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Li C, Hu Y, Mu Z, Shi L, Sun X, Wang X, Wang Y, Li X. Comparison of various excimer laser (EL) combination therapies for vitiligo: a systematic review and network meta-analysis. J DERMATOL TREAT 2024; 35:2302064. [PMID: 38230424 DOI: 10.1080/09546634.2024.2302064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
AIM This study aimed to compare the efficacy and safety of excimer laser (EL)-based combination regimens in improving repigmentation. METHODS A comprehensive search was conducted in PubMed, Web of Science, Cochrane Library, and Embase on July 1, 2023, to include randomized controlled trials of EL combination treatments for vitiligo that met the criteria. The primary outcome measure was a repigmentation rate ≥ 75%, and the secondary outcome measures were a repigmentation rate of ≤ 25% and adverse events. RESULTS Eleven studies involving 348 patients were included. Network Meta-Analysis showed that EL combined with antioxidants (SUCRA = 98.8%), EL combined with calcipotriol (SUCRA = 59.8%) and EL combined with tacalcitol (SUCRA = 59.6%) were the three optimal interventions achieving repigmentation rates ≥ 75%. EL alone (SUCRA = 77.6%), EL combined with tacalcitol (SUCRA = 61.7%) and EL combined with antioxidants (SUCRA = 57.2%) were the three interventions with the highest rates of treatment failure. Adverse events in all groups mainly included erythema, burning sensation and hyperpigmentation. Based on the results of the current study, EL combination therapies were safe with mild adverse events. CONCLUSION EL combined with antioxidants was the preferred regimen for vitiligo, whereas EL alone was the regimen with the highest rate of treatment failure in vitiligo.
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Affiliation(s)
- ChanXiu Li
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Yue Hu
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - ZengYi Mu
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Lei Shi
- Department of Otorhinolaryngology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Xiao Sun
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - XinYue Wang
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - YaPing Wang
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - XinHong Li
- Department of Dermatology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
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Hartmann Schatloff D, Retamal Altbir C, Valenzuela F. The role of excimer light in dermatology: a review. An Bras Dermatol 2024:S0365-0596(24)00161-2. [PMID: 39107199 DOI: 10.1016/j.abd.2023.12.007] [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: 10/29/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 08/09/2024] Open
Abstract
Excimer light is a subtype of NB-UVB that emits a 308 nm wavelength, and can provide targeted phototherapy treatment. The absorption of 308 nm light by skin cells leads to therapeutic response in various common and ultraviolet-responsive skin diseases, such as psoriasis and vitiligo, and photo-resistant skin diseases such as prurigo nodularis, localized scleroderma, genital lichen sclerosis, and granuloma annulare, cutaneous T-cell lymphomas, among others. Excimer light has few adverse reactions and overall is well tolerated by patients, furthermore, it can be performed in places that are difficult to access. This article aims to explain the therapeutic bases and applications of excimer light in current dermatology.
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Affiliation(s)
| | | | - Fernando Valenzuela
- Dermatology Department, Clinical Hospital of the University of Chile, Santiago, Chile
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3
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Zaky MS, Atallah RB, El Abasy NTA, Elsaie ML. Comparative study between efficacy of Excimer light with topical Tacrolimus 0.1% versus excimer light with topical Bimatoprost 0.01% in treatment of facial Vitiligo. Arch Dermatol Res 2024; 316:350. [PMID: 38850408 PMCID: PMC11162377 DOI: 10.1007/s00403-024-03054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/26/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
Loss and absence of melanocytes due to a number of factors is responsible for vitiligo; known to be the commonest disorder of pigmentation. The aim of the current work was to compare the efficacy and safety of excimer light with topical tacrolimus ointment 0.1% versus excimer light with topical bimatoprost gel 0.01% in treatment of facial vitiligo. The study was carried out on 48 patients presented with facial vitiligo. The patients were divided randomly using sealed envelope method into two groups (24 patients each). Group 1 were treated with excimer light plus topical tacrolimus ointment 0.1% and group 2 treated with excimer light plus topical bimatoprost gel 0.01%. Clinical improvement based on the quartile grading scale at the end of treatment did not show any statistically significant difference between groups. The majority of subjects in both groups experienced good to excellent improvement. Only 20.9% of patients in group 1 and 33.3% of subjects in group 2 achieved less than 50% repigmentation (p = 0.889). Our study demonstrated that 0.01% topical bimatoprost gel in combination with excimer light is considered safe and effective as treatment of nonsegmental facial vitiligo with comparable results to 0.1% tacrolimus.
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Affiliation(s)
- Mohamed S Zaky
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Rabie B Atallah
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mohamed L Elsaie
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt.
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Wu H, Niu C, Aisa HA. Research Progress of Small Molecules as Anti-vitiligo Agents. Curr Med Chem 2023; 31:CMC-EPUB-129498. [PMID: 36786141 DOI: 10.2174/0929867330666230214103054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/10/2022] [Accepted: 11/24/2022] [Indexed: 02/15/2023]
Abstract
Vitiligo is a disease characterized by skin discoloration, and no safe and effective drugs have been developed until now. New drug research and development are imminent. This article reviews the research on small-molecule drugs for vitiligo from 1990 to 2021 at home and abroad. They are classified according to their structures and mechanisms of action, including natural products and derivatives, anti-oxidative stress drugs, immunosuppressants, prostaglandins, etc. The research on their anti-vitiligo activity, structural modification, new dosage forms, clinical trials, and the development trend in new anti-vitiligo drugs are reviewed, which provides important references for the development of new drugs.
