1
|
Alshiyab D, Ba-Shammakh SA, Al-Fakih A, Tashman O, Sarakbi D, Al-Qarqaz F, Muhaidat J, Atwan A, Cork MJ. Efficacy and safety of 308-nm Excimer lamp combined with Tacrolimus 0.1% ointment vs Tacrolimus 0.1% ointment as monotherapy in treating children with limited vitiligo: a randomized controlled trial. J DERMATOL TREAT 2024; 35:2296851. [PMID: 38124534 DOI: 10.1080/09546634.2023.2296851] [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: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aims to assess the efficacy and safety of combining the 308-nm Excimer lamp with Tacrolimus 0.1% ointment, compared to Tacrolimus 0.1% ointment monotherapy, for treating pediatric vitiligo involving less than 10% of the body surface area. METHODS Fifty pediatric patients with vitiligo were randomly assigned to two groups. Group A received Tacrolimus 0.1% ointment twice daily and Excimer light at 308-nm twice weekly, while Group B received Tacrolimus 0.1% ointment alone, administered twice daily. Repigmentation percentages were evaluated after 30, 90, and 180 days using the rule of nine. RESULTS Group A exhibited a significant improvement in repigmentation, increasing from 10% after one month to 65% after six months. In contrast, Group B observed an increase from 10% to 30% over the same timeframe. The efficacy of the treatment was significantly higher in Group A at both the 3-month and 6-month follow-up points (p-value < .001). Moreover, Group A achieved notably higher repigmentation rates in the face, trunk, and lower limbs. CONCLUSION The combination of Tacrolimus and the 308-nm excimer lamp yielded superior repigmentation results compared to Tacrolimus monotherapy in pediatric vitiligo patients. This combined approach may offer an effective new treatment protocol for pediatric vitiligo.
Collapse
Affiliation(s)
- Diala Alshiyab
- Department of Dermatology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saleh A Ba-Shammakh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulqudos Al-Fakih
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Tashman
- Department of Dermatology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Danyah Sarakbi
- Department of Dermatology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Al-Qarqaz
- Department of Dermatology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jihan Muhaidat
- Department of Dermatology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Michael J Cork
- Sheffield Dermatology Research, IICD, University of Sheffield, UK
| |
Collapse
|
2
|
Bishnoi A, Parsad D. Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12968. [PMID: 38632705 DOI: 10.1111/phpp.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. AIMS AND METHODS This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. RESULTS AND DISCUSSION The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital-based and home-based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra-violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti-nuclear antibodies and tailoring approaches for non-photo-adapters are also examined. CONCLUSION In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field.
Collapse
Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
3
|
Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
Collapse
|
4
|
Luan C, Hu Y, Ju M, Huang D, Zhang RL, Zhang XH, Tian PP, Zhu Y, Zhuang C, Zhang JA, Chen K. Treatment of vitiligo with 308-nm light emitting diode: Our experience from a two-year follow-up of Chinese patients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:489-494. [PMID: 35075714 DOI: 10.1111/phpp.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A light emitting diode (LED), with a wavelength of 308 nm, has been utilized in the dermatologic treatment of vitiligo. OBJECTIVES We investigated the efficacy and safety of 308-nm LED for use in the treatment of vitiligo. METHODS We conducted a retrospective study of 70 stable-stage vitiligo patients (with a total of 99 lesions) who received 308-nm LED treatment at the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2018 to June 2020. Treatment efficacy was evaluated after 8 treatment sessions, 16 treatment sessions, and the final treatment session, to estimate the percentage of re-pigmentation in the treated area. The Kruskal-Wallis test was used for data analysis. RESULTS Based on the final treatment session analysis of all 99 lesions, 0 lesions showed no response, 21 lesions showed poor response, 29 lesions showed moderate response, 23 lesions showed good response, and 26 lesions showed excellent response. The efficacy rate was 49.49%, and there was a significant correlation between the six distinct anatomical regions treated and re-pigmentation grade (χ2 = 13.419, p = .009). Among these regions, facial lesions showed the best response to treatment, while the hands and feet lesions showed the poorest response. CONCLUSIONS The clinical efficacy of 308-nm LED treatment is limited based on the treatment area. It demonstrated significant practical application in the treatment of vitiligo.
