Treatment of vitiligo with khellin liposomes,ultraviolet light and blister roof transplantation

Background Various surgical and non‐surgical methods are available to treat vitiligo. Surgical techniques such as epidermal blister graft transplantation may be effective for the re‐pigmentation of stable, but refractory vitiligo areas. Khellin has phototherapeutic properties that are similar to those of the psoralens, but with substantially lower phototoxic effects and DNA mutation effects. Its penetration into the hair follicles is enhanced by encapsulating it into liposomes. Subsequent activation of the khellin with UV light stimulates the melanocytes in the hair follicles. Objective The first objective was to evaluate the additional value of combining blister roof transplantation (BRT) with khellin in liposomes and ultraviolet light (KLUV) in the treatment of recalcitrant vitiligo patches. The second objective was to assess patients’ satisfaction. Materials and methods Nineteen patients with vitiligo lesions which did not respond to KLUV treatment for at least a year were treated with BRT followed by KLUV. The transplantation was performed by creating blisters with a suction device, preparing the target site with Erbium laser ablation and the actual transplantation. Locations where randomly assigned. A blinded observer established the results. Results Seventy‐five percent of the patients were satisfied with the cosmetic result. All of the patients would recommend the treatment to other vitiligo patients. More than 75% re‐pigmentation of the vitiligo areas was noted in 47% of the patients according to the blinded evaluation of photographs taken before and after the treatment.     

窄谱中波紫外线辐射对白癜风黑素细胞生物学特性的影响

目的：探讨窄谱中波紫外线（NB—UVS）辐射对白癜风不同部位培养的黑素细胞生物学特性的影响，以指导设定NB—UVB最佳治疗间隔时间。方法：体外培养白癜风患者外观正常皮肤、皮损边缘处黑素细胞，倒置显微镜观察NB一[NB辐射对细胞形态的影响，MTT法和NaOH法检测NB—UVB辐射剂量（0-100mJ/cm^2，cm^2）和作用时间（辐射后48h、72h、96h）对细胞增殖和黑素合成的作用。结果：①NBUVB（50-mJ/cm^2）辐射黑素细胞后，细胞肿胀，树突缩短增粗，黏附性下降；②NB—UVB辐射后48h，在实验剂量下可提高细胞的黑素合成能力，辐射剂量≥60mJ／cm^2可抑制白癜风外观正常皮肤黑素细胞增殖，而≥40mJ／cm^2即可对皮损边缘处黑素细胞产生抑制作用；NB—UVB辐射后72h、96h，可促进黑素细胞增殖和黑素合成，对白癜风外观正常皮肤黑素细胞作用更明显，辐射后72h黑素细胞增殖率和黑素含量达到最高点。结论：NB—UVB辐射后72h对白癜风黑素细胞功能的影响最大，可用以指导临床设定NB-UVB照射最佳的治疗间隔时间。     

A comparative study on the use of fractional CO2 laser with tacrolimus or calcipotriol or narrow band ultraviolet‐B in treatment of stable nonsegmental vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO₂) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO₂ laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO₂ laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO₂ laser and NB‐UVB was found to be more effective.     

他扎罗汀凝胶外用联合NB-UVB治疗斑块状寻常型银屑病的疗效观察

目的：观察他扎罗汀凝胶外用联合NB-UVB照射治疗斑块状寻常型银屑病的疗效及安全性。方法：对35例轻、中度患者采用0．05％他扎罗汀凝胶每晚1次外涂配合NB-UVB每周2次照射，共治疗8周，用PASI积分评价疗效。结果：治疗开始1～2周后出现疗效，随着治疗时间的延长。有效率逐渐提高，治疗结束时痊愈率达到94．29％，有效率达100％。6例发生皮肤刺激反应，占17．14％。结论：他扎罗汀凝胶外用联合NB-UVB照射治疗斑块状寻常型银屑病具有良好疗效和安全性。     

补骨脂素长波紫外线和窄谱中波紫外线治疗寻常性银屑病临床疗效观察

目的:观察补骨脂素长波紫外线(PUVA)和窄谱中波紫外线(NB-UVB)治疗寻常性银屑病的临床疗效及其影响因素。方法:分别采用PUVA和311nmNB-UVB照射治疗146例寻常性银屑病患者,并以银屑病面积和严重度指数(PASI)评价疗效,分析照射剂量等对疗效和复发的影响。结果:NB-UVB治疗寻常性银屑病的疗效与PUVA相当,NB-UVB组患者的治疗时间明显短于PUVA组,NB-UVB组患者1年内复发率高于PUVA组。结论:NB-UVB治疗寻常性银屑病与PUVA相比,不良反应较少,起效较快。     

