1
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Tanemura A. Understanding of Pathomechanisms and Clinical Practice for Vitiligo. Ann Dermatol 2023; 35:333-341. [PMID: 37830414 PMCID: PMC10579571 DOI: 10.5021/ad.23.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
Vitiligo is a disease caused by the acquired depletion of melanocytes and/or melanocyte precursor cells in response to genetic and environmental factors, resulting in depigmentation of the entire body. It is roughly divided into segmental and non-segmental vitiligo, and it has been found that abnormalities of melanocytes themselves and dysregulation of autoimmune responses to melanocytes are greatly involved in the pathology of non-segmental vitiligo. Segmental vitiligo pathology is largely unknown; however, it has been suggested that it may be caused by skin or melanocyte mosaicism. Treatments for vitiligo include topical therapy, ultraviolet therapy, and surgical transplantation, and it is extremely important to correctly understand the pathology to perform optimal treatment. In recent years, the development of vitiligo treatments using Janus kinase (JAK) inhibitors has progressed rapidly. We herein outline the latest pathology of vitiligo, from general vitiligo treatment to the progress of clinical trials using JAK inhibitors, along with what clinicians should consider in archiving precision medicine, including my own ideas thereon.
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Affiliation(s)
- Atsushi Tanemura
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan.
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2
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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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3
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Lee H, Cowan TL, Daniel BS, Murrell DF. A review of JAK and IL-23 inhibitors to treat vitiligo. Australas J Dermatol 2023; 64:204-212. [PMID: 36810815 DOI: 10.1111/ajd.14001] [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: 09/26/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
Vitiligo is an autoimmune skin disorder resulting in the depigmentation of skin characterised by patches of varying sizes and shapes. A common disorder of pigmentation that affects 0.5%-2% of the global population. Despite its well-understood autoimmune pathogenesis, the targets for effective cytokine intervention remain unclear. Current first-line treatments include oral or topical corticosteroids, calcineurin inhibitors and phototherapy. These treatments are limited, have varying efficacies, and are associated with significant adverse events or can be time-consuming. Therefore, biologics should be explored as a potential treatment for vitiligo. There are currently limited data for the use of JAK and IL-23 inhibitors for vitiligo. A total of 25 studies were identified in the review. There is promising evidence regarding the use of JAK and IL-23 inhibitors for the treatment of vitiligo.
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Affiliation(s)
- Henry Lee
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy L Cowan
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | - Benjamin S Daniel
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | - Dédée F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
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4
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Song H, Hu Z, Zhang S, Yang L, Liu Y, Wang T. Effectiveness and safety of tofacitinib combined with narrowband ultraviolet B phototherapy for patients with refractory vitiligo in real‐world clinical practice. Dermatol Ther 2022; 35:e15821. [DOI: 10.1111/dth.15821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Hongbin Song
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Zhonghui Hu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Shiyu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Lu Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
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5
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Chen J, Yu N, Li H, Tang Y, Zhu H. Meta-analysis of the efficacy of adding platelet-rich plasma to 308-nm excimer laser for patients with vitiligo. J Int Med Res 2022; 50:3000605221119646. [PMID: 36062405 PMCID: PMC9446466 DOI: 10.1177/03000605221119646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Platelet-rich plasma (PRP) is a novel treatment option for vitiligo. PRP has
been reported to be effective in combination with 308-nm excimer laser
therapy, but there is no consensus on their combination use. Therefore, this
meta-analysis assessed the efficacy and safety of the combination regimen in
patients with vitiligo compared with laser therapy alone. Methods The meta-analysis was performed by searching PubMed, EMBASE, Web of Science,
Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang to
identify relevant publications published through 1 February 2022. Results Six studies involving 302 patients were included. Compared with phototherapy
alone, combination treatment with PRP and 308-nm excimer laser therapy
significantly improved the total response rate and reduced the no response
rate. Additionally, the proportions of patients with repigmentation rates of
≥75%, ≥50%, and ≥25% were significantly higher in the combination group than
in the monotherapy group. In addition, the rates of adverse events for
combination therapy were comparable to those for laser therapy alone, and
the recurrence rates were low. Conclusions This meta-analysis provided evidence supporting the combined use of PRP and
308-nm excimer laser therapy as a valuable treatment modality for patients
with vitiligo based on its superiority to monotherapy.
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Affiliation(s)
- Jiaoquan Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Nanji Yu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Huaping Li
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Yi Tang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Huilan Zhu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
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6
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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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7
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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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8
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Esmat SM, Bassiouny D, Hegazy R, Shalaby S, Ragab N, Ibrahim S, Mogawer RM. Early localized vitiligo, a medical emergency: Long-term follow-up study. Dermatol Ther 2021; 35:e15219. [PMID: 34812544 DOI: 10.1111/dth.15219] [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: 10/01/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T-cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty-five patients with recent onset (<6 months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6 months plus topical treatments and NB-UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4 years. Eighty-four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65 ± 2.19 months. Complete repigmentation was achieved in a mean duration of 6.88 ± 0.2 months. At the end of the 4-year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.
