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Winkie MJ, Sakunchotpanit G, Salazar CE, Gunasekera NS, Buzney EA, Nambudiri VE. A focused review of visible light therapies for vitiligo. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12939. [PMID: 38084061 DOI: 10.1111/phpp.12939] [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: 08/31/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Vitiligo can be challenging to treat and exhibit an unpredictable clinical course. Phototherapy in the form of visible light can achieve both repigmentation and depigmentation outcomes in vitiligo, with minimal associated adverse events. This review focuses on the mechanistic understandings and clinical outcomes of visible light-based treatments for vitiligo. METHODS Articles were retrieved from PubMed starting from May 1965 until August 2023, yielding 496 unique articles. We conducted title, abstract, and full-text screening to identify articles describing the use of visible light (380-750 nm), either as part of combination therapy or as monotherapy, for repigmentation or depigmentation treatment in vitiligo. RESULTS Twenty-seven articles met inclusion criteria, offering preclinical and clinical data regarding the utilization of helium-neon laser (red light) and blue light-emitting diodes (LEDs) as methods of repigmentation therapy in vitiligo. Preclinical and clinical data on the utilization of Q-switched ruby laser (694 nm) and frequency-doubled (FD) Nd:YAG laser (532 nm) for vitiligo depigmentation therapy were also identified. CONCLUSION While limited by small studies and a lack of standardized administration of phototherapy, the evidence for visible light's effectiveness in managing vitiligo is encouraging. Red light therapy using He-Ne lasers and blue light therapy via LEDs can stimulate repigmentation in patients with vitiligo with minimal adverse events. Q-switched ruby and FD Nd:YAG lasers provide viable, visible light depigmentation options, either alone or with topical agents. With limited clinical data, larger studies are needed to validate the efficacy of visible light therapy in treating vitiligo and to better understand its long-term outcomes.
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Affiliation(s)
- Mitchell J Winkie
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Goranit Sakunchotpanit
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Carlos E Salazar
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole S Gunasekera
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Buzney
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Di Nardo V, Barygina V, França K, Tirant M, Valle Y, Lotti T. Functional nutrition as integrated approach in vitiligo management. Dermatol Ther 2018; 32:e12625. [DOI: 10.1111/dth.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/16/2018] [Indexed: 01/29/2023]
Affiliation(s)
| | - Victoria Barygina
- Department of Biomedical Experimental and Clinical Sciences; University of Florence; Florence Italy
| | - Katlein França
- Department of Dermatology & Cutaneous Surgery, Institute for Bioethics & Health Policy; University of Miami Miller School of Medicine; Miami Florida
- Department of Psychiatry & Behavioral Sciences, Institute for Bioethics & Health Policy; University of Miami Miller School of Medicine; Miami Florida
| | | | - Yan Valle
- University of Rome “G. Marconi”; Rome Italy
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Gianfaldoni S, Tchernev G, Lotti J, Wollina U, Satolli F, Rovesti M, França K, Lotti T. Unconventional Treatments for Vitiligo: Are They (Un) Satisfactory? Open Access Maced J Med Sci 2018; 6:170-175. [PMID: 29484020 PMCID: PMC5816295 DOI: 10.3889/oamjms.2018.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/17/2017] [Accepted: 10/29/2017] [Indexed: 12/26/2022] Open
Abstract
The authors show a brief overview of the vitiligo’s unconventional therapies. A part for well-documented effectiveness of L-phenylalanine, PGE2 and antioxidant agents in the treatment of vitiligo, for the other therapeutical approaches more investigations are needed.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR-Sofia), General Skobelev 79, 1606 Sofia, Bulgaria.,Onkoderma - Policlinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
| | - Jacopo Lotti
- University G. Marconi of Rome, Dept. of Nuclear, Subnuclear and Radiation Physics, Via Plinio 44, Rome 00193, Italy
| | - Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Francesca Satolli
- Department of Dermatology, University of Parma, Via Gramsci 14, Parma, Parma 43126, Italy
| | - Miriam Rovesti
- Department of Dermatology, University of Parma, Via Gramsci 14, Parma, Parma 43126, Italy
| | - Katlein França
- University of Miami School of Medicine, 1400 NW 10th Avenue, Miami, Florida 33136-1015, United States
| | - Torello Lotti
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
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Zhang M, Ma WY. A comparative study for the short-term effects of targeted high-intensity UVB and narrow-band UVB in the treatment of vitiligo. Exp Ther Med 2017; 13:3383-3387. [PMID: 28587417 PMCID: PMC5450568 DOI: 10.3892/etm.2017.4381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 01/13/2017] [Indexed: 11/29/2022] Open
Abstract
Vitiligo is a common acquired depigmentation disorder for which many treatments have previously been used with varying effects. The aim of the present study was to evaluate the efficacy and safety of targeted high-intensity (TH) and narrow band (NB) ultraviolet B light (UVB) for vitiligo treatment. A total of 33 patients with vitiligo were enrolled in the present study. Patients with a symmetrical or near-symmetrical distribution of lesions on their bodies were selected for the present study. For each patient, half of the body was treated with TH-UVB and the other with NB-UVB twice weekly over a period of 12 weeks (24 times total). The patients were assessed each week for repigmentation of lesions. All data were analyzed using SPSS software, and a total of 30 patients were evaluated. The effective rate was significantly higher in the TH-UVB group (56.7%) compared with the NB-UVB group (20.0%; P<0.05). Additionally, the mean number of radiations necessary for initial repigmentation was significantly lower in the TH-UVB group (7.95±3.43) compared with the NB-UVB group (15.36±3.43; P<0.05). No correlation was found between the clinical features of patients and the efficacy of treatment. In summary, the results of the present study suggest that TH-UVB is a more effective treatment for vitiligo than NB-UVB.
