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Jafarzadeh A, Pour Mohammad A, Keramati H, Zeinali R, Khosravi M, Goodarzi A. Regenerative medicine in the treatment of specific dermatologic disorders: a systematic review of randomized controlled clinical trials. Stem Cell Res Ther 2024; 15:176. [PMID: 38886861 PMCID: PMC11184747 DOI: 10.1186/s13287-024-03800-6] [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: 04/13/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS AND OBJECTIVES The aim of this study is to systematically review randomized controlled clinical trials (RCTs) studying various types of regenerative medicine methods (such as platelet-rich plasma, stromal vascular fraction, cell therapy, conditioned media, etc.) in treating specific dermatologic diseases. Rejuvenation, scarring, wound healing, and other secondary conditions of skin damage were not investigated in this study. METHOD Major databases, including PubMed, Scopus, and Web of Science, were meticulously searched for RCTs up to January 2024, focusing on regenerative medicine interventions for specific dermatologic disorders (such as androgenetic alopecia, vitiligo, alopecia areata, etc.). Key data extracted encompassed participant characteristics and sample sizes, types of regenerative therapy, treatment efficacy, and adverse events. RESULTS In this systematic review, 64 studies involving a total of 2888 patients were examined. Women constituted 44.8% of the study population, while men made up 55.2% of the participants, with an average age of 27.64 years. The most frequently studied skin diseases were androgenetic alopecia (AGA) (45.3%) and vitiligo (31.2%). The most common regenerative methods investigated for these diseases were PRP and the transplantation of autologous epidermal melanocyte/keratinocyte cells, respectively. Studies reported up to 68.4% improvement in AGA and up to 71% improvement in vitiligo. Other diseases included in the review were alopecia areata, melasma, lichen sclerosus et atrophicus (LSA), inflammatory acne vulgaris, chronic telogen effluvium, erosive oral lichen planus, and dystrophic epidermolysis bullosa. Regenerative medicine was found to be an effective treatment option in all of these studies, along with other methods. The regenerative medicine techniques investigated in this study comprised the transplantation of autologous epidermal melanocyte/keratinocyte cells, isolated melanocyte transplantation, cell transplantation from hair follicle origins, melanocyte-keratinocyte suspension in PRP, conditioned media injection, a combination of PRP and basic fibroblast growth factor, intravenous injection of mesenchymal stem cells, concentrated growth factor, stromal vascular fraction (SVF), a combination of PRP and SVF, and preserving hair grafts in PRP. CONCLUSION Regenerative medicine holds promise as a treatment for specific dermatologic disorders. To validate our findings, it is recommended to conduct numerous clinical trials focusing on various skin conditions. In our study, we did not explore secondary skin lesions like scars or ulcers. Therefore, assessing the effectiveness of this treatment method for addressing these conditions would necessitate a separate study.
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Affiliation(s)
- Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, 1449614535, Iran
| | - Haniyeh Keramati
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Roya Zeinali
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Mina Khosravi
- Faculty of Medicine, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, 1449614535, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran.
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Abdel-Hamid S, Ibrahim HM, Hameed AM, Hegazy EM. Effectiveness of fractional erbium-YAG laser, microneedling, platelet-rich plasma in localized stable vitiligo patients: randomized clinical trial. Arch Dermatol Res 2024; 316:399. [PMID: 38878236 PMCID: PMC11180153 DOI: 10.1007/s00403-024-03035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 06/19/2024]
Abstract
Vitiligo is considered an autoimmune disease, and its treatment is challenging. We assessed and compared the effect of fractional erbium:yttrium-aluminum-garnet (Er:YAG) laser-assisted delivery of platelet-rich plasma versus microneedling (Mn) with platelet-rich plasma (PRP) in enhancing skin repigmentation in localized stable vitiligo patients. In total, 40 patients with localized stable vitiligo were selected in a random manner into two similar groups (20 each). Group (A) was subjected to fractional Er:YAG laser combined with platelet-rich plasma and Group (B) was subjected to microneedling combined with platelet-rich plasma. The procedure was repeated every 2 weeks for up to 6 months. Each individual was assessed clinically utilizing Vitiligo Area Scoring Index (VASI). Fractional Er:YAG + PRP group achieved better pigmentation100% (excellent 30%, very good 15%, good 30% and satisfactory 25%) which is comparable to Mn + PRP where 80% of cases demonstrate repigmentation (20% very good, 10% good and 50% mild). When comparing the VASI scores for both groups after therapy to the baseline VASI, there was a statistically significant decrease [p = 0.001 for group(A) and 0.003 for group(B)]. Regarding the treatment side effects, there was significantly (p = 0.048) side effects among cases treated with microneedling group(B) (25%) than those fractional Er:Yag laser therapy group(A) (5%). Both forms of therapy demonstrated induction of repigmentation of vitiligo, but fractional Er:YAG laser efficacy is greater when combined with platelet-rich plasma.Clinical trials.gov identifier: NCT05511493.
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Affiliation(s)
- Soheir Abdel-Hamid
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Hassan M Ibrahim
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Aya M Hameed
- Dermatology, Venereology, and Leprosy Hospital, Qena, Egypt
| | - Eisa M Hegazy
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, South Valley University, Qena, Egypt
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Omar SS, Elmulla KF, Aly RG, Elkaffas A, Ismail A. A triple combination of latanoprost, fractional CO 2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12944. [PMID: 38288773 DOI: 10.1111/phpp.12944] [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: 10/01/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Several treatment modalities are available for the treatment of vitiligo due to the lack of a uniformly effective therapy. Topical latanoprost 0.005% is an effective topical treatment. Fractional CO2 laser alone or combined with platelet-rich plasma (PRP) has been proposed as effective adjunctive therapies. OBJECTIVES We aimed to compare the efficacy of topical latanoprost 0.005% (Ioprost®, Orchidia, Egypt) combined with either add-on fractional CO2 laser or fractional CO2 -PRP versus topical latanoprost monotherapy in the treatment of localized stable vitiligo. PATIENTS/METHODS The study included 60 patients randomly assigned into three equal groups. Group A patients received topical latanoprost drops only. Group B patients received topical latanoprost drops and fractional CO2 laser sessions at 2-week interval for 3 months. Group C patients received topical latanoprost drops and fractional CO2 laser sessions combined with PRP at a 2-week interval for 3 months. The mean improvement score by the physician was calculated 4 months after the start of the study. Punch skin biopsies were obtained before treatment and 4 months from the beginning of the study and stained with H&E and HMB-45 antibody for evaluation of pigmentation. RESULTS Significant clinical improvement of vitiligo lesions with significant increase of re-pigmentation were reported in the three treated groups. Latanoprost in combination with fractional CO2 and PRP was associated with more significant therapeutic outcomes than either combined latanoprost and fractional CO2 or latanoprost alone. CONCLUSION Fractional CO2 laser-PRP enhances the therapeutic efficacy of latanoprost 0.005% in the treatment of localized stable vitiligo.