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Affiliation(s)
- Samia M Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Bassiouny
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan Shalaby
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nanis Ragab
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Shourick J, Seneschal J, Andreu N, Meurant JM, Pane I, Ravaud P, Tran VT, Ezzedine K. Vitiligo Treatment Impact score (VITs): development and validation of a vitiligo burden of treatment questionnaire using the ComPaRe Vitiligo e-cohort. J Eur Acad Dermatol Venereol 2021; 36:279-285. [PMID: 34657353 DOI: 10.1111/jdv.17742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo management is challenging and requires long-term adherence of patients who often complain of the burden associated with treatment. OBJECTIVE To develop and validate a patient reported measurement of the burden of treatment in vitiligo. METHODS The study was nested within the ComPaRe Vitiligo e-cohort, an online e-cohort of vitiligo patients in France. Items were derived from a literature review and from the qualitative analysis of a survey using open-ended questions of 204 patients with Vitiligo. Construct validity of the resulting instrument was assessed by comparing the instrument's score to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores. Reliability was assessed by test-retest with 15 ± 10 days of interval between both assessments. RESULTS In total, 343 adult participants participated in the validation of the Vitiligo Treatment Impact score (VITs). The VITs is a 19-item questionnaire assessing the burden of treatment in patients with vitiligo with results suggesting four domains ('Finding a doctor', 'Phototherapy', 'Topical treatment' and 'Impact on outdoor activities and photoprotection'). The VITs total score was well correlated with the DLQI, VIP and TBQ scores. Agreement between test and retest was good (ICC 0.705, 95% CI 0.491-0.818). CONCLUSIONS We developed a patient reported measurement of the burden of treatment in vitiligo with good psychometric properties.
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Affiliation(s)
- J Shourick
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Creteil, France
| | - J Seneschal
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France.,INSERM, BMGIC, U1035, Univ. Bordeaux, Bordeaux, France
| | - N Andreu
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - J-M Meurant
- Association Française du Vitiligo, Paris, France
| | - I Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - P Ravaud
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - V-T Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - K Ezzedine
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Creteil, France
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10
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Shourick J, Ahmed M, Seneschal J, Passeron T, Andreux N, Qureshi A, Chow EY, Natella PA, Harris J, Tran VT, Ezzedine K. Development of a shared decision-making tool in vitiligo: an international study. Br J Dermatol 2021; 185:787-796. [PMID: 33830502 DOI: 10.1111/bjd.20137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shared decision-making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology. OBJECTIVES To develop and validate a SDMt for use in specialized consultation for vitiligo. METHODS A prospective cross-sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision-making in the setting of a specialized consultation for vitiligo using an anchored-theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e-Delphi method. RESULTS We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision-making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English. CONCLUSIONS We developed a tool for shared decision-making in nonsegmental vitiligo, which we translated and cross-culturally validated in a US patient population with vitiligo to ensure its generalizability.
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Affiliation(s)
- J Shourick
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France
| | - M Ahmed
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - J Seneschal
- Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - T Passeron
- Université Côte d'Azur, Department of Dermatology, CHU Nice, Nice, France.,Université Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - N Andreux
- Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy Street, Providence, RI, 02903, USA
| | - E Y Chow
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, 02903, USA
| | - P A Natella
- Assistance Publique-Hôpitaux de Paris, Public Health Department/Clinical Research Unit (URC-Mondor), Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - J Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - V-T Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Center d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - K Ezzedine
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France.,Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
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11
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Ju HJ, Han JH, Kim MS, Lee SH, Shin JW, Choi M, Jeong KH, Han TY, Choi CW, Lee HJ, Oh SH, Lee SH, Kim DH, Shin J, Lee JH, Kim SS, Kang HY, Chang SE, Kim JS, Lee DY, Choi GS, Suh DH, Chan Kim Y, Park CJ, Kim KH, Lee AY, Chan Park K, Lee MH, Bae JM. The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo. J Am Acad Dermatol 2021; 84:1619-1627. [PMID: 33508387 DOI: 10.1016/j.jaad.2021.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. OBJECTIVE To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. METHODS A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. RESULTS During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. LIMITATIONS Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. CONCLUSION The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ju Hee Han
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min-Soo Kim
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Si-Hyung Lee
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Seoul, South Korea
| | - Ki-Heon Jeong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Tae Young Han
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, South Korea
| | - Chong Won Choi
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hee Jung Lee
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Department of Dermatology, Soon Chun Hyang University Hospital, Bucheon, South Korea
| | - Dong Hyun Kim
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Seok Kim
- Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Soo Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Chul Jong Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Ho Kim
- Department of Dermatology, Dong-A University School of Medicine, Busan, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongkuk University Ilsan Hospital, Dongguk University Graduate School of Medicine, Goyang, South Korea
| | - Kyoung Chan Park
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mu-Hyoung Lee
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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12
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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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13
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Choi CW. Non-surgical treatment of vitiligo. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.12.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vitiligo is an acquired depigmenting skin disorder that affects 0.5% to 2% of the population. Skin lesions from vitiligo, white macules and patches on the skin, can pose a substantial psychological burdencan, causing a significant decrease in one’s quality of life. Recent basic and clinical studies have found that vitiligo is an autoimmune disorder, mediated by CD8+ T-cell and interferon-γ-mediated cytokine/chemokines. Although no treatment modality presents a complete cure for vitiligo, current treatment modalities have a modest effect on vitiligo by reversing the disease’s progression, inducing its stabilization, and promoting melanocyte regeneration. Current non-surgical treatment modalities include topical corticosteroids, topical calcineurin inhibitors, systemic corticosteroids, and phototherapy such as narrowband ultraviolet B phototherapy and excimer laser. In addition, clinicians have used and combined non-surgical treatment modalities based on the activity and extent of vitiligo. Moreover, considering the high risk of vitiligo relapse, maintenance therapy for re-pigmented lesions has also been introduced. Lastly, based on the results of recent translational research, new and emerging treatment modalities have been introduced, such as Janus kinase inhibitors. This review presents an overview of the current non-surgical treatment modalities for vitiligo and discusses emerging treatments.
