2013欧洲白癜风指南

欧洲不少国家都有自己的白癜风治疗指南,但尚无统一的欧洲指南版。该指南是欧洲白癜风学组在循证医学和专家共识的基础上,第一次制定的针对节段型和非节段型白癜风的欧洲指南。该文解读此指南以供参考。     

脓疱型银屑病诊疗中国专家共识(2022版)

脓疱型银屑病是银屑病的特殊类型, 临床表现以红斑基础上的无菌性脓疱为特征, 病因涉及遗传、免疫及感染等多种因素。脓疱型银屑病分为局限性和泛发性两个主要亚型。局限性脓疱型银屑病以外用药物治疗为主, 疗效欠佳者可采用系统治疗和光疗;泛发性脓疱型银屑病通常需要系统治疗, 可联合外用药物治疗和光疗。在国内外最新指南及共识的基础上, 结合我国的诊疗现状, 本专家委员会重点在脓疱型银屑病的临床表现及分型、辅助检查、诊断标准和治疗等方面形成共识, 以进一步形成规范化诊疗模式。     

白癜风诊疗共识（2014版）

本指南以中国中西医结合学会皮肤性病专业委员会色素病学组制订的白癜风治疗共识（2009版）为基础,经色素病学组、中华医学会皮肤科分会白癜风研究中心部分专家及国内相关专家讨论制定……     

国内外斑秃诊疗指南/共识比较

迄今, 各国均制定了相应的斑秃诊疗指南/共识, 不同指南/共识间的差异体现了各国不同的背景、相关研究状况、医疗资源差异以及诊疗习惯。本文比较了近3年内发表的中外斑秃诊疗指南/共识, 分析斑秃的流行病学、病因、诊断、病情评估及治疗, 从而对我国斑秃规范化、个体化诊治起到借鉴作用。     

白癜风靶向药物临床应用进展及前景

近年针对白癜风的发病机制研究取得了较大进展, 涌现了较多新的治疗方法和药物。γ干扰素激活的Janus激酶(JAK)信号和黑色素细胞再生信号通路是目前白癜风治疗研究中最受关注的靶点。本文总结了当前针对这些通路的新药物在白癜风治疗中的效果和经验, JAK抑制剂是目前最有前景的新型药物, 且联合光疗可提高疗效。     

白癜风治疗指南文献分析

白癜风是一种常见的色素脱失性疾病,以皮肤或黏膜色素减退为特征,易诊而难治.近年来,国内外对其治疗方案很多,其目的主要是控制白斑的进展,使白斑复色直至正常的皮肤.目前英国、美国、荷兰、沙特阿拉伯、希腊、中国等国家已有针对白癜风的治疗指南.但是白癜风治疗方案的选择受不同文化背景和疾病临床特征的影响.概述国内外有关白癜风的治疗指南及不同国家的治疗指南做一简要比较,为白癜风患者的治疗提供参考方案.     

白癜风治疗共识(2009版)

本指南以中国中西医结合学会皮肤性病专业委员会色素病学组制订的白癜风治疗共识修改稿(2005版)为基础,经色素病学组委员及国内相关专家讨论制定.     

带状疱疹抗病毒药物的合理选择

抗病毒治疗是带状疱疹治疗的核心, 本文结合最新研究、共识和指南, 探讨抗病毒药物种类和剂量的合理选择。伐昔洛韦口服生物利用度高, 且用药更方便, 一般是口服抗病毒药物的首选;而对于一些特殊情况, 如免疫力低下患者, 应酌情选择静脉滴注阿昔洛韦。对于严重肾功能不全的患者, 溴夫定往往是更好的选择;对阿昔洛韦耐药的患者应考虑使用泛昔洛韦或者其他抗病毒药物治疗;而对于免疫力低下同时合并阿昔洛韦耐药的患者可选择静脉滴注膦甲酸钠。使用口服抗病毒药应达到足够的剂量。选择合适的抗病毒药物及剂量能有效缓解患者急性期症状, 同时降低发生带状疱疹后神经痛的可能性。     

