儿童白癜风

儿童患者构成了白癜风的一个独特亚群,其临床特点、治疗方案及治疗反应等方面与成人患者有所不同,本文将介绍儿童白癜风的临床及治疗并与成年患者比较分析.     

中外白癜风诊疗指南及共识比较

本文从白癜风分型、分期、病情评估、药物治疗及非药物治疗等方面比较了欧洲、美国、日本、韩国、中国等地区和国家的白癜风诊疗指南或共识, 概要分析各指南及共识中推荐的白癜风疗法和强调理念的异同, 以帮助临床医生为白癜风患者提供合适的个体化治疗方案。     

遮盖疗法在白癜风治疗中的应用

【摘要】 白癜风目前缺乏特异性靶向治疗药物,现有治疗存在复色慢、周期长及易复发等问题。遮盖疗法作为一种能够快速改善患者容貌的治疗策略,在多种皮肤病治疗中发挥着独有的优势。国内外多项研究表明,正确使用遮盖疗法可以有效改善白癜风患者的容貌及生活质量。本文总结了各种遮盖疗法的相关知识以及有关遮盖疗法与白癜风患者生活质量的临床研究,并阐述了遮盖疗法在白癜风治疗中的应用前景。     

光疗及光化学疗法治疗儿童皮肤病

临床实践证实,光疗及光化学疗法可以治疗儿童银屑病、白癜风、特应性皮炎及副银屑病等疾病,并且疗效肯定。另外,在一些少见皮肤病中也有应用。但是出于对光疗和光化学疗法长期应用的潜在不确切的致癌性的考虑,以及用于儿童治疗时所采用方法的不统一,和儿童依从性差等问题,限制了其在儿童中的应用。为此,介绍光疗及光化学疗法在儿童皮肤病的应用情况及其安全性和治疗特点等。     

外用光化学疗法治疗儿童白癜风疗效及安全性评价

目的　评价外用光化学疗法治疗儿童白癜风的临床疗效和安全性。方法　以局部外用 8 甲氧补骨脂素配合局部照射UVA为治疗组 ,以单纯外用 8 甲氧补骨脂素为对照组 ,分别于治疗 3个月、6个月时进行疗效及不良反应的评价。结果　治疗组临床疗效明显优于对照组 (P <0 .0 5 ) ;治疗期间 ,两组患者均无严重不良反应发生。结论　外用光化学疗法治疗儿童白癜风疗效确切 ,安全性好     

白癜风的外科治疗

白癜风(vitligo)是一种常见的色素脱失性皮肤病,发病可能与遗传、神经、生化、病毒感染和自身免疫等因素有关.治疗白癜风主要有物理疗法、药物疗法及外科疗法,近年来一些新技术、新药物的出现,尤其是白癜风的细胞悬液移植技术给白癜风的治疗带来了新的希望.本文综述白癜风的外科疗法进展.     

水浴PUVA成功治疗儿童白癜风

白癜风在儿童并不少见,口服PUVA治疗虽然对成人有效,但因有远期副作用而不推荐用于治疗儿童;外用PUVA虽是可选择疗法之一,在其不足之处是明显的光毒反应、不规则色素沉着和系统吸收。作者使用水浴PUVA,成功地治疗1例9岁进行期白癜风患儿,报告如     

儿童白癜风治疗进展

白癜风治疗方法很多,但一般而言,儿童及青少年患者治疗效果要优于成人。白癜风治疗的关键在于稳定疾病进展、促使皮损复色,本文对临床常用治疗儿童白癜风的方法进行了综述。     

白癜风外科治疗新进展——毛囊外根鞘细胞悬液移植

白癜风是一种皮肤色素异常性疾病,表现为慢性局限性的皮肤色素脱失斑,表皮黑素细胞功能进行性丢失,如果出现毛发变白则提示预后较差。白癜风的外科疗法即手术治疗,适用于对光疗或药物治疗无效的稳定期白癜风患者,对非手术疗法不敏感的皮损,如唇部、手足、手指及生殖器等部位也可采用外科疗法。除了常见的自体表皮移植和自体黑素细胞移植,近年来采用毛囊单位提取法获取毛囊外毛根鞘细胞悬液移植作为一种新的外科手段,逐渐显现出其在白癜风治疗中的优势。该文就该方法在白癜风中的应用作一综述。     

白癜风外科治疗共识（2012）

白癜风是一种常见的影响美容的获得性皮肤色素脱失性疾病,病因及发病机制仍然不清楚,临床治疗比较棘手.目前多采用综合疗法治疗白癜风,但是某些类型白癜风对药物治疗反应不好,甚至部分治疗有效的患者也存在某些皮损对治疗疗效不佳的现象.因此,外科治疗是对顽固性白癜风的有效手段之一,特别是对局限性稳定性白癜风皮损有良效.     

