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Desai VA, Momin AM, Vaishnani JB. Effect of Topical 5% 5-Fluorouracil with Microneedling in Vitiligo Patients as an Additional Modality to Standard Treatment at Tertiary Care Hospital. Indian Dermatol Online J 2024; 15:443-448. [PMID: 38845671 PMCID: PMC11152467 DOI: 10.4103/idoj.idoj_774_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 06/09/2024] Open
Abstract
Background Vitiligo is an inveterate disease of great aesthetic concern presenting with depigmented macules and patches. It is often incorrigible to medical treatment. Aim To study the clinical profile of vitiligo patients and evaluate the effect of 5% 5-fluorouracil (5-FU) cream with microneedling. Materials and Methods This observational analytical study was conducted from November 2019 to July 2021. A total of 33 adult vitiligo patients were treated with oral mini-pulse (dexamethasone) therapy and topical corticosteroid (clobetasol propionate 0.05%). Patient's total number of vitiligo lesions with <10-cm size were counted and half of the lesions were treated with 5-FU + microneedling (Group A), while a remaining number of lesions were not treated with 5-FU + microneedling (Group B). In the case of the odd number of lesions, the total number of lesions minus one was considered and then divided into equal numbers for treatment. The procedure was performed every 2 weeks for 3 months. Clinical improvement was assessed monthly till 6 months by serial clinical photographs and grading scores. Results Initiation of repigmentation started in the first month in Group A, whereas in Group B, it was seen in the second, which was statistically significant (P < 0.0001). Excellent improvement (>75% repigmentation) was noted in Group A as compared to Group B at the end of 6 months (P < 0.0001). Conclusions Needling with 5% 5-FU appears to be a simple, safe, and effective treatment in vitiligo. It can be used in poor responders to conventional therapy.
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Affiliation(s)
- Valay A. Desai
- Department of Dermatology, Venereology and Leprology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India
| | - Anjum M. Momin
- Department of Dermatology, Venereology and Leprology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India
| | - Jignesh B. Vaishnani
- Department of Dermatology, Venereology and Leprology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India
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Ju HJ, Bae JM. Bridging Molecular Mechanism and Clinical Practice in Vitiligo Treatment: An Updated Review. Dermatology 2024; 240:474-486. [PMID: 38417409 DOI: 10.1159/000537810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Treatment of vitiligo seeks to achieve three goals: cessation of disease progression, regeneration of pigmentation, and prevention of recurrence. SUMMARY Number of nonsurgical interventions are available that suppress the autoimmune response and regenerate the melanocytes from the reservoir: phototherapy including psoralen and ultraviolet A, narrowband ultraviolet B, and 308-nm excimer and 311-nm Titanium:Sapphire lasers; topical agents including topical calcineurin inhibitors, topical corticosteroids, and topical 5-fluorouracil; and systemic agents including corticosteorids, mycophenolate mofetil, cyclosporine, methotrexate, minocycline, afamelanotide, and antioxidants. In recent years, a great advance has been made in the understanding of pathogenesis of vitiligo, and JAK inhibitors are being investigated as a new treatment. Minimally invasive procedures such as fractional lasers or microneedling can help achieve the optimal treatment outcome when used properly. KEY MESSAGES Our review describes various treatment modalities for vitiligo based on their molecular mechanism of action. Bridging the gap between molecular mechanisms and therapeutic options would be a valuable reference for physicians in clinical practice.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim S, Woo YR, Cho SH, Lee JD, Kim HS. Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology. J Clin Med 2024; 13:335. [PMID: 38256469 PMCID: PMC10816055 DOI: 10.3390/jcm13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin treatment is effective in hypertrophic scars and warts, but intralesional 5-FU may also be considered since it is cheaper and less painful. Moreover, intralesional 5-FU and bleomycin injection is a viable option for premalignant lesions (i.e., actinic keratosis) and inoperable skin cancers. Both bleomycin and 5-FU have been applied as treatment adjuncts for vitiligo, with 5-FU showing a slightly better outcome. Both agents have a good safety profile, and no serious side effects have been reported following their use in the field of dermatology.
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Affiliation(s)
| | | | | | | | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (Y.R.W.); (S.H.C.); (J.D.L.)