Collapse
Affiliation(s)
- Chao Luan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yu Hu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Mei Ju
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Dan Huang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Rong-Lin Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xiao-Hua Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Pan-Pan Tian
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yan Zhu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Chen Zhuang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jia-An Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| |
Collapse
|
5
|
Khalili M, Amiri R, Mohammadi S, Iranmanesh B, Aflatoonian M. Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article. J Cosmet Dermatol 2022; 21:2360-2373. [DOI: 10.1111/jocd.14899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Maryam Khalili
- Department of Dermatology Kerman University of Medical Sciences Iran
| | - Rezvan Amiri
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Saman Mohammadi
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Behzad Iranmanesh
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| | - Mahin Aflatoonian
- Department of Dermatology Afzalipour Hospital Afzalipour faculty of Medicine Kerman University of Medical Sciences Kerman Iran
| |
Collapse
|
6
|
Tabassum H, Majid I, Imran S. Is targeted UVB as effective as excimer light phototherapy in treatment of vitiligo? Dermatol Ther 2021; 34:e15058. [PMID: 34245476 DOI: 10.1111/dth.15058] [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: 05/05/2021] [Revised: 06/04/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
Excimer light (EL) and targeted UVB (TUVB) devices have been used successfully in repigmenting vitiligo. To compare the repigmenting efficacy and safety of EL with TUVB device in vitiligo. The study was conducted retrospectively on patients of vitiligo who had received either EL (Group A) or TUVB (Group B) from year 2015 to 2020. Data pertaining to 40 such age and sex matched patients from each group was retrieved with almost similar sites of involvement. Only patients whose phototherapy sessions had been given twice weekly for minimum of 30 sessions or until 90%-100% repigmentation were included in the study. The study was retrospective in nature and the principles outlined in the Declaration of Helsinki were followed during the study. The primary endpoint compared between the two groups was the extent of repigmentation achieved on different sites of body and adverse effects from treatment. Secondary endpoints compared included total number of doses, cumulative dose needed for complete repigmentation and number of doses needed for onset of repigmentation. There were 82.6% responders in Group A and 76.3% in Group B who had achieved at least 50% repigmentation. Excellent response (75%-100% repigmentation) was achieved in 68.1% lesions in Group A and 46.4% lesions in Group B. Patients in Group A needed less number of doses (13.75 vs. 19.37) and less cumulative dose (6.14 vs. 7.69 J/cm2 ) to achieve complete or near complete repigmentation. Adverse effects were negligible in both groups. Targeted phototherapy with EL demonstrated better repigmenting efficacy than TUVB in vitiligo.
Collapse
Affiliation(s)
- Hera Tabassum
- Department of Dermatology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University (AMU), Aligarh, India
| | - Imran Majid
- Dermatology, Venereology & Leprosy, CUTIS Institute of Dermatology, Srinagar, India
| | - Saher Imran
- Dermatology, CUTIS Institute of Dermatology, Srinagar, India
| |
Collapse
|
7
|
Kubelis-López DE, Zapata-Salazar NA, Said-Fernández SL, Sánchez-Domínguez CN, Salinas-Santander MA, Martínez-Rodríguez HG, Vázquez-Martínez OT, Wollina U, Lotti T, Ocampo-Candiani J. Updates and new medical treatments for vitiligo (Review). Exp Ther Med 2021; 22:797. [PMID: 34093753 PMCID: PMC8170669 DOI: 10.3892/etm.2021.10229] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Vitiligo is a multifactorial disease characterized by the loss of skin pigment, which results in achromic macules and patches. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. These treatments alone or combined have exhibited varying degrees of pigmentation, and the majority are safe and effective. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Individualized treatment is appropriate according to the location, clinical presentation and the presence of disease activity. The present review summarizes the medical treatments available for vitiligo: Systemic and topic pharmacological therapies, physical and depigmentation treatments. Several treatments are still underway and have not yet been approved. However, due to the promising preliminary results, these are also mentioned in the present review.
