic insights in the use of a Polypodium leucotomos extract as an oral and topical photoprotective agent. Photochem Photobiol Sci 2010; 9:559-63. [DOI: 10.1039/b9pp00156e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Szczurko O, Boon HS. A systematic review of natural health product treatment for vitiligo. BMC DERMATOLOGY 2008; 8:2. [PMID: 18498646 PMCID: PMC2432048 DOI: 10.1186/1471-5945-8-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 05/22/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected. METHODS Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality. RESULTS Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that Ginkgo biloba monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting. CONCLUSION Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral Ginkgo biloba as monotherapy show promise and warrant further investigation.
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Affiliation(s)
- Orest Szczurko
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Heather S Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
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Abstract
Fototerapia é a modalidade terapêutica que aplica exposições repetidas e controladas de radiação ultravioleta para alterar a fisiologia cutânea de modo a induzir a regressão ou controlar a evolução de diversas dermatoses. Este texto apresenta uma visão geral das práticas correntes que utilizam a radiação ultravioleta isolada ou em combinação com fotossensibilizantes ou outras medicações. Serão ainda discutidos os mecanismos de ação de cada modalidade, as indicações mais aceitas, seus esquemas de prescrição, efeitos adversos e cuidados especiais.
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Affiliation(s)
- Tania F. Cestari
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas, Brasil
| | | | - Gustavo Pinto Corrêa
- Sociedade Brasileira de Dermatologia; Secretaria Estadual de Saúde do Rio Grande do Sul, Brasil
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