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Affiliation(s)
- Heng Wu
- Xinjiang Technical Institute of Physics & Chemistry State Key Laboratory Basis of Xinjiang indigenous medicinal plants resource utilization, CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, University of Ürümqi China
| | - Chao Niu
- Xinjiang Technical Institute of Physics & Chemistry State Key Laboratory Basis of Xinjiang indigenous medicinal plants resource utilization, CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, University of Ürümqi China
| | - Haji Akber Aisa
- Xinjiang Technical Institute of Physics & Chemistry State Key Laboratory Basis of Xinjiang indigenous medicinal plants resource utilization, CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, University of Ürümqi China
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5
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Eleftheriadou V, Bergqvist C, Kechichian E, Shourick J, Ju HJ, van Geel N, Bae JM, Ezzedine K. Has the core outcome (domain) set for vitiligo been implemented? An updated systematic review on outcomes and outcome measures in vitiligo randomized clinical trials. Br J Dermatol 2023; 188:247-258. [PMID: 36763863 DOI: 10.1093/bjd/ljac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 2015, a major achievement in vitiligo research was the development of an internationally agreed upon core outcome domain set for randomized clinical trials (RCTs). Three outcomes were identified as being essential: repigmentation, side-effects/harms and maintenance of gained repigmentation. Four items were further recommended for inclusion. The following recommendations then followed: repigmentation should be assessed by measuring the percentage of repigmentation in quartiles (0-25%, 26-50%, 51-79%, 80-100%) and cosmetic acceptability of the results should be assessed using the Vitiligo Noticeability Scale. OBJECTIVES The primary objective of this study was to assess uptake of the core outcome domain set for RCTs in vitiligo. Secondary objectives were to update the systematic review on outcomes reported in vitiligo RCTs, and to assess whether repigmentation and cosmetic acceptability of the results were measured using the above-mentioned recommended scales. METHODS We searched PubMed, Cochrane Library (CENTRAL and Systematic Reviews) and ClinicalTrials.gov for vitiligo RCTs between November 2009 and March 2021. Screening and data extraction were independently performed on title and summary by two researchers. All outcomes and outcome measures reported in eligible RCTs were retrieved and collated. RESULTS In total, 174 RCTs were identified: 62 were published between 2009 and 2015, and 112 were published between 2016 and 2021.Thirty-eight different outcomes were reported. Repigmentation was the primary outcome in 89% of trials (150 of 169). Forty-nine different tools were used to measure repigmentation. Side-effects and harms were reported in 78% of trials (136 of 174). Maintenance of gained repigmentation was reported in only 11% of trials (20 of 174) and duration of follow-up varied greatly from 1 to 14 months. Cosmetic acceptability of the results and cessation of disease activity were assessed in only 2% of trials (four of 174). Quality of life of patients with vitiligo was assessed in 13% of trials (22 of 174). Finally, only 11 of 112 RCTs (10%) published between 2016 and 2021 reported all three essential core outcome domains (repigmentation, side-effects and maintenance of gained repigmentation) and none of the trials reported both essential and recommended core outcome domains. CONCLUSIONS Efforts are still needed to close the gap between set recommendations and RCT outcome reporting.
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Affiliation(s)
- Viktoria Eleftheriadou
- Department of Dermatology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France
| | - Elio Kechichian
- Department of Dermatology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Hyun-Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France.,EA 7379 EpidermE, Faculty of Medicine, Université Paris-Est Créteil, UPEC, Créteil, France
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6
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Zhou F, Chen S, Jin W, Lu Y, Gao Y, Wu J. Comparison of the efficacy and safety of 308-nm excimer laser as monotherapy and combination therapy with topical tacrolimus in the treatment of periocular vitiligo. Dermatol Ther 2022; 35:e15556. [PMID: 35514034 DOI: 10.1111/dth.15556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/17/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
Vitiligo is an acquired depigmenting disorder in which destruction of skin melanocytes. In recent years, 308-nm excimer laser (308-nm EL) and topical tacrolimus have been extensively used to treat vitiligo. This study aimed to investigate the effectiveness and safety of combined treatment of 308-nm EL and topical tacrolimus for treating periocular vitiligo compared to 308-nm EL monotherapy. This study is a retrospective observational study, involving 58 Chinese patients of periocular vitiligo, divided into two groups: the control group (28 patients) treated with 308-nm EL; and the experimental group (30 patients) treated with 308-nm EL and topical tacrolimus 0.1% ointment. Repigmentation was assessed at four grades. In the control group, there were four patients (14%) with poor repigmentation, eleven patients (39%) with moderate repigmentation, ten patients (36%) with good repigmentation, three patients (11%) with excellent repigmentation. In the experimental group, two patients (7%) experienced poor repigmentation, six patients (20%) experienced moderate repigmentation, fifteen patients (50%) experienced good repigmentation, seven patients (23%) experienced excellent repigmentation. The experimental group efficacy rate (good and excellent repigmentation) was 73.3%, higher than 46.4% for the control group (p=0.037). Our findings suggest that both treatments are safe and the combination of tacrolimus and 308-nm EL is more effective than 308-nm EL alone for periocular vitiligo.
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Affiliation(s)
- Fangyan Zhou
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
| | - Shisheng Chen
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
| | - Wanwan Jin
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
| | - Yuwen Lu
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
| | - Yu Gao
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
| | - Jianming Wu
- Yuying Children's Hospital, The second Affiliated Hospital of Wenzhou Medical University; Wenzhou, Zhejiang, China
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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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8
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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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9
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Post NF, Ezekwe N, Narayan VS, Bekkenk MW, Van Geel N, Hamzavi I, Passeron T, Wolkerstorfer A. The use of lasers in vitiligo, an overview. J Eur Acad Dermatol Venereol 2022; 36:779-789. [PMID: 35176186 PMCID: PMC9314124 DOI: 10.1111/jdv.18005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
Abstract
Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB‐UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte–keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB‐UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q‐switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.