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Chen J, Wan Y, Lin Y, Jiang H. Current art of combination therapy with autologous platelet-rich plasma for stable vitiligo: A meta-analysis. Int Wound J 2020; 18:251-260. [PMID: 33245822 PMCID: PMC8243985 DOI: 10.1111/iwj.13524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022] Open
Abstract
Presently, there is an explosion in various uses of platelet‐rich plasma (PRP). Several trials comparing combination therapy with PRP vs monotherapy for vitiligo have been published. However, evidence‐based information is not enough for making well‐informed decisions. This study aimed to evaluate several combination therapy strategies for vitiligo. EMBASE, PubMed, Web of Science, Cochrane Library and Google Scholar databases were searched to identify randomised controlled trials comparing combination therapy with PRP vs monotherapy for vitiligo. Eleven studies with 670 cases were included. Compared with monotherapy, clinical improvement of repigmentation was significantly higher in 308‐nm excimer laser combined with PRP (odds rate for response rate of 50%‐100% repigmentation, 4.47; 95% CI, 2.47‐8.10; P < .00001) and in fractional carbon dioxide laser combined with PRP (mean difference for mean improvement grades of repigmentation, 1.61; 95% CI, 0.24‐2.99; P = .02), respectively. Compared to monotherapy, there is no higher clinical improvement in strategies of PRP combined with narrowband‐ultraviolet B or non‐cultured epidermal cell suspension. Trivial adverse events were reported. This meta‐analysis summarises current evidence that PRP combined with 308‐nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo. This systematic review and meta‐analysis aims to evaluate the effectiveness and safety of several combination therapy strategies with PRP in the treatment of vitiligo. The response rate of repigmentation and mean improvement grades of repigmentation were mainly used for qualitative assessment. PRP combined with 308‐nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo due to its healing and regenerative properties.
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Affiliation(s)
- Jianguo Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Wan
- Department of Internal Medicine, Xi Yuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lin
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Li M, Wang F, Ding X, Xu Q, Du J. Evaluation of the potential interference of camouflage on the treatment of vitiligo: An observer-blinded self-controlled study. Dermatol Ther 2020; 34:e14545. [PMID: 33190372 DOI: 10.1111/dth.14545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
Camouflage improves the quality of life in vitiligo patients. However, whether the use of camouflage interferes the efficacy of the treatment of vitiligo remains controversial. To evaluate the impact and safety of dihydroxyacetone (DHA)-containing camouflage on the treatment of vitiligo. Thirty patients were enrolled. Comparable vitiliginous patches in each patient were randomly divided into camouflage group or blank group. The therapeutic modalities including topical corticosteroids with or without NB-UVB phototherapy were applied to both groups of lesions. The outcomes were assessed at baseline and then every 4 weeks for up to 12 weeks, including types of repigmentation patterns, percentage of repigmentation, trans epidermal water loss (TEWL), and adverse events. Twenty-eight patients completed the study. There were no differences in repigmentation types and percentage of repigmentation at the endpoint of study between two groups. No difference in TEWL was found at the end of the study between the two groups. Temporary skin irritation (itching and tingling) occurred in one patient in camouflage group after phototherapy between 8 and 12 weeks' treatment. DHA-containing camouflage is a safe make-up for vitiligo. It has little impact on the efficacy of the treatment of vitiligo or on the function of skin barrier.
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Affiliation(s)
- Man Li
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Fang Wang
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Xiaolan Ding
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Qianxi Xu
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Juan Du
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
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Diekmann J, Theves I, Thom KA, Gilch P. Tracing the Photoaddition of Pharmaceutical Psoralens to DNA. Molecules 2020; 25:E5242. [PMID: 33182821 PMCID: PMC7696755 DOI: 10.3390/molecules25225242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023] Open
Abstract
The psoralens 8-methoxypsoralen (8-MOP), 4,5',8-trimethylpsoralen (TMP) and 5-methoxypsoralen (5-MOP) find clinical application in PUVA (psoralen + UVA) therapy. PUVA treats skin diseases like psoriasis and atopic eczema. Psoralens target the DNA of cells. Upon photo-excitation psoralens bind to the DNA base thymine. This photo-binding was studied using steady-state UV/Vis and IR spectroscopy as well as nanosecond transient UV/Vis absorption. The experiments show that the photo-addition of 8-MOP and TMP involve the psoralen triplet state and a biradical intermediate. 5-MOP forms a structurally different photo-product. Its formation could not be traced by the present spectroscopic technique.
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Affiliation(s)
| | | | | | - Peter Gilch
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; (J.D.); (I.T.); (K.A.T.)