白癜风治疗进展

白癜风系色素脱失性皮肤病,易诊断,难治疗,一般可参考国内2009版白癜风治疗共识。近年来联合治疗成为临床最常用的治疗模式,如光疗联合外用药物治疗,手术治疗联合光疗等。新的治疗方法主要为手术方法的改进、非常规口服药及外用药、基因治疗及生物制剂如抗肿瘤坏死因子(TNF)-α制剂治疗,这些方法临床应用较少,其疗效尚需临床试验的验证。     

2022年医学期刊发表中国皮肤病学指南和共识的科学性、透明性和适用性评级

目的评估并分析2022年期刊发表的中国皮肤病学指南和共识的科学性、透明性和适用性。方法在中国知网、万方数据知识服务平台、中国生物医学数据库、中华医学期刊网、Medline(PubMed)和Web of Science数据库中检索并筛选2022年中国皮肤病学领域发表的指南及共识。由指南和共识的科学性、透明性和适用性评级(STAR)皮肤科学专科委员会中获评级资格认证的委员采用STAR工具进行评级, 每部指南或共识均由2位评价人员开展独立评价并交叉核对。计算指南及共识得分及各领域和各条目得分比例。结果共纳入中/英文指南及共识34部, 包括指南11部, 共识23部。STAR评级最高分84.6分, 最低分4.3分, M(Q1, Q3)为20.7(12.7, 29.3)分, 平均得分24.7分。得分比例最高的3个领域分别为"推荐意见"领域(44.9%)、"其他"领域(44.1%)和"工作组"领域(31.8%), 得分比例最低的3个领域分别为"计划书"领域(3.7%)、"资助"领域(9.8%)和"注册"领域(11.8%)。得分比例最高的条目为主要推荐意见有明确的参考文献(94.1%), 得分比例最低...     

The development of guidelines for the treatment of vitiligo. Clinical Epidemiology Unit of the Istituto Dermopatico dell'Immacolata-Istituto di Recovero e Cura a Carattere Scientifico (IDI-IRCCS) and the Archives of Dermatology

OBJECTIVE: To develop and introduce evidence-based guidelines for the treatment of vitiligo in children and in adults. PATIENTS AND SETTING: Patients, residents, and dermatologists from the Department of Dermatology, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Pigmentary Disorders in Amsterdam. DESIGN: Scientific evidence obtained from 3 systematic reviews of the literature was combined with the results of 2 questionnaires and interviews of potential users of the guidelines, 3 internal expert meetings, and 1 local expert meeting, during which preliminary guidelines were presented and commented on. A final version of the guidelines was synthesized and disseminated among potential users. Six months after the introduction of these guidelines, their use was evaluated. RESULTS: Before the development of the guidelines, there was no uniformity in treatment selection, and there was a variability in estimates of treatment outcome. The metaanalysis showed class 3 corticosteroids and narrowband UV-B to be the most effective and safest therapies for localized and for generalized vitiligo, respectively. From another systematic review, it could be concluded that patients with segmental, stable, or lip-tip vitiligo could be successfully treated with most autologous transplantation methods. For vitiligo universalis, results of the systematic review showed that depigmentation using monobenzone or a Q-switched ruby laser was equally effective. The final version of the guidelines consisted of a treatment scheme together with detailed treatment protocols. Implementation of the guidelines was evaluated in 5 physicians. After the introduction of these guidelines, they were followed in most adult cases with vitiligo (71% of patients with localized vitiligo, 82% with generalized vitiligo, 100% with stable or segmental vitiligo, and 80% with universal vitiligo). In children with vitiligo, the physicians adhered to the guidelines for 52% of the cases. CONCLUSIONS: Guidelines for the treatment of vitiligo can be successfully developed and disseminated for daily clinical practice. The results of the implementation of these guidelines should be confirmed in other centers involving more clinicians.     

白癜风诊疗共识（2021版）

【摘要】 白癜风是一种常见色素性皮肤病之一,严重影响患者的身心健康。中国中西医结合学会皮肤性病专业委员会色素病学组在2018版白癜风治疗共识的基础上复习近3年白癜风的研究进展,同时结合专家的临床经验,对白癜风的维持治疗和糖皮质激素干预应用进行修订,展望JAK抑制剂治疗,最终达成本共识。     

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.     