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Affiliation(s)
- N F Post
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - N Ezekwe
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - V S Narayan
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - M W Bekkenk
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
| | - N Van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - I Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - T Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, France
| | - A Wolkerstorfer
- Department of dermatology, Amsterdam University Medical Centers, The Netherlands
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10
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Mohammadi S, Amiri R, Khalili M, Iranmanesh B, Aflatoonian M. Treatment protocols and efficacy of combined laser with medical treatment modalities in vitiligo. J Cosmet Dermatol 2021; 21:3272-3291. [PMID: 34766697 DOI: 10.1111/jocd.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUNDS Nowadays, lasers are used for treatment of vitiligo in difficult-to-treat areas and refractory lesions. Combination of lasers with other medical modalities can provide higher efficacy, faster response rate, and higher compliance of patients to treatment. AIM In this article, we reviewed articles regarding safety, efficacy, and treatment protocols of combined laser with other medical modalities. METHODS We searched articles with relevant key words in Google scholar and PubMed. Inclusion criteria were articles in English language since January 2000 until March 2021that evaluate combination of laser with other topical or systemic medical treatments. RESULTS A total of 42 articles evaluated efficacy of lasers [excimer, carbon dioxide (CO2 ), erbium-doped yttrium-aluminum-garnet (Er:YAG), and non-ablative resurfacing laser] combined with topical or systemic medical treatment modalities. Effective response rate (more than 50% improvement) varied between 7.7% and 92%. Initial repigmentation observed between 4 and 13 weeks after beginning of treatment. CONCLUSION Combination of laser with medical modalities leads to more rapid repigmentation, superior efficacy, and better compliance of patients with localized non-segmental type of vitiligo compared to monotherapy. Combination of excimer laser with topical therapy might be suggested for recalcitrant vitiligo lesions in face and neck. Combination of fractional ablative resurfacing lasers with topical therapy, especially 5-flurouracil, can be recommended particularly in recalcitrant acral and bony prominent areas. Further studies are required to achieve conclusive evidence in order to define the best stage of vitiligo for laser therapy and most effective combined treatment regimen.
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Affiliation(s)
- Saman Mohammadi
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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11
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Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol 2021; 48:252-270. [DOI: 10.1111/1346-8138.15743] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Christina Bergqvist
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
| | - Khaled Ezzedine
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil, UPEC Créteil France
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12
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Bakr RM, Abdel-Gaber RM, Tawfik YM. A comparative study on the use of fractional CO 2 laser with tacrolimus or calcipotriol or narrow band ultraviolet-B in treatment of stable nonsegmental vitiligo. Dermatol Ther 2020; 34:e14604. [PMID: 33249712 DOI: 10.1111/dth.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO2 ) laser therapy followed by narrow band ultraviolet-B (NB-UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO2 laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB-UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB-UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB-UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO2 laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO2 laser and NB-UVB was found to be more effective.
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Affiliation(s)
- Radwa M Bakr
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Reham M Abdel-Gaber
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Yasmin M Tawfik
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
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13
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Dong Y, Yang Q, Guo B, Zhu J, Sun X. The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis. Arch Dermatol Res 2020; 313:461-471. [PMID: 32785837 DOI: 10.1007/s00403-020-02121-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
The objective of this meta-analysis was performed to compare the effects of tacrolimus plus phototherapy in the treatment of patients with vitiligo. Relevant studies were identified by searching PubMed, Embase, and Web of Science databases. The main outcomes of interest included excellent response (≥ 75% repigmentation), good response (50-75% repigmentation), moderate response (25%-50% repigmentation), and poor response (< 25% repigmentation). Risk ratio (RR) with 95% confidence intervals (95% CIs) was used to calculate the data. Eleven studies were included in this study. Compared with phototherapy alone, combination treatment of tacrolimus and phototherapy significantly improved excellent response rate (RR = 1.40, 95% CI 1.16, 1.69; P < 0.001) and reduced the poor response rate (RR = 0.37, 95% CI 0.22, 0.61; P = 0.001). However, the good response rate (RR = 1.00, 95% CI 0.59, 1.69, P = 1.000) and moderate response rate (RR = 0.91, 95% CI 0.60, 1.38; P = 0.653) were not significantly different between the two treatments. Subgroup analysis suggested that combination treatment had a higher excellent response rate than phototherapy alone for lesions located in the face and proximal limbs. Both NB-UVB and EL, when added to tacrolimus, resulted in a significantly higher excellent response rate than they were used alone. Meta-regression analysis showed that age was a predictive factor that influenced the effect of combination treatment on an excellent response, in which children had a high excellent response to the treatment. Other demographic and clinical variables, including gender, disease duration, family history, and type of vitiligo, did not have any impact on the treatment effect. Combination treatment with tacrolimus and phototherapy was more effective than phototherapy monotherapy for patients with vitiligo, especially in the lesions located in the face and proximal limbs. More large-scale, well-performed trials are needed to verify our findings.
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Affiliation(s)
- Yujie Dong
- Department of Emergency, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Qi Yang
- Department of Obstetrics and Gynecology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Baofeng Guo
- Department of Plastic and Reconstruction Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Jiajing Zhu
- Radiology Department, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Xiaojie Sun
- Department of Plastic and Reconstruction Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, China.
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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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15
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Ebrahim HM, Albalate W. Efficacy of microneedling combined with tacrolimus versus either one alone for vitiligo treatment. J Cosmet Dermatol 2020; 19:855-862. [DOI: 10.1111/jocd.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Howyda M. Ebrahim
- Dermatology, Venereology and Andrology Department Faculty of Medicine Zagazig University Zagazig Egypt
| | - Waleed Albalate
- Dermatology, Venereology and Andrology Department Faculty of Medicine Zagazig University Zagazig Egypt
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Ly K, Smith MP, Thibodeaux QG, Beck KM, Liao W, Bhutani T. Beyond the Booth: Excimer Laser for Cutaneous Conditions. Dermatol Clin 2019; 38:157-163. [PMID: 31753188 DOI: 10.1016/j.det.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The excimer laser has emerged as an efficacious treatment modality for many dermatologic diseases. The excimer laser is an alternative to standard narrowband ultraviolet B (NBUVB) phototherapy treatment in patients with limited disease. In comparison to standard NBUVB, the excimer laser requires fewer treatment sessions, has reduced treatment duration, requires a lower cumulative UVB dose, and limits UVB exposure to lesional skin. This review addresses the mechanism, safety, application, and efficacy of the excimer laser for the treatment of these conditions.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Quinn G Thibodeaux
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA.