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。     

儿童白癜风396例临床分析

目的 探讨汉族儿童白癜风的临床特点。方法 采用问卷调查方式对浙江省396例儿童白癜风及825例成人白癜风患者进行临床分析，用SPSS 10.0软件包对资料进行分析。结果 396例儿童白癜风患者中男183例占46.2%，女213例占53.8%，与成年患者相比，男女之间无性别差异。儿童患者中节段型的比例为33.3%，明显高于成人患者的13.5%，泛发型比例为4.3%，显著低于成人患者的11.6%。儿童患者家族史阳性比例为12.4%，成人患者家族史阳性比例为12.7%，两组间差异无统计学意义。有家族史患者一级亲属的发病率均明显高于二级亲属。儿童患者的诱发因素以外伤为主，伴发晕痣的比例明显高于成人患者；成人患者伴发甲状腺疾病的比例显著高于儿童患者。结论 儿童白癜风临床特点与成人相比有一定差异。     

Childhood Vitiligo: Treatment Paradigms

Childhood vitiligo differs from the adults by showing a higher incidence in females, segmental vitiligo being more common and less frequent association with other systemic autoimmune and endocrine disorders. Childhood vitiligo is often associated with a marked psychosocial and long lasting effect on the self-esteem of the affected children and their parents, hence an adequate treatment is very essential. Treatment of vitiligo is indeed a tough challenge for the dermatologists’ more so in the background of childhood vitiligo. Although multiple therapeutic modalities are available in the therapeutic armamentarium, not all can be used in children. This brief report updates regarding various therapies available in the treatment of childhood vitiligo.     

Childhood Vitiligo: Clinicoepidemiologic Profile of 268 Children from the Kumaun Region of Uttarakhand,India

Childhood vitiligo differs from adult vitiligo in many clinical parameters. The objective of the current study was to study the clinicoepidemiologic profile of childhood vitiligo and to compare various clinical characteristics of childhood‐ and later‐onset vitiligo. The clinical presentation of vitiligo was examined and analyzed in 762 individuals attending the Dermatology Clinic of Government Medical College, Haldwani, a referral center for the Kumaun region of Uttarakhand state, India, between January 2006 and December 2010. Of the 762 individuals with vitiligo, 268 (35.2%) were children: 152 (56.7%) female and 116 (43.3%) male. The mean age of onset of vitiligo was 6.9 years. A family history of vitiligo was found in 24.3% of children. The most common site of onset was the head and neck (36.9%), followed by the lower limbs and trunk. The most common type of vitiligo observed was acrofacial vitiligo (38.1%), followed by vulgaris, segmental, focal, and mucosal. Leukotrichia was observed in 32.5% of children and Koebner's phenomenon in 24.3%. On comparison of childhood‐ and later‐onset vitiligo, there were statistically significant differences (p < 0.05) in sex, family history, type of vitiligo (segmental and vulgaris), and site of onset. Atopic dermatitis was one of the important cutaneous diseases associated with childhood‐onset vitiligo. Thirty‐five percent of all patients with vitiligo were children (≤12 yrs). Childhood‐onset vitilgo differs from later‐onset vitiligo in many clinical parameters such as sex, family history, types of vitiligo, and sites of onset.     

三种胎盘制剂联合红外线照射治疗儿童白癜风的临床疗效观察

目的 探讨3种胎盘制剂治疗儿童白癜风的临床疗效。方法 儿童白癜风182例,分为3组,分别采用黑素生成素、人胎盘组织液以及人胎盘脂多糖3种药物外用,3组均联合红外线照射,每天照射2次,每次20 min,照射期间每隔5 min搽药液1次。结果 黑素生成素治疗组治疗儿童白癜风有效率为75.65%;人胎盘组织液组有效率35.00%;人胎盘脂多糖组有效率44.44%,3种胎盘制剂的总有效率之间差异有统计学意义（P值均 < 0.05）,尤其是对于头皮较大面积患者,黑素生成素组疗效明显优于其他两组。结论 3种胎盘制剂外用联合红外线照射治疗儿童白癜风有较好疗效。     

The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo

Background: Numerous modalities have been used to treat vitiligo in children. Up to now, phototherapy and topical corticosteroids are the most commonly used treatments for adult vitiligo but studies evaluating the efficacy of these treatments in the pediatric population remain insufficient. Objective: This study was a retrospective review to evaluate the efficacy and safety of 308‐nm excimer laser treatment in 30 childhood vitiligo patients. Methods: Thirty vitiligo patients with 40 vitiligo patches were evaluated after the cessation of 308‐nm excimer laser treatment. Results: Seventeen patients (56.7%) with 20 patches (50%) achieved an acceptable degree (>50%) of repigmentation at the end of the treatment, with five patches (12.5%) showing >75% of repigmentation. The treatment response showed anatomical preferences, favoring the face, neck and trunk. However, the treatment response did not correlate to the cumulative dose or duration of treatment. Side effects occurred in nine patients, but were transient and minimal. Conclusion: The results of this study shows that the 308‐nm excimer laser can be an effective and promising device for the treatment of various vitiligo types, other than generalized, in childhood.     

