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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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2
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Esmat SM, El-Mofty M, Rasheed H, Mostafa WZ, Anbar TS, Abdallah M, Bassiouny D, Abdel-Halim D, Hegazy R, Eid AA, Nassar A, Abdel-Aziz RT, Fawzy MM, Gawdat HI, El Hawary M, Sany I, Shalaby S, Ragab N, Abdel-Gaber RM, Tawfik YM, El-Bassiouny M, El-Husseiny R, Attia MS, Farid C, Genedy RM, Mogawer RM. Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:277-287. [PMID: 34726808 DOI: 10.1111/phpp.12749] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. PURPOSE To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). METHODS This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6 months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. RESULTS In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. CONCLUSION NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.
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Affiliation(s)
- Samia M Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Medhat El-Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H Rasheed
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wedad Z Mostafa
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tag S Anbar
- Department of Dermatology, STDs and Andrology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa Abdallah
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Dalia Bassiouny
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdel-Halim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Abulfotooh Eid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Nassar
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Rasha Ta Abdel-Aziz
- Department of Dermatology, STDs and Andrology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa M Fawzy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa El Hawary
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Sany
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan Shalaby
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nanis Ragab
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham M Abdel-Gaber
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmin M Tawfik
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Mahy El-Bassiouny
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Rania El-Husseiny
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Miriam Samir Attia
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Carmen Farid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rasha Mahmoud Genedy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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3
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Smith MP, Ly K, Thibodeaux Q, Bhutani T, Nakamura M. Home phototherapy for patients with vitiligo: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:451-459. [PMID: 31388308 PMCID: PMC6607222 DOI: 10.2147/ccid.s185798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022]
Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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4
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Gan EY, Eleftheriadou V, Esmat S, Hamzavi I, Passeron T, Böhm M, Anbar T, Goh BK, Lan CCE, Lui H, Ramam M, Raboobee N, Katayama I, Suzuki T, Parsad D, Seth V, Lim HW, van Geel N, Mulekar S, Harris J, Wittal R, Benzekri L, Gauthier Y, Kumarasinghe P, Thng STG, Silva de Castro CC, Abdallah M, Vrijman C, Bekkenk M, Seneschal J, Pandya AG, Ezzedine K, Picardo M, Taïeb A. Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2017; 30:28-40. [PMID: 27864868 DOI: 10.1111/pcmr.12561] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/10/2016] [Indexed: 02/01/2023]
Abstract
The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.
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Affiliation(s)
- Emily Y Gan
- National Skin Centre, Singapore City, Singapore
| | | | - Samia Esmat
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Iltefat Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France.,INSERM U1065, Team 12, C3M, Nice, France
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Tag Anbar
- Dermatology Department, Minia University, Minia, Egypt
| | - Boon Kee Goh
- Skin Physicians, Mount Elizabeth Medical Center, Singapore City, Singapore
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - M Ramam
- Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ichiro Katayama
- Department of Dermatology Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tamio Suzuki
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vaneeta Seth
- Department of Dermatology, Newton Wellesley Hospital, Newton, MA, USA
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Sanjeev Mulekar
- National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia.,Mulekar Clinic, Mumbai, India
| | - John Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard Wittal
- Department of Dermatology, University of New South Wales, Sydney, NSW, Australia.,Skin and Cancer Foundation, Darlinghurst, NSW, Australia.,Beecroft Dermatology, Beecroft, Sydney, NSW, Australia
| | - Laila Benzekri
- Mohammed V University in Rabat, Department of Dermatology, Ibn Sina University Hospital, Rabat, Morocco
| | - Yvon Gauthier
- Pigmentary Disorders Outpatient Clinic, Bordeaux, France
| | - Prasad Kumarasinghe
- Department of Dermatology, Fiona Stanley Hospital and University of Western Australia, Perth, WA, Australia
| | | | | | - Marwa Abdallah
- Dermatology, Andrology & Venereology Department, Ain Shams University, Cairo, Egypt
| | - Charlotte Vrijman
- Department of Dermatology, Academic Medical Centre, Netherlands Institute for Pigment Disorders, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Bekkenk
- Department of Dermatology, Academic Medical Centre, Netherlands Institute for Pigment Disorders, University of Amsterdam, Amsterdam, The Netherlands
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France.,INSERM U 1035, University of Bordeaux, Bordeaux, France
| | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France.,EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil, Créteil, France
| | - Mauro Picardo
- Cutaneous pathophysiology, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France.,INSERM U 1035, University of Bordeaux, Bordeaux, France
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5
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Esmat S, Hegazy RA, Shalaby S, Hu SCS, Lan CCE. Phototherapy and Combination Therapies for Vitiligo. Dermatol Clin 2017; 35:171-192. [PMID: 28317527 DOI: 10.1016/j.det.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
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Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
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6
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Esmat S, Mostafa W, Hegazy RA, Shalaby S, Sheth V, Youssef R, El-Mofty M. WITHDRAWN: Phototherapy: The Vitiligo Management Pillar. Clin Dermatol 2016. [DOI: 10.1016/j.clindermatol.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Esmat S, Mostafa W, Hegazy RA, Shalaby S, Sheth V, Youssef R, El-Mofty M. Phototherapy: The vitiligo management pillar. Clin Dermatol 2016; 34:594-602. [PMID: 27638438 DOI: 10.1016/j.clindermatol.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but narrowband ultraviolet B remains the safest and most commonly used treatment. Acting on multiple steps in vitiligo pathogenesis, narrowband ultraviolet B is one of the few therapies that can effectively induce stabilization and stimulate repigmentation. Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations. Individual patient characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype, should all be considered, along with combination therapies.