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Arora CJ, Rafiq M, Shumack S, Gupta M. The efficacy and safety of tacrolimus as mono‐ and adjunctive therapy for vitiligo: A systematic review of randomised clinical trials. Australas J Dermatol 2019; 61:e1-e9. [DOI: 10.1111/ajd.13096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - Muhammad Rafiq
- Department of Learning, Informatics, Management and Ethics (LIME) Karolinska Instiutet Stockholm Sweden
| | - Stephen Shumack
- Sydney Medical School University of SydneySydney New South Wales Australia
- Department of Dermatology Royal North Shore HospitalSydney New South Wales Australia
| | - Monisha Gupta
- Department of Dermatology Liverpool HospitalSydney New South Wales Australia
- Department of Medicine UNSW SydneyNew South Wales Australia
- The Skin Hospital Darlinghurst New South Wales Australia
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18
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Shah SD, Shah A, Ankad B, Mutalik S. Efficacy of 308-nm Monochromatic Excimer Light in the Management of Halo Nevi: An Open-Label, Pilot Study. J Cutan Aesthet Surg 2019; 12:17-24. [PMID: 31057264 PMCID: PMC6484574 DOI: 10.4103/jcas.jcas_138_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Halo nevus (HN) affects approximately 1% of the population. Presence of hypo- or depigmented lesion carries tremendous psychosocial disturbance in the mind-set of population in the Indian subcontinent. Hence, HN requires intervention by any modalities. Here authors attempted to evaluate the efficacy of monochromatic excimer light (MEL) in treating HN. Materials and Methods: A total of 29 patients with HN were included in the study. A xenon chloride lamp emitting noncoherent, monochromatic 308-nm light that represents the natural evolution of the excimer laser was used. The initial dose was 100 mJ/cm2, which was increased by 100 mJ/cm2 per session. All the patients were followed up for 6 months. Results: A total of 29 patients with 10 males and 19 females (male to female ratio of 1:1.9) completed the study. The age of onset of HN ranged from 5 to 47 years and the mean age of the patients was 23 years. HN was seen on the face, back, neck, chest, trunk, and extremities in 5 (17.2%), 6 (20.7%), 4 (13.7%), and 6 (20.7%) patients, respectively. Outstanding response was noticed in 14 patients (48.2%), whereas 6 (20.6%) patients showed excellent improvement. Only 2 (6.8%) patients showed no response after 10 consecutive sessions. Conclusion: HN causes apprehension in the Indian population because of the social stigma associated with depigmented patches on the body. Mere observation and only counseling in the treatment protocol are not sufficient. MEL is a noninvasive procedure, which results in excellent repigmentation of HN without scarring.
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Affiliation(s)
- Swapnil D Shah
- Department of Dermatology, Ashwini Rural Medical College, Hospital and Research Centre, Solapur, Maharashtra, India
| | - Amit Shah
- Shobhana Skin Cosmetic and Laser Clinic, Sangli, Maharashtra, India
| | - Bhalachandra Ankad
- Department of Dermatology, S. Nijalingappa Medical College and H. S. K. Hospital and Research Centre, Bagalkot, Karnataka, India
| | - Sharad Mutalik
- Department of Dermato-Cosmetology, Joshi Hospital, Pune, Maharashtra, India
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Ibrahim ZA, Hassan GF, Elgendy HY, Al‐shenawy HA. Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo. J Cosmet Dermatol 2018; 18:581-588. [DOI: 10.1111/jocd.12704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Zeinab A. Ibrahim
- Dermatology and Venereology, Faculty of Medicine Tanta University Tanta Egypt
| | - Ghada F. Hassan
- Dermatology and Venereology, Faculty of Medicine Tanta University Tanta Egypt
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Abstract
Use of the 308 nm Excimer laser to treat hypopigmentation and vitiligo is usually superior to conventional ultraviolet (UV) therapy with regard to results and safety. It is particularly advantageous because specific areas of skin can be targeted without burdening the rest of the skin. Fewer sessions with lower cumulative doses are required. Various combination therapies can improve the outcome; selection criteria such as early initiation of treatment and more frequent sessions with shorter intervals make it easier to decide which patients should be treated and how to achieve the greatest benefit.
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Affiliation(s)
- K Fritz
- Hautärzte- und Laserzentrum Landau (Pfalz), Reduitstr. 13, 76829, Landau, Deutschland.
- Medizinische und Pharmazeutische Universität Carol Davila, Bucharest, Rumänien.
| | - C Salavastru
- Medizinische und Pharmazeutische Universität Carol Davila, Bucharest, Rumänien
- Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus, Bucharest, Rumänien
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Successful Treatment of Refractory Vitiligo with a Combination of Khellin and 308-nm Excimer Lamp: An Open-Label, 1-Year Prospective Study. Dermatol Ther (Heidelb) 2017; 8:127-135. [PMID: 29282672 PMCID: PMC5825323 DOI: 10.1007/s13555-017-0218-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Phototherapy is the cornerstone of treatment of vitiligo. The 308-nm excimer lamp (EL) induces T cell apoptosis and the stimulation of melanocyte proliferation. Khellin is a furanochromone with a chemical structure close to psoralens. The objective of the study was to evaluate the safety and efficacy of 1-year treatment of recalcitrant vitiligo with a combination of 308-nm EL and khellin. Methods Twenty patients with resistant vitiligo were included. Khellin was applied 45 min before irradiation with EL, twice a week, at a dose of 250 mJ/cm2. The repigmentation was assessed in four categories: excellent repigmentation (ER) (> 75% repigmentation), good repigmentation (GR) (50–75% repigmentation), moderate repigmentation (MR) (25–50% repigmentation), and poor repigmentation (PR) (< 25% repigmentation). Results An ER was observed in 45% of patients (9/20), 5/20 (25%) achieved a GR, 3/20 (15%) an MR, and 3/20 (15%) a PR. Better response was observed on the face, neck, upper limb, hands, and abdomen. The mean number of procedures was 54.1 and the mean cumulative dose was 2967.5 mJ/cm2. Six months after the last session no recurrences were observed. Conclusion The combination of 308-nm EL and khellin is a safe and effective treatment and represents a new alternative therapy for vitiligo. Further comparative controlled randomized investigations are needed to confirm these promising results with the appropriate therapeutic protocols.