Collapse
Affiliation(s)
- David Emmanuel Kubelis-López
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Natalia Aranza Zapata-Salazar
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Salvador Luis Said-Fernández
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Celia Nohemí Sánchez-Domínguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | | | - Herminia Guadalupe Martínez-Rodríguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Osvaldo Tomás Vázquez-Martínez
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Uwe Wollina
- Department of Dermatology and Allergology and Skin Cancer Center, Städtisches Klinikum Dresden, D-01067 Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome G. Marconi, I-00193 Rome, Italy.,Department of Dermatology and Communicable Diseases, First Medical State University of Moscow I. M. Sechenev Ministry of Health, Moscow 119991, Russia
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| |
Collapse
|
8
|
Oh SH. Classification and diagnosis of vitiligo. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.12.731] [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 a relatively common, acquired hypopigmentary disorder caused by the loss of epidermal melanocytes. It is characterized by asymptomatic, well-circumscribed round to oval-shaped whitish patches that vary in size. Depending on various clinical features, vitiligo is classified into several types, that is, non-segmental, segmental, and undetermined/unclassified vitiligo. The uniform classification of vitiligo is very important in predicting its clinical course and prognosis and communication among researchers. In particular, segmental vitiligo is a highly distinctive subtype of vitiligo considering its clinical features and prognosis. It usually has an onset early in life and spreads rapidly within the affected area limited to one segment of the integument. Signs of vitiligo activity such as Koebnerʼs phenomenon, trichrome vitiligo, inflammatory vitiligo, and confetti-like lesions give useful information to start treatments to block the progression of the disease. Lastly, other hypopigmentary disorders should be distinguished from vitiligo to make the correct diagnosis and prescribe the right treatment. In this report, I review the clinical features of vitiligo, various subtypes according to classification, and the importance for differential diagnosis of hypopigmentary disorders from vitiligo.
Collapse
|
9
|
Majid I, Imran S. Excimer light therapy in childhood segmental vitiligo: Early treatment gives better results. Dermatol Ther 2020; 33:e13408. [PMID: 32304121 DOI: 10.1111/dth.13408] [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: 01/04/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Abstract
Segmental vitiligo (SV) is considered to be relatively less responsive form of vitiligo to medical treatment. While excimer light (EL) has shown great promise in treating localized vitiligo especially on face and neck, its efficacy in SV is not reported so commonly. We conducted a retrospective study on patients of childhood SV who had received EL therapy from January 2016 to December 2018 at our institute. Data of all such cases who had received at least 10 doses of EL treatment or achieved complete repigmentation were selected for analysis. Records of 26 children with SV satisfied the selection criteria. Excellent response (>75% repigmentation) was documented in 65.4% (17/26) patients with 7.7% (2/26) patients showing partial (50%-75%) repigmentation. Response to treatment was seen to correlate inversely with the duration of SV. Patients with SV of <6 months reported better results with all 10 cases achieving complete or near complete (>75%) repigmentation. In contrast, only 44% patients (7/16) with disease duration of >6 months were seen to have achieved >75% repigmentation.
