补骨脂素光化学疗法对于分布广泛的白癜风只是适度有效的:一个10年回顾性研究

白癜风是一种常见的皮肤病 ,以境界清楚、形状不规则、黑素细胞脱失的皮肤白斑为特征。据估计 ,患病率为 1%～ 2 % ,通常在 2 0岁之前发病 ,大多缓慢进展。补骨脂素光化学疗法 (PUVA)被认为是治疗白癜风最有效的方法 ,>5 0 %的患者症状改善。但是 ,PUVA起效慢 ,常需数月到数年 ,而且发表的疗效数据是不一致的。没有令人信服的证据表明PUVA影响了白癜风的自然病程 ,因此PUVA引起的色素再生应假定只是达到了临时改善。英国伦敦圣约翰皮肤病研究所对用PUVA治疗的 97例白癜风患者进行了 10年回顾性分析。病例和方法 :1984年 1月～ 1993…     

自体表皮移植结合局部PUVA治疗白癜风24例

白癜风是一种色素脱失性疾病,自体表皮移植治疗白癜风已获肯定疗效,但部分患者移植后出现色素不均,色素斑扩展慢以及补丁样、鹅卵样外观,为克服上述缺点,我们采用自体表皮移植术结合局部PUVA治疗白癜风24例,取得了满意效果,现将结果报告如下：     

Application of portable therapeutic UV instrument in the treatment of vitiligo

目的:观察365 nm波长便携式紫外光治疗仪治疗稳定期白癜风的疗效和不良反应.方法:应用365 nm波长便携式紫外光治疗仪治疗白癜风患者26例,以自身未治疗皮损作为对照,每例患者选择两处相近或对称部位的皮损,试验组外涂甲氧沙林溶液后使用365 nm波长便携式紫外光治疗仪光照(即PUVA),对照组单用甲氧沙林溶液外涂.试验结束时依据治疗前、后皮损的照片进行疗效评价,并记录不良反应.结果:试验结束时,治疗组有效率为50.00%(13/26),对照组有效率为7.69%(2/26),两组间有效率差异有统计学意义(P < 0.05).结论:甲氧沙林联合365 nm波长便携式紫外光治疗仪治疗白癜风疗效好,局部不良反应少.     

白癜风的光化学疗法

目前白癜风的治疗仍是皮肤科医生面临的一大难题 ,传统的PUVA等光化学疗法其效果肯定 ,但受多种因素的影响而有一定的局限性。近年来人们尝试将PUVA与钙泊三醇外用联合 ,其疗效高、安全 ,尤适用于单用PUVA无效的手足部皮损。PUVA与表皮移植方法联合 ,是稳定期白癜风在其它治疗失败后的最佳选择。窄波带UVB( 311nm )与UVA疗效等同 ,但其光毒性小、色素恢复均匀、疗程短 ,是儿童和孕妇患者首选的治疗方法。     

外用8-MOP配合UVA照射治疗局限型白癜风32例

目的 进一步探讨PUVA治疗局限型白癜风的临床疗效。方法 对32例局限型白癜风患者外用0.1%甲氧沙林溶液（8-MOP）配合长波紫外线（UVA）照射治疗。结果 经1-2疗程治疗后，痊愈率为65.63%，总有效率为90.63%；病程愈短则痊愈率愈高；对紫外线敏感性高的部位皮损，疗效亦高，副作用小。结论 本法避免了口服药的不良副作用。对病程短、紫外线敏感性高的部位皮损疗效较好，是临床上治疗局限性白癜风安全有效的疗法之一。     

白癜风局部治疗的新进展

白癜风为特发性色素脱失性疾病。常规局部治疗方法有局部外用糖皮质激素制剂、胎盘提取液及PUVA等 ,但对于临床上部分病例疗效不佳 ,且存在一定的不良反应和用药局限。随着对白癜风研究的深入和医疗手段的进步 ,不断有新的治疗方法出现 ,在一定程度上提高了疗效。现将最新的局部治疗进展作一综述 ,以便于临床参考。     

白癜风局部治疗的新进展

白癜风为特发性色素脱失性疾病。常规局部治疗方法有局部外用糖皮质激素制剂、胎盘提取液及PUVA等，但对于临床上部分病例疗效不佳，且存在一定的不良反应和用药局限。随着对白癜风研究的深入和医疗手段的进步，不断有新的治疗方法出现，在一定程度上提高了疗效。现将最新的局部治疗进展作一综述，以便于临床参考。     