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Bae JM, Jeong K, Choi CW, Park JH, Lee HJ, Kim HJ, Lee SH, Oh SH, Shin J, Kang HY, Lee WJ, Ju HJ, Kim DH, Chang SE, Lee DY, Kim YC, Choi GS, Kim K, Kim TH, Lee SC, Lee A, Hann S, Lee M, Park CJ. Development of evidence‐based consensus on critical issues in the management of patients with vitiligo: A modified Delphi study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 37:3-11. [DOI: 10.1111/phpp.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/25/2020] [Accepted: 08/02/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Jung Min Bae
- Department of Dermatology College of Medicine, The Catholic University of Korea Seoul Korea
| | - Ki‐Heon Jeong
- Department of Dermatology College of Medicine, Kyung Hee University Seoul South Korea
| | - Chong Won Choi
- Department of Dermatology Chungnam National University School of Medicine Daejeon South Korea
| | - Ji Hun Park
- Drs Woo and Hann’s Skin Center Seoul South Korea
| | - Hee Jung Lee
- Department of Dermatology Cha University Bundang Cha Medical Center School of Medicine Bundang South Korea
| | - Hee Jung Kim
- YK Park Yoon Kee's Dermatology Clinic Seoul South Korea
| | - Sang Hoon Lee
- Department of Dermatology Soon Chun Hyang University Hospital Bucheon South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute Yonsei University College of Medicine Seoul South Korea
| | - Jeonghyun Shin
- Department of Dermatology Inha University School of Medicine Incheon South Korea
| | - Hee Young Kang
- Department of Dermatology Ajou University School of Medicine Suwon South Korea
| | - Weon Ju Lee
- Department of Dermatology Kyungpook National University School of Medicine Daegu South Korea
| | - Hyun Jeong Ju
- Department of Dermatology College of Medicine, The Catholic University of Korea Seoul Korea
| | - Dong Hyun Kim
- Department of Dermatology Cha University Bundang Cha Medical Center School of Medicine Bundang South Korea
| | - Sung Eun Chang
- Department of Dermatology Asan Medical Center, University of Ulsan College of Medicine Seoul Korea
| | - Dong Youn Lee
- Department of Dermatology SungKyunKwann University School of Medicine Seoul South Korea
| | - You Chan Kim
- Department of Dermatology Ajou University School of Medicine Suwon South Korea
| | - Gwang Seong Choi
- Department of Dermatology Inha University School of Medicine Incheon South Korea
| | - Ki‐Ho Kim
- Department of Dermatology Dong‐A University School of Medicine Busan South Korea
| | | | - Seung Chul Lee
- Department of Dermatology Chonnam National University School of Medicine Gwangju South Korea
| | - Ai‐Young Lee
- Department of Dermatology Dongkuk University School of Medicine Ilsan Korea
| | | | - Mu‐Hyoung Lee
- Department of Dermatology College of Medicine, Kyung Hee University Seoul South Korea
| | - Chul Jong Park
- Department of Dermatology College of Medicine, The Catholic University of Korea Seoul Korea
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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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Abstract
Vitiligo is a common disorder with a severe impact on quality of life. The authors review recent advances in phototherapy for vitiligo focusing on narrowband ultraviolet B including mechanisms, treatment recommendations, and combination therapies. Phototherapy is the first-line treatment of choice for vitiligo with narrowband UVB preferred for widespread vitiligo and excimer used for localized lesions. However, unfamiliarity with prescribing phototherapy may be limiting clinicians from using it to its full potential. This article provides clinicians with the critical information needed to safely and effectively provide phototherapy for their patients with vitiligo.
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Affiliation(s)
- Raheel Zubair
- Broward Health Medical Center, Graduate Medical Education, 1600 S Andrews Avenue, Fort Lauderdale, FL 33301, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI, USA.
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20
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Lee JH, Kwon HS, Jung HM, Lee H, Kim GM, Yim HW, Bae JM. Treatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:929-938. [PMID: 31141108 DOI: 10.1001/jamadermatol.2019.0696] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Topical calcineurin inhibitors (TCIs), including tacrolimus and pimecrolimus, have been widely used for the treatment of vitiligo; however, the efficacy of TCI monotherapy is often underestimated. Objectives To estimate the treatment responses to both TCI monotherapy and TCI accompanied by phototherapy for vitiligo, based on relevant prospective studies, and to systematically review the mechanism of action of TCIs for vitiligo treatment. Data Sources A comprehensive search of the MEDLINE, Embase, Web of Science and Cochrane Library databases from the date of database inception to August 6, 2018, was conducted. The main key words used were vitiligo, topical calcineurin inhibitor, tacrolimus, pimecrolimus, and FK506. Study Selection Of 250 studies initially identified, the full texts of 102 articles were assessed for eligibility. A total of 56 studies were identified: 11 studies on the TCI mechanism, 36 studies on TCI monotherapy, 12 studies on TCI plus phototherapy, and 1 study on TCI maintenance therapy. Data Extraction and Synthesis Two reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random-effects meta-analyses using the generic inverse variance weighting were performed for the TCI monotherapy and TCI plus phototherapy groups. Main Outcomes and Measures The primary outcomes were the rates of at least mild (≥25%), at least moderate (≥50%), and marked (≥75%) repigmentation responses to treatment. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed that study. Results In the 56 studies included in the analysis, 46 (1499 patients) were selected to evaluate treatment response. For TCI monotherapy, an at least mild response was achieved in 55.0% (95% CI, 42.2%-67.8%) of 560 patients in 21 studies, an at least moderate response in 38.5% (95% CI, 28.2%-48.8%) of 619 patients in 23 studies, and a marked response in 18.1% (95% CI, 13.2%-23.1%) of 520 patients in 19 studies after median treatment duration of 3 months (range, 2-7 months). In the subgroup analyses, face and neck lesions showed an at least mild response in 73.1% (95% CI, 32.6-83.5%) of patients, and a marked response in 35.4% (95% CI, 24.9-46.0%) of patients. For TCI plus phototherapy, an at least mild response to TCI plus phototherapy was achieved in 89.5% (95% CI, 81.1-97.9%) of patients, and a marked response was achieved in 47.5% (95% CI, 30.6-64.4%) of patients. Conclusions and Relevance The use of TCIs, both as a monotherapy and in combination with phototherapy, should be encouraged in patients with vitiligo.