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Affiliation(s)
- Min Zhang
- Department of Dermatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Wei-Yuan Ma
- Department of Dermatology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Khurrum H, AlGhamdi KM. The Relationship Between the Serum Level of Vitamin D and Vitiligo: A Controlled Study on 300 Subjects. J Cutan Med Surg 2015; 20:139-45. [PMID: 26458407 DOI: 10.1177/1203475415610071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Low vitamin D levels have been associated with several autoimmune diseases. Vitiligo could be associated with low vitamin D levels. OBJECTIVE To determine the level of serum vitamin D in vitiligo patients compared to controls and reveal the possible association of vitamin levels with the pathogenesis of vitiligo. PATIENTS AND METHODS A case-controlled study was conducted. After excluding factors that may affect serum vitamin D levels, blood samples were taken from vitiligo patients and controls. The association between vitamin D levels and various vitiligo subgroups (duration of vitiligo, site of onset, age, etc) was measured and correlated. RESULTS A total of 150 vitiligo patients, 90 (60%) males with a mean age of 30.6 ± 11.4 years, were recruited. The study also had 150 age- and gender-matched vitiligo-free control subjects. There was no significant difference in median serum vitamin D levels between the cases and the controls (P = .25). The serum levels of vitamin D of the vitiligo patients were found to be lower in males (P = .01), the younger age group (P = .01), and patients not treated with ultraviolet (UV) treatment (P = .01). CONCLUSION There is no difference between the vitamin D levels of the vitiligo patients and the control subjects. However, deficiency of 25(OH)D levels within the vitiligo subgroups may be linked to younger age, male gender, short duration of vitiligo, and non-use of phototherapy.
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Affiliation(s)
- Huma Khurrum
- Vitiligo research chair, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M AlGhamdi
- Dermatology Department, Director Vitiligo Research Chair, College of Medicine, King Saud University,Riyadh, Saudi Arabia
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Dai W, Zhou FB, Wei C, Wang XW, Guo S, Yi XL, Li K, Gao TW, Liu L, Li CY. A functional single-nucleotide polymorphism in the ERCC1 gene alters the efficacy of narrowband ultraviolet B therapy in patients with active vitiligo in a Chinese population. Br J Dermatol 2015; 173:457-63. [PMID: 25965418 DOI: 10.1111/bjd.13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND T lymphocytes have been shown to cause the destruction of melanocytes in vitiligo pathogenesis. Narrowband ultraviolet B (NB-UVB), as an effective therapeutic strategy in vitiligo, can lead to the formation of DNA photoproducts such as cyclobutane pyrimidine dimers (CPDs) in perilesional lymphocytes and thus induce skin immunosuppression. The repair of DNA photoproducts is performed mainly through the nucleotide excision repair (NER) pathway. We hypothesized that single-nucleotide polymorphisms (SNPs) in NER genes might influence the repair capacity of CPDs and thus contribute to variations in phototherapy efficiency. OBJECTIVES To detect genetic polymorphisms in NER genes and their relationship with the efficacy of NB-UVB therapy in patients with active vitiligo. METHODS We investigated the association of NER SNPs (XPA A23G, XPC Ci11A, XPC C2919A and ERCC1 C118T) with phototherapy efficacy in 86 patients with vitiligo who received NB-UVB treatment. Furthermore, we examined the impact of ERCC1 C118T on the apoptosis of T lymphocytes and CPD accumulation after NB-UVB irradiation. RESULTS We found that patients with vitiligo with the ERCC1 codon 118 CC genotype showed better efficacy after NB-UVB irradiation than those with the ERCC1 118 TT and CT genotypes, whereas no such association was documented among the genotypes of XPA A23G, XPC Ci11A or XPC C2919A. Additionally, the apoptosis rates and CPD levels of lymphocytes after NB-UVB irradiation in patients with the ERCC1 118 CC genotype were significantly higher than those in patients with the ERCC1 118 TT and CT genotypes. CONCLUSIONS The ERCC1 118 CC genotype confers better efficacy of NB-UVB therapy in patients with active vitiligo.