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Affiliation(s)
- Salma Samir Omar
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Fawzy Elmulla
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania Gaber Aly
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Aliaa Ismail
- Department of Dermatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Fawzy M, Al-Mokadem S, Alshereef M, Elkholy B. Narrowband ultraviolet B phototherapy combined with intralesional injection of either latanoprost or platelet-rich plasma for stable nonsegmental vitiligo. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12929. [PMID: 37984828 DOI: 10.1111/phpp.12929] [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: 07/30/2023] [Revised: 09/18/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) phototherapy is the cornerstone of vitiligo treatment. Its combination with other treatments usually yields a better response. Latanoprost, a prostaglandin F2α analog, and autologous platelet-rich plasma (PRP) have been reported to be effective for vitiligo. AIM To evaluate the efficacy of NB-UVB combined with intralesional latanoprost or PRP for stable nonsegmental vitiligo (NSV). METHODS Sixty patients with stable NSV were recruited and randomly allocated to two equal groups. NB-UVB phototherapy was administered twice a week for all patients. Additionally, group A received intralesional latanoprost injections once weekly, while group B received intralesional autologous PRP injections every 2 weeks. RESULTS At 24 weeks, excellent repigmentation response was observed in 26.7% and 13.3% of patients in the latanoprost/NB-UVB and PRP/NB-UVB groups, respectively, with no significant difference in degrees of repigmentation between the two groups. However, the Vitiligo Extent Score for a Target Area (VESTA) score was significantly higher in the latanoprost/NB-UVB group (p = .032). Moreover, lesions located on nonacral skin responded significantly better than those on acral skin. Only erythema was significantly higher in the PRP/NB-UVB group, while the recurrence of depigmentation was significantly higher in the latanoprost/NB-UVB group. CONCLUSIONS Both latanoprost and PRP have the potential to be effective add-on therapies to NB-UVB phototherapy for stable NSV, with latanoprost resulting in a greater repigmentation response and PRP producing a more stable response.
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Affiliation(s)
- Manal Fawzy
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sahar Al-Mokadem
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mabrokah Alshereef
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basma Elkholy
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Vladulescu D, Scurtu LG, Simionescu AA, Scurtu F, Popescu MI, Simionescu O. Platelet-Rich Plasma (PRP) in Dermatology: Cellular and Molecular Mechanisms of Action. Biomedicines 2023; 12:7. [PMID: 38275368 PMCID: PMC10813350 DOI: 10.3390/biomedicines12010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Platelet-rich plasma (PRP) therapy has gained attention in the scientific field due to its potential regenerative effects and great benefit-risk ratio. This review extensively explores the most studied mechanisms of this therapy according to the etiopathogenesis of skin diseases: cellular proliferation, matrix formation, regulation of inflammation, angiogenesis, collagen synthesis, and the remodeling of new tissue. Moreover, it draws on newly reported and lesser-known effects of PRP: its anti-apoptotic effects, immunological suppression, decrease in melanin synthesis, anti-microbial effects, overexpression of miR-155, antioxidant effects, and their involved pathways. This work aims to provide a complete update for understanding PRP's benefits and clinical relevance in wound healing, alopecia, pigmentary disorders, scars, rejuvenation, lichen sclerosus, and other inflammatory dermatoses, based on the current evidence. Furthermore, recent reports with novel indications for PRP therapy are highlighted, and new potential pathways correlated with the pathogenesis of skin diseases are explored.
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Affiliation(s)
- Denisa Vladulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Lucian G. Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
| | - Anca Angela Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Francesca Scurtu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Marco I. Popescu
- Faculty of Medicine, “Titu Maiorescu” University, 040441 Bucharest, Romania
| | - Olga Simionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology I, Colentina Hospital, 020125 Bucharest, Romania
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Perez-Bootello J, Cova-Martin R, Naharro-Rodriguez J, Segurado-Miravalles G. Vitiligo: Pathogenesis and New and Emerging Treatments. Int J Mol Sci 2023; 24:17306. [PMID: 38139134 PMCID: PMC10743634 DOI: 10.3390/ijms242417306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Vitiligo is a complex disease with a multifactorial nature and a high impact on the quality of life of patients. Although there are multiple therapeutic alternatives, there is currently no fully effective treatment for this disease. In the current era, multiple drugs are being developed for the treatment of autoimmune diseases. This review assesses the available evidence on the pathogenesis of vitiligo, and a comprehensive review of treatments available for vitiligo now and in the near future is provided. This qualitative analysis spans 116 articles. We reviewed the mechanism of action, efficacy and safety data of phototherapy, afamelanotide, cyclosporine, phosphodiesterase 4 inhibitors, trichloroacetic acid, basic fibroblast growth factor, tumor necrosis factor (TNF) inhibitors, secukinumab, pseudocatalase and janus kinase (JAK) inhibitors. At the moment, there is no clearly outstanding option or fully satisfactory treatment for vitiligo, so it is necessary to keep up the development of new drugs as well as the publication of long-term effectiveness and safety data for existing treatments.
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Pixley JN, Cook MK, Singh R, Larrondo J, McMichael AJ. A comprehensive review of platelet-rich plasma for the treatment of dermatologic disorders. J DERMATOL TREAT 2023; 34:2142035. [PMID: 36318219 DOI: 10.1080/09546634.2022.2142035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Platelet-rich plasma (PRP) offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well-understood. Our objective is to review the use and effectiveness of PRP for dermatologic conditions. A literature search was performed through PubMed and yielded 54 articles published between January 2000 and November 2021; articles written in English were reviewed. Intradermal injections were associated with increased hair density in androgenic alopecia. Successful treatment of inflammatory nail diseases with PRP has been reported. Improvement in psoriasis was described, but only two studies were available. PRP was associated with higher patient self-assessment scores of photoaging and fine lines. Treatment with PRP in melasma has been associated with improved subjective satisfaction, but not with objective measures of disease improvement. PRP can serve as a safe and potentially effective adjunct for hair loss, vitiligo, nonhealing wounds, photoaging, and acne scars. An important barrier to interpreting PRP research is lack of standardization of PRP preparation protocols, inconsistent clinical endpoints, and frequent combination treatments. However, PRP is relatively noninvasive, has a well-established safety profile, and patient satisfaction is often high as patients perceive great benefit from treatment with PRP.
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Affiliation(s)
- Jessica N Pixley
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Madison K Cook
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Rohan Singh
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Jorge Larrondo
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Amy J McMichael
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
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Wang Z, Feng C, Chang G, Liu H, Li S. The use of platelet-rich plasma in wound healing and vitiligo: A systematic review and meta-analysis. Skin Res Technol 2023; 29:e13444. [PMID: 37753680 PMCID: PMC10444946 DOI: 10.1111/srt.13444] [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: 02/27/2023] [Accepted: 08/13/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To critically assess the effect and safety of platelet-rich plasma (PRP) in chronic wounds and vitiligo. METHODS A systematic literature searching was performed. Results were expressed as weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. RESULTS A total of 27 studies were included in this meta-analysis. In patients with chronic diabetic ulcers, PRP significantly increased proportion of complete wound healing, percentage of wound area healed, and shortened the complete wound healing. In venous ulcers, PRP improved the epithelialized area and percentage of wound area healed. In vitiligo, PRP had better results in degree of improvement and mean repigmentation than controls. Regarding the safety profile, PRP did not increase the risk of infection in patients with chronic diabetic ulcers. Meta-regression revealed that source of PRP and preparation method of PRP significantly affected the proportion of complete wound healing, whereas age, gender, country, duration of wound, and wound size had no impact on this outcome. CONCLUSION PRP is effective and safe, and can be used as a potential therapeutic adjunct or alternative treatment in chronic wounds of multiple etiologies and vitiligo.
