白癜风靶向治疗的研究进展

随着白癜风发病机制的研究进展,针对特定免疫通路和分子的一系列靶向药物的研发也取得了一定突破。Janus激酶（JAK）抑制剂的局部外用剂型在II期临床试验中促进皮损显著复色;白介素-15受体（CD122）、诱导性热休克蛋白70（HSP70i）、NLRP3炎症小体、WNT蛋白等靶点的干预也在白癜风的细胞或动物模型中表现出确切疗效。本文从作用机制、疗效、安全性等方面综述了近五年来白癜风靶向治疗的研究进展。     

A new,innovative, and safe treatment in vitiligo: Results of a randomized,double‐blinded,parallel‐group study

Vitiligo is a chronic autoimmune disease affecting around 1% of the population worldwide. No existing treatment is giving fully satisfactory results. Further investigations are welcomed for innovative and safe treatments bringing better results. This trial aimed to compare the efficacy and tolerance of various treatment protocols on vitiligo lesions. Four randomized groups of 10 patients with vitiligo covering 8% to 14% of skin surface, except hands and feet were assigned during 8 weeks to (a) UVB microphototherapy 300 to 320 nm (Bioskin?) 1 x week; (b) VITILSI? gel 2 x day; (c) VITILSI? gel 2xday + Bioskin? 1 x week; and (d) placebo 2 x day. Efficacy of the treatment was assessed by planimetry, comparing the photographs of the patients taken at baseline and after 8‐week treatment. After completion of the treatment, the increase of the pigment area was 28% in G1 (Bioskin?), 19% in G2 (VITILSI?), 41% in G3 (Bioskin? + VITILSI?) and null in G4. No subject stopped the treatment and no side effect was observed. It was demonstrated that the gel under study was able per se to induce repigmentation in vitiligo lesions and that the results were significantly better when combined with NB‐UVB. The protocols used in this trial resulted safe and efficient.     

白癜风动物模型研究进展

白癜风的病因和发病机制尚未完全阐明,遗传、自身免疫、氧化应激和环境等多种因素参与了白癜风的发病, 建立适宜的白癜风动物模型可为研究其发病机制和开发新疗法奠定基础。相较自发性白癜风模型,诱导性模型能更好的模拟白癜风发病的病理过程及影响因素。本文着重综述了诱导性白癜风动物模型的最新进展。     

儿童白癜风的研究进展

白癜风是一种常见的获得性色素脱失性疾病。与成人白癜风相比,儿童白癜风从流行病学、临床表现、相关性疾病以及治疗选择均有一定的特异性。     

Evaluation of the effect of narrow band‐ultraviolet B on the expression of tyrosinase,TYRP‐1, and TYRP‐2 mRNA in vitiligo skin and their correlations with clinical improvement: A retrospective study

Narrowband‐ultraviolet B (NB‐UVB) is considered one of the main therapeutic tools in vitiligo, which is able to induce repigmentation and halt depigmentation. However, little remains known about the effect of NB‐UVB on TYR gene family, the main pigmentary genes, in vitiligo patients. To assess the effect of NB‐UVB on expression of some genes related to the pigmentary problem of vitiligo; tyrosinase (TYR), tyrosinase related protein 1 (TYRP1) and tyrosinase related protein 2 (TYRP2), mRNA levels of those genes were quantitatively evaluated by Real‐Time quantitative Polymerase Chain Reaction (RT‐qPCR) in skin biopsies obtained from 30 patients with nonsegmental vitiligo and five healthy controls. Vitiligo patients were classified into two groups; group 1, involving 12 untreated vitiligo patients and group 2, including 18 vitiligo patients treated by NB‐UVB. The levels of TYR, TYRP‐1, and TYRP‐2 mRNAs in untreated group were significantly lower than in control subjects (P < .001). In NB‐UVB treated group, the three genes were significantly higher than in group 1 (P < .001), however, they were still significantly lower than in the control subjects (P < .001). A significant positive correlation was detected between TYR and TYRP‐2 genes in group 2 (P = .03). This study demonstrated that mRNA level of TYR, TYRP‐1, and TYRP‐2, which decreased in vitiligo, was significantly increased upon treatment with NB‐UVB. Accordingly, the mechanism of depigmentation in vitiligo disease and repigmentation by NB‐UVB treatment may be related to the changes in the expression of these genes.     