补骨脂素长波紫外线雀斑样痣1例

补骨脂素长波紫外线(PUVA)雀斑样痣为长期PUVA治疗后在避光部位出现的褐色至黑色斑点,表皮内有较大的黑素细胞增生,伴轻度的异形,往往在长期、大量PUVA治疗后发生。笔者近期在皮肤科门诊见到1例,该患者在接受局部光化学疗法治疗后,短期内出现PUVA雀斑样痣,现报告如下。 患者男,16岁。右腹股沟处白斑半年。在外院拟诊为“白癜风”,每日上午局部涂搽8-MOP溶液(具体浓度不详)1次,半小时后,日晒10min(上午9:00开始)。4 d后,白斑处出现红肿、     

白癜风治疗的新进展

白癜风为特发性色素脱失性疾病。常规治疗方法如局部外用皮质类固醇、PUVA等对于临床上部分病例疗效不佳。随着对白癜风研究的深入和医疗手段的进步 ,不断有新的治疗方法和思路出现 ,在一定程度上提高了疗效。现将光疗、移植治疗、细胞因子治疗和治疗方法的选择等进展作一综述 ,以便于临床参考     

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     

Experience with calcipotriol as adjunctive treatment for vitiligo in patients who do not respond to PUVA alone: a preliminary study

BACKGROUND: PUVA therapy remains a primary treatment for vitiligo, despite unsatisfactory results. Because of calcipotriol's reported effects on melanocytes and on immunomodulatory and inflammatory mediators we wondered whether adding calcipotriol to PUVA would be more effective than PUVA alone in treating vitiligo. OBJECTIVE: We sought to determine whether the combination of topical calcipotriol and PUVA therapy increases the responsiveness of patients with vitiligo refractory to PUVA alone. METHODS: Twenty-one patients with vitiligo refractory to previous PUVA therapy were studied. Patients received 60 sessions of PUVA 3 times a week and 0.005% topical calcipotriol twice daily. Patients were monitored for repigmentation overall and on the trunk, extremities, and acral regions. RESULTS: Starting at the median of the 17th treatment session, some degree of repigmentation was observed in 71.5% of the patients. After treatment, cosmetically acceptable overall repigmentation was observed in 29% of patients; repigmentation of lesions on the trunk, extremities, and acral region was noted in 36%, 58%, and 0% of patients, respectively. Adverse reactions were mild and tolerable. CONCLUSION: The combination of PUVA and calcipotriol may be effective therapy and should be further investigated for the treatment of vitiligo.     

Psoralen–ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo

BACKGROUND: Although many treatment modalities have been tried for the treatment of vitiligo, none is uniformly effective. Psoralen phototherapy (psoralen ultraviolet A (PUVA)) is established as efficacious treatment for vitiligo. Recently, narrow-band UVB (NBUVB) has been reported to be an effective and safe therapeutic option in patients with vitiligo. OBJECTIVE: To compare the efficacy of PUVA and NBUVB in the treatment of vitiligo. DESIGN AND SETTING: Retrospective analysis of 69 patients with vitiligo who were treated either with PUVA or NBUVB at the pigmentary clinic of the Dermatology Department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. OUTCOME MEASURES: The following variables were compared between the two groups of patients: repigmentation status, number of treatments for marked to complete repigmentation in existing lesions, appearance of new lesions or increase in size of existing lesions, adverse effect of therapy, stability of repigmentation and colour match. RESULTS: In PUVA-treated group, 9 patients showed marked to complete repigmentation (23.6%) and 14 patients showed moderate improvement (36.8%), whereas in NBUVB-treated group, 13 patients showed marked to complete repigmentation (41.9%) and 10 patients showed moderate improvement (32.2%). A statistically significantly better stability and colour match of repigmentation with surrounding skin was seen in NBUVB-treated patients. CONCLUSION: We showed that NBUVB is more effective than PUVA and repigmentation induced with NBUVB is statistically significantly more stable.     

Psoralen photochemotherapy (PUVA) is only moderately effective in widespread vitiligo: a 10-year retrospective study

A 10-year retrospective analysis of the use of psoralen photochemotherapy (PUVA) in the treatment of vitiligo was undertaken at the St John's Institute of Dermatology, London, UK. Of 97 patients included in this study, eight had complete or almost complete repigmentation, 59 moderate to extensive repigmentation, and 30 showed little or no response. However, 24 of those who had responded to PUVA with extensive repigmentation did not consider their response satisfactory because of persistence of vitiligo at cosmetically sensitive sites, and poorly matching, speckled repigmentation. Fifty-seven patients who initially improved with PUVA therapy subsequently relapsed, in most cases within a year of stopping treatment. Relapses in 22 patients were on the same cutaneous sites as previously affected, while vitiligo at new sites developed in 20 patients and both new and old sites were affected in a further 15 patients. Patients who retained their pigmentation after 2 years appeared to have a better chance of permanent remission. The only statistically significant prognostic indicator of relapse was patient age at the start of treatment, younger patients tending to retain their pigmentation longer than older patients. This study emphasizes the need for careful patient counselling before PUVA therapy as this treatment seldom achieves extensive repigmentation that is cosmetically acceptable, and treatment response is often followed by relapse.     