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Affiliation(s)
- Zhi Wang
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Cheng Feng
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Guojing Chang
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Hao Liu
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Shuo Li
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
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Abdel Halim DM, Fekry A, Mogawer RM. The value of adding platelet-rich plasma (PRP) to noncultured epidermal cell suspension (NCECS) in surgical treatment of stable resistant vitiligo: A self-controlled randomised double-blinded study. Australas J Dermatol 2023; 64:359-367. [PMID: 37228170 DOI: 10.1111/ajd.14080] [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: 02/11/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Noncultured epidermal cell suspension (NCECS) is a commonly used surgical treatment for resistant stable acral vitiligo and vitiligo overlying joints. Platelet-rich plasma (PRP) has been reported to enhance the repigmentation response of different therapeutic modalities for vitiligo, including vitiligo surgery. OBJECTIVE To assess the value of adding of PRP to NCECS in the surgical treatment of acral vitiligo and vitiligo overlying joints. PATIENTS AND METHODS This self-controlled randomised trial included 15 patients with 30 lesions in which NCECS suspended in PRP was performed for one lesion and NCECS in ringer's lactate for another comparable lesion. Following NCECS, patients underwent thrice weekly excimer light sessions for 3 months. After 8 weeks, patients underwent preliminary assessment. By the end of the 3 months, both lesions were compared as regards improvement in surface area and pigmentation. Additionally, physician global assessment was made by a blinded investigator. RESULTS Significant improvement was reported in both lesional extent and pigmentation (after PRP and lactated ringer NCECS) with no statistical difference between them. CONCLUSION Despite previous promising results, suspending NCECS in PRP offered no privilege in surgical treatment of acral vitiligo and vitiligo overlying joints, which are quite resistant to treat. PAN AFRICAN CLINICAL TRIAL REGISTRY ID PACTR202108873035929, Date: 16 August 2021.
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Affiliation(s)
| | - Ahmad Fekry
- Alayyat Central Hospital, National Institute of Health, Cairo, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ahlawat S, Kothiwala R, Meherda A. A Comparative Study to Evaluate the Efficacy of Fractional CO 2 Laser + PRP Vs. Fractional CO 2 Laser Alone in Patients with Vitiligo. J Cutan Aesthet Surg 2023; 16:186-191. [PMID: 38189059 PMCID: PMC10768947 DOI: 10.4103/jcas.jcas_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Introduction Vitiligo is a multifactorial acquired disorder clinically characterized by amelanotic lesions on the skin, due to destruction of melanocytes. The course of vitiligo is unpredictable. Vitiligo causes significant psychological impact and cosmetic disfigurement. Treatment of vitiligo is challenging and requires a multidisciplinary approach. Materials and Methods A prospective comparative interventional study was carried out from October 2018 to March 2020. The study enrolled 60 stable vitiligo patients divided into groups A and B. Group A (30 patients) was treated with both fractional CO2 laser and autologous platelet-rich plasma (PRP) injection. Group B (30 patients) was treated with fractional CO2 laser alone. A total of four sessions were conducted in each group at 1-month interval along with photographic assessment. Final assessment was done 1 month after the completion of four sessions. Results In group A, the median values of repigmentation and visual-analog score (VAS) were 3 and 7, and in group B, the median values of repigmentation and VAS were 1 and 2, respectively. Lesions over the trunk showed the best response followed by face and extremities lesions. Acral lesions showed the least response. Conclusion A combination of fractional CO2 laser and PRP is superior to fractional CO2 laser alone in the treatment of stable vitiligo.
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Affiliation(s)
- Shweta Ahlawat
- Department of Dermatology, JLN Medical College, Ajmer, Rajasthan, India
| | | | - Ashok Meherda
- Department of Dermatology, JLN Medical College, Ajmer, Rajasthan, India
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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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Eleftheriadou V, Bergqvist C, Kechichian E, Shourick J, Ju HJ, van Geel N, Bae JM, Ezzedine K. Has the core outcome (domain) set for vitiligo been implemented? An updated systematic review on outcomes and outcome measures in vitiligo randomized clinical trials. Br J Dermatol 2023; 188:247-258. [PMID: 36763863 DOI: 10.1093/bjd/ljac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 2015, a major achievement in vitiligo research was the development of an internationally agreed upon core outcome domain set for randomized clinical trials (RCTs). Three outcomes were identified as being essential: repigmentation, side-effects/harms and maintenance of gained repigmentation. Four items were further recommended for inclusion. The following recommendations then followed: repigmentation should be assessed by measuring the percentage of repigmentation in quartiles (0-25%, 26-50%, 51-79%, 80-100%) and cosmetic acceptability of the results should be assessed using the Vitiligo Noticeability Scale. OBJECTIVES The primary objective of this study was to assess uptake of the core outcome domain set for RCTs in vitiligo. Secondary objectives were to update the systematic review on outcomes reported in vitiligo RCTs, and to assess whether repigmentation and cosmetic acceptability of the results were measured using the above-mentioned recommended scales. METHODS We searched PubMed, Cochrane Library (CENTRAL and Systematic Reviews) and ClinicalTrials.gov for vitiligo RCTs between November 2009 and March 2021. Screening and data extraction were independently performed on title and summary by two researchers. All outcomes and outcome measures reported in eligible RCTs were retrieved and collated. RESULTS In total, 174 RCTs were identified: 62 were published between 2009 and 2015, and 112 were published between 2016 and 2021.Thirty-eight different outcomes were reported. Repigmentation was the primary outcome in 89% of trials (150 of 169). Forty-nine different tools were used to measure repigmentation. Side-effects and harms were reported in 78% of trials (136 of 174). Maintenance of gained repigmentation was reported in only 11% of trials (20 of 174) and duration of follow-up varied greatly from 1 to 14 months. Cosmetic acceptability of the results and cessation of disease activity were assessed in only 2% of trials (four of 174). Quality of life of patients with vitiligo was assessed in 13% of trials (22 of 174). Finally, only 11 of 112 RCTs (10%) published between 2016 and 2021 reported all three essential core outcome domains (repigmentation, side-effects and maintenance of gained repigmentation) and none of the trials reported both essential and recommended core outcome domains. CONCLUSIONS Efforts are still needed to close the gap between set recommendations and RCT outcome reporting.
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Affiliation(s)
- Viktoria Eleftheriadou
- Department of Dermatology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France
| | - Elio Kechichian
- Department of Dermatology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Hyun-Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France.,EA 7379 EpidermE, Faculty of Medicine, Université Paris-Est Créteil, UPEC, Créteil, France
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13
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Weshahy R, Abdelhamid MF, Sayed KS, El Desouky ED, Ramez SA. Efficacy and safety of combined fractional ablative CO 2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study. J Cosmet Dermatol 2022; 21:5636-5641. [PMID: 35621236 DOI: 10.1111/jocd.15116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO2 has shown efficacy in treatment of vitiligo in combination with other modalities. METHODS Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores. RESULTS Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators. CONCLUSION The combination of fractional ablative CO2 and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.
