白癜风光电治疗的研究进展

白癜风是一种获得性、特发性疾病,以局限性脱色斑为特征,并伴有表皮黑色素细胞的消失,由于病因及发病机制尚不完全清楚,白癜风的治疗仍是皮肤科医生面临的一大难题。近年来,光电技术的发展为白癜风患者的治疗提供了新的可能,文章就近年来白癜风的光电治疗机制、方法、疗效进行综述。     

308 nm准分子激光治疗白癜风的现状

白癜风的治疗仍是皮肤科医生面临的一大难题。光疗作为有效、安全的治疗手段,在白癜风治疗中的应用正在逐步推广。308nm准分子激光治疗白癜风快速有效、不良反应少。联合其他治疗方法可提高紫外线抵抗区的疗效。为此,综述308nm准分子激光治疗白癜风的新进展,以供临床参考。     

难治性白癜风的治疗进展

近年来白癜风治疗有了长足发展，目前欧洲、英国、日本、中国都制定了相关诊疗共识，大部分患者可以依此制定有效、合理的治疗方案，但白癜风治疗中仍存在难点，如特殊部位白斑（黏膜及薄嫩部位、毛发部位、肢端部位）、大面积白斑和残留不规则白斑的治疗等。针对以上难题本文对近五年来国内外文献进行了综述。     

308 nm准分子激光治疗白癜风及影响疗效的相关因素

308 nm准分子激光是近年来治疗白癜风的一种新型激光治疗手段,和传统光疗相比,它具有操作灵活、起效快、疗效理想、不良反应少的优势,目前有不少临床医生将其应用于白癜风的治疗,并发现联合外用他克莫司治疗能够促进疗效.影响准分子激光治疗白癜风临床疗效的相关因素有很多,文中对治疗部位、频率、次数、皮肤日光反应类型、病程等相关因素进行综述,以供临床参考.     

精神神经因素在白癜风发生、发展和预防中的作用

白癜风是一种获得性色素脱失性疾病,临床表现为皮肤黏膜白斑,其多发生于头面部、肢端等暴露部位,造成损容性的外观,严重影响患者的精神心理健康。除自身免疫及氧化应激学说外,神经-内分泌-免疫学说也是白癜风发病机制之一,然而精神因素在白癜风患者的治疗中常被忽略。因此,本文就精神因素对白癜风患者的影响,及精神神经因素在白癜风发生、发展和预防中的作用进行综述,旨在提高临床医生对精神因素的重视,同时为白癜风的治疗和预防提供更多有效手段,进而提高患者生活质量。     

带黑素细胞毛球刮取物治疗特殊部位白癜风疗效观察

自体表皮移植治疗白癜风已有肯定疗效。对不平坦部位的白癜风，如鼻旁、眼睑等部位，有些作者已进行了技术改进，并达到较好效果。但对一些特殊部位的白癜风，如耳廓、睑缘、唇红等部位，目前仍无较好方法，或疗效甚差。我们采用带黑素细胞毛球刮取物注射治疗这些部位白癜风，取得一定效果，现报道如下：     

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。     

光疗在白癜风治疗中的临床应用

白癜风是一种常见的慢性获得性色素减少性疾病,其发病机制尚不清楚,可能的机制有自身免疫、黑素细胞自毁、神经精神因素、表皮因子失衡及遗传因素等.临床上治疗白癜风的方法很多,光疗及其联合疗法是目前有效的治疗方法之一,尤其适用于泛发性及难治性白癜风.而临床应用中,光疗疗效受多因素影响,如疾病分型、患病年龄、皮损部位等.因此了解各种光疗的作用机制,适应证,临床疗效及不良反应,有助于临床医生选择最佳的治疗方案.     