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Melnikova N, Sheferov I, Panteleev D, Emasheva A, Druzhkova I, Ignatova N, Mishchenko T, Vedunova M. Design and Study of Nanoceria Modified by 5-Fluorouracil for Gel and Polymer Dermal Film Preparation. Pharmaceuticals (Basel) 2023; 16:1082. [PMID: 37630997 PMCID: PMC10458209 DOI: 10.3390/ph16081082] [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: 07/08/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
In this work we studied nanoceria (CeO2NPs) and nanoceria modified by 5-fluorouracil (5FU) as potential APIs. Nanoceria were synthesized by precipitation in a matrix of hydroxyethyl cellulose or hydroxypropylmethyl cellulose, using cerium (III) nitrate and meglumine. Nanoceria properties were estimated by UV, FTIR and X-ray photoelectron spectra; scanning electron and atomic force microscopy; powder X-ray diffraction patterns and energy dispersive X-ray microanalysis. The cytotoxicity of nanoceria and polymer-protected nanoparticles was evaluated using the established cell line NCTC clone 929 (C3H/An mouse, subcutaneous connective tissue, clone of L. line). The morphology and metabolic activity of nanoparticles at 10 μg∙mL-1 of cells was not significant. In addition, the cytotoxic effects of nanoceria were assessed on two human colorectal cancer cell lines (HT29 and HCT116), murine melanoma B16 cells and normal human skin fibroblasts. An inhibitory effect was shown for HCT116 human colorectal cancer cells. The IC50 values for pure CeO2NPs and CeO2NPs-5FU were 219.0 ± 45.6 μg∙mL-1 and 89.2 ± 14.0 μg∙mL-1, respectively. On the other hand, the IC50 of 5FU in the combination of CeO2NPs-5FU was 2-fold higher than that of pure 5FU, amounting to 5.0 nmol∙mL-1. New compositions of nanoceria modified by 5-fluorouracil in a polymer matrix were designed as a dermal polymer film and gel. The permeability of the components was studied using a Franz cell.
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Affiliation(s)
- Nina Melnikova
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Ilya Sheferov
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Dmitry Panteleev
- Department of Pharmaceutical Chemistry, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia;
| | - Anastasia Emasheva
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Irina Druzhkova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Nadezhda Ignatova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Tatiana Mishchenko
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Maria Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
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Melnikova N, Sheferov I, Panteleev D, Emasheva A, Druzhkova I, Ignatova N, Mishchenko T, Vedunova M. Design and Study of Nanoceria Modified by 5-Fluorouracil for Gel and Polymer Dermal Film Preparation. Pharmaceuticals (Basel) 2023; 16:1082. [DOI: https:/doi.org/10.3390/ph16081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Abstract
In this work we studied nanoceria (CeO2NPs) and nanoceria modified by 5-fluorouracil (5FU) as potential APIs. Nanoceria were synthesized by precipitation in a matrix of hydroxyethyl cellulose or hydroxypropylmethyl cellulose, using cerium (III) nitrate and meglumine. Nanoceria properties were estimated by UV, FTIR and X-ray photoelectron spectra; scanning electron and atomic force microscopy; powder X-ray diffraction patterns and energy dispersive X-ray microanalysis. The cytotoxicity of nanoceria and polymer-protected nanoparticles was evaluated using the established cell line NCTC clone 929 (C3H/An mouse, subcutaneous connective tissue, clone of L. line). The morphology and metabolic activity of nanoparticles at 10 μg∙mL−1 of cells was not significant. In addition, the cytotoxic effects of nanoceria were assessed on two human colorectal cancer cell lines (HT29 and HCT116), murine melanoma B16 cells and normal human skin fibroblasts. An inhibitory effect was shown for HCT116 human colorectal cancer cells. The IC50 values for pure CeO2NPs and CeO2NPs-5FU were 219.0 ± 45.6 μg∙mL−1 and 89.2 ± 14.0 μg∙mL−1, respectively. On the other hand, the IC50 of 5FU in the combination of CeO2NPs-5FU was 2-fold higher than that of pure 5FU, amounting to 5.0 nmol∙mL−1. New compositions of nanoceria modified by 5-fluorouracil in a polymer matrix were designed as a dermal polymer film and gel. The permeability of the components was studied using a Franz cell.