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Affiliation(s)
- Ragia Weshahy
- Dermatology and Venereology Research Department, Medical Research and Clinical Studies Institute- National Research Center, Cairo, Egypt
| | - Mahmoud F Abdelhamid
- Dermatology and Venereology Research Department, Medical Research and Clinical Studies Institute- National Research Center, Cairo, Egypt
| | - Khadiga S Sayed
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Shahenda A Ramez
- Dermatology and Venereology Research Department, Medical Research and Clinical Studies Institute- National Research Center, Cairo, Egypt
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14
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Zou B, Zheng W, Pan H, Yang B, Liu Z. Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace. J Cosmet Dermatol 2022; 21:5484-5499. [PMID: 35869829 DOI: 10.1111/jocd.15267] [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: 01/29/2022] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION There is limited basic research on carbon dioxide (CO2 ) fractional laser, indicating blind spots in CO2 fractional laser treatment of certain diseases. This study aimed to organize previous literature, summarize the current research, and speculate on possible future development. METHODS We searched document data on fractional CO2 lasers from the Web of Science core collection database and retrieved 928 articles from 2004 to 2021. CiteSpace software was used to analyze the main institutions, authors, subject hotspots, and research frontiers in global CO2 fractional laser research. RESULTS The results revealed that 928 related papers were published in the past 18 years (2004-2021), and the number has increased annually. The publications were written by 3239 authors from 626 institutions in 60 countries/regions. The United States (US) dominates this field (312 documents), followed by Italy (289), and South Korea (88). Lasers in Surgery and Medicine is the journal with the most publications and citations, and Uebelhoer is the central author. The main research hotspots include vulvovaginal atrophy, fractional photothermolysis, keloids, drug delivery, gene expressions, facial acne scarring, resurfacing, vitiligo, and photo damage. CONCLUSION Using CiteSpace, this paper draws a map of authors, institutions, and keywords in fractional CO2 laser from 2004 to 2021; summarizes the main authors, institutions, research hotspots, and cutting-edge topics of global fractional CO2 laser technology in recent years; and summarizes the current application status of global fractional CO2 laser in disease treatment. It also provides new ideas for the future application and research of fractional CO2 lasers.
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Affiliation(s)
- Boya Zou
- The First Clinical Medical College, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenyue Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Hongju Pan
- Guangdong Provincial Engineering Technology Research and Development Center for External Drugs, Foshan City, Guangdong Province, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Zhenfeng Liu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
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15
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Regenerative Medicine-Based Treatment for Vitiligo: An Overview. Biomedicines 2022; 10:biomedicines10112744. [DOI: 10.3390/biomedicines10112744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Vitiligo is a complex disorder with an important effect on the self-esteem and social life of patients. It is the commonest acquired depigmentation disorder characterized by the development of white macules resulting from the selective loss of epidermal melanocytes. The pathophysiology is complex and involves genetic predisposition, environmental factors, oxidative stress, intrinsic metabolic dysfunctions, and abnormal inflammatory/immune responses. Although several therapeutic options have been proposed to stabilize the disease by stopping the depigmentation process and inducing durable repigmentation, no specific cure has yet been defined, and the long-term persistence of repigmentation is unpredictable. Recently, due to the progressive loss of functional melanocytes associated with failure to spontaneously recover pigmentation, several different cell-based and cell-free regenerative approaches have been suggested to treat vitiligo. This review gives an overview of clinical and preclinical evidence for innovative regenerative approaches for vitiligo patients.
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16
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El Mulla KF, Elmorsy EH, Halwag DI, Hassan EM. Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Micro-needling in Treatment of Alopecia Areata. Dermatol Pract Concept 2022; 12:e2022196. [PMID: 36534509 PMCID: PMC9681232 DOI: 10.5826/dpc.1204a196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Trans-epidermal drug delivery, using "laser-assisted drug delivery", or micro-needling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. OBJECTIVES To evaluate the use of fractional carbon dioxide laser versus micro-needling in trans-epidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. METHODS Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I: Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: micro-needling with Dermapen and triamcinolone acetonide. Group III: fractional carbon dioxide laser and platelet-rich plasma. Group IV: micro-needling with Dermapen and platelet-rich plasma. Patients were evaluated clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. RESULTS In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (P = 0.001) and last (P = 0.008) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit, results were in favor of Dermapen, compared to Carbon dioxide laser for trans-epidermal drug delivery (P = 0.023); and in favor of triamcinolone acetonide, compared to platelet-rich plasma as topical medication (P = 0.015). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (P < 0.001). CONCLUSIONS Micro-needling and fractional carbon dioxide laser are effective tools for trans-epidermal drug delivery for Alopecia areata treatment. Micro-needling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy is highly beneficial in evaluating treatment response in alopecia areata.
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Affiliation(s)
- Khaled Fawzy El Mulla
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Hamed Elmorsy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Dalia Ibrahim Halwag
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Mohamed Hassan
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
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17
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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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18
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Utilization of Our Toolkit: A Systematic Review and Meta-analysis of Surgical Therapies in Vitiligo Treatment. Dermatol Surg 2022; 48:815-821. [DOI: 10.1097/dss.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Feily A, Nilforoushzadeh MA, Parvar SY, Hadibarhaghtalab M, Gilman C, Seifi V, Hesamzadeh D, Arzhangian MH, Ghahartars M, Lange CS, Ramirez-Fort MK. Platelet-rich plasma and follicular transplantation versus follicular transplantation alone in the treatment of refractory vitiligo: a comparative pilot study. Dermatol Ther 2022; 35:e15577. [PMID: 35535631 DOI: 10.1111/dth.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Student research committee, Shiraz University of medical sciences, Shiraz, Iran
| | - Maryam Hadibarhaghtalab
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Casey Gilman
- Pathology and Physiology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Vahid Seifi
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Jahrom University of medical Sciences, Department of Dermatology, Jahrom, Iran
| | - Daryoush Hesamzadeh
- Jahrom University of medical Sciences, Department of Dermatology, Jahrom, Iran
| | | | - Mahdi Ghahartars
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christopher S Lange
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
| | - Marigdalia K Ramirez-Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico.,Department of Radiation Oncology, Caribbean Radiation Oncology Center, Bayamon, Puerto Rico
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20
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Bhota S, Mehta P, Verma G, Tegta G. Platelet-rich plasma for the treatment of vitiligo: A case series. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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21
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Elsaadany AE, El-Khalawany M, Elshahid AR, Seddeik Abdel-Hameed AK. Comparison between 308-nm excimer light alone versus 308-nm excimer light and platelet-rich plasma in the treatment for localized vitiligo. J Cosmet Dermatol 2021; 21:2826-2831. [PMID: 34719101 DOI: 10.1111/jocd.14582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Monochromatic excimer light (MEL) is a safe and effective treatment for localized stable vitiligo. Previous reports of the combination of platelet-rich plasma (PRP) with narrowband ultraviolet B (NB-UVB) or excimer laser yielded conflicting results. AIMS This prospective, self-controlled, randomized, comparative study aimed to assess whether the addition of PRP to MEL therapy would be of an additive benefit in the treatment for localized stable vitiligo. Patients/Methods The current study included 36 patients with at least 2 more or less symmetrical patches of localized stable vitiligo (72 patches). For each patient, each of the 2 vitiligo patches was randomly assigned to receive either MEL therapy (twice weekly) with bi-weekly intradermal PRP (group A) or MEL therapy alone (group B) for a maximum of 4 months or till complete repigmentation. The degree of repigmentation was categorized as absent (0%), poor (1-25%), moderate (26-50%), good (51-75%), or excellent (>75%). Patients were asked about their level of satisfaction (not satisfied at all, partially satisfied, satisfied, or completely satisfied). Side effects were recorded, and follow-up for 3 months was done. RESULTS No statistically significant difference was observed between the 2 groups regarding the degree of repigmentation, the patients' level of satisfaction, and the frequency of side effects (p = 0.504, 0.490, and 0.912, respectively). At the end of the follow-up period, recurrence was observed in only 3 patients. CONCLUSIONS The current study showed no statistically significant difference between using MEL alone or with intradermal PRP in the treatment for localized stable vitiligo.
