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。     

儿童白癜风250例外周血白介素-6和粒细胞-巨噬细胞集落刺激因子的检测

目的检测儿童白癜风患者外周血中白介素-6(IL-6)和粒细胞-巨噬细胞集落刺激因子(GM-CSF),并探讨其意义。方法选取250位白癜风患儿为病例组,同时期年龄和性别匹配的健康体检儿童250例为对照组。病例组患儿根据白癜风分型标准再分为寻常型白癜风187例(局限型27例、散发型36、泛发型102例、肢端型22例)和节段型白癜风63例;按病期分为进展期134例,稳定期116例。两组对象的血清IL-6和GM-CSF浓度使用放射性免疫法测定并作比较。结果病例组中寻常型白癜风各亚型组患儿血清IL-6和GM-CSF水平均比对照组高(P均<0.05);寻常型白癜风患儿血清IL-6和GM-CSF水平也比节段型白癜风患儿高(P<0.05),但节段型白殿风患儿与对照组的水平差异无统计学意义(P>0.05)。病例组中寻常型白癜风各亚型组进展期患儿血清IL-6和GM-CSF水平比稳定期患儿高(P<0.05)。结论寻常型白癜风患儿血清中IL-6和GM-CSF水平与节段型白癜风患儿存在差异,提示它们在两种类型白癜风中可能发挥着不同的作用。     

1367例局限型白癜风的回顾性分析

目的 总结和分析局限型白癜风进展的临床特征.方法 采取调查问卷方式收集1 367例局限型白癜风门诊患者的临床资料,进行整理,统计分析局限型白癜风进展的临床特征.结果 由局限型发展到散发型白癜风782例(57.21％),平均4.701年；由局限型进展到肢端型白癜风199例(14.56％),平均6.721年；局限型发展为节段型191例(13.97％),平均2.034年；局限型发展为泛发型33例(2.41％),平均7.18年；有162例(11.85％)仍是局限型白癜风.结论 大多数局限型白癜风是寻常型白癜风的早期,少部分是节段型白癜风的早期.随着时间的进展以及相关可能诱因的影响,进展为散发型白癜风占多数.局限型白癜风平均经过7～8年,能进展为泛发型白癜风.因此,白癜风应尽早治疗,控制其发展.     

四物汤加味联合NB-UVB治疗白癜风33例临床观察

目的观察四物汤加味联合窄谱中波紫外线(NB-UVB)治疗白癜风的临床疗效和安全性。方法将入选的66例白癜风患者随机分为2组,各33例,全部患者予NB-UVB照射治疗,治疗组同时还予四物汤加味治疗,治疗3个月后判定疗效。结果治疗组有效率为75.76%,对照组有效率为45.45%;节段型白癜风有效率为84.61%,非节段型白癜风有效率为52.83%,治疗组和节段型白癜风患者的有效率明显高于对照组和非节段型白癜风患者的有效率,且差异均有统计学意义(P均0.05)。结论四物汤加味联合NB-UVB照射治疗治疗白癜风的疗效好,安全性高,值得临床医生选用。     

节段型白癜风的研究进展

同非节段型白癜风相比,节段型白癜风相对少见,发病更早,发展快,稳定也快,毛发在早期即被累及,好发于面部,常不伴发自身免疫性疾病,自体移植疗效好,且稳定。本文从节段型白癜风的历史、发病机制、临床特征和治疗等方面进行综述。     

节段型白癜风特殊性、辨治体会及验案举隅

白癜风是一种常见难治性皮肤顽疾，诸多白癜风患者体质辨识证候难循，而节段型白癜风发病部位、年龄、诱因等皆有其特殊性，中医证候、辨证治疗较非节段型更具特点。本文探讨节段型白癜风的特殊性及中医辨治体会，并报告1例典型病例，强调四诊合参、体察入微的重要性。     

色素障碍性皮肤病

20073006 208例儿童白癜风患者外周血免疫球蛋白、补体及T淋巴细胞亚群分析/林晓(复旦大学附属华山医院皮肤科),傅雯雯∥中华皮肤科杂志.-2007,40(9).-572~573检测了208例儿童白癜风患者外周血免疫球蛋白、补体和T淋巴细胞亚群的水平。结果发现:进展期与稳定期儿童白癜风患者体内体液免疫和细胞免疫水平均有显著差异,提示疾病的进展可能与免疫有关。节段型、局限型和散发型患者IgG水平明显低于肢端型,节段型患者CD3 水平高于散发型。提示各类白癜风患者体内免疫反应程度不同,节段型和局限型免疫反应程度可能较轻,肢端型相对来说可能体液…     

色素障碍性皮肤病

20101979儿童白癜风250例外周血白介素-6和粒细胞巨噬细胞集落刺激因子的检测/钟桂书(泸州医学院附院),史丙俊,熊霞∥中国皮肤性病学杂志.-2010,24(4).-318~320分病例组和相匹配的健康体检儿童对照组,以放射免疫法测定。结果血白介素-6(IL-6)和粒细胞巨噬细胞集落刺激因子(GM-CSF)水平检测如下:病例组显著高于对照组,寻常型白癜风组显著高于节段型,进展期显著高于稳定期。认为儿童寻常型白癜风血清中IL-6和GM-CSF水平与节段型白癜风存在差异,提示两指标在两型白癜风中发挥着不同的作用。表2参11(张江安)20101980白癜风与黑色素瘤关系的研究进展(综述)/牛建     