A pilot comparative study of topical latanoprost and tacrolimus in combination with narrow‐band ultraviolet B phototherapy and microneedling for the treatment of nonsegmental vitiligo

Prostaglandins and their analogues are beneficial as topical agents in vitiligo treatment, yet neither of the previous study addressed their comparative efficiency with conventional topical agents used in vitiligo treatment. In this pilot (24 patients) left‐right comparative study we addressed efficiency of prostaglandin F2α analogue latanoprost versus tacrolimus when combined with narrow‐band ultraviolet B and microneedling in repigmentation of nonsegmental vitiligo lesions. Our results confirm potency of prostaglandins, in particular, that of latanoprost, in inducing repigmentation, with the efficiency being at least comparable to that of tacrolimus, while contribution of microneedling remains unclear. In summary, results of our study provide further evidences for justified use of prostaglandins, in particular, latanoprost, in vitiligo treatment. In turn, this warrants future studies on the topic aiming to conclusively introduce prostaglandin‐based formulations as conventional agents for vitiligo management.     

Bath psoralen+ultraviolet A photochemotherapy vs. narrow band‐ultraviolet B in psoriasis: a comparison of clinical outcome and effect on circulating T‐helper and T‐suppressor/cytotoxic cells

Background: Comparative success rates of bath psoralen+ultraviolet A (PUVA) and narrow band‐ultraviolet B (NB‐UVB) in psoriasis treatment are variably reported with no previous studies on the possible effect of bath PUVA on circulating CD4+ and CD8+ T cells. Objective: We aimed to compare the effect of bath PUVA and NB‐UVB clinically and on circulating T‐helper and T‐suppressor/cytotoxic cells in psoriasis. Patients and methods: Thirty‐four psoriatic patients divided into a bath PUVA‐treated group (18 patients) and a NB‐UVB‐treated group (16 patients) were compared regarding the disease severity by psoriasis area and severity index (PASI) score and percentage of circulating CD4+ and CD8+ T cells by flowcytometry before and after treatment. Results: After treatment, the bath PUVA group showed a significantly higher reduction of PASI score (85.44%) than the NB‐UVB group (58.72%). Mean peripheral CD4+ T‐cell percentage was significantly lower after [36.8; 95% confidence interval (CI) 33.80, 39.97] compared with before treatment (42.06; 95% CI 38.29, 45.83) (P<0.05) in the bath PUVA group while this difference was insignificant in the NB‐UVB group (P>0.05). Conclusion: Bath PUVA therapy is superior to NB‐UVB in the treatment of moderate and severe psoriasis with mild reversible side effects. Both modalities have a systemic effect decreasing peripheral CD4+ T cells, which is more with bath PUVA.     

C‐reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy

Background Psoriasis vulgaris is a chronic recurrent inflammatory skin disease and psoriatic lesions have shown leucocyte infiltration. Objectives We aimed to study C‐reactive protein (CRP) and leucocyte activation markers/inhibitors as potential monitors of psoriasis vulgaris. Methods A cross‐sectional (n = 73) and a longitudinal study (before, at 3, 6 and 12 weeks of therapy; n = 47) was performed; 10 patients started topical treatment, 17 narrow‐band ultraviolet light B (NBUVB) and 20 psolaren associated to UVA (PUVA); psoriasis severity was defined by Psoriasis Area and Severity Index (PASI). Results Compared with control (n = 38), we found higher CRP levels, total leukocyte/neutrophil count, elastase, lactoferrin and α1‐antitrypsin. Increasing PASI was linked to increasing CRP and a trend to higher elastase and lactoferrin, suggesting that worsening enhances inflammatory response with neutrophil activation. CRP correlated with PASI, total leucocytes, neutrophils, elastase, lactoferrin and α1‐antitrypsin. NBUVB and PUVA presented similar effects. Conclusion We propose CRP as a useful marker of psoriasis severity that could be used to monitor psoriasis and its treatment, and, together with PASI and elastase, could also be used as a global index of severity.     