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.     

Autologous transplantation techniques for vitiligo: how to evaluate treatment outcome

Effective methods for measuring treatment outcome in vitiligo are essential to accurately assess possible therapeutic modalities. This systematic review article aims to bring the problems concerning evaluation of treatment outcome in vitiligo studies using transplantation techniques to the attention of clinical investigators. Furthermore we highlight the interpretation of the achieved result from both physicians' and patients' view point using a questionnaire put to 558 dermatologists and 152 vitiligo patients in Belgium. There is no consensus about the choice of an evaluation method in surgical vitiligo studies. The interpretation of a 'successful' treatment result seemed to differ among dermatologists and vitiligo patients. We conclude that further research is needed to develop a universally accepted, objective, reliable and useful measurement method to evaluate the efficacy of surgical vitiligo treatments. A combination of both a clinical and a psychological measurement is likely to be the most appropriate choice.     

Which outcomes should we measure in vitiligo? Results of a systematic review and a survey among patients and clinicians on outcomes in vitiligo trials

Summary Background Relevant and reliable outcomes play a crucial role in the correct interpretation and comparison of the results of clinical trials. There is a lack of consensus around methods of assessment and outcome measures for vitiligo, which makes it difficult to compare results of randomized controlled trials (RCTs) and perform meta-analysis. Objectives To describe the heterogeneity in outcome measures used in published RCTs of vitiligo treatments, and to report the most desirable outcomes from patients' and clinicians' perspectives. Methods We conducted a systematic review of outcome measures used in RCTs as well as a survey of the most desirable outcomes identified by patients and clinicians as part of a Vitiligo Priority Setting Partnership. Results Outcomes from 54 eligible trials were analysed and compared with outcomes suggested by patients and clinicians. In the systematic review, 25 different outcomes were reported. Only 22% of trials had clearly stated primary outcome measures. Repigmentation was the most frequently reported outcome in 96% of trials and was measured using 48 different scales. Only 9% of trials assessed quality of life. Thirteen per cent measured cessation of spreading of the disease and 17% of studies reported patients' opinions and satisfaction with the treatment. In contrast, out of 438 suggestions made by patients and clinicians, cosmetically acceptable repigmentation (rather than percentage of repigmentation) was the most desirable outcome (68%), followed by cessation of spread of vitiligo (15%), quality of life (8%) and maintenance of repigmentation (4%). Conclusions We propose that future vitiligo trials should include repigmentation, cosmetic acceptability of results, global assessment of the disease, quality of life, maintenance of repigmentation, stabilization of vitiligo and side-effects. International consensus among clinicians, researchers and patients is needed to establish an agreed core outcome set for future vitiligo trials.     

儿童白癜风的特点及治疗进展

 白癜风是常见的色素脱失性疾病,儿童白癜风在流行病学、临床表现、伴发疾病等方面有一定的特异性。另外,考虑儿童生长发育阶段的特殊性,儿童白癜风的治疗选择也不同于成人。尽管目前儿童白癜风的治疗仍以传统疗法为主,应用糖皮质激素、维生素D衍生物、钙调磷酸酶抑制剂等方法治疗白癜风在疗效方面仍具有局限性。因此包括Janus激酶抑制剂、阿法诺肽、前列腺素类似物等在内的新兴疗法被尝试引入白癜风的治疗中,未来有望应用于儿童群体。因此,本文结合儿童白癜风的特点、国内外指南及临床试验,对儿童白癜风的一般治疗及新兴治疗相关进展进行综述。     

Management of vitiligo. Results of a questionnaire among dermatologists in The Netherlands