PUVA treatment of vitiligo: a retrospective study of 59 patients.

We have performed a retrospective study of 59 patients with vitiligo who received PUVA therapy from 1972 to 1986. Sixteen patients had generalized vitiligo and 43 vitiligo in four locations (focal vitiligo). In both groups there were repigmentation in 44% of the patients. Half of the repigmented patients had improved more than 50%. None developed hypertrichosis, actinic keratosis, lentigines, or skin cancer within the observation period. Regardless of the results of PUVA therapy half of the patients thought PUVA was an acceptable therapy.     

PUVA treatment of vitiligo: a retrospective study of Turkish patients

BACKGROUND: Psoralen plus ultraviolet A (PUVA) is considered to be the treatment of choice for subtotal vitiligo; however, it is time consuming and carries certain health risks for both patients and physicians. This study attempts to evaluate the efficacy of the treatment in Turkish vitiligo patients. METHODS: We have performed a retrospective study of 33 patients with vitiligo who received systemic PUVA therapy during the period 1985 to 1997, and have evaluated their response to treatment. RESULTS: Overall, 28 patients (84%) showed some improvement; 12 patients experienced a repigmentation of 51-75% and six patients achieved greater than 75% repigmentation. Face and trunk lesions showed better repigmentation than other areas, whereas hands, feet, perioral, and periorbital areas were generally refractory to treatment. The age of the patient, age at onset of the disease, sex, disease duration, and degree of depigmentation prior to initiation of therapy had no influence on PUVA-induced repigmentation. CONCLUSIONS: The distribution of vitiliginous skin must be taken into consideration before the initiation of PUVA therapy, as the response to treatment varies greatly with different body sites; hands, feet, perioral, and periorbital regions are particularly treatment resistant.     

Narrowband ultraviolet B radiation therapy for recalcitrant vitiligo in Asians

BACKGROUND: Narrowband ultraviolet B (NBUVB) has recently been reported to be effective therapy for vitiligo. However, reports on its efficacy in recalcitrant vitiligo are lacking. OBJECTIVE: Our objective was to assess the efficacy of NBUVB in patients with vitiligo who did not respond to either topical therapy or oral psoralen plus ultraviolet A (PUVA). METHOD: This was a retrospective analysis of patients with vitiligo who were treated with NBUVB from February 1998 to January 2001. They received NBUVB treatment 2 times per week, with an initial dose of 100 mJ/cm(2). The dose was increased by 10% to 20% per treatment for 20 treatments. The dose was then increased by 2% to 5% per treatment until 50% repigmentation was observed or persistent erythema developed. The treatment was continued until maximum repigmentation was achieved. The treatment was terminated if the patient showed less than 25% improvement after 40 to 50 exposures. RESULTS: There were 60 patients: 22 men and 38 women, aged 11 to 61 years. The mean duration of vitiligo was 8.2 +/- 7.1 years. There were 53 cases of generalized and 7 cases of localized vitiligo. The lesions covered from less than 5% to 50% of body surface. Twenty-five patients were skin type III, 33 patients were skin type IV, and 2 patients were skin type V. Every case had been previously treated with topical steroid with or without topical psoralen with solar light exposure. Thirty-six patients (60%) had been treated with oral PUVA before NBUVB therapy. After NBUVB treatment, 25 of 60 patients (42%) achieved more than 50% repigmentation on face, trunk, arms, and legs. However, hand and foot lesions showed less than 25% repigmentation in all cases. There was no significant difference between the responders and nonresponders in age, sex, duration of diseases, and skin type. The response rate of patients who had not been previously treated with PUVA was significantly higher than that of patients who had been previously treated with PUVA (67% vs 36%, P =.003). CONCLUSION: This retrospective, open study demonstrated that NBUVB therapy was effective in 42% of Asian patients with recalcitrant vitiligo without serious side effect. The only clinical parameter that could differentiate nonresponders from responders was previous exposure to PUVA.     

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.     

