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Elrewiny EM, Shawky A, Mohamed SFF, Ammar AM, Mansour M, Rageh MA. Intralesional methotrexate in the treatment of localized vitiligo: A pilot study. Australas J Dermatol 2023; 64:e207-e211. [PMID: 37166107 DOI: 10.1111/ajd.14071] [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: 02/28/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND/OBJECTIVES Vitiligo is an immune-mediated skin disorder that targets epidermal melanocytes leading to the appearance of depigmented skin patches. Different treatment modalities have been reported with varied efficacy. We tried to evaluate the safety and efficacy of intralesional methotrexate in treating localized areas of vitiligo. METHODS Thirty participants with localized patches of vitiligo were recruited. They were treated with intralesional injections of methotrexate every 2 weeks for a maximum of six sessions. At the end of the study, the degree of repigmentation was categorized into: excellent improvement (>75% repigmentation), good improvement (50%-75% repigmentation), fair improvement (25%-50% repigmentation) and poor improvement (<25% repigmentation). RESULTS We included 7 males (23.3%) and 23 females (76.7%). Their mean age was 33.6 ± 8.6 years. The duration of the disease ranged from 1 to 22 years. Four patients had a family history of vitiligo. At the end of the study, there was a highly statistically significant improvement (p < 0.001) after treatment regarding repigmentation. CONCLUSIONS This study showed that intralesional methotrexate is a safe and effective treatment option for patients with localized vitiligo lesions. Further studies on a larger scale are needed to evaluate the long-term effects of treatment and detect the ideal dose to be injected.
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Affiliation(s)
- Emad M Elrewiny
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shawky
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Amr Mohammad Ammar
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mofreh Mansour
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mahmoud A Rageh
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Youssef YE, Eldegla HEA, Elmekkawy RSM, Gaballah MA. Evaluation of vitamin D receptor gene polymorphisms (ApaI and TaqI) as risk factors of vitiligo and predictors of response to narrowband UVB phototherapy. Arch Dermatol Res 2023; 315:379-386. [PMID: 35318513 PMCID: PMC10020320 DOI: 10.1007/s00403-022-02348-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
Vitiligo is acquired depigmentation due to multiple factors. Vitamin D in skin, through its receptors (VDR), regulates cell growth, differentiation, immune response and exerts both stimulatory and protective effects on melanocytes. The gene sequence encoding VDR has polymorphic forms such as ApaI and TaqI that may affect vitamin D actions. Narrowband ultraviolet B (NB-UVB) phototherapy became the mainstay of vitiligo treatment because of its efficacy and little side effects. The current work aimed at evaluating the possible association between VDR gene polymorphisms (TaqI and ApaI) and susceptibility of vitiligo and if they could be predictors of response to NB-UVB phototherapy in Egyptian vitiligo patients. 100 vitiligo patients indicated for NB-UVB phototherapy and 100 healthy age and sex matched controls were included. All participants were subjected to history taking, general and dermatological examinations, and VDR ApaI and TaqI gene polymorphisms analysis by PCR-RFLP. The patients received NB-UVB 3times per week for 6 months then revaluated. There was significant increase in Aa genotype of ApaI polymorphism in patients associated with significant increase in vitiligo activity. 66% of patient showed variable degrees of response to NB-UVB. The responders significantly had AA genotype of ApaI polymorphism. TaqI polymorphism showed nonsignificant effects on vitiligo susceptibility and response to NB-UVB. A allele of ApaI was significant independent predictor of NB-UVB phototherapy responders. VDR gene polymorphism (ApaI) may share in vitiligo pathogenesis and response to NB-UVB. Knowing the genetic background of the patient helps individualization of treatment to get better results.