A case of giant congenital nevocytic nevus with neurotization and onset of vitiligo

The authors report the case of a 21-year-old woman with a giant congenital nevocytic nevus (GCNN) who developed vitiligo at the age of 16 years on skin areas remote from the GCNN. This is the first reported case of GCNN developing neurotization combined with vitiliginous changes within the GCNN lesion. Treatment with PUVA achieved repigmentation of the vitiligo lesions, except for the hypochromic areas within the area of the nevus that were shielded from UVA radiation.     

Association of vitiligo with HLA-A2: a meta-analysis

BACKGROUND: Linkage and association studies suggest that the human leucocyte antigen (HLA) region may be involved in the genetic susceptibility of vitiligo. HLA-A2 has been reported to be associated with vitiligo in some, but not all, studies. OBJECTIVE: To identify sources of the heterogeneity among studies and to quantify effect estimates, we examined the association of HLA-A2 with vitiligo in a meta-analysis of all observational studies comparing the frequencies of HLA-A2 between vitiligo individuals and controls during 1966-2005. METHODS: The summary odds ratio (OR) was calculated by using a fixed- or a random-effects model. Meta-regression analysis was undertaken to investigate the effects of study characteristics on the pooled OR. RESULTS: Eleven case-controlled studies fulfilled our inclusion criteria. The studies identified a total of 777 patients and 4820 controls. Meta-analysis showed a significantly increased frequency of HLA-A2 in vitiligo among cases [OR = 2.07, 95% confidence interval (CI) 1.67-2.58]. Heterogeneity was explained by the quality of the study and the ethnic background of the participants. Meta-regression analysis further showed that the percentage of familial vitiligo among the subjects had a significant effect on the pooled OR (P = 0.008). No study had a significant effect on the pooled OR and no publication bias presented in the studies analysed (P = 0.688). CONCLUSION: These findings strongly suggest an association between HLA-A2 and vitiligo.     

Suplatast Tosilate (IPD®), a New Immunoregulator,Is Effective in Vitiligo Treatment

The major type of vitiligo is considered to be an autoimmune disorder. Anti-melanocyte antibodies are frequently detected in sera of patients with this disease. Interleukin (IL)-4 released from Th2 cells is an important factor in stimulating autoantibody production by B-cells. In this study, seven patients with vitiligo treated with suplatast tosilate (IPD), three showed repigmentation and improvement of their lesions after administration of the drug. IPD halted the continuous spread of the lesions in three of the other patients, and, in two of them, also reduced microsome test and thyroid test titers. The efficacy of IPD in treating vitiligo was thought to be due to the suppressive effect of this drug on IL-4 production. No side effect was observed. Thus IPD may represent a new alternative in vitiligo treatment due to its inhibition of autoimmunity by the suppression of IL-4.     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的:探讨外用0.1%他克莫司软膏联合308nm准分子激光治疗白癜风的疗效及安全性。方法:患者35例,以自身未治疗皮损作为空白对照,每例患者选择两处相近或对称部位的皮损,每周2次以308nm准分子激光进行治疗,共治疗16次。A组皮损同时每天早晚外用0.1%他克莫司软膏,B组单用308nm准分子激光治疗,试验结束时依据治疗前、后皮损的照片进行疗效评价。结果:试验结束时,未治疗的皮损均未出现任何改善,A组有效率为97.1%(34/35),B组为85.7%(30/35),显效率A组为74.3(&/35)、B组为48.6%(17/35),两组间显效率有显著性差(异2χ=4.884,P=0.023),但有效率差异不显著(2χ=2.917,P=0.088)。对18例患者进行随访,3个月内,A组所有治疗皮损均维持稳定或持续好转,而B组有3例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合外用0.1%他克莫司软膏可显著提高其疗效并减少复发。