Clinical study of repigmentation patterns with different treatment modalities and their correlation with speed and stability of repigmentation in 352 vitiliginous patches

Because the etiopathogenesis of depigmentation in vitiligo is still obscure, the source of pigmentation in the repigmentating lesion and its stability is also not fully known. Several authors have shown on histopathology and electron microscopy predominantly a perifollicular spread of pigment. The aim of this study was to clinically assess the types of repigmentation patterns obtained with different treatment modalities and their correlation with speed and stability of repigmentation. A total of 125 patients with vitiligo on treatment with psoralens (topical and systemic psoralen-UVA [PUVA]), steroids (both topical and systemic), and topical calcipotriol, alone or in combination were enrolled. Representative lesions of vitiligo excluding mucosal sites were selected in each patient and photographed at baseline. Repigmentation was assessed and labeled as marginal, perifollicular, diffuse, or combined. The preselected patches were evaluated at 3 months to assess the speed of repigmentation. Retention of pigment (stability) was noted at 6 months, after the stoppage of active treatment. Of the 352 vitiligo patches selected, 194 (55%) showed predominant perifollicular repigmentation, of which a majority (127; 65.5%) were on systemic PUVA and 35 (18%) were on topical PUVA. Diffuse pigmentation was observed in 98 patches (27.8%) of which 66 (67.3%) were on topical steroids. Marginal repigmentation was seen in 15, of which the majority (80%) were on systemic PUVA and topical calcipotriol. Of the 28 total lesions showing marked repigmentation at 3 months, 22 lesions pigmented in a diffuse manner, 2 in a perifollicular pattern, and 4 showed a combined type of repigmentation. On follow-up, marginal repigmentation was the most stable (93.3%), followed by perifollicular (91.7%) and combined type (84.4%). Diffuse repigmentation was the least stable (78.5%). Psoralens predominantly exhibit a perifollicular pattern of repigmentation and steroids (topical/systemic), a diffuse type. The speed of repigmentation is much faster when initial repigmentation is of the diffuse type as compared with follicular repigmentation. The marginal and perifollicular repigmentation is more stable than the diffuse type of repigmentation.     

SUCCESSFUL TREATMENT OF VITILIGO WITH PUVA-PIGMENTED AUTOLOGOUS EPIDERMAL GRAFTING

Background. The methoxypsoralen-ultraviolet A-light (PUVA)-induced pigmented epidermal grafting procedure appears to be a more effective treatment for vitiligo than similar treatments presently available. This finding was based on: 1) a more vigorous and completely homogeneous repigmentation was observed in the vitiliginous area and 2) that the treatment was safe, easy, inexpensive, and not time-consuming (approximately 3–4 hours), thus making it a suitable outpatient clinic treatment procedure for vitiligo patients. Patients and Methods. Twenty-eight patients with amelanotic depigmented lesions that had been refractory to conventional therapy were treated using suction blisters from autologous epidermal sheets. These had 8-methoxypsoralen (8-MOP) solution applied and had been exposed to ultraviolet A light (topical PUVA) in order to stimulate melanogenesis. Results. Successful repigmentation was obtained after transplantation in all patients with segmental and localized vitiligo. The most homogeneous repigmentation was obtained within 3 months after grafting. Conclusions. This novel procedure is an excellent tool by which to treat segmental and localized vitiligo lesions that have failed to respond to other therapies.     

Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebo‐controlled double‐blind study

BACKGROUND: Encouraging results of previous uncontrolled trials suggest that calcipotriol may potentiate the efficacy of psoralen plus ultraviolet (UV) A (PUVA) therapy in patients with vitiligo. OBJECTIVES: We performed a placebo-controlled double-blind study to investigate whether the effectiveness of PUVA treatment could be enhanced by combination with topical calcipotriol in the treatment of vitiligo. METHODS: Thirty-five patients with generalized vitiligo enrolled in the study. Symmetrical lesions of similar dimensions and with no spontaneous repigmentation on arms, legs or trunk were selected as reference lesions. In this randomized left-right comparison study, calcipotriol 0.05 mg g(-1) cream or placebo was applied to the reference lesions 1 h before PUVA treatment (oral 8-methoxypsoralen and conventional UVA units) twice weekly. Patients were examined at weekly intervals. The mean number of sessions and the cumulative UVA dosage for initial and complete repigmentation were calculated. RESULTS: Twenty-seven patients (nine women, 18 men; mean +/- SEM age 29.8 +/- 13.5 years) were evaluated. The mean +/- SEM cumulative UVA dose and number of UVA exposures for initial repigmentation were 52.52 +/- 6.10 J cm(-2) and 9.33 +/- 0.65 on the calcipotriol side, and 78.20 +/- 7.88 J cm(-2) and 12.00 +/- 0.81 on the placebo side, respectively (P < 0.001). For complete repigmentation, respective values were 232.79 +/- 14.97 J cm(-2) and 27.40 +/- 1.47 on the calcipotriol side and 259.93 +/- 13.71 J cm(-2) and 30.07 +/- 1.34 on the placebo side (P = 0.001). Treatment with calcipotriol and PUVA resulted in significantly higher percentages of repigmentation for both initial (81%) and complete pigmentation (63%), compared with placebo and PUVA (7% and 15%, respectively). CONCLUSIONS: Our results have shown that concurrent topical calcipotriol potentiates the efficacy of PUVA in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total UVA dosage.