Collapse
Affiliation(s)
- Imran Majid
- CUTIS Institute of Dermatology, Srinagar, Kashmir, India
| | - Saher Imran
- CUTIS Institute of Dermatology, Srinagar, Kashmir, India
| |
Collapse
|
10
|
Abdel-Malek ZA, Jordan C, Ho T, Upadhyay PR, Fleischer A, Hamzavi I. The enigma and challenges of vitiligo pathophysiology and treatment. Pigment Cell Melanoma Res 2020; 33:778-787. [PMID: 32198977 DOI: 10.1111/pcmr.12878] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/03/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Abstract
Vitiligo is the most common acquired pigmentary disorder, which afflicts 0.5%-1% of the world population, and is characterized by depigmented skin patches resulting from melanocyte loss. Vitiligo has a complex etiology and varies in its manifestations, progression, and response to treatment. It presents as an autoimmune disease, evidenced by circulating melanocyte-specific antibodies, and association with other autoimmune diseases. However, autoimmunity may be secondary to the high oxidative stress in vitiligo skin and to intrinsic defects in melanocytes and their microenvironment, which contribute to aberrant stress response, neo-antigenicity, and susceptibility of melanocytes to immune attack and apoptosis. There is also a genetic predisposition to vitiligo, which sensitizes melanocytes to environmental agents, such as phenolic compounds. Currently, there are different treatment modalities for re-pigmenting vitiligo skin. However, when repigmentation is achieved, the major challenge is maintaining the pigmentation, which is lost in 40% of cases. In this review, we present an overview of the clinical aspects of vitiligo, its pathophysiology, the intrinsic defects in melanocytes and their microenvironment, and treatment strategies. Based on lessons from the biology of human melanocytes, we present our perspective of how repigmentation of vitiligo skin can be achieved and sustained.
Collapse
Affiliation(s)
| | - Christian Jordan
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Tina Ho
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Parth Rajendrakumar Upadhyay
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio.,Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Alan Fleischer
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
11
|
Yang TT, Chiu SH, Lan CCE. The effects of UVB irradiance on vitiligo phototherapy and UVB-induced photocarcinogenesis. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:257-262. [PMID: 32022939 DOI: 10.1111/phpp.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
Phototherapy is the most commonly used modality for repigmenting vitiligo. Currently, UVB emitting devices, including narrow-band UVB (NBUVB) and excimer laser/light, are considered as the treatment of choice. While emitting wavelengths at close proximity, excimer lights emit higher irradiance (HI; W/m2 ) compared to NBUVB. Clinical reports have shown that excimer light is more efficacious in treating vitiligo compared to NBUVB, and we demonstrated that irradiance plays a critical role in promoting melanoblasts differentiation. UVB radiation from the sun is closely associated with photocarcinogenesis of the skin. Sunscreens were used to protect the skin by reducing UVB irradiance (low irradiance (LI) UVB). Sunscreen use was associated with skin cancer reduction in clinical trials. Paradoxically, sunscreen use was associated with increased sunburn episodes in the real-world settings. It was shown that UVB-induced sunburn depends on fluence (J/m2 ) but not irradiance of UVB radiation. We investigated the significance of irradiance in the context of UVB-induced carcinogenesis of the skin. For mice receiving equivalent fluence of UVB exposure, the LIUVB-treated mice showed earlier tumor development, larger tumor burden, and more epidermal keratinocytes harboring mutant p53 as compared to their HIUVB-treated counterparts. These results suggested that at equivalent fluence, LIUVB radiation has more photocarcinogenic potential on the skin compared to its HI counterpart. Since development of sunburn with or without sunscreen use indicates that certain threshold of UVB fluence has been received by the skin at LI and HI, respectively, sunburn episodes with sunscreen use (LIUVB) are more damaging to the skin compared to that without sunscreen (HIUVB) application. In summary, since irradiance plays an important role determining the biological effects of UVB radiation on the skin, future related studies should take this critical parameter into consideration.
Collapse
Affiliation(s)
- Ting-Ting Yang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Hao Chiu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
12
|
Abstract
Phototherapy has been used successfully to treat a wide range of pediatric skin conditions. It is a viable option in children with severe dermatologic disease or who have failed first-line treatments, and several studies have demonstrated its efficacy and safety in the pediatric population. Despite the growing body of evidence on the use of phototherapy in children, large controlled trials and long-term studies are lacking. Moreover, special considerations must be taken when using phototherapy in children. This review highlights the recent evidence supporting the efficacy and safety of phototherapy in children, with focus on the common light-sensitive pediatric skin conditions.