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Affiliation(s)
- Ahmed Elsaeed Elsaadany
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El-Khalawany
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Rashad Elshahid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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22
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Albalat W, Elsayed M, Salem A, Ehab R, Fawzy M. Non-cultured epidermal cells suspended in either platelet-rich plasma or ringer lactate for stable vitiligo: A prospective comparative study. J Cosmet Dermatol 2021; 21:3102-3109. [PMID: 34706162 DOI: 10.1111/jocd.14576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. AIM To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. PATIENTS AND METHODS A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. RESULTS Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups. CONCLUSION The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.
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Affiliation(s)
- Waleed Albalat
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manal Elsayed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amira Salem
- Department of Dermatopathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rana Ehab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manal Fawzy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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23
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Pilot Study on the Use of the "Monocyte-Rich" Platelet-Rich Plasma in Combination with 1927 nm Fractional and 308 nm Excimer Lasers for the Treatment of Vitiligo. ACTA ACUST UNITED AC 2021; 57:medicina57090904. [PMID: 34577827 PMCID: PMC8470656 DOI: 10.3390/medicina57090904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
Background and objectives: Vitiligo is an acquired chronic and idiopathic skin disorder, characterized by selective loss of melanocytes and resulting in a cutaneous depigmentation. Treatment for vitiligo remains a challenge for dermatologists; thus, it is frustrating both for physicians and patients. The objective of this study was to evaluate a combination treatment characterized by the use of a leukocyte-rich platelet-rich plasma, which is particularly rich in monocytes (defined here as monocyte-rich PRP), in combination with a 1927 nm fraxel laser and a 308 nm excimer laser. Materials and Methods: Treatment with monocyte-rich PRP combined with 1927 nm fraxel laser and 308 nm excimer laser was performed in nine sessions in 80 days and the median follow-up of the patients was 10 months. A total of 27 Caucasian patients were included in the present study. The median age of patients was 41 years, ranging between 20 and 69 years. Results: A re-pigmentation occurred in 16 cases (59%) with a reduction of the Vitiligo Extent Score (VES) and absence of re-pigmentation in untreated areas. Performing a rank correlation between VES and re-pigmentation in the treated areas, we found that there was a significant correlation (p < 0.0001). The presence of progressive vitiligo (p = 0.1) and the anatomic areas (p = 0.1) did not influence the treatment. Untreated areas did not show any improvement of the depigmented lesions, except in one case (p < 0.0001). Conclusions: in this report, we show for the first time how PRP rich in monocytes, in combination with laser therapies, gives a long therapeutic response, which persists even after 10 months of follow-up.
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24
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Jamal-Edine AM, El-Barbary RA, Moftah NH. Fractional versus full ablative CO 2 laser in recipient site of non-cultured melanocytes and keratinocyte transplantation in treatment of vitiligo. J Cosmet Dermatol 2021; 21:1506-1513. [PMID: 34213808 DOI: 10.1111/jocd.14324] [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: 02/12/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melanocyte-keratinocyte transplant procedure (MKTP) or non-cultured epidermal cell suspension transplantation is a very popular surgical modality for treating stable vitiligo. The recipient-site preparation is one potential determinant in the repigmentation outcomes. AIM To assess the efficacy of fractional CO2 (FCO2 ) laser in recipient-site preparation before MKTP and comparing it to the frequently used full surface laser ablation. METHODS This randomized comparative trial included 19 patients with 40 stable vitiligo lesions. In each patient, the treated sites were randomly categorized into two groups according to the recipient-site ablation (either fractional or full ablative CO2 laser). Assessment of repigmentation was performed six months after the procedure. RESULTS Both modalities achieved successful repigmentation of a median of 80% and 77.5% for fractional and full ablation groups, respectively, with a non-statistically significant difference between them. The median of VASI change percent was -73% and -71% with fractional and full surface ablation, respectively. CONCLUSIONS FCO2 laser ablation is effective for recipient-site preparation before cell suspension transplantation as well as the full ablative CO2 laser.
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Affiliation(s)
| | - Rasha Aly El-Barbary
- Dermatology and Venereology Department, Faculty of Medicine for girls, Alazhar University, Cairo, Egypt
| | - Nayera Hassan Moftah
- Dermatology and Venereology Department, Faculty of Medicine for girls, Alazhar University, Cairo, Egypt
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25
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Cole AM, Sclafani AP. Theory and Evidence for Platelet Therapy of the Aging Face. Facial Plast Surg 2021; 37:218-223. [PMID: 33634450 DOI: 10.1055/s-0041-1725107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Platelet preparations are autologous blood concentrates with supraphysiologic concentrations of platelets with or without leukocytes used in various clinical applications including regenerative medicine, wound healing, and facial rejuvenation. Their use harnesses the important role of platelets and their secretory products in immunoregulation, wound healing, angiogenesis, and tissue remodeling. The use of platelet preparations has been long documented in orthopaedic surgery, maxillofacial surgery, and other fields, but over the years research has increased in their application to facial plastic surgical techniques. Here we review the various formulations of platelet rich concentrates, their applications to facial skin rejuvenation, wound healing, scar reduction, and tissue fill as documented in the literature since 2018.
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Affiliation(s)
- Arron M Cole
- Otolaryngology Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anthony P Sclafani
- Department of Otolaryngology, Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York.,Department of Facial Plastic Surgery, Center for Facial Plastic Surgery, Chappaqua, New York
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26
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Salem SAM, Fezeaa TA, El Khazragy N, Soltan MY. Effect of platelet-rich plasma on the outcome of mini-punch grafting procedure in localized stable vitiligo: Clinical evaluation and relation to lesional basic fibroblast growth factor. Dermatol Ther 2021; 34:e14738. [PMID: 33403743 DOI: 10.1111/dth.14738] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
Surgical methods are favorably used for treatment of stable vitiligo, and platelet-rich plasma (PRP) can be added to augment the effect. The additive value of PRP, however, remains elusive. Basic fibroblast growth factor (bFGF) is released from activated platelets with a capacity for stimulating melanocyte proliferation and migration. The treatment outcomes for the mini-punch grafting (MPG)/phototherapy treatment with and without PRP were assessed and the relation between bFGF and the obtained results were evaluated. Thirty-four vitiliginous patches, two per each patient with stable vitiligo, were enrolled in this intrapatient-controlled study and treated with autologous MPG and subsequent exposure to phototherapy with and without enhancement via PRP procedure at the time of the procedure, and monthly for the subsequent 3 months. Re-pigmentation assessment via vitiligo scores as well as measurement of lesional bFGF were done. PRP assistance to MPG/phototherapy treatment resulted in earlier re-pigmentation at week 8. However, this enhancement effect vanished at the study end (week 20) as ideal re-pigmentation (>75% re-pigmentation) was encountered in 10 patches (58.8%) treated with MPG/phototherapy modality, and in 12 patches (70.6%) treated with PRP-assisted method without significant difference between them. Lesional bFGF increased after both treatments with a higher expression with PRP assistance but without clinical reflection on the final outcome. PRP can speed the re-pigmentation response for MPG/phototherapy procedure without any significant effect on the final outcome.