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Bapur Erduran F, Adışen E. Comparison of the efficacy of 308-nm excimer lamp monotherapy with topical tacrolimus or clobetasol 17-propionate combination therapies in localized vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:247-253. [PMID: 27552312 DOI: 10.1111/phpp.12266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND In recent years, excimer light treatments have come to the fore in localized vitiligo because of their high efficacy and safety. OBJECTIVE We aimed to evaluate the efficacy of 308-nm excimer lamp as a monotherapy and its combination with tacrolimus 0.1% or clobetasol 17-propionate 0.05% ointment in localized vitiligo. METHODS We performed a retrospective study including a total of 82 patients who were treated with excimer lamp monotherapy (EL group) (n = 30), excimer lamp + topical tacrolimus (EL + T group) (n = 29), or excimer lamp + topical clobetasol 17-propionate (EL + CS group) (n = 23). We used digital morphometric analysis for the evaluation of repigmentation. RESULTS Median healing rate after 24 sessions was significantly higher in EL + T group (69%) than EL (42.5%) and EL + CS (44%) groups (P = 0.008 and P = 0.032). There were not any patients with face lesions in EL + CS group, so when these patients were excluded, EL + T and EL + CS groups had higher healing rates than EL group (P = 0.037 and P = 0.043). It was confirmed that combination with tacrolimus was superior to clobetasol-17 propionate (P = 0.048) with multivariate regression analysis. CONCLUSION We noted that 308-nm excimer lamp therapy was efficacious; adding topical tacrolimus or topical clobetasol-17 propionate could increase response to treatment.
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Affiliation(s)
| | - Esra Adışen
- Department of Dermatology, Gazi University Hospital, Ankara, Turkey
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23
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Babino G, Giunta A, Esposito M, Saraceno R, Pavlidis A, Del Duca E, Chimenti S, Nisticò SP. UVA1 Laser in the Treatment of Vitiligo. Photomed Laser Surg 2016; 34:200-4. [PMID: 27070209 DOI: 10.1089/pho.2015.4004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The purpose of this article was to evaluate the clinical efficacy and safety of a monochromatic 355 nm ultraviolet (UVA) laser in the treatment of vitiligo. BACKGROUND DATA Broadband and narrow-band UV phototherapy has been proposed as an effective therapeutic option in vitiligo patients. METHODS Seventeen consecutive, unselected patients (7 men and 10 women) were enrolled in an open-label, prospective study and treated twice weekly for 8 weeks at a fixed dose of 80-140 J/cm(2). Follow-up was 12 weeks. RESULTS Clinical repigmentation was observed in 15/17 patients (88.23%), with limited side effects (mild post-treatment erythema and itching). Results were maintained during the 12 week phototherapy-free follow-up period. CONCLUSIONS the present report suggests that UVA1 laser could be an applicable therapeutic option in patients with vitiligo.
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Affiliation(s)
- Graziella Babino
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Alessandro Giunta
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Maria Esposito
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Rosita Saraceno
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | | | - Ester Del Duca
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Sergio Chimenti
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Steven Paul Nisticò
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy .,2 Department of Health Sciences, Magna Graecia University , Catanzaro, Italy
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24
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Vitiligo: Pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2016; 15:335-43. [DOI: 10.1016/j.autrev.2015.12.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 02/08/2023]
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25
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Cannarozzo G, Sannino M, Tamburi F, Chiricozzi A, Saraceno R, Morini C, Nisticò S. Deep pulse fractional CO2 laser combined with a radiofrequency system: results of a case series. Photomed Laser Surg 2016; 32:409-12. [PMID: 24992275 DOI: 10.1089/pho.2014.3733] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. BACKGROUND DATA Minimally ablative or subablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the same clinical results observed with traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapid wound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. METHODS Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. RESULTS All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. CONCLUSIONS This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.
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26
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Bae JM, Hong BY, Lee JH, Lee JH, Kim GM. The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs). J Am Acad Dermatol 2016; 74:907-15. [PMID: 26785803 DOI: 10.1016/j.jaad.2015.11.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/20/2015] [Accepted: 11/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Combination therapies of excimer laser/light (EL) and various topical agents are widely used in the treatment of vitiligo. OBJECTIVE We sought to compare the efficacy of EL and topical agent combination therapy versus EL monotherapy for vitiligo. METHODS Manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, and Cochrane library (from inception through December 15, 2014) were conducted to identify randomized controlled trials that assessed the efficacy of EL alone or in combination with topical agents for vitiligo. The primary outcome was treatment success (≥75% repigmentation), and the secondary outcome was treatment failure (<25% repigmentation); meta-analyses were performed when possible. RESULTS We analyzed 8 randomized controlled trials comprising a total of 425 patches/patients. The combination of EL and topical calcineurin inhibitors (4 studies: relative risk 1.93, 95% confidence interval 1.28-2.91; number needed to treat 4.5, 95% confidence interval 2.9-10) was superior to EL monotherapy for vitiligo. There was insufficient evidence to support beneficial effects of topical vitamin-D3 analogs (3 studies) and corticosteroids (1 study). LIMITATIONS These findings are based on small numbers of randomized controlled trials and heterogeneities among included studies are another limitation. CONCLUSION Topical calcineurin inhibitors in conjunction with EL are more effective compared with EL monotherapy.
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Affiliation(s)
- Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Joo Hee Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Dang YP, Li Q, Shi F, Yuan XY, Liu W. Effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment: a meta-analysis. Dermatol Ther 2015; 29:126-33. [PMID: 26460804 DOI: 10.1111/dth.12295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yu-Ping Dang
- Department of Dermatology; Air Force General Hospital of People's Liberation Army; Beijing China
| | - Qiang Li
- Department of Dermatology; Air Force General Hospital of People's Liberation Army; Beijing China
| | | | - Xiao-Ying Yuan
- Department of Dermatology; Air Force General Hospital of People's Liberation Army; Beijing China
| | - Wei Liu
- Department of Dermatology; Air Force General Hospital of People's Liberation Army; Beijing China
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Park OJ, Park GH, Choi JR, Jung HJ, Oh ES, Choi JH, Lee MW, Chang SE. A combination of excimer laser treatment and topical tacrolimus is more effective in treating vitiligo than either therapy alone for the initial 6 months, but not thereafter. Clin Exp Dermatol 2015; 41:236-41. [PMID: 26299799 DOI: 10.1111/ced.12742] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus. AIM To evaluate the clinical efficacy according to the duration of treatment and in vitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo. METHODS In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser. RESULTS After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P < 0.001 and P < 0.01, respectively) for the first 6 months. However, this superiority was not observed after the initial 6 months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone. CONCLUSIONS A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6 months, but continuation of this therapy for > 6 months might not provide a better final outcome than monotherapy.