A randomized, double-blinded, placebo-controlled trial of pseudocatalase cream and narrowband ultraviolet B in the treatment of vitiligo

Background  Pseudocatalase cream in conjunction with narrowband ultraviolet B (NB-UVB) has previously been reported to result in repigmentation of vitiliginous skin.
Objectives  The purpose of this 24-week, double-blind, placebo-controlled, randomized, single-centre trial was to assess the efficacy of pseudocatalase cream and NB-UVB vs. placebo and NB-UVB for the treatment of vitiligo.
Methods  Patients with active vitiligo on their face and/or hands applied either pseudocatalase cream or placebo to their whole body, twice daily for 24 weeks. NB-UVB therapy was administered three times a week for the duration of the trial. Efficacy was assessed primarily by digital image analysis of photographs.
Results  Thirty-two patients were randomized to either the pseudocatalase arm ( n  =   14) or placebo ( n  =   18). Between-group analysis did not show a statistically significant improvement in percentage area affected in the pseudocatalase cream group when compared with placebo. However, a statistically significant improvement was found within each group by week 12, which was maintained throughout the study.
Conclusions  NB-UVB treatment is a moderately effective treatment for vitiligo. Pseudocatalase cream does not appear to add any incremental benefit to NB-UVB alone.     

Comparisons of clinical features of HLA‐DRB1*07 positive and negative vitiligo patients in Chinese Han population

Background Human leucocyte antigen (HLA)‐II alleles have been found to be associated with vitiligo in different populations, and several studies also suggested that HLA class II alleles/haplotypes were associated with a different type vitiligo. Of HLA class II alleles, DRB1*07 has consistently shown a positive association with vitiligo in Chinese Han population. Objective To further explore the relationship between DRB1*07 and vitiligo and to evaluate the DRB1*07 effect on the clinical features of vitiligo in Chinese Han population. Methods This study investigated DRB1*07 allele distribution in 1178 unrelated Chinese vitiligo patients and 1743 healthy controls using polymerase chain reaction/sequence specific primer method and observed clinical differences between DRB1*07 positive and DRB1*07 negative patients. Results The analysis of the 1178 cases and 1743 controls revealed a highly association between DRB1*07 allele and vitiligo [odds ratio (OR) = 1.97, P = 2.13 × 10^?17]. DRB1*07 positive patients had early disease onset (OR = 1.49, P = 0.001), higher frequency of family history (OR = 1.44, P = 0.006) compared with DRB1*07 negative patients. Conclusions The DRB1*07 showed significant association with vitiligo in the study population. This study confirmed that DRB1*07 positive patients had some obvious clinical differences from DRB1*07 negative patients in the Chinese Han population.     

Successful treatment with narrow‐band UVB therapy for a case of generalized Hailey–Hailey disease with a novel splice‐site mutation in ATP2C1 gene

Hailey–Hailey disease (HHD) is a rare autosomal dominant disorder characterized by development of recurrent blisters, erosions, and crustations in the intertriginous areas. The treatment of HHD is often challenging, and various methods have been tried. We report here a case of a 45‐year‐old woman with a generalized form of HHD that was dramatically improved and well controlled by narrow‐band ultraviolet B phototherapy.     

Epidermal grafting in vitiligo: influence of age,site of lesion,and type of disease on outcome

BACKGROUND: The success of suction blister epidermal grafting may be influenced by various factors, all of which have not been studied to date. OBJECTIVE: We sought to determine the influence of age of the patient, site of vitiligo patch, and type of disease on the outcome of the procedure in our patients and in the cumulative data derived from literature analysis. METHODS: This was a retrospective, uncontrolled case series and literature review of suction blister epidermal grafting in patients with stable and recalcitrant vitiligo. All published studies of suction blister epidermal grafting in vitiligo involving 10 or more patients were included in the literature analysis. RESULTS: The procedure was performed in 143 patients. However, sufficient length (6 postoperative months) of follow-up was available in only 117 patients, and only these patients were included for analysis. Only limited information was available about various factors in the majority of published studies. The success rates for generalized and segmental/focal disease in this study were 53% (confidence interval [CI] 42-64) and 91% (CI 81-100), respectively (P <.001), and in the literature, 61% (CI 46-76) and 88% (CI 82-94), respectively (P <.01). The success rates in patients aged < 20 years and >or= 20 years in this study were 82% (CI 67-97) and 58% (CI 48-68), respectively (P <.05), and in the literature, 100% and 66% (CI 56-76), respectively (P <.05). There was no significant difference in the success rates achieved on different body sites in this study and in the screened literature. Among adverse reactions, hyperpigmentation in 32% (CI 24-40) and 17% (CI 14-20), infection in 6% (CI 2-10) and 0%, and contact dermatitis in 1% (CI 0-3) and 1% (CI 0-2) of patients were observed in this study and in the analyzed literature, respectively. CONCLUSIONS: The results were significantly better in segmental/focal vitiligo than in the generalized type, and in individuals < 20 years of age. However, unlike in medical therapies, localization of the vitiligo patch did not influence the treatment outcome significantly.