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Affiliation(s)
- Samar Abdallah M Salem
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Nashwa El Khazragy
- Department of Clinical Pathology-Hematology and Ain Shams Medical Research Institute (MASRI), Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Marwa Y Soltan
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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27
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Bakr RM, Abdel-Gaber RM, Tawfik YM. A comparative study on the use of fractional CO 2 laser with tacrolimus or calcipotriol or narrow band ultraviolet-B in treatment of stable nonsegmental vitiligo. Dermatol Ther 2020; 34:e14604. [PMID: 33249712 DOI: 10.1111/dth.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO2 ) laser therapy followed by narrow band ultraviolet-B (NB-UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO2 laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB-UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB-UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB-UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO2 laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO2 laser and NB-UVB was found to be more effective.
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Affiliation(s)
- Radwa M Bakr
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Reham M Abdel-Gaber
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Yasmin M Tawfik
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
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28
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Yin L, Adotama P, Svigos K, Gutierrez D, Lo Sicco K. Platelet-rich plasma, a promising adjunctive treatment for vitiligo: A case report. JAAD Case Rep 2020; 6:1320-1322. [PMID: 33052310 PMCID: PMC7543927 DOI: 10.1016/j.jdcr.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lu Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Daniel Gutierrez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
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29
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Abstract
Platelets play a crucial role in hemostasis, tissue regeneration and host defense. Based on these settings, platelet-rich plasma (PRP) and its derivatives are therapeutically used to promote wound healing in several scenarios. This review summarizes the biological mechanisms underlying the most traditional as well as innovative applications of PRP in wound healing. These mechanisms involve the combined action of platelet-derived growth factors and cytokines, together with the role of plasma-derived fibrillar, antioxidant and homeostatic factors. In addition, regenerative treatments with PRP consist of personalized and non-standardized methods. Thus, the quality of PRP varies depending on endogenous factors (e.g., age; gender; concomitant medication; disease-associated systemic factors; nutrition) and exogenous factors (anticoagulants and cellular composition). This review also analyses whether these factors affect the biological mechanisms of PRP in wound healing applications.
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Affiliation(s)
- Paula Oneto
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
| | - Julia Etulain
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
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30
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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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31
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Fractional CO2 laser, platelet rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A randomized clinical trial). Lasers Med Sci 2020; 36:1479-1486. [PMID: 33236202 DOI: 10.1007/s10103-020-03195-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
Vitiligo is a chronic acquired disease. Various therapeutic strategies are available but with variable degrees of success. Fractional CO2 laser is claimed to be effective in the treatment of refractory non-segmental vitiligo. Platelet-rich plasma may help in stimulation of the proliferation of melanocytes and repigmentation within vitiliginous patches.Our aim was to evaluate and compare the efficacy and safety of fractional CO2 laser, PRP, and NB-UVB either alone or in combination in the treatment of vitiligo. This self-controlled randomized clinical trial included 20 patients with at least 6 patches of vitiligo (VIDA score 1 and 0). Each patch was randomly assigned to receive either, fractional CO2 laser, PRP, combined fractional CO2 with PRP, combined fractional CO2 with NB-UVB, combined fractional CO2 with PRP and NB-UVB or left as a control. There was a statistically significant improvement in all treatment groups on comparing the surface area of vitiligo patches before and after treatment. However on comparing the percentage of reduction in surface area in different treatment groups, there was no statistically significant difference (P = 0.122). Fr: CO2 laser and PRP may be adjuvant therapeutic options to NB-UVB especially in the treatment of refractory cases of non-segmental vitiligo.
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Vocetkova K, Sovkova V, Buzgo M, Lukasova V, Divin R, Rampichova M, Blazek P, Zikmund T, Kaiser J, Karpisek Z, Amler E, Filova E. A Simple Drug Delivery System for Platelet-Derived Bioactive Molecules, to Improve Melanocyte Stimulation in Vitiligo Treatment. NANOMATERIALS 2020; 10:nano10091801. [PMID: 32927642 PMCID: PMC7559479 DOI: 10.3390/nano10091801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Vitiligo is the most common depigmentation disorder of the skin. Currently, its therapy focuses on the halting of the immune response and stimulation of the regenerative processes, leading to the restoration of normal melanocyte function. Platelet-rich plasma (PRP) represents a safe and cheap regenerative therapy option, as it delivers a wide spectrum of native growth factors, cytokines and other bioactive molecules. The aim of this study was to develop a simple delivery system to prolong the effects of the bioactive molecules released from platelets. The surface of electrospun and centrifugally spun poly-ε-caprolactone (PCL) fibrous scaffolds was functionalized with various concentrations of platelets; the influence of the morphology of the scaffolds and the concentration of the released platelet-derived bioactive molecules on melanocytes, was then assessed. An almost two-fold increase in the amount of the released bioactive molecules was detected on the centrifugally spun vs. electrospun scaffolds, and a sustained 14-day release of the bioactive molecules was demonstrated. A strong concentration-dependent response of melanocyte to the bioactive molecules was observed; higher concentrations of bioactive molecules resulted in improved metabolic activity and proliferation of melanocytes. This simple system improves melanocyte viability, offers on-site preparation and is suitable for prolonged topical PRP administration.
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Affiliation(s)
- Karolina Vocetkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
- Correspondence:
| | - Vera Sovkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Matej Buzgo
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Vera Lukasova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Radek Divin
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Michala Rampichova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
| | - Pavel Blazek
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Tomas Zikmund
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Jozef Kaiser
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Zdenek Karpisek
- Institute of Mathematics, Faculty of Mechanical Engineering, Brno University of Technology, Technicka 2, 616 69 Brno, Czech Republic;
| | - Evzen Amler
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Eva Filova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
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Bellei B, Papaccio F, Filoni A, Caputo S, Lopez G, Migliano E, Picardo M. Extracellular fraction of adipose tissue as an innovative regenerative approach for vitiligo treatment. Exp Dermatol 2020; 28:695-703. [PMID: 31066942 DOI: 10.1111/exd.13954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
Abstract
Vitiligo is a common, disfiguring autoimmune disease that negatively affects patients' self-esteem and quality of life. Current treatments are moderately effective in reversing disease and promoting melanocyte regeneration. Thus, therapeutic advanced strategies are emerging from regenerative medicine. It has recently emerged that adipose tissue secretome may be used as a cell-free therapy in skin regeneration since paracrine functions of adipose-derived stem cells alone are responsible for most of the therapeutic effect of stem cells in several animal disease models. In this study, we tested the effect of adipose tissue extracellular fraction (AT-Ex) isolated from lipoaspirates on dermal and epidermal vitiligo cells in vitro. Using this experimental model, we demonstrated that molecules secreted by adipose tissue ameliorate the capability to counteract oxidative stress by a physiological stimulation of intracellular antioxidant enzymes and positively impact on cell proliferation. Due to the presence of Wnt-secreted factors, AT-Ex treatment promotes glycogen synthase kinase 3β inactivation and consequently Wnt/β-catenin pathway activation. Collectively, our findings show that AT-Ex could be useful as a natural approach to improve treatment of vitiligo.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Federica Papaccio
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Filoni
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Silvia Caputo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Gianluca Lopez
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Emilia Migliano
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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34
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Deng Y, Li J, Yang G. 308-nm Excimer Laser Plus Platelet-Rich Plasma for Treatment of Stable Vitiligo: A Prospective, Randomized Case-Control Study. Clin Cosmet Investig Dermatol 2020; 13:461-467. [PMID: 32801821 PMCID: PMC7398870 DOI: 10.2147/ccid.s260434] [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: 04/29/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Purpose 308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo. Patients and Methods A total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi’an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects. Results The VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups. Conclusion The effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.