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Affiliation(s)
- Ji Hae Lee
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuck Sun Kwon
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Mi Jung
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunyong Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - Gyong Moon Kim
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Brown AE, Qiu CC, Drozd B, Sklover LR, Vickers CM, Hsu S. The color of skin: white diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:561-579. [PMID: 31896410 DOI: 10.1016/j.clindermatol.2019.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.
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Affiliation(s)
- Ashley E Brown
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA.
| | - Connie C Qiu
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Brandy Drozd
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA
| | - Lindsay R Sklover
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Conor M Vickers
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
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22
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Ohtsuki M, Morimoto H, Nakagawa H. Tacrolimus ointment for the treatment of adult and pediatric atopic dermatitis: Review on safety and benefits. J Dermatol 2018; 45:936-942. [PMID: 29927498 PMCID: PMC6099320 DOI: 10.1111/1346-8138.14501] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022]
Abstract
Atopic dermatitis (AD) requires long-term management, mainly with topical anti-inflammatory agents. Topical corticosteroids (TCS) and tacrolimus ointment (TAC-O) are recommended as first-line treatments for AD. However, the long-term use of TCS is limited by cutaneous adverse events such as skin atrophy. For TAC-O, Japanese and US labelings were updated in 2003 and 2006, respectively, to include a boxed warning about a theoretical risk of skin cancer and lymphoma in patients treated with topical calcineurin inhibitors. However, TAC-O has been used worldwide for longer than 15 years to treat adult and pediatric patients with AD. Available data suggest that TAC-O is effective and well tolerated, and can improve quality of life. TAC-O has successfully been used in the proactive management of AD consisting of long-term intermittent use to prevent, delay or reduce the occurrence of AD flares. Systemic drug absorption after TAC-O application is negligible and unlikely to result in systemic immunosuppression. There is currently no strong evidence of an increased rate of malignancy in treated patients, and observational data from postmarketing surveillance studies have shown no safety concerns. In the absence of robust evidence, the warning about the carcinogenic potential in the Japanese labeling for TAC-O does not appear justified and should be reconsidered. This mitigation of description would allow adult and pediatric patients with AD to receive the effective treatment more appropriately.
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Affiliation(s)
| | | | - Hidemi Nakagawa
- Department of DermatologyThe Jikei University School of MedicineTokyoJapan
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23
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Lommerts J, Uitentuis S, Bekkenk M, de Rie M, Wolkerstorfer A. The role of phototherapy in the surgical treatment of vitiligo: a systematic review. J Eur Acad Dermatol Venereol 2018; 32:1427-1435. [DOI: 10.1111/jdv.14950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- J.E. Lommerts
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - S.E. Uitentuis
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.W. Bekkenk
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
| | - M.A. de Rie
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
- Department of Dermatology; VU Medical Centre; Amsterdam The Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders; Academic Medical Centre; Amsterdam The Netherlands
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24
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Abstract
Cutaneous melanoma derives from the tumoral transformation of melanocytes. These pigmented cells produce melanin prior transmitting it to the surrounding keratinocytes of the skin, hair and mane. The main function of melanin is to protect cells and their DNA from damage caused by ultraviolet light. Melanoma is the most aggressive skin cancer whose incidence has increased steadily in recent decades. Advances in basic research have resulted in a better understanding of the molecular and cellular events responsible for the initiation and progression of melanomas. In this review, we present an overview of the knowledge gained in recent years and show how recent advances lead to new targeted and more efficient therapeutic approaches.