白癜风243例临床分析及与HLA-DQB1相关性研究

目的 总结和分析白癜风的临床特征及与两种HLA-DQB1等位基因的相关性,探讨白癜风的病因.方法 登记243例白癜风门诊患者的临床资料,利用聚合酶链反应-序列特异引物(PCR-SSP)法,对243例白癜风患者和250例健康人进行等位基因检测,对各项指标进行统计分析.结果 白癜风平均初发年龄男性为23.1岁,女性为23.7岁;首发类型以局限型为主,77%的节段型为儿童,家族史阳性患者发病年龄早于家族史阴性患者.白癜风与HLA-DQB1等位基因相关.结论 ①寻常型与节段型白癜风发病机制不同;②有阳性家族史者符合多基因遗传规律,有家族史和无家族史白癜风患者在其遗传背景上可能存在差异;③HLA-DQB1*0201可能是寻常型白癜风的易感基因或与易感基因相连锁.     

儿童白癜风与甲状腺功能指标异常及其他免疫性疾病的关系

目的 探讨儿童白癜风与甲状腺功能指标异常及其他免疫性疾病的关系。方法 对363例白癜风儿童（男198例 ,女165例 ）和 93 例对照儿童（男55例,女38例）进行甲状腺功能指标的检查。结果 363例白癜风儿童中有43例（11.8%）儿童有不同程度的甲状腺功能指标的异常,93例对照组正常儿童中有4例儿童甲状腺功能指标异常,两者比较差异有统计学意义。白癜风儿童甲状腺功能指标异常发生率明显增高（P < 0.05）。而43例甲状腺功能异常的白癜风儿童中,寻常型白癜风儿童为39 例（13.6%）,节段型白癜风儿童为4 例（5.3 %）,寻常型比节段型白癜风儿童甲状腺功能指标异常发生率有明显增高（P < 0.05）。结论 儿童寻常型白癜风患者的甲状腺功能指标异常的发生率明显增高。     

Guidelines for the management of vitiligo: the European Dermatology Forum consensus

The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence‐based and expert‐based recommendations (S1 level).     

Multiple keratoses and squamous carcinoma after PUVA treatment of vitiligo

PUVA is known to be carcinogenic when used in the treatment of psoriasis. To date skin cancer has not been demonstrated after PUVA treatment of vitiligo. We report a patient in whom multiple squamous cell carcinomata and keratoses developed in vitiligo areas after a prolonged course of PUVA.     

Development of vitiligo during melanoma treatment with a novel survivin inhibitor: a case report and review of the literature

Background  The development of vitiligo has been associated with an improved clinical response in melanoma patients.
Methods  We report a case of vitiligo associated with a novel antisurvivin drug and review the literature to determine the pathogenesis of vitiligo occurring during melanoma treatment.
Results  A 78-year-old man with stage IV malignant melanoma developed vitiligo after the first therapeutic cycle of a novel antisurvivin drug. Although his vitiligo remained static, his melanoma continued to progress and he died in 8 months. A review of the literature demonstrates a relationship between vitiligo development and improved clinical response in many melanoma cases treated with immunotherapy; however, the relationship may depend on the type of treatment.
Conclusions  Understanding complex immune responses in vitiliginous skin and melanoma sites is important in order to interpret the development of vitiligo occurring during melanoma treatment.     

Vitiligo as a reaction to topical treatment with diphencyprone

During the topical treatment of 45 patients, who had extensive forms of alopecia areata, with the allergen diphencyprone, 3 of them (6.7%) developed vitiligo. Two were females and 1 male aged 53, 19 and 28 years respectively. None of these patients had a personal or family history of vitiligo. Vitiligo appeared 3-5 months after the onset of treatment and was localized only to the areas of topical application in the younger woman and the man. In the older woman, vitiligo extended to several areas apart from those where the medicament was applied. After the end of diphencyprone treatment, vitiligo had a spontaneous significant improvement only in the man. Mitochondrial autoantibodies were found in the older woman only. To our knowledge, vitiligo due to diphencyprone has not been previously reported.     

A review of monochromatic excimer light in vitiligo

Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB‐UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308‐nm radiation wavelength is delivered in a targeted form by the xenon‐chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB‐UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head‐to‐head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side‐effect profile. Long‐term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.     

Thyroid abnormalities in pediatric patients with vitiligo in New York City

The link between vitiligo and thyroid disease has been well-established. However, the types of patients at risk for thyroid disease and the strength of this connection in childhood are debatable. We retrospectively reviewed 67 charts of pediatric dermatology patients with vitiligo vulgaris (53 with nonsegmental vitiligo) who were tested for thyroid disease. In our cohort of 28 patients with available thyroid test results, we identified 7 patients (25%) with active thyroid disease. None of the 7 patients with thyroid disease had segmental vitiligo. If we had included the broader number of patients (N=67), the rate may have been as low as 10.4% overall (7/67), which is still a substantial rate of thyroid disease. These results are comparable to the European literature and highlight the need for thyroid screening in children with vitiligo vulgaris of a generalized nonsegmental type.     