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Affiliation(s)
- Nina Melnikova
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Ilya Sheferov
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Dmitry Panteleev
- Department of Pharmaceutical Chemistry, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Anastasia Emasheva
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Irina Druzhkova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Nadezhda Ignatova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Tatiana Mishchenko
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Maria Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
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Saad MA, Tawfik KM, Abdelaleem HL. Efficacy and safety of micro-needling combined with topical 5-fluorouracil and excimer light vs. excimer light alone in treatment of non-segmental vitiligo: A comparative study. J Cosmet Dermatol 2023; 22:810-821. [PMID: 36343160 DOI: 10.1111/jocd.15481] [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: 08/25/2022] [Revised: 09/19/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE Vitiligo is one of the most challenging dermatological diseases with little improvement promises. Various modalities of treatment both medical and surgical have been used in the treatment of vitiligo. Some proved to be effective, others with controversial results and the rest were effective less. The aim of the present study was to evaluate the additional effect of topical 5-fluorouracil after micro-needling to excimer light (308 nm) in treatment of non-segmental vitiligo. METHODS Fifty patients were included in the present study, only 33 patients continued the treatment for 6 months. Two patches were selected in every patient to be treated, one patch with micro-needling then application of 5 FU and excimer (Group A), and the other with excimer only (Group B). RESULTS The treatment with the combination of micro-needling then application of 5 FU and excimer showed significant earlier response versus excimer alone. Also, the percentage of re-pigmentation was higher in the patches treated with the combination especially in the face and trunk. The combination of 5 FU after micro-needling and Excimer is more suitable for localized and focal vitiligo. CONCLUSION Topical 5 FU after micro-needling is a promising, rapid, and cost-effective therapeutic strategy for treatment of non-segmental vitiligo It had limited side effects, and the best response was reported for lesions affecting face and trunk.
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Affiliation(s)
- Mohammad A Saad
- Department of Dermatology, Venerology, and Andrology, Faculty of Medicine Al-Azhar University (Assiut), Assiut, Egypt
| | - Khaled Mohamed Tawfik
- Department of Dermatology, Venerology, and Andrology, Faculty of Medicine Al-Azhar University (Assiut), Assiut, Egypt
| | - Hazem L Abdelaleem
- Department of Dermatology, Venerology, and Andrology, Faculty of Medicine Al-Azhar University (Assiut), Assiut, Egypt
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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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Enhanced Uptake and Retention of 0.03% Bimatoprost, 0.5% 5-Fluorouracil, and 5% Minoxidil After 1,550-nm or 1,927-nm Nonablative Laser Pretreatment. Dermatol Surg 2022; 48:932-936. [DOI: 10.1097/dss.0000000000003532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cabral AMTDPV, Fernandes ACG, Joaquim NAM, Veiga F, Sofio SPC, Paiva I, Esteso MA, Rodrigo MM, Valente AJM, Ribeiro ACF. Complexation of 5-Fluorouracil with β-Cyclodextrin and Sodium Dodecyl Sulfate: A Useful Tool for Encapsulating and Removing This Polluting Drug. TOXICS 2022; 10:toxics10060300. [PMID: 35736908 PMCID: PMC9228719 DOI: 10.3390/toxics10060300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
The formation of complexes of the drug 5-fluorouracil (5-FU) with β-cyclodextrin (β-CD) and sodium dodecyl sulphate (SDS) was studied through experimental measurements of the ternary mutual diffusion coefficients (D11, D22, D12, and D21) for the systems {5-FU (component 1) + β-CD (component 2) + water} and {5-FU (component 1) + SDS (component 2) + water} at 298.15 K and at concentrations up to 0.05 mol dm−3 by using the Taylor dispersion method, with the objective of removing this polluting drug from the residual systems in which it was present. The results found showed that a coupled diffusion of 5-FU occurred with both β-CD and SDS, as indicated by the nonzero values of the cross-diffusion coefficients, D12 and D21, as a consequence of the complex formation between 5-FU and the β-CD or SDS species. That is, 5-FU was solubilized (encapsulated) by both carriers, although to a greater extent with SDS (K = 20.0 (±0.5) mol−1 dm3) than with β-CD (K = 10.0 (±0.5) mol−1 dm3). Values of 0.107 and 0.190 were determined for the maximum fraction of 5-FU solubilized with β-CD and SDS (at concentrations above its CMC), respectively. This meant that SDS was more efficient at encapsulating and thus removing the 5-FU drug.