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Affiliation(s)
- O J Park
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G-H Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - J R Choi
- Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea
| | - H J Jung
- Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea
| | - E S Oh
- Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea
| | - J H Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M W Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S E Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ghafourian A, Ghafourian S, Sadeghifard N, Mohebi R, Shokoohini Y, Nezamoleslami S, Hamat RA. Vitiligo: symptoms, pathogenesis and treatment. Int J Immunopathol Pharmacol 2015; 27:485-9. [PMID: 25572727 DOI: 10.1177/039463201402700403] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.
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Affiliation(s)
- A Ghafourian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Ghafourian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - N Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - R Mohebi
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Y Shokoohini
- Department of Pharmacognosy and Biotechnology, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Nezamoleslami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - R A Hamat
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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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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Sun Y, Wu Y, Xiao B, Li L, Li L, Chen HD, Gao XH. Treatment of 308-nm excimer laser on vitiligo: A systemic review of randomized controlled trials. J DERMATOL TREAT 2015; 26:347-53. [PMID: 25428573 DOI: 10.3109/09546634.2014.991268] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vitiligo is an acquired cutaneous hypopigmentary disorder, which characterized by solitary or multiple depigmented maculae or patches. The 308-nm excimer laser has been used as phototherapy on vitiligo. OBJECTIVE To evaluate the efficacy and safety of 308-nm excimer laser on vitiligo. METHODS Randomized controlled trials were searched to conduct a systematic review. The keywords were identified as laser/excimer laser/quasimolecule/XeCl" and "vitiligo". RESULTS Seven studies with 390 vitiligo patients were included. No significant differences were seen between 308-nm excimer laser and 308-nm excimer lamp on either ≥75% or ≥50% re-pigmentation rate, or between 308-nm excimer laser and narrowband-ultraviolet B (NB-UVB) on either 100% or ≥75% re-pigmentation rate. More patients or lesions achieved ≥50% re-pigmentation rate by 308-nm excimer laser treatment than by NB-UVB treatment. The side effects of 308-nm excimer laser were slight and tolerable. CONCLUSIONS The 308-nm excimer laser showed equivalent efficacies to 308-nm excimer lamp control and NB-UVB control concerning ≥75% re-pigmentation rate of vitiligo patches. More studies with high methodological quality, low risk of bias and more sample size are needed to confirm the conclusion.
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Affiliation(s)
- Yan Sun
- Department of Dermatology, No. 1 Hospital of China Medical University , Shenyang , China
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Caporuscio S, Pranteda G, Nistico S, Maucione T, Canzoni M, Stefani A, Muscianese M, Fanto M, Sorgi M. An incomplete form of childhood Behçet's disease treated with infliximab. Int J Immunopathol Pharmacol 2014; 27:445-8. [PMID: 25280037 DOI: 10.1177/039463201402700316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) is a multi-systemic vasculitis characterized by the possible presence of cutaneous, ocular, articular and neurological manifestations. In this report, we examine the case of a fifteen-year old boy with an incomplete form of juvenile Behçet's disease which began with joint involvement and developed into a complete form only after several years. The patient showed a rapid response to anti-TNF-alpha (infliximab) with an improvement of mucocutaneous lesions (oral and genital ulcers, pseudofolliculitis) and arthritis.
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Affiliation(s)
- S Caporuscio
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - G Pranteda
- Division of Dermatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - S Nistico
- Unit of Dermatology, University of Catanzaro, Italy
| | - T Maucione
- Sapienza University of Rome, Rome, Italy
| | - M Canzoni
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A Stefani
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Muscianese
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Fanto
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Sorgi
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Del Porto F, Proietta M, Muscianese M, Tamburi F, Cifani N, Ferri L, Nisticò S, Bottoni U, Bruno G, Pranteda G. Granuloma annularis revealing Wegener's granulomatosis. Int J Immunopathol Pharmacol 2014; 27:273-8. [PMID: 25033485 DOI: 10.1177/039463201402700215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Skin manifestations are often associated with systemic autoimmune diseases (SAD). Some SAD, such as systemic lupus erythematosus, psoriatic arthritis and scleroderma display pathognomonic dermatological features, whereas other systemic diseases such as sarcoidosis, vasculitis and rheumatoid arthritis can present with non-specific skin manifestations that range from erythema nodosum to necrotic lesions. Here we report the case of a 25-year-old man with uveitis, polyarthrirtis, pulmonary involvement, nephrotic syndrome, cutaneous granuloma and pneumonia by E. coli.
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Specchio F, Carboni I, Cannarozzo G, Tamburi F, Dattola E, Nisticò S. Excimer UV radiation in dermatology. Int J Immunopathol Pharmacol 2014; 27:287-9. [PMID: 25004841 DOI: 10.1177/039463201402700217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ultraviolet B (UVB 290-320 nm) radiation has been used in the treatment of different skin diseases. Light sources with narrowband UVB output spectrum have been developed with the aim of increasing the rates of beneficial to side effect profile of the treatment. Narrowband UVB phototherapy using fluorescent lamps (TL01, 311∓2nm) has been widely adopted over the past 10 years. Monochromatic Excimer Light (MEL) represents a new source of narrow-band UVB emitting at 308 nm and guarantees a safe and effective approach to different chronic and recurrent skin diseases thanks to its potent and selective immunosuppressant action.
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Affiliation(s)
- F Specchio
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | - I Carboni
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | | | - F Tamburi
- Unit of Dermatology, Complesso Integrato Columbus, Rome, Italy
| | - E Dattola
- Department of Health Sciences, University of Catanzaro Magna Græcia, Italy
| | - S Nisticò
- Department of Health Sciences, University of Catanzaro Magna Græcia, Italy
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Specchio F, Carboni I, Chimenti S, Tamburi F, Nistico' S. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Int J Immunopathol Pharmacol 2014; 27:1-4. [PMID: 24674672 DOI: 10.1177/039463201402700101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with chronic renal failure (CRF) may exhibit various cutaneous abnormalities, including changes in skin colour, pruritus, xerosis, hair, nail and oral changes, metastatic calcinosis, and bullous dermatosis. These changes have a considerable negative effect on the patient's quality of life. Early recognition of cutaneous signs and prompt initiation of treatment can dramatically alter their course and decrease morbidity.