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Affiliation(s)
- Yanyan Deng
- Department of Dermatology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, People's Republic of China.,Department of Dermatology, The Second People's Hospital of Changzhi, Changzhi 046000, People's Republic of China
| | - Jia Li
- Department of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan 030009, People's Republic of China
| | - Gaoyun Yang
- Department of Dermatology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, People's Republic of China
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35
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Mercuri SR, Vollono L, Paolino G. The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:1749-1755. [PMID: 32440100 PMCID: PMC7213865 DOI: 10.2147/dddt.s239912] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
Introduction Vitiligo is an acquired, idiopathic disorder clinically characterized by amelanotic lesions on the skin which cause significant impairment of patients’ quality of life. A variety of treatments have been proposed, with inconsistent results. In the last decades, the use of platelet-rich plasma (PRP) is receiving increasing interest as a potential effective technique in the treatment of several dermatological diseases, including vitiligo. Objective We conducted a review with the aim to identify studies that documented the use of PRP for vitiligo. Materials and Methods Electronic databases of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 2019 have been searched using different combinations of the following terms: “platelet-rich plasma”, “platelet gel”, “platelet-rich fibrin”, “PRP” and “vitiligo”. Results We identified 6 clinical studies consistent with our research, with a total of 253 patients, listing and discussing the obtained results. In all reports, all treated patients showed a stable vitiligo, and a significantly higher improvement in the PRP groups was always observed compared to control groups. Regarding the side effects, PRP in vitiligo patients is useful and without important side effects. Conclusion PRP is a promising treatment for stable vitiligo lesions in different body sites. The possible use of PRP in combination with traditional therapeutic options and the standardization of processing protocols represents a very fertile field for future research. Larger clinical trials with longer time of observation would provide solid evidence regarding the effectiveness of PRP for the treatment of vitiligo.
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Affiliation(s)
- S R Mercuri
- Unit of Dermatology, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - L Vollono
- Dermatology Unit, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - G Paolino
- Unit of Dermatology, IRCCS, Ospedale San Raffaele, Milan, Italy.,Dermatologic Clinic, La Sapienza University of Rome, Rome, Italy
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36
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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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37
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Krenitsky A, Ghamrawi RI, Feldman SR. Phototherapy: a Review and Update of Treatment Options in Dermatology. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00290-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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38
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Bellei B, Picardo M. Premature cell senescence in human skin: Dual face in chronic acquired pigmentary disorders. Ageing Res Rev 2020; 57:100981. [PMID: 31733332 DOI: 10.1016/j.arr.2019.100981] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Although senescence was originally described as an in vitro acquired cellular characteristic, it was recently recognized that senescence is physiologically and pathologically involved in aging and age-related diseases in vivo. The definition of cellular senescence has expanded to include the growth arrest caused by various cellular stresses, including DNA damage, inadequate mitochondria function, activated oncogene or tumor suppressor genes and oxidative stress. While senescence in normal aging involves various tissues over time and contributes to a decline in tissue function even with healthy aging, disease-induced premature senescence may be restricted to one or a few organs triggering a prolonged and more intense rate of accumulation of senescent cells than in normal aging. Organ-specific high senescence rate could lead to chronic diseases, especially in post-mitotic rich tissue. Recently, two opposite acquired pathological conditions related to skin pigmentation were described to be associated with premature senescence: vitiligo and melasma. In both cases, it was demonstrated that pathological dysfunctions are not restricted to melanocytes, the cell type responsible for melanin production and transport to surrounding keratinocytes. Similar to physiological melanogenesis, dermal and epidermal cells contribute directly and indirectly to deregulate skin pigmentation as a result of complex intercellular communication. Thus, despite senescence usually being reported as a uniform phenotype sharing the expression of characteristic markers, skin senescence involving mainly the dermal compartment and its paracrine function could be associated with the disappearance of melanocytes in vitiligo lesions and with the exacerbated activity of melanocytes in the hyperpigmentation spots of melasma. This suggests that the difference may arise in melanocyte intrinsic differences and/or in highly defined microenvironment peculiarities poorly explored at the current state of the art. A similar dualistic phenotype has been attributed to intratumoral stromal cells as cancer-associated fibroblasts presenting a senescent-like phenotype which influence the behavior of neoplastic cells in either a tumor-promoting or tumor-inhibiting manner. Here, we present a framework dissecting senescent-related molecular alterations shared by vitiligo and melasma patients and we also discuss disease-specific differences representing new challenges for treatment.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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39
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Liu X, Gorzelanny C, Schneider SW. Platelets in Skin Autoimmune Diseases. Front Immunol 2019; 10:1453. [PMID: 31333641 PMCID: PMC6620619 DOI: 10.3389/fimmu.2019.01453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and small vessel vasculitis are three autoimmune diseases frequently manifested in the skin. They share common pathogenic features, including production of autoantibodies, loss of tolerance to self-antigens, tissue necrosis and fibrosis, vasculopathy and activation of the coagulation system. Platelets occupy a central part within the coagulation cascade and are well-recognized for their hemostatic role. However, recent cumulative evidence implicates their additional and multifaceted immunoregulatory functions. Platelets express immune receptors and they store growth factors, cytokines, and chemokines in their granules enabling a significant contribution to inflammation. A plethora of activating triggers such as damage associated molecular patterns (DAMPs) released from damaged endothelial cells, immune complexes, or complement effector molecules can mediate platelet activation. Activated platelets further foster an inflammatory environment and the crosstalk with the endothelium and leukocytes by the release of immunoactive molecules and microparticles. Further insight into the pathogenic implications of platelet activation will pave the way for new therapeutic strategies targeting autoimmune diseases. In this review, we discuss the inflammatory functions of platelets and their mechanistic contribution to the pathophysiology of SSc, ANCA associated small vessel vasculitis and other autoimmune diseases affecting the skin.