白癜风同形反应研究进展

白癜风的同形反应又称为Koebner现象(KP),是白癜风进展的重要标志,同时也对白癜风治疗和防控有重要意义。白癜风欧洲工作组(VETF)对白癜风KP作了分型,部分国家学者基于新的KP分型进行流行病学调查研究。该文重点对白癜风KP的发生率、临床表现、诱因、分型和分级、发生机制以及临床意义的研究作了详细的文献回顾及总结,希望有助于提高临床医生对白癜风KP的认识及优化治疗方案,同时更好地指导患者预防复发。     

微型毛胚自体移植治疗特殊部位白癜风疗效观察

自体表皮移植治疗白癜风有效,但对发生在特殊部位（眉弓、睑缘、口周等）的白癜风,由于这些部位有毛发生长,皮肤易活动使移植表皮不易固定,皮片难以成活,手术成功率较低,近几年来,笔者采用微型毛胚自体移植治疗特殊部位白癜风,取得明显效果,现报告如下。     

难治部位白癜风的治疗进展

白癜风是一种与黑素细胞缺失有关的色素脱失性皮肤病,易诊难治,尤其对难治部位,诸如嘴唇、生殖器、头皮、眼睑、肘膝部及四肢、掌跖足底等疗效更差.就近年来对难治部位的有效疗法,如药物、外科移植术、光疗及联合疗法等进行概述.根据难治部位的临床特点,选用合理的治疗方案,以提高难治部位的疗效,指导临床治疗.     

难治部位白癜风的治疗进展

白癜风是一种与黑素细胞缺失有关的色素脱失性皮肤病,易诊难治,尤其对难治部位,诸如嘴唇、生殖器、头皮、眼睑、肘膝部及四肢、掌跖足底等疗效更差.就近年来对难治部位的有效疗法,如药物、外科移植术、光疗及联合疗法等进行概述.根据难治部位的临床特点,选用合理的治疗方案,以提高难治部位的疗效,指导临床治疗.     

难治部位白癜风的治疗进展

白癜风是一种与黑素细胞缺失有关的色素脱失性皮肤病,易诊难治,尤其对难治部位,诸如嘴唇、生殖器、头皮、眼睑、肘膝部及四肢、掌跖足底等疗效更差.就近年来对难治部位的有效疗法,如药物、外科移植术、光疗及联合疗法等进行概述.根据难治部位的临床特点,选用合理的治疗方案,以提高难治部位的疗效,指导临床治疗.     

Epithelial grafting for vitiligo requires ultraviolet A phototherapy to increase success rate

Background Phototherapeutic techniques were introduced into medical practice by the ancient Egyptians. It is considered a cornerstone in the management of resistant vitiligo; yet, failures are very well known. Recently, the introduction of surgical techniques provided a major development in the management of vitiligo and replaced other conventional unsuccessful therapies. Objectives The aim of this work is to find out if phototherapy, which failed to resolve the vitiligo problem in patients, is still required in the treatment strategy after epithelial grafting of the same cases. Methods Twenty‐five vitiligo patients, nonresponding to classic phototherapy, were treated surgically. Ultrathin Thiersch grafts and suction blister grafts were used. Phototherapy using untraviolet A (UVA) bulbs in combination with psoralen or khellin was used postoperatively immediately after take of grafts onto recipient sites. Results In spite of reactivation of depigmentary effects at grafted areas, phototherapy acted as a stimulator for melanocytic proliferation and function and as an immunosuppressant, halting the melanocytic destructive process. The application of UVA phototherapy resulted in successful treatment in the patients receiving it. Conclusion The success of epithelial grafting in patients with vitiligo can be increased by UVA phototherapy.     

钙调神经磷酸酶抑制剂治疗白癜风的进展

白癜风是一种以黑素细胞破坏为特征的获得性色素脱失性疾病,目前许多学者认为其发病机制主要与免疫异常有关.局部外用钙调神经磷酸酶抑制剂治疗白癜风有较好的疗效.单用钙调神经磷酸酶抑制剂治疗白癜风的疗效与用药方法、用药部位、疾病的病程、分期有关,也与疗程有关系.联合窄谱中波紫外线、308准分子激光及其他方法可以提高其有效率.钙调神经磷酸酶抑制剂治疗白癜风安全有效,长期使用的安全性和稳定性还需要进一步评估.

Abstract：

Vitiligo is an acquired hypopigmented disease characterized by the destruction of melanocytes.Many scholars consider that the pathogenesis of vitiligo is mainly associated with immune abnormalities.Topical calcineurin inhibitors have favorable efficacy in the treatment of vitiligo,and the efficacy is associated with the treatment regimen,course,application sites,duration and stage of vitiligo,etc.The combination with narrow-band ultraviolet B,308-nm excimer laser or other therapies may have synergistic effect on the efficiency of calcineurin inhibitors.Although calcineurin inhibitors are safe and effective in the treatment of vitiligo,further studies are needed to evaluate their long-term safety and stability.     