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Affiliation(s)
- Youssef Elbayoumy Youssef
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
| | - Heba Elsayed Abdelmoneim Eldegla
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohammad Ali Gaballah
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
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Tawfik NZ, Anbar MT, Atwa MA. Assessment of changes in color and size of vitiligo lesions during treatment with narrow band ultraviolet B. J Cosmet Dermatol 2022; 21:3522-3529. [PMID: 34806278 DOI: 10.1111/jocd.14625] [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: 08/06/2021] [Revised: 10/23/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many treatment modalities have been used to stabilize vitiligo and induce repigmentation. Several methods were used to monitor the color changes inside the treated lesions such as spectroscopes and colorimeters that measure the melanin index inside the lesion. OBJECTIVE To study whether the colorimeter and point counting technique can be used as objective methods in monitoring vitiligo lesions during treatment with Nb-UVB. METHODS Twenty randomly chosen patients with non-segmental vitiligo were enrolled in this interventional study. Vitiligo disease activity score was recorded in each patient. Patients received Nb-UVB three times per week for 6 months. Two lesions were chosen in each patient, and each lesion was assessed for size using point counting technique and degree of color using the Dermacatch® at the beginning of the treatment and evaluated for changes in color and size every 4 weeks till the end of the treatment. RESULTS After 6 months of treatment, regarding the lesion size, 90% of lesions showed variable degrees of repigmentation and 10% showed increase in size, indicating increased activity of the disease, and regarding to color changes. We noticed that after one month of Nb-UVB treatment, there is marked increase in MI measurements in many lesions before any clinical improvement appeared, while at the end of treatment, inside the lesion; 95% showed an increase in melanin index and 5% showed no elevation. While the color changes outside the lesion showed 75% of lesions increased in melanin index, 15% remained unchanged and 10% of the lesions showed decrease in melanin index. CONCLUSION Colorimeter was able to detect change in color after only one month of treatment before it was clinically apparent which means that it can be used as a prognostic tool.
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Affiliation(s)
- Noha Z Tawfik
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Mona A Atwa
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Anbar TS, Mohammed SS, Mohamed DM, Abdel‐Rahman AT. Clinical evaluation of interrupted versus continuous narrowband ultraviolet B phototherapy in nonsegmental vitiligo treatment: A prospective randomized comparative study. Dermatol Ther 2019; 32:e13117. [DOI: 10.1111/dth.13117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tag S. Anbar
- Dermatology DepartmentMinia University Minia Egypt
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Abstract
Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.
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Affiliation(s)
- Electra Nicolaidou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Styliani Mastraftsi
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece.
| | - Vassiliki Tzanetakou
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- First Department of Dermatology and Venereology, National and Kapodistrian University of Athens School of Medicine, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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Peralta-Pedrero ML, Jurado Santa-Cruz F. What we Know About the Clinical Course of Nonsegmental Vitiligo: Experience of a Researcher and a Dermatologist. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:767-770. [PMID: 30401473 DOI: 10.1016/j.ad.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/25/2018] [Accepted: 05/01/2018] [Indexed: 11/16/2022] Open
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Peralta-Pedrero M, Jurado Santa-Cruz F. What We Know About the Clinical Course of Nonsegmental Vitiligo: Experience of a Researcher and a Dermatologist. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Valle Y, Korobko I, Sigova J, Borodina M, Lomonosov K, França K, Lotti T. Patient-reported outcomes: A 5-year long study reveals previously unreported therapeutic, demographic, socio-economic, and other correlations in vitiligo. Dermatol Ther 2018; 31:e12620. [PMID: 30253018 DOI: 10.1111/dth.12620] [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: 04/17/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Abstract
Vitiligo is a non-lethal, non-communicable, immune-mediated, and generally progressive skin disease, with poorly understood etiopathogenesis and weak evidence base. The aim of the study is to contribute to the scant research on the patient-reported outcomes in vitiligo, and to examine the presence of associations between various inputs for possible use in clinical practice. The study was designed as a web-based questionnaire with 40 inputs across seven dimensions. The questions include demographics, skin type, eye and natural hair color, age of respondent and age of onset, possible triggers, disease extent, localization, progression and activity, the efficacy of most common treatment modalities, medication side-effects, heredity and diseases among parents, and out-of-pocket expenses for treatments to date. The analysis presented with this work contributes to the discussion about the relation between therapies, socio-economic factors, and treatment outcomes in vitiligo. All physicians should adequately manage patient expectations in terms of overall treatment duration and expected out-of-pocket expenses, and actively evaluate patients at shorter intervals. A more aggressive therapeutic approach using telehealth devices should be considered to supplement therapy, monitor treatment progress, and protocol compliance.
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Affiliation(s)
- Yan Valle
- Vitiligo Research Foundation, New York, New York
| | - Igor Korobko
- Vitiligo Research Foundation, New York, New York
| | - Julia Sigova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Maria Borodina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Katlein França
- University of Miami Miller School of Medicine, Miami, Florida
| | - Torello Lotti
- University G. Marconi of Rome, Institute of Dermatology, Rome, Italy
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Abdelmaksoud A. Methotrexate for treatment of vitiligo. Dermatol Ther 2017; 30. [PMID: 28796400 DOI: 10.1111/dth.12532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022]
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