Impact of childhood vitiligo on adult life

Background The onset of vitiligo occurs before the age of 20 years in 50% of patients. Having a chronic disease in childhood can impede a child’s health‐related quality of life (HRQL). Objectives Firstly, to compare the social and psychosexual development and current HRQL of young adult patients with childhood vitiligo with those of a group of healthy controls. Secondly, to compare these outcomes in patients reporting negative childhood experiences with those of patients not reporting negative childhood experiences. Methods Eligible patients were mailed questionnaires on (i) sociodemographic and clinical characteristics, (ii) social and psychosexual development, (iii) generic and dermatology‐specific HRQL, (iv) presence of negative childhood experiences related to vitiligo, (v) specification of these negative experiences and (vi) patients’ recommendations for further care. Results A total of 232 patients with vitiligo completed the questionnaires. Social and psychosexual development and generic HRQL in young adult patients with childhood vitiligo were not different from those of healthy controls. However, patients reporting negative childhood experiences reported significantly more problems in social development than those not reporting negative experiences. Furthermore, negative childhood experiences were significantly associated with more HRQL impairment in early adulthood. Conclusions Reporting negative experiences from childhood vitiligo appears to be associated with HRQL impairment in young adults with vitiligo.     

胎盘制剂治疗白癜风的研究进展

白癜风是最常见的色素减退性皮肤病,临床治疗困难.胎盘制剂含有相对分子质量大于3000的蛋白,肽类和鞘脂,可以通过p38丝裂原活化蛋白激酶通路促进黑素合成.胎盘制剂也可以促进成黑素细胞增殖和分化,其治疗白癜风具有安全、有效、不良反应少的特点,尤其是治疗儿童头皮部白癜风的理想药物.     

Effects of age of onset on disease characteristics in non‐segmental vitiligo

In patients with vitiligo, the clinical and laboratory features of the disease may vary according to time of onset. This is addressed in the literature by only a few studies with conflicting results. The aim of this study was to determine the demographic and clinical features of patients with non‐segmental vitiligo and to establish the association between vitiligo and autoimmune diseases with a focus on time of disease onset. A total of 224 vitiligo patients for whom complete medical records were available were evaluated retrospectively. Demographic data, scores on the Vitiligo Area Score Index (VASI), clinical features, vitiligo disease activity, repigmentation status, presence of any accompanying autoimmune disease, antinuclear antibody (ANA) titers, serum levels of glucose, thyroid‐stimulating hormone (TSH), thyroxine (T4) hormone, anti‐thyroid peroxidase (anti‐TPO), and anti‐thyroglobulin (anti‐TG) were recorded. The prevalence of halo nevi was significantly higher (P < 0.001) among children than in other patient groups. The prevalence of leukotrichia was higher in adults with adult‐onset disease than in either pediatric patients or adults with childhood‐onset disease (P = 0.002). Both anti‐TG and anti‐TPO levels were significantly higher in adults with adult‐onset disease than in pediatric patients and adult patients with childhood‐onset disease. The prevalence of autoimmune disease was 22.2%. Anti‐TG levels were significantly higher in patients with treatment‐related repigmentation than in those without repigmentation. This study shows that clinical features and associations with autoimmune disease may vary according to the age of onset of vitiligo.     

A Pilot Study of 1% Pimecrolimus Cream for the Treatment of Childhood Segmental Vitiligo

Background

There is as yet no effective and safe treatment for vitiligo. One percent pimecrolimus cream, a topical calcineurin inhibitor, has been tried for the treatment of vitiligo, with its therapeutic efficacy having mostly been reported in non-segmental vitiligo. However, questions about the therapeutic efficacy of 1% pimecrolimus cream have remained unanswered regarding segmental vitiligo.

Objective

The aim of this study was to study the therapeutic efficacy and safety of 1% pimecrolimus cream for segmental childhood vitiligo.

Methods

Nine childhood patients with segmental vitiligo were treated with 1% pimecrolimus cream twice daily for three months, after which good responders were scheduled to continue with the 1% pimecrolimus cream monotherapy. The efficacy and safety of this treatment were determined by the levels of repigmentation, initial response time and the presence of adverse events including burning, dryness, stinging and itching.

Results

Four of nine patients achieved mild to moderate responses after three months of treatment and thus continued with treatment. Among these four patients, three achieved an excellent response and one patient achieved a moderate response, with a mean treatment duration of 7.3 months. Transient local burning sensation was the most common adverse event. In comparison with the patients with poor response, those patients with good response showed a shorter disease duration (8.5±10.5 mo vs. 13.4±10.1 mo), more frequent facial involvement (4/4 patients vs. 3/5 patients) and earlier initial response after treatment (1.0±0.0 mo vs. 2.0±1.0 mo).

Conclusion

This study suggests that 1% pimecrolimus cream is an effective and well-tolerated treatment for segmental childhood vitiligo.