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Affiliation(s)
- Franck Gesbert
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Inserm U1021, Développement normal et pathologique des mélanocytes, 91405 Orsay, France - Univ Paris-Sud, Univ Paris-Saclay, CNRS UMR3347, 91405 Orsay, France - Équipe labellisée Ligue contre le cancer, 91405 Orsay, France
| | - Lionel Larue
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Inserm U1021, Développement normal et pathologique des mélanocytes, 91405 Orsay, France - Univ Paris-Sud, Univ Paris-Saclay, CNRS UMR3347, 91405 Orsay, France - Équipe labellisée Ligue contre le cancer, 91405 Orsay, France
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25
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Tofani LB, Depieri LV, Campos PM, Riul TB, Antonietto KS, de Abreu Fantini MC, Bentley MVLB. In Vitro TyRP-1 Knockdown Based on siRNA Carried by Liquid Crystalline Nanodispersions: an Alternative Approach for Topical Treatment of Vitiligo. Pharm Res 2018; 35:104. [PMID: 29560584 DOI: 10.1007/s11095-017-2330-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/12/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE Vitiligo is a skin disease characterized by depigmentation and the presence of white patches that are associated with the loss of melanocytes. The most common explanation for the cause of this condition is that it is an autoimmune condition. TyRP-1 is involved in melanin pigment synthesis but can also function as a melanocyte differentiation antigen. This protein plays a role in the autoimmune destruction of melanocytes, which results in the depigmentation, characteristic of this disease. In this study, we evaluated liquid crystalline nanodispersions as non-viral vectors to deliver siRNA-TyRP-1 as an alternative for topical treatment of vitiligo. METHODS Liquid crystalline nanodispersions were obtained and characterized with respect to their physical-chemical parameters including size, PdI and zeta potential, as well as Small Angle X-ray Scattering and complexing to siRNA. The effects of the liquid crystalline nanodispersions on the cellular viability, cell uptake and levels of the knockdown target TyRP-1 were evaluated in melan-A cells after 24 h of treatment. RESULTS The liquid crystalline nanodispersions demonstrated adequate physical-chemical parameters including nanometer size and a PdI below 0.38. These systems promoted a high rate of cell uptake and an impressive TyRP-1 target knockdown (> 80%) associated with suitable loading of TyRp-1 siRNA. CONCLUSIONS We demonstrated that the liquid crystalline nanodispersions showed promising alternative for the topical treatment of vitiligo due to their physical parameters and ability in knockdown the target protein involved with autoimmune destruction of melanocytes.
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Affiliation(s)
- Larissa Bueno Tofani
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil
| | - Lívia Vieira Depieri
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil
| | - Patrícia Mazureki Campos
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil
| | - Thalita Bachelli Riul
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil
| | - Kamilla Swiech Antonietto
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil
| | | | - Maria Vitória Lopes Badra Bentley
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Avenida do Café, s/n, Ribeirão Preto, SP, 14040-903, Brazil.
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Watabe A, Yamasaki K, Asano M, Kanbayashi Y, Nasu-Tamabuchi M, Terui H, Furudate S, Kakizaki A, Tsuchiyama K, Kimura Y, Ito Y, Kikuchi K, Aiba S. Efficacy of oral cholecalciferol on rhododendrol-induced vitiligo: A blinded randomized clinical trial. J Dermatol 2018; 45:456-462. [DOI: 10.1111/1346-8138.14244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Akiko Watabe
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Kenshi Yamasaki
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Masayuki Asano
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yumi Kanbayashi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Mei Nasu-Tamabuchi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hitoshi Terui
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Sadanori Furudate
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Aya Kakizaki
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Kenichiro Tsuchiyama
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yutaka Kimura
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yumiko Ito
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Katsuko Kikuchi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Setsuya Aiba
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
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Lin Z, Tian Y, Bai B, Liu M, Wu Y, Xiao B, Gao XH, Chen HD. Comprehensive survey of vitiligo patients in the northeast of China using a predesigned questionnaire. J Dermatol 2018; 45:39-45. [PMID: 28940447 DOI: 10.1111/1346-8138.14016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
To assess the sociodemographic data and clinical information of outpatients affected by vitiligo in the northeast of China, vitiligo patients or guardians who presented to the clinic were invited to participate in an exploratory questionnaire. The questionnaire consisted of two sections related to vitiligo, including sociodemographic data and clinical information. A total of 983 vitiligo patients answered the questionnaire. The rates of female and male patients were comparable. The investigated patients were mostly young and middle-aged. Most patients suffered from vitiligo in childhood or young adulthood. Vitiligo vulgaris was the most common type of vitiligo in clinic and 53.0% of patients were categorized as body surface area (BSA) of 10% or less. In response to the latest treatment, 43.6% of patients achieved good response (completely stopped or almost disappeared). More patients at active stage showed good response than the patients at stable stage (χ2 = 7.866, P < 0.05). Chronic comorbid condition(s) were observed in 12.6% of patients with BSA of more than 10%, whereas those were seen in 6.0% of patients with BSA of 10% or less (χ2 = 12.969, P < 0.05). In conclusion, active vitiligo seems to respond better than stable vitiligo and complications with other autoimmune diseases more frequently observed in severe patients than mild patients. The current study presented a comprehensive understanding of vitiligo in the northeast of China.