Treatment of vitiligo vulgaris with narrow band UVB (311 nm) for one year and the effect of addition of folic acid and vitamin B12

Narrow band UVB is succeeding psoralen and UVA irradiation as the main treatment of vitiligo vulgaris in several European countries. Vitamin B12 and folic acid deficiency in some vitiligo patients has prompted researchers to investigate the efficacy of these vitamins in the treatment of vitiligo. In the present controlled study we investigated the value of narrow band UVB phototherapy in the treatment of vitiligo and the possible additive effect of vitamin B12 and folic acid. Twenty-seven patients with long-term stable vitiligo were included and randomized in a "UVB only" (UVB) or "UVB combined with vitamin B12 and folic acid" (UVB+) group. Patients were irradiated thrice weekly for one year, whilst repigmentation was carefully monitored. In 92% (25/27) of the patients up to 100% repigmentation was seen. Repigmentation was notable in lesions on the face, neck and throat, lower arm, chest, back and lower legs, whilst repigmentation on the hands, wrists, feet and ankles proved to be minimal. Maximum repigmentation rates did not differ significantly between the UVB group and the UVB+ group. Our study reconfirms that narrow band UVB phototherapy is an effective treatment for vitiligo and shows that co-treatment with vitamin B12 and folic acid does not improve the outcome of treatment of vitiligo with narrow band UVB phototherapy.     

Efficacy of oral cholecalciferol on rhododendrol‐induced vitiligo: A blinded randomized clinical trial

Rhododendrol (RD), 4‐(4‐hydroxyphenyl)‐2‐butanol, inhibits melanin synthesis and has been used for skin‐whitening cosmetic products. RD has been very effective in lightening skin pigmentation, but some persons have developed so‐called RD vitiligo, in which vitiligo starts on the face, neck and hands where topical RD has been applied and even extended over skin areas where RD has not been applied. RD vitiligo lesions in some patients have lasted for years and have been resistant to conventional vitiligo treatments. We examined the effects of cholecalciferol on RD vitiligo in a blinded randomized clinical trial. Forty‐eight female RD vitiligo patients were recruited for the trial and were randomized into two groups: the vitamin D (VD)‐intervention group that received daily 5000 IU cholecalciferol for 5 months and the control group. Three blinded investigators scored vitiligo improvement by comparing photographic images of baseline and at 5‐month observation. Serum 25(OH)D3 of RD vitiligo patients was not significantly different from age‐matched healthy volunteers. Twenty‐two in the VD‐intervention group and 23 in the control group completed the 5‐month observation. Serum 25(OH)D3 levels were significantly increased after the 5‐month VD intervention, while the control group did not change. The improvement scores were significantly higher in the VD‐intervention group than the control group. The improvement scores were positively correlated with the serum 25(OH)D3 levels after the 5‐month intervention period but not before the treatment. This blinded randomized clinical trial showed favor in administrating 5000 IU cholecalciferol daily to RD vitiligo patients.     

Vitiligo following intense pulsed light treatment

Vitiligo is an acquired depigmenting disorder characterized by the progressive loss of melanocytes from the epidermis and epidermal appendages, which results in milky‐white macular lesions. Various factors are suspected to affect the induction and progression of vitiligo such as emotional shock, sunburn, pregnancy, physical illness and trauma. The intense pulsed light (IPL) device which mostly affects redness and dyspigmentation has a broad spectrum of emissions of white light with wavelengths between approximately 515 and 1200 nm. Adverse effects such as purpura and pigmentary changes are known to be rare. We present a 41‐year‐old woman who developed multiple round, hypopigmented macules on both the cheek and mandibular area following the treatment with IPL for lentigines and dyspigmentation. Based on biopsy and Wood’s lamp examination, diagnosis as vitiligo was made. She was treated with a 308‐nm excimer laser. After 3 months of treatment, almost complete repigmentation was seen but another coin‐sized hypopigmented patch was noted after 5 months later. Herein, we report a case of vitiligo which developed after IPL treatment. This is the first case to be reported which vitiligo developed after IPL treatment. Therefore, dermatologists should be aware of unsighted vitiligo lesion before IPL treatment.     

Therapie der Vitiligo

The range of treatment options for vitiligo has significantly expanded in the last 10 years and we can offer our patients more effective treatment strategies supported by European guidelines and consensus findings. Topical and UV therapy are—often in combination—the main components of vitiligo treatment. The main outcome parameters include extent and maintenance of gained repigmentation, cessation of spreading, avoidance of side effects and the influence of the treatment on the quality of life. The efficacy of the currently available treatments is often limited. New options include antioxidative or melanocyte-stimulating adjuvant therapies in combination with UV or laser light as well as a topical maintenance treatment to reduce the risk of recurrences. In many cases, psychological support is indicated.