Collapse
Affiliation(s)
- Michelle C Juarez
- The Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Anna L Grossberg
- Department of Dermatology, Division of Pediatric Dermatology, The Johns Hopkins University School of Medicine, 200 North Wolfe Street, Unit 2107, Baltimore, MD 21287, USA.
| |
Collapse
|
13
|
Low-dose UVB therapy is comparable with conventional UVB phototherapy for treatment of vitiligo: A pilot study. J Dermatol Sci 2018; 92:218-220. [PMID: 30227989 DOI: 10.1016/j.jdermsci.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022]
|
14
|
Wang LM, Lu WJ, Yuan JT, Zeng BB, Li D, Zhang F, Li JJ. Utility of dermoscopy for evaluating the therapeutic efficacy of tacrolimus ointment plus 308-nm excimer laser combination therapy in localized vitiligo patients. Exp Ther Med 2018; 15:3981-3988. [PMID: 29581746 DOI: 10.3892/etm.2018.5911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to assess the function of dermoscopy in evaluating the therapeutic efficacy of tacrolimus ointment plus 308-nm excimer laser combination therapy in patients with localized vitiligo. A total of 147 patients with localized vitiligo (progressive disease, n=92; stable period, n=55) were enrolled and received combination therapy for 12 weeks. The condition of the skin lesions was monitored by dermoscopy and visual observation. At the initial visit, skin lesions were observed in 61 progressive and 19 stable patients. Residual perifollicular pigmentation was more abundant in progressive-stage patients than in stable-stage patients, whereas the presence of perilesional hyperpigmentation was obviously lower in patients with progressive vitiligo. After 12 weeks of combination therapy, marked differences in residual perifollicular pigmentation were identified between the progressive- and stable-stage patients. Dermoscopy and visual observation indicated that the 12-week treatment efficacy in patients with progressive disease was significantly higher than in those with stable disease and that assessment by dermoscopy was superior to visual observation at 8 or 12 weeks of treatment. Binary logistic regression analysis revealed that the disease stage, vitiliginous areas and disease course were risk factors associated with the treatment efficacy of the combination therapy. In conclusion, dermoscopy may be used as an effective means of vitiligo therapy assessment to provide an accurate and scientific evaluation of treatment efficacy for localized vitiligo patients.
Collapse
Affiliation(s)
- Lu-Mei Wang
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Wan-Jiao Lu
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Jing-Tao Yuan
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Bi-Bing Zeng
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Dan Li
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Feng Zhang
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| | - Jun-Jie Li
- Department of Dermatology, Dong Guan People's Hospital, Dongguan, Guangdong 523018, P.R. China
| |
Collapse
|
15
|
Esmat S, Hegazy RA, Shalaby S, Hu SCS, Lan CCE. Phototherapy and Combination Therapies for Vitiligo. Dermatol Clin 2017; 35:171-192. [PMID: 28317527 DOI: 10.1016/j.det.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
Collapse
Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
| |
Collapse
|
16
|
Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. Current and emerging treatments for vitiligo. J Am Acad Dermatol 2017; 77:17-29. [DOI: 10.1016/j.jaad.2016.11.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 01/28/2023]
|
17
|
Dong DK, Pan ZY, Zhang J, Lu XF, Jin C, Tao SQ, Yang LJ. Efficacy and Safety of Targeted High-Intensity Medium-Band (304-312 nm) Ultraviolet B Light in Pediatric Vitiligo. Pediatr Dermatol 2017; 34:266-270. [PMID: 28318054 DOI: 10.1111/pde.13098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Phototherapy is a commonly used treatment for vitiligo that has demonstrated safety and efficacy. High-intensity targeted ultraviolet B (UVB) light (304-312 nm) delivered using a phototherapy device is a useful therapeutic option because it can induce repigmentation in a short time without global exposure to radiation, but information regarding this device in children is limited. METHODS We performed a retrospective analysis of 95 patches of vitiligo in 27 children treated using a targeted phototherapy device. Phototherapy was administered twice a week. RESULTS After the first 10 treatment sessions, 82 (86.3%) patches demonstrated some repigmentation and 36.8% achieved 50% or more repigmentation. After a mean of 20.4 treatment sessions, 86 patches (90%) demonstrated some repigmentation and 53.7% achieved 50% or more repigmentation. Responses varied depending on the anatomic location of the lesions. Better responses were usually observed on the face and trunk, whereas the extremities typically showed little response. Repigmentation was better in patients with active vitiligo than in those with stable vitiligo, with responses better with a disease duration of 1 year or less than in those with a duration of more than 1 year. There was no statistically significant difference in repigmentation between those with segmental and generalized vitiligo. The only short-term local side effect was mild erythema that required a decrease in dosage in six patients. CONCLUSION Targeted high-intensity medium-band UVB phototherapy alone can produce clinical improvement in pediatric vitiligo and is well tolerated.