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Affiliation(s)
- W Dai
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - F-B Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - C Wei
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - X-W Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - S Guo
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - X-L Yi
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - K Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - T-W Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - L Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
| | - C-Y Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an, Shaanxi, 710032, China
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Faria AR, Tarlé RG, Dellatorre G, Mira MT, Castro CCSD. Vitiligo--Part 2--classification, histopathology and treatment. An Bras Dermatol 2015; 89:784-90. [PMID: 25184918 PMCID: PMC4155957 DOI: 10.1590/abd1806-4841.20142717] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 11/22/2022] Open
Abstract
In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.
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Anbar TS, Hegazy RA, Picardo M, Taieb A. Beyond vitiligo guidelines: combined stratified/personalized approaches for the vitiligo patient. Exp Dermatol 2015; 23:219-23. [PMID: 24521008 DOI: 10.1111/exd.12344] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 11/26/2022]
Abstract
'Vitiligo' is a word that bears endless possibilities and no promises. Each vitiligo patient has a different story that demands a different therapeutic approach. Even though great efforts have been made to evaluate, study, compare and document the different therapeutic modalities available for vitiligo, clearly handling their modes of actions as well as their side effects and establishing clear stratified guidelines, numerous dilemmas are frequently met on practical grounds. 'Stabilize', 'repigment', 'depigment' or 'camouflage'? 'for whom and how do we achieve the best results' ? 'Separately or in combination ? - questions that need to be answered and decisions need to be taken in the appropriate timing and altered when the necessity arises. In the current viewpoint, we have utilized the available knowledge and exploited years of experience in an attempt to go beyond the guidelines to set the rationale for an optimal and personalized therapy, within the framework of a stratified approach.
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Affiliation(s)
- Tag S Anbar
- Department of Dermatology and Andrology, Faculty of Medicine, AL-Minya University, AL-Minya, Egypt
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Topical delivery of clobetasol propionate loaded microemulsion based gel for effective treatment of vitiligo – Part II: Rheological characterization and in vivo assessment through dermatopharmacokinetic and pilot clinical studies. Colloids Surf B Biointerfaces 2014; 119:145-53. [DOI: 10.1016/j.colsurfb.2014.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/31/2013] [Accepted: 02/04/2014] [Indexed: 11/20/2022]
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Patel HK, Barot BS, Parejiya PB, Shelat PK, Shukla A. Topical delivery of clobetasol propionate loaded microemulsion based gel for effective treatment of vitiligo: Ex vivo permeation and skin irritation studies. Colloids Surf B Biointerfaces 2013; 102:86-94. [DOI: 10.1016/j.colsurfb.2012.08.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/26/2012] [Accepted: 08/08/2012] [Indexed: 11/24/2022]
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Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
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Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
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Prignano F, Ricceri F, Bianchi B, Guasti D, Bonciolini V, Lotti T, Pimpinelli N. Dendritic cells: ultrastructural and immunophenotypical changes upon nb-UVB in vitiligo skin. Arch Dermatol Res 2010; 303:231-8. [PMID: 21174109 DOI: 10.1007/s00403-010-1109-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/28/2022]
Abstract
The role of dendritic cells in vitiligo is still unclear. Few studies have provided contradictory results about their quantitative variation and no data exist concerning their immunophenotypical distribution in diseased skin. The purpose of our study was to analyze the presence, the distribution, the immunophenotypical markers and the effects of nb-UVB therapy on dendritic cells in non-lesional, perilesional, and lesional vitiligo skin. Punch-biopsies of 6 mm were taken from lesional, perilesional, and non-lesional skin of 12 patients affected by non-segmental vitiligo, treated with nb-UVB. An immunohistochemical and an ultrastructural analysis were performed. Immunohistochemical and ultrastructural analysis showed both quantitative and qualitative modifications of Langerhans cells. Nb-UVB therapy, one of the most effective treatments for the disease, was able to reduce the Langerhans cells number and to redistribute main dendritic subsets. This study underlines the importance of dendritic cells, Langerhans cells in particular, in non-segmental vitiligo, in its pathogenesis and in its better therapeutical approach.
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Affiliation(s)
- Francesca Prignano
- Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Italy.
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