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Affiliation(s)
- Xiaobo Liu
- Department of Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gorzelanny
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ghasemloo S, Gauthier Y, Ghalamkarpour F. Evaluation of using fractional CO 2 laser plus NB-UVB versus NB-UVB alone in inducing marginal repigmentation of vitiligo lesions. J DERMATOL TREAT 2019; 30:697-700. [PMID: 30592235 DOI: 10.1080/09546634.2018.1564232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Vitiligo is a common depigmenting skin disorder, characterized by patchy loss of skin color and finding effective treatment has remained a challenging issue. Methods: A paired (half-body) randomized clinical trial study was done to compare the efficacy and the safety of narrowband ultraviolet B (NB-UVB) plus fractional CO2 versus NB-UVB alone in stimulation of marginal repigmentation of vitiliginous patches. One side of the body was randomly treated with a fractional CO2 laser and NB-UVB twice weekly, while the other side was exposed only to NB-UVB with the same manner. Results: Thirty patients with the nonsegmental stable vitiligo and mean age of 43 ± 15 years completed a 16-week treatment period with NB-UVB on one side of the body and fractional CO2 laser therapy with NB-UBV on the other side. In addition to the higher rate of response in the combination side compared to the monotherapy side of the body (p < .001), repigmentation was greater in the combination side rather than the NB-UVB monotherapy side (p = .002). In the combination treated side, marginal repigmentation pattern was more frequently seen than perifollicular pattern (p < .001) and more frequently than monotherapy side (p < .001). Conclusion: The fractional CO2 laser combined with NB-UVB seems to be a more effective therapeutic option for treatment than NB-UVB alone for inducing marginal repigmentation.
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Affiliation(s)
- Sara Ghasemloo
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Yvon Gauthier
- b Vitiligo and Melasma Research Association , Bordeaux , France
| | - Fariba Ghalamkarpour
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Platelet-rich plasma and its utility in medical dermatology: A systematic review. J Am Acad Dermatol 2019; 81:834-846. [PMID: 31009668 DOI: 10.1016/j.jaad.2019.04.037] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 02/06/2023]
Abstract
The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.
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42
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Bastonini E, Bellei B, Filoni A, Kovacs D, Iacovelli P, Picardo M. Involvement of non‐melanocytic skin cells in vitiligo. Exp Dermatol 2019; 28:667-673. [DOI: 10.1111/exd.13868] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/23/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Emanuela Bastonini
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
| | - Barbara Bellei
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
| | - Angela Filoni
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
| | - Paolo Iacovelli
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
| | - Mauro Picardo
- Cutaneous Physiopathology and Integrated Center of Metabolomics ResearchSan Gallicano Dermatological Institute, IRCCS Rome Italy
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Abstract
Vitiligo is an acquired disorder of skin pigmentation that produces significant psychological impact especially in those with skin of color. Narrow-band ultraviolet B (NB-UVB) therapy, which was first used in vitiligo in 1997 by Westerhof and Nieuweboer-Krobotova, has emerged as one of the safest and most effective therapy for this dermatosis. The light source used for NB-UVB phototherapy is the TL-01 lamp, and the most common model of the NB-UVB phototherapy device is the upright in-office booth or chamber which has 24-48 such lamps. In recent years, there have been several advances in the understanding of the mechanism of action of NB-UVB and the use of combination treatments, many of which increase the efficacy of NB-UVB. In 2017, the Vitiligo Working Group made vital recommendations on the dosage, frequency, and safety of NB-UVB in vitiligo. Furthermore, home phototherapy devices are gaining popularity as they lead to an improved patient compliance. There is still need for large multicenter randomized controlled trials to assess benefits of home phototherapy in vitiligo and studies investigating additional benefits of phototherapy following surgical therapy.
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Affiliation(s)
- Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sujay Khandpur
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
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Parambath N, Sharma VK, Parihar AS, Sahni K, Gupta S. Use of platelet-rich plasma to suspend noncultured epidermal cell suspension improves repigmentation after autologous transplantation in stable vitiligo: a double-blind randomized controlled trial. Int J Dermatol 2018; 58:472-476. [DOI: 10.1111/ijd.14286] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/15/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Nimitha Parambath
- Department of Dermatology & Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Vinod K. Sharma
- Department of Dermatology & Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Anita S. Parihar
- Department of Dermatology & Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Kanika Sahni
- Department of Dermatology & Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Somesh Gupta
- Department of Dermatology & Venereology; All India Institute of Medical Sciences; New Delhi India
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Kadry M, Tawfik A, Abdallah N, Badawi A, Shokeir H. Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study. Clin Cosmet Investig Dermatol 2018; 11:551-559. [PMID: 30510437 PMCID: PMC6231433 DOI: 10.2147/ccid.s178817] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions. Patients and methods This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months. Results A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser. Conclusion According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.
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Affiliation(s)
- Mostafa Kadry
- Faculty of Medicine, Dermatology Department, Helwan University Cairo, Helwan, Egypt
| | - Abeer Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Department of Allergology and Dermatology, Szeged University, Hungary,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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46
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Shih S. Platelet-rich plasma: Potential role in combined therapy for vitiligo. Dermatol Ther 2018; 32:e12773. [PMID: 30338878 DOI: 10.1111/dth.12773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shawn Shih
- College of Medicine, University of Central Florida, Orlando, Florida
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47
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Andia I, Maffulli N. A contemporary view of platelet-rich plasma therapies: moving toward refined clinical protocols and precise indications. Regen Med 2018; 13:717-728. [PMID: 30246605 DOI: 10.2217/rme-2018-0042] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP + cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies.
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Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine & Dentristry, Salerno, Italy.,Queen Mary University of London, Barts & the London School of Medicine & Dentistry, London, UK
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48
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Chiu YJ, Perng CK, Ma H. Fractional CO 2 laser contributes to the treatment of non-segmental vitiligo as an adjunct therapy: a systemic review and meta-analysis. Lasers Med Sci 2018; 33:1549-1556. [PMID: 29696444 DOI: 10.1007/s10103-018-2516-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
The treatment of stable non-segmental vitiligo is often challenging, which new therapies are being searched. Multiple clinical trials have proposed the benefits and safety of using fractional carbon dioxide (CO2) laser as an adjunct therapy to conventional treatments. This study aimed to evaluate the safety and efficacy of fractional carbon dioxide laser as a combination therapy to conventional treatments in patients with stable non-segmental vitiligo. A literature search using PubMed, EMBASE, and the Cochrane Library was performed for comparative studies among vitiligo patients treated with additional fractional CO2 laser. Clinical outcomes in the selected studies were compared, and a meta-analysis was performed via Review Manager version 5.3, according to the PRISMA guidelines. Six studies with a total of 184 patches/patients were included in the present meta-analysis. The combination therapy group had significantly superior results than that of the control group (≥ 75% re-pigmentation, risk ratio [RR] 2.80, 95% confidence interval [CI] 1.29-6.07; ≥ 50% re-pigmentation, RR 2.26, 95% CI 1.23-5.9; < 25% re-pigmentation, RR 0.57, 95% CI 0.43-0.75). Limitations of the study included the small number of studies and sample size, inadequate blinding of participants, and variation between therapy protocols. Meta-analysis revealed that using fractional CO2 laser in combination with conventional treatments is efficient and safe, and may be considered as an adjunct therapeutic option for patients with refractive non-segmental vitiligo.
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Affiliation(s)
- Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, 11217, Taiwan.
- Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan.
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan.
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49
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Recent Advances in Pathogenesis and Medical Management of Vitiligo. PIGMENTARY SKIN DISORDERS 2018. [DOI: 10.1007/978-3-319-70419-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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