Collapse
Affiliation(s)
- Da-Ke Dong
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhan-Yan Pan
- Department of Dermatology, Ren ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Juan Zhang
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xue-Fen Lu
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Cheng Jin
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Shi-Qin Tao
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Li-Jia Yang
- Department of Dermatology, Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| |
Collapse
|
18
|
Park OJ, Han JS, Lee SH, Park CS, Won CH, Lee MW, Choi JH, Chang SE. Expression of Epidermal c-Kit+ of Vitiligo Lesions Is Related to Responses to Excimer Laser. Ann Dermatol 2016; 28:457-63. [PMID: 27489428 PMCID: PMC4969475 DOI: 10.5021/ad.2016.28.4.457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/14/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022] Open
Abstract
Background The survival and growth of melanocytes are controlled by the binding of stem cell factor to its cell surface receptor c-kit+ (CD117). We have observed that c-kit+ melanocytes existed in some lesions of vitiligo, while Melan A+ cells were absent. Objective To verify possible relation between c-kit+ expression and treatment response in non-segmental vitiligo lesions Methods Skin biopsies were done from the center of the 47 lesions from the 47 patients with non-segmental vitiligo. Expression of c-kit+ and Melan A, and amounts of melanin in the epidermis were assessed in each lesion, and treatment responses to excimer laser were evaluated. Results Thirty-five of the 47 lesions (74.5%) had c-kit+ phenotypes. There was significant difference of c-kit staining value between good responders in 3 months of excimer laser treatment (average of 24 sessions) and the others. Conclusion c-Kit expression in vitiliginous epidermis may be related to better treatment responses to excimer laser.
Collapse
Affiliation(s)
- Oun Jae Park
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Su Han
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyung Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Ezzedine K, Silverberg N. A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children. Pediatrics 2016; 138:peds.2015-4126. [PMID: 27328922 DOI: 10.1542/peds.2015-4126] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/24/2022] Open
Abstract
Vitiligo is a common inflammatory skin disease with a worldwide prevalence of 0.5% to 2.0% of the population. In the pediatric population, the exact prevalence of vitiligo is unknown, although many studies state that most cases of vitiligo are acquired early in life. The disease is disfiguring, with a major psychological impact on children and their parents. Half of vitiligo cases have a childhood onset, needing thus a treatment approach that will minimize treatment side effects while avoiding psychological impacts. Management of vitiligo should take into account several factors, including extension, psychological impact, and possible associations with other autoimmune diseases. This review discusses the epidemiology of vitiligo and outlines the various clinical presentations associated with the disorder and their differential diagnosis. In addition, the pathophysiology and genetic determinants, the psychological impact of vitiligo, and management strategies are reviewed.
