Targeted phototherapy in combination with drug therapy for segmental vitiligo

According to the previous reports, segmental vitiligo usually shows a poor response to phototherapy. Here, we report two cases of recent onset segmental vitiligo that showed good or excellent response to targeted phototherapy in combination with drug therapy. These findings suggest that segmental vitiligo can be improved by combination therapy if its onset is recent.     

光疗法在白癜风治疗中的应用

白癜风是一种较为常见的影响美观的色素脱失性皮肤病.目前临床上多种方法被应用于白癜风的治疗,其中光疗法是相对比较有效的治疗手段,并且正在逐步推广应用于临床,也逐渐被越来越多的白癜风患者接受.     

Comparison of NB-UVB combination therapy regimens for vitiligo: A systematic review and network meta-analysis

Background

Vitiligo was an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance repigmentation.

Objectives

To compare the effectiveness of current NB-UVB combination regimen at the improvement in repigmentation through a systematic review and network meta-analysis.

Methods

We searched the electronic databases for randomized controlled trials related to NB-UVB combination therapy for vitiligo till October 2022. STATA15.0 software was applied to carrying out data analysis.

Results

A total of 28 eligible studies involving 1194 participants were enrolled in the analysis. The NMA results revealed that compared with NB-UVB, carboxytherapy [OR = 32.35, 95% CI (1.79, 586.05)], Er: YAG laser+ topical 5% 5-FU [OR = 10.74, 95% CI (4.05, 28.49)], needling/micro-needling [OR = 3.42, 95% CI (1.18, 9.88)], betamethasone intramuscular injection [OR = 3.08, 95% CI (1.17, 8.13)], topical tacrolimus [OR = 2.54, 95% CI (1.30, 4.94)], and oral Chinese herbal medicine compound [OR = 2.51, 95% CI (1.40, 4.50)] integrated with NB-UVB were more efficacious in excellent to complete repigmentation response rate (≥75%). Besides, NB-UVB+ Er: YAG laser+ topical 5% 5-FU [OR = 0.17, 95% CI (0.04, 0.67)] and NB-UVB+ needling/micro-needling [OR = 0.24, 95% CI (0.06, 0.88)] were less likely evaluated as ineffective repigmentation response (≤25%).

Conclusions

All combination therapies ranked higher than NB-UVB monotherapy in inducing successful repigmentation and avoiding failed treatment in patients with vitiligo. Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5% 5-FU and NB-UVB+ needling/microneedling would be the preferred therapeutic approaches.     

外用他克莫司软膏治疗白癜风临床观察

目的：观察他克莫司软膏治疗白癜风的临床疗效及安全性。方法：给予33例白癜风患者他克莫司软膏，每日2次外用，观察治疗后靶皮损复色情况，并与治疗前进行对比。结果：33例患者共计81处皮损，外用他克莫司软膏1～4个月后有效率为60．49％。2例患者用药后出现轻微瘙痒，2例患者局部出现炎性丘疹，均不影响治疗。结论：外用他克莫司软膏治疗白癜风疗效较好，不良反应少。     

High-dose prednisolone and psoralen ultraviolet A combination therapy in 36 patients with vitiligo

It is well known that systemic corticosteroids arrest the progress of vitiligo and lead to repigmentation, but they may produce unacceptable side-effects. The use of high-dose prednisolone therapy to minimize the side-effects of systemic steroids has been reported, but there have been no reports on the effectiveness of such treatment combined with phototherapy. We evaluated the efficacy and safety of combination therapy with intravenous prednisolone and psoralen ultraviolet A (PUVA). In 36 patients with vitiligo, intravenous methylprednisolone for 3 days was followed by PUVA twice weekly. After 6 months, vitiligo lesions on the face were reduced in size by 57.5%, on the upper extremities by 34.5%, on the trunk by 30.4% and on the lower extremities by 26.3%. Overall, improvement was seen in 13 patients (36.1%), with >50% repigmentation. Side-effects were mild and transient. We conclude that combination treatment of high-dose prednisolone therapy and PUVA may represent a highly effective therapeutic option for generalized vitiligo.     