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Affiliation(s)
- Zheng Lin
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
| | - Yaping Tian
- Department of Dermatology, No. 1 Hospital of Jilin University, Changchun, China
| | - Bingxue Bai
- Department of Dermatology, No. 2 Hospital of Harbin Medical University, Harbin, China
| | - Mei Liu
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
| | - Yan Wu
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
| | - Bihuan Xiao
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
| | - Hong-Duo Chen
- Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, China
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Al Houssien AO, Al Houssien RO, Al Ajroush W, Al Kahtani HS. Chronic diseases among vitiligo patients. A case control study. Saudi Med J 2017; 38:400-404. [PMID: 28397947 PMCID: PMC5447193 DOI: 10.15537/smj.2017.4.17551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify the proportion and risk of chronic diseases in vitiligo patients in a tertiary hospital in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A retrospective case-control study included 61 vitiligo patients and 61 normal non-dermatology controls in King Abdulaziz Medical City, Riyadh, KSA between January and September 2016. Age, gender and co-morbid diseases including hypertension, diabetes, dyslipidemia, obesity and hypothyroidism were retrieved from participants' charts and medical records. Proportion and mean were used to describe the variables, and odds ratio (OR) was used to test the data. Results: A total of 122 participants (34 males, 88 females) equally divided in cases and controls. The mean age was 45±19 years for the case and 40±17 years for the control group. The proportion of diabetes (51%) was higher in the case group than the control (33%) (OR: 0.47; 95% confidence interval [CI]: 0.23-0.98; p=0.04). Dyslipidemia was significantly associated with vitiligo (67%) compared with the control group (48%) (OR: 0.44; 95% CI: 0.21-0.92; p=0.03). Vitiligo participants had a significantly increased risk of having hypothyroidism (26%) compared with the control group (10%) (OR: 0.31; 95% CI: 0.11-0.85; p=0.02). Conclusion: There is an increased risk of chronic diseases among vitiligo patients including diabetes, dyslipidemia, hypothyroidism, renal injuries, and obesity.
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Affiliation(s)
- Abdullah O Al Houssien
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Fibromyalgia Syndrome and Vitiligo: A Novel Association. Arch Rheumatol 2017; 33:174-180. [PMID: 30207563 DOI: 10.5606/archrheumatol.2018.6524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the relationship between fibromyalgia syndrome (FMS) and vitiligo in Iraqi patients and evaluate the predictors of this relationship, if present. Patients and methods The case-control study included 100 Iraqi patients (46 males, 54 females; mean age 30.4±14 years; range 15 to 65 years) with vitiligo and 200 age- and sex-matched healthy controls (74 males, 126 females; mean age 30.3±9.4 years; range 15 to 62 years). Baseline characteristics of patients and controls were recorded. The 2012 Canadian Guidelines criteria were used for the diagnosis of FMS and applied to all patients and controls. Results Prevalence of FMS in vitiligo patients and controls was 12% and 7%, respectively (p=0.15, odds ratio=1.8, 95% confidence interval=0.8-4.08). FMS symptoms in vitiligo patients were fatigue (46%), diffuse body pain (34%), sleep disturbance (33%), cognitive dysfunction (30%), and mood disorders (23%), while visceral involvements were central nervous system (52%), skin (35%), gastrointestinal tract (32%), cardiovascular system- respiratory system (16%), genitourinary tract (8%), and ear nose throat (7%). Of vitiligo patients, FMS was significantly more common among females (22.2%) compared to none among males (0%) (p<0.05). Prevalence of FMS was restricted to female sex only and a significantly higher prevalence rate of FMS was found among female vitiligo patients (22.2%) compared to controls (9.5%). Receiving phototherapy significantly increased the risk of having FMS by 5 times compared to female patients not receiving phototherapy. Use of any steroid reduced the risk of having FMS by 2.5 times (inverse of odds ratio=0.4) among females patients (p>0/05). No significant association was found between FMS in vitiligo patients and age, disease duration, type of vitiligo, use of any immunosuppressant and body mass index (p>0.05). Conclusion Fibromyalgia syndrome was more prevalent in vitiligo patients compared to controls, which was clinically important but statistically not significant. There was a significant association between FMS in vitiligo patients and female sex, severe form of vitiligo, and receiving phototherapy. This may suggest that early diagnosis of FMS in vitiligo patients may help in early treatment and subsequently improve patients' quality of life.
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Hussain I, Hussain N, Manan A, Rashid A, Khan B, Bakhsh S. Fabrication of anti-vitiligo ointment containing Psoralea corylifolia: in vitro and in vivo characterization. Drug Des Devel Ther 2016; 10:3805-3816. [PMID: 27920496 PMCID: PMC5125804 DOI: 10.2147/dddt.s114328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vitiligo is a repugnant and odious dermatological malady of the time. It has an detrimental impact on the pigmentation of the human skin as a result of the destruction of cutaneous melanocytes. It affects 1%-2% of the population worldwide. Different therapeutic regimens have been deployed to treat vitiligo, but none of them could stand alone to be stated as a perfect cure. Recently, a change has been observed through novel experimental-designed optimization leading to the development of an anti-vitiligo ointment containing Psoralea corylifolia (PC) seed powder. AIM The aim of this study was to explore the clinical outcomes of ointment containing powdered seeds of PC. MATERIALS AND METHODS Guided by the protocol Response Surface Methodology, 13 formulations of concentration variance of permeation enhancers were prepared. The formulation fulfilling the required criteria (pH; temperature stability tests at 8°C±0.1°C, 25°C±0.1°C and 40°C±0.1°C; and the physical properties such as color, bleeding and rheology) was selected for clinical trials. Fourier transform infrared spectroscopy studies of seed powder of PC and selected formulation of the seed powder were performed. After obtaining informed consents and with prior approval of university and hospital ethical review boards, 20 patients (age range 25-65 years) were included in the present study. Formulations were applied on the affected body parts of patients, and some affected portion of the same patient was taken as control (self-control study design). The pigmentation of white spots of vitiligo was photographically evaluated before, during and after 12 weeks of treatment. Analysis of the measured values was performed using GraphPad Prism version 5 statistical software. A paired sample t-test was performed to observe variation between repigmented patches and white patches of self-control. RESULTS Hydrophilic ointment (10% w/w) prepared with seed powder of PC was fabricated. The ointment was found effective for small circular white lesions of vitiligo as compared to self-control. Pre- and post-treatment differences in the levels of pigmentation were statistically significant (P≤0.05). CONCLUSION Ointment containing seed powder of PC could be an effective monotherapy for small circular white lesions of vitiligo.