BACKGROUND: Several therapeutic options are available for the treatment of vitiligo. Concern exists that there is no uniform approach towards the management of vitiligo among Dutch dermatologists. METHODS: A written survey concerning the management of vitiligo was sent to 332 dermatologists in The Netherlands. RESULTS: The response rate was 86%. "Giving information and reassurance concerning the nature of disease" was regarded by most dermatologists (68%) as being the most important goal in the management of vitiligo. Only 16% of the dermatologists aimed for active treatment in vitiligo. The reported therapy choices in children resembled those of adults, except that slightly more dermatologists did not prescribe active therapy in children. Nine different therapeutic modalities were mentioned as first choice therapies. Topical corticosteroids were indicated by most dermatologists as first choice therapy (241 out of 266, i.e. 91%); however, only 2% indicated that 50% or more of the patients achieved a successful treatment; 66% found that less than 25% of the patients were successfully treated with topical corticosteroids. Only 15% of the respondents reported that 50% or more of the patients were treated successfully with narrow-band UVB. The observed response profile to broad-band UVB therapy was found to be comparable with that of narrow-band UVB. The classical therapy with oral psoralen plus UVA (PUVA) was prescribed as first choice therapy by only 12% (32 out of 266) of the dermatologists. Only 6% of these respondents observed that 50% or more of the patients achieved successful therapy using oral PUVA. The recommended maximum treatment duration for topical corticosteroids, oral PUVA, and UVB therapy was found to vary from 3 to 12 months. CONCLUSIONS: Most dermatologists in The Netherlands do not offer active treatment in vitiligo, probably because the estimated effectiveness of (nonsurgical) repigmentation therapy is low. In cases where treatment is prescribed, there appears to be no consensus on the choice of therapies and treatment strategies. The development of practice guidelines may be helpful in reducing inappropriate care and improving treatment outcome.     

Digital photography in skin cancer screening by mobile units in remote areas of Brazil

Background

Vitiligo is a chronic depigmenting skin disorder which affects around 0.5-1% of the world’s population. The outcome measures used most commonly in trials to judge treatment success focus on repigmentation. Patient-reported outcome measures of treatment success are rarely used, although recommendations have been made for their inclusion in vitiligo trials. This study aimed to evaluate the face validity of a new patient-reported outcome measure of treatment response, for use in future trials and clinical practice.

Method

An online survey to gather initial views on what constitutes treatment success for people with vitiligo or their parents/carers, followed by online discussion groups with patients to reach consensus on what constitutes treatment success for individuals with vitiligo, and how this can be assessed in the context of trials. Participants were recruited from an existing database of vitiligo patients and through posts on the social network sites Facebook and Twitter.

Results

A total of 202 survey responses were received, of which 37 were excluded and 165 analysed. Three main themes emerged as important in assessing treatment response: a) the match between vitiligo and normal skin (how well it blends in); b) how noticeable the vitiligo is and c) a reduction in the size of the white patches. The majority of respondents said they would consider 80% or more repigmentation to be a worthwhile treatment response after 9 months of treatment. Three online discussion groups involving 12 participants led to consensus that treatment success is best measured by asking patients how noticeable their vitiligo is after treatment. This was judged to be best answered using a 5-point Likert scale, on which a score of 4 or 5 represents treatment success.

Conclusions

This study represents the first step in developing a patient reported measure of treatment success in vitiligo trials. Further work is now needed to assess its construct validity and responsiveness to change.

     

[Translated article] Practical Update of the Recommendations Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis with Biologic Therapy. Part 1. Concepts and General Management of Psoriasis With Biologic Therapy

Background and objectivesA new, updated AEDV Psoriasis Group (GPs) consensus document on the treatment of moderate to severe psoriasis was needed owing to the approval, in recent years, of a large number of new drugs and changes in the treatment paradigm.MethodologyThe consensus document was developed using the nominal group technique and a scoping review. First, a designated coordinator selected a group of Psoriasis Group members for the panel. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. Based on these reviews, the coordinator drew up a set of proposed recommendations, which were then discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted.ResultsThe present guidelines include general principles for the treatment of patients with moderate to severe psoriasis and also define treatment goals and criteria for the indication of biologic therapy and the selection of initial and subsequent therapies. Practical issues, such as treatment failure and maintenance of response, are also addressed.