Collapse
Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor Hospital and EpiDermE, Université Paris-Est Créteil Val-de-Marne, Créteil, France; and
| | - Nanette Silverberg
- Department of Dermatology and Pediatrics, Mount Sinai St. Luke's-Roosevelt and Beth Israel Medical Centers, New York, New York
| |
Collapse
|
20
|
Attwa E. Review of narrowband ultraviolet B radiation in vitiligo. World J Dermatol 2016; 5:93-108. [DOI: 10.5314/wjd.v5.i2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/16/2015] [Accepted: 04/11/2016] [Indexed: 02/06/2023] Open
Abstract
Vitiligo is a common, acquired pigmentary disorder of unknown etiology with great impact on patient’s appearance and quality of life. It presents a therapeutic challenge to many dermatologists. Photochemotherapy using psoralen and ultraviolet A (UVA) therapy, topical and oral immunosuppresants, as well as cosmetic camouflage are also commonly employed with varying clinical efficacy. Phototherapy is a popular treatment option, which includes both of the generalized ultraviolet B (UVB) therapies, broadband UVB and narrowband UVB (NB-UVB). It has been used favorably, both alone as well as in combination with other agents like topical calcineurin inhibitors, vitamin-D analogs. Combination therapies are useful and may provide quicker regimentation and treat vitiligo with an additive mechanism of action than UVB phototherapy. Advances in technology may lead to the continuing use of UVB phototherapy as a treatment for vitiligo through the development of sophisticated devices and delivery systems as well as innovative application methods. These will provide increased therapeutic options for all vitiligo patients, particularly those with refractory disease. In this article, I have reviewed the available data pertaining to efficacy and safety issues for NB-UVB as monotherapy, its comparison with psoralen plus UVA and other modes of phototherapy, combination regimens that have been tried and future prospects of NB-UVB in vitiligo.
Collapse
|
21
|
Kim MS, Cho EB, Park EJ, Kim KH, Kim KJ. Effect of excimer laser treatment on vitiliginous areas with leukotrichia after confirmation by dermoscopy. Int J Dermatol 2015; 55:886-92. [DOI: 10.1111/ijd.12972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/04/2015] [Accepted: 01/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Min Seok Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Eun Byul Cho
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Eun Joo Park
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Kwang Ho Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| | - Kwang Joong Kim
- Department of Dermatology; College of Medicine; Hallym University; Anyang Korea
| |
Collapse
|
22
|
Bae JM, Yoo HJ, Kim H, Lee JH, Kim GM. Combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for segmental vitiligo: A retrospective study of 159 patients. J Am Acad Dermatol 2015; 73:76-82. [PMID: 25956660 DOI: 10.1016/j.jaad.2015.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/13/2015] [Accepted: 04/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Segmental vitiligo (SV) is characterized by a unilateral and localized distribution, early onset, and stable disease after rapid progression. And SV is often associated with poor response to various treatment modalities. OBJECTIVE We sought to evaluate the effectiveness of combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for SV, and to search for factors associated with the treatment response. METHODS A retrospective interventional case-series study was performed on 159 patients with SV who were treated with the combination therapy for more than 3 months. RESULTS The rate of 75% or more repigmentation was 50.3% after a median treatment duration of 12.1 months; 36.5% and 13.8% of the patients showed nearly complete (75%-99%) and complete (100%) repigmentation, respectively. Multivariable analysis showed the following to be independent factors with poor response: disease duration longer than 12 months (odds ratio 0.372, 95% confidence interval 0.157-0.882, P = .025), poliosis (odds ratio 0.494, 95% confidence interval 0.247-0.988, P = .046), and plurisegmental subtype (odds ratio 0.175, 95% confidence interval 0.065-0.474, P = .001). LIMITATIONS This was a retrospective study. CONCLUSION The combination therapy is effective for SV. Prolonged disease duration, poliosis, and plurisegmental subtype were shown to be independent prognostic factors of poor response in patients with SV.