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Affiliation(s)
- Irshad Hussain
- Department of Dermatology
- Department of Pharmacy, SMBB Medical University, Larkana
| | - Nisar Hussain
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan
| | - Abdul Manan
- Department of Dermatology
- Department of Pharmacy, SMBB Medical University, Larkana
| | - Abdur Rashid
- Drug Regulatory Authority of Pakistan, Islamabad
| | - Barkat Khan
- Faculty of Pharmacy, Gomal University, D.I.Khan, Pakistan
| | - Sattar Bakhsh
- Faculty of Pharmacy, Gomal University, D.I.Khan, Pakistan
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Abstract
Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.
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Abstract
Human melanocytes are distributed not only in the epidermis and in hair follicles but also in mucosa, cochlea (ear), iris (eye), and mesencephalon (brain) among other tissues. Melanocytes, which are derived from the neural crest, are unique in that they produce eu-/pheo-melanin pigments in unique membrane-bound organelles termed melanosomes, which can be divided into four stages depending on their degree of maturation. Pigmentation production is determined by three distinct elements: enzymes involved in melanin synthesis, proteins required for melanosome structure, and proteins required for their trafficking and distribution. Many genes are involved in regulating pigmentation at various levels, and mutations in many of them cause pigmentary disorders, which can be classified into three types: hyperpigmentation (including melasma), hypopigmentation (including oculocutaneous albinism [OCA]), and mixed hyper-/hypopigmentation (including dyschromatosis symmetrica hereditaria). We briefly review vitiligo as a representative of an acquired hypopigmentation disorder.
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Ezzedine K, Le Thuaut A, Jouary T, Ballanger F, Taieb A, Bastuji-Garin S. Latent class analysis of a series of 717 patients with vitiligo allows the identification of two clinical subtypes. Pigment Cell Melanoma Res 2013; 27:134-9. [PMID: 24127636 DOI: 10.1111/pcmr.12186] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/14/2013] [Indexed: 02/02/2023]
Abstract
Non-segmental vitiligo (NSV) is an enigmatic disease with various clinical courses. To empirically identify underlying subtypes of NSV, we performed latent class analysis (LCA) of 717 consecutive patients with NSV seen between 2006 and 2012 and were analyzed. Median age was 32 yrs (14-45), median age at NSV onset was 18 yrs (8-32), and median NSV duration 5 yrs (0.75-78.5). A two-class model showed the best fit. Of the 717 patients, 280 (39%) belonged to LC1 and 437 (61%) to LC2. LC1 patients had high probabilities for early disease onset (<12 yrs), halo nevi, family history of premature hair greying, Koebner phenomenon, previous episodes of repigmentation, and family history of vitiligo. By contrast, LC2 patients were characterized by a late disease onset (after or at the age of 12 yrs, median age of 30 yrs) and acrofacial localization without any lesions on trunk or limbs. These two LCA classes (LC1, 'prepubertal onset'; LC2, 'post-pubertal onset') may help refining results from genome-wide association studies (GWAS) and allow a more accurate genotype-phenotype correlation and help defining more directed treatment protocols.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin and University of Bordeaux and Inserm U1035, Bordeaux, France
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Oiso N, Tanemura A, Kotobuki Y, Kimura M, Katayama I, Kawada A. Role of macrophage infiltration in successful repigmentation in a new periphery-spreading vitiligo lesion in a male Japanese patient. J Dermatol 2013; 40:915-8. [PMID: 24106919 DOI: 10.1111/1346-8138.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Abstract
Vitiligo is an acquired disorder in which depigmented macules result from mostly autoimmune loss of melanocytes. The initiating process in vitiligo has still been uncertain. Here, we report the case of a 19-year-old man with undetermined/unclassified vitiligo with a new periphery-spreading vitiligo lesion on the right dorsal hand after rigorous sun exposure. Histopathological evaluation showed noticeable infiltration of CD68(+) macrophages, moderate infiltration of CD3(+) T cells, little infiltration of CD8(+) T cells and CD11c(+) myeloid dendritic cells, HMB45/CD11c double-positive cells, and Melan-A/MART1(+) deposits in the dermis. We surmised that melanocyte-derived deposits were mostly phagocytosed by CD68(+) macrophages and were faintly phagocytosed by CD11c(+) myeloid dendritic cells, referring distribution of CD68(+) mononuclear cells and melanocyte biomarkers. Complete repigmentation was achieved following topical application of hydrocortisone butyrate propionate 0.1% ointment. We summarize that prompt clearance of debris by macrophages would be essential to an excellent prognosis of complete repigmentation.
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Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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