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Affiliation(s)
- Ana M. T. D. P. V. Cabral
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.T.D.P.V.C.); (N.A.M.J.); (F.V.)
- Department of Chemistry, CQC, Institute of Molecular Sciences, University of Coimbra, 3004-535 Coimbra, Portugal; (A.C.G.F.); (S.P.C.S.); (A.J.M.V.)
| | - Ana C. G. Fernandes
- Department of Chemistry, CQC, Institute of Molecular Sciences, University of Coimbra, 3004-535 Coimbra, Portugal; (A.C.G.F.); (S.P.C.S.); (A.J.M.V.)
| | - Neuza A. M. Joaquim
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.T.D.P.V.C.); (N.A.M.J.); (F.V.)
| | - Francisco Veiga
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.T.D.P.V.C.); (N.A.M.J.); (F.V.)
| | - Sara P. C. Sofio
- Department of Chemistry, CQC, Institute of Molecular Sciences, University of Coimbra, 3004-535 Coimbra, Portugal; (A.C.G.F.); (S.P.C.S.); (A.J.M.V.)
| | - Isabel Paiva
- Centre of Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal;
| | - Miguel A. Esteso
- Universidad Católica de Ávila, Calle los Canteros s/n, 05005 Ávila, Spain
- U.D. Química Física, Universidad de Alcalá, 28805 Alcalá de Henares, Spain;
- Correspondence: (M.A.E.); (A.C.F.R.)
| | - M. Melia Rodrigo
- U.D. Química Física, Universidad de Alcalá, 28805 Alcalá de Henares, Spain;
| | - Artur J. M. Valente
- Department of Chemistry, CQC, Institute of Molecular Sciences, University of Coimbra, 3004-535 Coimbra, Portugal; (A.C.G.F.); (S.P.C.S.); (A.J.M.V.)
| | - Ana C. F. Ribeiro
- Department of Chemistry, CQC, Institute of Molecular Sciences, University of Coimbra, 3004-535 Coimbra, Portugal; (A.C.G.F.); (S.P.C.S.); (A.J.M.V.)
- Correspondence: (M.A.E.); (A.C.F.R.)
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Elgarhy LH, El-Tatawy RA, Ali DM, Anber DM, Iskandarani YA, Ismail MA. Treatment of stable nonsegmental vitiligo using transdermal delivery of 5-fluorouracil by fractional CO 2 laser versus intralesional injection of 5-fluorouracil, both followed by narrow-band type ultraviolet B (UVB): A comparative study. J Cosmet Dermatol 2022; 21:3832-3841. [PMID: 35005831 DOI: 10.1111/jocd.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Updates of treatment methods of stable vitiligo are needed to give better outcomes with a shorter duration of treatment. OBJECTIVE To test the effect of transdermal 5-fluorouracil (5-FU) delivery using fractional CO2 (FrCO2 ) laser versus intralesional 5-FU injection, with narrow-band type ultraviolet B (UVB) (NB-UVB) therapy after both, in the treatment of stable vitiligo. PATIENTS AND METHODS The present study comprised 40 patients with nearly symmetrical stable vitiligo lesions. The left side was treated with FrCO2 laser followed by topical 5-FU (FrCO2 + 5-FU), while the right side was treated with 5-FU intradermal injection. Both procedures were done at 2-week intervals for 3 sessions followed by 24 sessions of narrow-band UVB for both sides. RESULTS Repigmentation was demonstrated on the left side of 90% of patients and the right side of 85% of patients. As much as >50% improvement was demonstrated on the left side of 50% of patients, and the right side of 55% of patients. Intralesional 5-FU showed a statistically significant difference in repigmentation compared to FrCO2 + 5-FU. CONCLUSION Both 5-FU injection and FrCO2 + 5-FU were effective therapeutic modalities for vitiligo. Patients were more compliant with FrCO2 + 5-FU.