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Affiliation(s)
- F Specchio
- Department of Systems Medicine, University of Rome, Tor Vergata, Rome, Italy
| | - I Carboni
- Department of Systems Medicine, University of Rome, Tor Vergata, Rome, Italy
| | - S Chimenti
- Department of Systems Medicine, University of Rome, Tor Vergata, Rome, Italy
| | - F Tamburi
- Unit of Dermatology, Complesso Integrato Columbus, Rome, Italy
| | - S Nistico'
- Department of Health Sciences, University of Catanzaro Magna Græcia, Catanzaro, Italy
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Specchio F, Saraceno R, Chimenti S, Nisticò S. Management of Non-Melanoma Skin Cancer in Solid Organ Transplant Recipients. Int J Immunopathol Pharmacol 2014; 27:21-4. [DOI: 10.1177/039463201402700104] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- F. Specchio
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | - R. Saraceno
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | - S. Chimenti
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | - S. Nisticò
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Pranteda G, Muscianese M, Grimaldi M, Tuzi M, Pranteda G, Fidanza L, Tamburi F, Bottoni U, Nisticò S. Pharmacological Management of Pediatric Kerion Celsi. Int J Immunopathol Pharmacol 2013; 26:973-6. [PMID: 24355234 DOI: 10.1177/039463201302600417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of severe tinea capitis, treated successfully with griseofulvin. In our opinion, the treatment of this severe dermatophytosis with griseofulvin is safe and effective. Other treatments, such as itraconazole pulsed therapy, failed, despite an initial improvement, leading to an aggressive recurrence of the lesion. We chose griseofulvin for its well-known large spectrum activity, also against uncommon species, like Microsporum Gypseum, which are responsible for the most severe cases.
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Affiliation(s)
- G. Pranteda
- U.O.C. Department of Dermatology, NESMOS, Facoltà di Medicina e Psicologia “Sapienza” Ospedale Sant'Andrea, Roma, Italy
| | - M. Muscianese
- U.O.C. Department of Dermatology, NESMOS, Facoltà di Medicina e Psicologia “Sapienza” Ospedale Sant'Andrea, Roma, Italy
| | - M. Grimaldi
- Unità di Chirurgia Plastica, Ospedale Madonna delle Grazie, Matera, Italy
| | - M. Tuzi
- U.O.C. Department of Dermatology, NESMOS, Facoltà di Medicina e Psicologia “Sapienza” Ospedale Sant'Andrea, Roma, Italy
| | - G. Pranteda
- U.O.C. Dermatologia, Facoltà di Medicina e Psicologia “Sapienza” Ospedale Umberto I, Roma, Italy
| | - L. Fidanza
- U.O.C. Department of Dermatology, NESMOS, Facoltà di Medicina e Psicologia “Sapienza” Ospedale Sant'Andrea, Roma, Italy
| | - F. Tamburi
- U.O. Dermatologia, Complesso Integrato Columbus, Università Cattolica, Roma, Italy
| | - U. Bottoni
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - S. Nisticò
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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38
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Pranteda G, Muscianese M, Marmo G, Fidanza L, Pranteda G, Tamburi F, Bottoni U, Nisticò S. Role of Steroid Therapy in Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis. Int J Immunopathol Pharmacol 2013; 26:1013-8. [DOI: 10.1177/039463201302600423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis (PXE-PDE) is a peculiar idiopathic elastolytic disorder that clinically resembles Psudoxanthoma elasticum (PXE). It is histologically characterized by a total or partial loss of elastic fibers in the papillary dermis. It more often affects elderly women and is characterized by asymptomatic and symmetrical yellowish papules localized predominantly on the neck, supraclavicular regions, and flexural areas. After analyzing a series of cases and the recent literature suggesting that glucocorticoids may down-regulate the elastin gene expression and elastin mRNA, in cultured human skin fibroblasts, we think that high dose and prolonged steroid therapy may contribute to the appearance of PXE-PDE lesions.
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Affiliation(s)
- G. Pranteda
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - M. Muscianese
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - G. Marmo
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - L. Fidanza
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - G. Pranteda
- Dermatology Unit, Faculty of Medicine, Umberto I Hospital, Sapienza University, Rome, Italy
| | - F. Tamburi
- Dermatology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - U. Bottoni
- Dermatology Unit, Department of Health Sciences University Magna Graecia of Catanzaro, Italy
| | - S. Nisticò
- Dermatology Unit, Department of Health Sciences University Magna Graecia of Catanzaro, Italy
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Carboni I, Maurici M, Bonatti C, Specchio F, Salvatori C, Docimo R, Chimenti S, Tamburi F, Franco E, Nisticò S. Clinical Aspects of the Oral Cavity in Patients with Psoriasis: An Initial Study and a Proposal of a New Evaluation Method. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The involvement of the oral cavity is rare but possible in patients with psoriasis. Most frequently different clinical entities are reported such as geographic tongue, fissures, angular cheilitis and ectopic geographic tongue. This interdisciplinary study was conducted by dermatologists in collaboration with dental hygienists on 22 patients with psoriasis. We examined 11 men and 11 women aged between 25 and 72 years during a period of 6 months. The involvement of the oral cavity was examined and a full photographic evaluation was carried out. A new assessment evaluation named Oral Psoriasis Area and Severity Index (OPASI) is proposed herein. The results obtained show the presence of oral lesions in 45.6% of the cases. This high involvement could be explained by the interdisciplinary nature of the study. We believe OPASI can be useful to assess the severity of lesions of the oral cavity, and may help to evaluate the response to therapy in relation to the Psoriasis Area and Severity Index (PASI) improvement.