Topical PUVA therapy for vitiligo.

Vitiligo, a pigmentary disorder of the skin, causes the appearance of white patches which are profoundly devastating to the person afflicted with this disease. This article outlines the safe use of topical PUVA therapy in the office for treating those patients with less than 20% skin surface involvement. This treatment has a response rate of approximately 50%.     

Successful treatment of autoimmune bullous diseases with a combination therapy of ciclosporin and corticosteroid

Three patients with autoimmune bullous diseases, pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid, were treated with a combination therapy of ciclosporin and corticosteroid. These patients responded to systemic low-dose prednisolone (or dexamethasone) and low-dose ciclosporin therapy; the result was prolonged complete remission. The addition of low-dose ciclosporin may produce enhanced clinical effects of steroid therapy without increasing any significant side effects.     

308nm准分子光联合他克莫司软膏治疗白癜风临床观察

目的观察308nm准分子光联合他克莫司治疗白癜风的临床疗效。方法 360例白癜风患者随机分为联合组和308单频光组,两组均采用准分子光系统进行308nm光疗,联合组同时外用他克莫司软膏。结果联合组和308单频光组的有效率分别为83.9%和70.1%,差异具有统计学意义(P<0.05)。两组临床有效率最高的部位均为颈部、面部和躯干,最低为手足部;稳定期疗效高于进展期,差异均具有统计学意义(P<0.05)。结论 308nm准分子光联合外用他克莫司软膏治疗白癜风临床疗效好。     

Photo(chemo)therapy for vitiligo

Vitiligo is a common skin disease characterized by loss of normal melanin pigments in the skin and its pathogenesis is still unclear. Treatment modalities include psoralen plus ultraviolet A, narrow-band ultraviolet B (NB UVB) phototherapy, topical and systemic steroids, topical calcineurin inhibitors, topical vitamin D analogues in monotherapy or in association with phototherapy, and surgical treatment. NB UVB (310-315 nm) radiation is now considered as the 'gold standard' for the treatment of diffuse vitiligo, and treatment with two recently introduced UVB sources that emit 308 nm wavelengths, the 308 nm xenon chloride (XeCl) excimer laser and the 308 nm XeCl excimer light, has also been reported to be effective and might be the treatment of choice for localized disease: this treatment modality has been defined as 'targeted phototherapy.'     

Photo(chemo) therapy for vitiligo

Vitiligo has always been difficult to treat. Several modes of treatment are available, but the therapeutic effect varies greatly, and rarely does one achieve complete repigmentation. One of the most efficient treatment methods is photo(chemo) therapy. Already in ancient Egypt, vitiligo lesions were treated with extracts of the Ammi maius plant followed by exposure to the sun. This principle is at the basis of the photochemotherapy or PUVA therapy, whereby UVA irradiations are given 2 h after administration of 8-methoxypsoralen, a photosensitizer. Another efficient treatment form is UVB phototherapy, particularly narrow-band UVB. This not only gives good therapeutic results but also has the advantage of eliminating the need for a photosensitizer. All these treatments must be applied for many months to be efficient. They can also be combined with various surgical skin-grafting techniques. A newer approach is targeted UVB phototherapy, whereby xenon-chloride lasers or monochromatic excimer light is used.     

Original article title: "Comparison of therapeutic efficacy of topical corticosteroid and oral zinc sulfate-topical corticosteroid combination in the treatment of vitiligo patients: a clinical trial"

Background

The prevalence of infections by nontuberculous mycobacteria (NTM) has steadily increased over the past decades, especially in immunocompromised patients.

Case presentation

We present a patient with IgA-deficiency and mixed cutaneous infection by two slowly growing mycobacteria, Mycobacterium (M.) haemophilum and M. kansasii.

Conclusions

Cutaneous M. haemophilum infections most often result from HIV or transplantation-associated immunosuppression. Rarely, M. haemophilum may also infect healthy patients or iatrogenically immunosuppressed patients without transplantation. M. kansasii is one of the most frequent NTM and large awareness exists about its involvement in human diseases. Mycobacterial diagnosis of cutaneous infections should be considered in long-lasting skin lesions.