Collapse
Affiliation(s)
- Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun Ju Yoo
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyub Kim
- Sosom Dermatologic Clinic, Seoul, Korea
| | - Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
| |
Collapse
|
23
|
Sun Y, Wu Y, Xiao B, Li L, Li L, Chen HD, Gao XH. Treatment of 308-nm excimer laser on vitiligo: A systemic review of randomized controlled trials. J DERMATOL TREAT 2015; 26:347-53. [PMID: 25428573 DOI: 10.3109/09546634.2014.991268] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vitiligo is an acquired cutaneous hypopigmentary disorder, which characterized by solitary or multiple depigmented maculae or patches. The 308-nm excimer laser has been used as phototherapy on vitiligo. OBJECTIVE To evaluate the efficacy and safety of 308-nm excimer laser on vitiligo. METHODS Randomized controlled trials were searched to conduct a systematic review. The keywords were identified as laser/excimer laser/quasimolecule/XeCl" and "vitiligo". RESULTS Seven studies with 390 vitiligo patients were included. No significant differences were seen between 308-nm excimer laser and 308-nm excimer lamp on either ≥75% or ≥50% re-pigmentation rate, or between 308-nm excimer laser and narrowband-ultraviolet B (NB-UVB) on either 100% or ≥75% re-pigmentation rate. More patients or lesions achieved ≥50% re-pigmentation rate by 308-nm excimer laser treatment than by NB-UVB treatment. The side effects of 308-nm excimer laser were slight and tolerable. CONCLUSIONS The 308-nm excimer laser showed equivalent efficacies to 308-nm excimer lamp control and NB-UVB control concerning ≥75% re-pigmentation rate of vitiligo patches. More studies with high methodological quality, low risk of bias and more sample size are needed to confirm the conclusion.
Collapse
Affiliation(s)
- Yan Sun
- Department of Dermatology, No. 1 Hospital of China Medical University , Shenyang , China
| | | | | | | | | | | | | |
Collapse
|
24
|
Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2014; 56:85-92. [DOI: 10.1111/ajd.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Richard Wittal
- University of New South Wales; Sydney New South Wales Australia
- Skin and Cancer Foundation; Sydney New South Wales Australia
| |
Collapse
|
25
|
Abstract
There is a limited number of options in vitiligo treatment, with the disease frequently refractory to all existing treatment modalities. This warrants development of novel and improving existing vitiligo treatments as well as finding predicting factors to improve treatment outcome through appropriate selection and the most efficient application of a treatment. These issues are addressed in clinical studies aiming to evaluate safety and efficiency of novel treatments, improvements and modifications introduced to existing treatments, and to define predictors of treatment efficiency and their limitations. Here, results of recent (since year 2009) clinical studies in vitiligo field are overviewed, with the emphasis on their contribution to improved vitiligo management.
Collapse
|
26
|
Park JH, Park SW, Lee DY, Lee JH, Yang JM. The effectiveness of early treatment in segmental vitiligo: retrospective study according to disease duration. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:103-5. [DOI: 10.1111/phpp.12029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Ji-Hye Park
- Department of Dermatology; Kangbuk Samsung Hospital; Seoul; Korea
| | - Se Won Park
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Dong-Youn Lee
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Joo-Heung Lee
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Jun-Mo Yang
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| |
Collapse
|
27
|
Vtyurina NN, Grohovsky SL, Vasiliev AB, Titov II, Ponomarenko PM, Ponomarenko MP, Peltek SE, Nechipurenko YD, Kolchanov NA. Contextual DNA features significant for the DNA damage by the 193-nm ultraviolet laser beam. DOKL BIOCHEM BIOPHYS 2013; 447:267-72. [DOI: 10.1134/s1607672912060038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Indexed: 11/23/2022]
|
28
|
Abstract
Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB-UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308-nm radiation wavelength is delivered in a targeted form by the xenon-chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB-UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head-to-head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side-effect profile. Long-term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.
Collapse
Affiliation(s)
- K K Park
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA.
| | | | | |
Collapse
|
29
|
Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
Collapse
Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
| | | | | |
Collapse
|
30
|
Cheng YP, Chiu HY, Jee SH, Tsai TF. Excimer light photototherapy of segmental and non-segmental vitiligo: experience in Taiwan. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 28:6-11. [DOI: 10.1111/j.1600-0781.2011.00628.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Yu-Pin Cheng
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| |
Collapse
|