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Affiliation(s)
- Lamia H Elgarhy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rania A El-Tatawy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dareen M Ali
- Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doha M Anber
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mayada A Ismail
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Abdou AG, Farag AGA, Rashwan M, Shehata WA. The clinical and pathological effectiveness of microneedling and topical 5-fluorouracil in vitiligo treatment: An association with matrix metalloproteinase 2 immunohistochemical expression. J Cosmet Dermatol 2021; 21:2153-2161. [PMID: 34416072 DOI: 10.1111/jocd.14388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The current therapies for vitiligo require long duration with often disappointing outcomes. 5-Fluorouracil (5-FU) is a chemotherapeutic agent approved for topical use in the treatment of several dermatologic conditions. Matrix metalloproteinase 2 (MMP2) is synthesized by keratinocytes during the epidermal remodeling process and has been found to help in melanocyte migration. AIM To investigate the efficacy and safety of flexible microneedling followed by application of 5-FU in vitiligo treatment and to evaluate the immunohistochemical expression of MMP2 in involved skin in vitiligo patients before and after treatment. METHODS Twenty patients presented with vitiligo were planned to receive one session every 2 weeks for 12 weeks of microneedling followed by 5-FU application. Clinical response to therapy was evaluated by VASI score. Pre- and post-treatment biopsies were taken from vitiliginous patches for MMP2 immunostaining. RESULTS Fifteen patients (75%) responded to therapy with observed side effects such as pain, erythema, and hyperpigmentation of margins. The clinical response was more in young patients and those who have short disease duration. MMP2 was significantly increased in post-treatment biopsy compared with the pretreatment one. CONCLUSIONS 5-Fluorouracil application after microneedling is effective in the treatment of vitiligo with 75% response, 60% patient satisfaction, and tolerable side effects. The improvement in vitiligo patients by microneedling and 5-fluorouracil could be due to upregulation of MMP2 in affected vitiligo specimens.
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Affiliation(s)
- Asmaa Gaber Abdou
- Pathology Department, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Azza Gaber Antar Farag
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Manal Rashwan
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
| | - Wafaa Ahmed Shehata
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebein Elkom, Egypt
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12
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5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease. Dermatol Surg 2021; 47:e66-e70. [PMID: 33587385 DOI: 10.1097/dss.0000000000002879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND 5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. OBJECTIVE We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. METHODS We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). CONCLUSION In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
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13
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Kubelis-López DE, Zapata-Salazar NA, Said-Fernández SL, Sánchez-Domínguez CN, Salinas-Santander MA, Martínez-Rodríguez HG, Vázquez-Martínez OT, Wollina U, Lotti T, Ocampo-Candiani J. Updates and new medical treatments for vitiligo (Review). Exp Ther Med 2021; 22:797. [PMID: 34093753 PMCID: PMC8170669 DOI: 10.3892/etm.2021.10229] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Vitiligo is a multifactorial disease characterized by the loss of skin pigment, which results in achromic macules and patches. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. These treatments alone or combined have exhibited varying degrees of pigmentation, and the majority are safe and effective. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Individualized treatment is appropriate according to the location, clinical presentation and the presence of disease activity. The present review summarizes the medical treatments available for vitiligo: Systemic and topic pharmacological therapies, physical and depigmentation treatments. Several treatments are still underway and have not yet been approved. However, due to the promising preliminary results, these are also mentioned in the present review.
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Affiliation(s)
- David Emmanuel Kubelis-López
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Natalia Aranza Zapata-Salazar
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Salvador Luis Said-Fernández
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Celia Nohemí Sánchez-Domínguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | | | - Herminia Guadalupe Martínez-Rodríguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Osvaldo Tomás Vázquez-Martínez
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Uwe Wollina
- Department of Dermatology and Allergology and Skin Cancer Center, Städtisches Klinikum Dresden, D-01067 Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome G. Marconi, I-00193 Rome, Italy.,Department of Dermatology and Communicable Diseases, First Medical State University of Moscow I. M. Sechenev Ministry of Health, Moscow 119991, Russia
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
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Ewert de Oliveira B, Junqueira Amorim OH, Lima LL, Rezende RA, Mestnik NC, Bagatin E, Leonardi GR. 5-Fluorouracil, innovative drug delivery systems to enhance bioavailability for topical use. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Khater M, Nasr M, Salah S, Khattab FM. Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5‐fluorouracil in the treatment of nonsegmental vitiligo; A prospective comparative study. Dermatol Ther 2020; 33:e13532. [DOI: 10.1111/dth.13532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamed Khater
- Dermatology, Venereology and Andrology Department, Faculty of Medicine Zagazig University Egypt
| | - Mohamed Nasr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine Zagazig University Egypt
| | | | - Fathia M. Khattab
- Dermatology, Venereology and Andrology Department, Faculty of Medicine Zagazig University Egypt
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