Male genital vitiligo

Vitiligo is a polygenetic multifactorial disease leading to melanocytic loss in skin and sometimes in hair. Genital areas may be involved and represent a specific therapeutic challenge. Surprisingly, data on male genital vitiligo remain scarce. This review aims to collate current knowledge on male genital vitiligo and to discuss the risks and benefits of the various therapeutic approaches. Male genital vitiligo is relatively frequent and often induces marked impairment of quality of life, with a specific impact on sex life. Prompt recognition of activity remains mandatory to halt disease progression, as repigmentation remains difficult to achieve in most cases. Thanks to progress in understanding of the pathophysiology of vitiligo, new therapeutic approaches are under development. Topical ruxolitinib, a JAK pathway inhibitor, is currently the product in the most advanced stage of development, with a very encouraging repigmentation rate on the face, although specific efficacy in genital area remains to be assessed. The next generation of treatments, such as topical WNT agonists, could be of great interest in genital vitiligo as they will not require combination with UV therapy and they may be able to enhance the differentiation and proliferation of melanocyte stem cells in this difficult-to-treat area.     

Surgical therapies, part III: melanocyte transplants

ABSTRACT: Melanocyte transplantation is currently the most effective treatment modality for patients who have stable depigmentation unresponsive to traditional medical therapies. Patient selection is extremely important since patients with active vitiligo or large areas of depigmentation will not respond well to this treatment method. This article discusses techniques available for harvesting and preparing donor tissue, preparing the depigmented recipient site, applying the melanocytes, and caring for the transplantation site postoperatively. Common complications and responses are also discussed. Many variations in the transplantation procedure exist, allowing practitioners to tailor the treatment to the facilities available and to individual patient needs. Melanocyte transplantation is becoming a more commonly utilized treatment option that is likely to increase in the future as medical therapies capable of halting the progression of vitiligo become available.     

Chemical peeling with phenol : For the treatment of stable vitiligo and alopecia areata

Chemical peeling with 88% phenol was carried out on 142 sites of stable vitiligo (hairy-126, non hairy-16) and on 69 sites of alopecia areata (AA). After cleansing and defatting, phenol was applied on affected areas till a uniform frost appeared. On healing, all the lesions of vitiligo showed perifollicular pigmentation in hairy areas and perilesional repigmentation in non hairy areas. These were further treated with PUVA/PUVASOL. After the healing, 82.5% of hairy sites and 81.3% of non hairy sites showed repigmentation. In cases of AA, patients developed vellus hair. In AA, 72.5% had good regrowth and 27.5% had poor response. Side effects seen were hypopigmentation (58 AA), hyperpigmentation (11 AA), persistent erythema (42 vitiligo, 28 AA), demarcation lines (4 AA), secondary bacterial infection (2 vitiligo, 5 AA) and superficial scarring (2 vitiligo, 7 AA). The wounding action of phenol is useful to repigment the vitiligo patches and for induction of regrwoth of hair in alopecia areata.     

Current state of vitiligo therapy – evidence-based analysis of the literature

Vitiligo is a skin disease with a worldwide prevalence ranging from 0.5% to 4%. Conservative therapies include photochemotherapy, phototherapy with UVB radiation (broadband UVB 290–320 nm, narrow band UVB 311 nm), systemic steroids and pseudocatalase. Modern therapeutic options include treatment with topical immunomodulators (tacrolimus, pimecrolimus), analogues of vitamin D3, excimer laser and surgery/transplantation. Our analysis compares these therapies for vitiligo and the evidence levels supporting their effectiveness. Conclusions: The face and neck respond best to all therapeutic approaches, while the acral areas are least responsive. For generalized vitiligo, phototherapy with UVB radiation is most effective with the fewest side effects; PUVA is the second best choice.Topical corticosteroids are the preferred drugs for localized vitiligo. They may be replaced by topical immunomodulators which display comparable effectiveness and fewer side effects.The effectiveness of vitamin D analogues is controversial with limited data. Surgical therapy can be very successful, but requires an experienced surgeon and is very demanding of time and facilities, thus limiting its widespread use. L-phenylalanine therapy appears effective on the face but enjoys neither widespread use nor extensive data support. No single therapy for vitiligo can be regarded as the most effective as the success of each treatment modality depends on the type and location of vitiligo.