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Affiliation(s)
- I. Carboni
- Department of Systems Medicine, Dermatology, University of Rome Tor Vergata, Italy
| | - M. Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - C. Bonatti
- Department of Systems Medicine, Dermatology, University of Rome Tor Vergata, Italy
| | - F. Specchio
- Department of Systems Medicine, Dermatology, University of Rome Tor Vergata, Italy
| | - C. Salvatori
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R. Docimo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S. Chimenti
- Department of Systems Medicine, Dermatology, University of Rome Tor Vergata, Italy
| | - F. Tamburi
- Columbus Integrated Complex, Catholic University, Rome, Italy
| | - E. Franco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - S. Nisticò
- Department of Health Science, Dermatology Unit University of Catanzaro, Catanzaro, Italy
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Saraceno R, Lorè B, Ventura A, Nisticò S, Perugia C, Chimenti S, Bianchi L. Oral Lichen Planus: Novel Acquisitions in the Pathogenesis and Treatment. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lichen planus (LP) is a mucocutaneous disease of chronic inflammatory nature, commonly seen in dermatological and dental clinics; it is a relatively common disorder of stratified squamous epithelia, frequently exclusively involving the oral cavity. Oral Lichen Planus (OLP) is often asymptomatic, the atrophic-erosive form can cause symptoms ranging from burning sensation to severe pain, interfering with speaking, eating, and swallowing. Lichen planus is regarded as a premalignant lesion. This review discusses the role of hepatitis C virus (HCV), bacterial and fungal infection in LP. Analysing the seroprevalence of HCV infection in LP patients and patients with oral OLP in particular, which was the case in the vast majority of studies, the association varied from 0% to 62% and seemed to be connected to the high HCV seroprevalence in the general population. Candida albicans is present in about 37% of oral LP lesions. The aim of this review is to summarize what is new in the pathogenesis and treatment of OLP.
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Affiliation(s)
- R. Saraceno
- U.O.C. of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - B. Lorè
- Department of Oral and Maxillo-Facial Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A. Ventura
- U.O.C. of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - S.P. Nisticò
- Department of Dermatology, University of Catanzaro “Magna Grcecia”, Catanzaro, Italy
| | - C. Perugia
- Department of Paediatric Dentistry, University of Rome Tor Vergata, Rome, Italy
| | - S. Chimenti
- U.O.C. of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - L. Bianchi
- U.O.C. of Dermatology, University of Rome Tor Vergata, Rome, Italy
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41
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Donato G, Nicoletti G, Gabriele A, Conforti F, Zuccalà V, Amorosi A, Tamburi F, Nisticò S, Bottoni U. Neurocutaneous Melanosis in a Woman with Multiple Brain Melanocytomas, Cutaneous Melanocytosis and Oral Involvement. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 34-year-old female was referred to us for a consultation of her dermatological lesions (pigmented lesions present in her oral cavity and on her right shoulder) in May 2007. These lesions had been present since childhood. Recently, the patient had developed seizures and a headache. An MRI of the brain showed the presence of two intracranial masses. The intracranial tumours were surgically removed whereas skin and mucosal lesions were biopsied. Histological findings of brain tumours were consistent with a diagnosis of “melanocytoma” while cutaneous lesions presented “benign dermal melanocytic infiltrations”. Whole brain irradiation was performed. After 3 months a new melanocytic skin lesion appeared on the scalp with histological picture similar to the other cutaneous ones. At the 5-year follow-up examination no recurrence of intracranial tumour or other skin or mucosal lesions were registered. According to the clinical and histological findings, we classify our case as a form of neurocutaneous melanosis in a young adult patient and we present it for the rarity of this syndrome, for the difficulty of the diagnosis, for the potential aggressive behaviour of intracranial lesions that necessitates a constant attentive follow-up and for the unusual feature of new developing skin lesion during the course of the disease.
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Affiliation(s)
- G. Donato
- Unit of Pathology, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - G. Nicoletti
- Institute of Neurological Sciences, National Research Council (CNR), University Magna Graecia, Catanzaro, Italy
| | - A. Gabriele
- Institute of Neurological Sciences, National Research Council (CNR), University Magna Graecia, Catanzaro, Italy
| | - F. Conforti
- Unit of Pathology, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - V. Zuccalà
- Unit of Pathology, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - A. Amorosi
- Unit of Pathology, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - F. Tamburi
- Complesso Integrato Columbus, Università Cattolica, Rome, Italy
| | - S. Nisticò
- Dermatology Unit, University Magna Graecia, Catanzaro, Italy
| | - U. Bottoni
- Dermatology Unit, University Magna Graecia, Catanzaro, Italy
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Sanchez-Sosa S, Aguirre-Lombardo M, Jimenez-Brito G, Ruiz-Argüelles A. Immunophenotypic characterization of lymphoid cell infiltrates in vitiligo. Clin Exp Immunol 2013; 173:179-83. [PMID: 23607858 PMCID: PMC3722918 DOI: 10.1111/cei.12096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/26/2022] Open
Abstract
The pathogenesis of vitiligo is still controversial. The purpose of this study was to gain insight into the nature of lymphoid cells infiltrating depigmented areas of skin in vitiligo. Immunochemical procedures were carried out in biopsies from 20 patients with active lesions to search for cells expressing CD1a, CD2, CD3, CD4, CD5, CD8, CD20, CD25, CD30, CD56, CD68 and CD79a. Results indicate that early lesions are infiltrated mainly by dendritic cells, whereas older lesions display significantly lower proportions of these cells and increased percentages of mature T cells. This finding might suggest that the autoimmune reactivity towards melanocyte antigens might be T cell-dependent and antigen-driven. It is possible that a non-immune offence of melanocytes is responsible for the exposure of intracellular antigens, while autoreactivity might be a secondary, self-perpetuating mechanism.
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Affiliation(s)
- S Sanchez-Sosa
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
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Abstract
There is a limited number of options in vitiligo treatment, with the disease frequently refractory to all existing treatment modalities. This warrants development of novel and improving existing vitiligo treatments as well as finding predicting factors to improve treatment outcome through appropriate selection and the most efficient application of a treatment. These issues are addressed in clinical studies aiming to evaluate safety and efficiency of novel treatments, improvements and modifications introduced to existing treatments, and to define predictors of treatment efficiency and their limitations. Here, results of recent (since year 2009) clinical studies in vitiligo field are overviewed, with the emphasis on their contribution to improved vitiligo management.
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Wong R, Lin AN. Efficacy of topical calcineurin inhibitors in vitiligo. Int J Dermatol 2013; 52:491-6. [DOI: 10.1111/j.1365-4632.2012.05697.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/25/2012] [Accepted: 04/22/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew N. Lin
- Division of Dermatology and Cutaneous Sciences; Department of Medicine; University of Alberta; Edmonton; Alberta; Canada
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Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review. Lasers Med Sci 2012; 28:1035-41. [DOI: 10.1007/s10103-012-1185-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/06/2012] [Indexed: 11/27/2022]
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Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
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Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
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