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Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt.
| | - Wedad Mostafa
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Vaneeta Sheth
- Newton-Wellesley Dermatology Associates, Wellesley, MA
| | - Randa Youssef
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Medhat El-Mofty
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
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8
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Ghafourian A, Ghafourian S, Sadeghifard N, Mohebi R, Shokoohini Y, Nezamoleslami S, Hamat RA. Vitiligo: symptoms, pathogenesis and treatment. Int J Immunopathol Pharmacol 2015; 27:485-9. [PMID: 25572727 DOI: 10.1177/039463201402700403] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.
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Affiliation(s)
- A Ghafourian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Ghafourian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - N Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - R Mohebi
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Y Shokoohini
- Department of Pharmacognosy and Biotechnology, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Nezamoleslami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - R A Hamat
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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9
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Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2014; 56:85-92. [DOI: 10.1111/ajd.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Richard Wittal
- University of New South Wales; Sydney New South Wales Australia
- Skin and Cancer Foundation; Sydney New South Wales Australia
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10
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Chen GY, Hsu MML, Tai HK, Chou TC, Tseng CL, Chang HY, Lan CCE, Sheu HM. Narrow-Band UVB Treatment of Vitiligo in Chinese. J Dermatol 2014; 32:793-800. [PMID: 16361730 DOI: 10.1111/j.1346-8138.2005.tb00847.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 05/20/2005] [Indexed: 11/30/2022]
Abstract
Narrow-band ultraviolet B (NBUVB) phototherapy has recently been reported to be an effective and safe treatment modality for vitiligo. In the present report, we evaluated the efficacy and safety of NBUVB therapy for vitiligo in Chinese patients. Seventy-two vitiligo patients treated from 2000 to 2003, were included retrospectively (male: female=33:39, mean age: 38.5). Among them, 61 were non-segmental type and 11 the segmental type. Treatments were given two to three times a week for a maximum period of one year with an initial dose of 0.2 J/cm2 and a 0-20% increment each session (mean accumulation dose: 155.3 J/cm2). Computer image analysis by Supervise classification was used to estimate the area of vitiligo involvement before and after treatment. An excellent response (75-100% area of repigmentation) was obtained in 9 patients (12.5%) and a good response (50-75%) in 24 (33.3%), a moderate response (25-50%) in 20 (27.8%), and a poor response (0-25%) in 19 (26.4%). In summary, 45.8% of our patients had more than 50% repigmentation. Burns were a side effect in 5 patients (7%) and transient erythema with itching or xerosis was noted in 5 patients (7%). These results indicate that NBUVB phototherapy is an effective and safe treatment choice for generalized vitiligo.
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Affiliation(s)
- Guan-Yu Chen
- Department of Dermatology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan
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11
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Oiso N, Suzuki T, Wataya-Kaneda M, Tanemura A, Tanioka M, Fujimoto T, Fukai K, Kawakami T, Tsukamoto K, Yamaguchi Y, Sano S, Mitsuhashi Y, Nishigori C, Morita A, Nakagawa H, Mizoguchi M, Katayama I. Guidelines for the diagnosis and treatment of vitiligo in Japan. J Dermatol 2013; 40:344-54. [PMID: 23441960 DOI: 10.1111/1346-8138.12099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 01/08/2023]
Abstract
Vitiligo is an acquired pigment disorder in which depigmented macules result from the loss of melanocytes from the involved regions of skin and hair. The color dissimilarity on the cosmetically sensitive regions frequently induces quality of life impairment and high willingness to pay for treatment in patients with vitiligo. The Vitiligo Japanese Task Force was organized to overcome this situation and to cooperate with the Vitiligo Global Issues Consensus Conference. This guideline for the diagnosis and treatment of vitiligo in Japan is proposed to improve the circumstances of Japanese individuals with vitiligo. Its contents include information regarding the diagnosis, pathogenesis, evaluation of disease severity and effectiveness of treatment, and evidence-based recommendations for the treatment of vitiligo. The therapeutic algorithm based on the proposed recommendation is designed to cure and improve the affected lesions and quality of life of individuals with vitiligo.
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Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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12
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13
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Abstract
Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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14
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15
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Rodríguez-Martín M, García Bustínduy M, Sáez Rodríguez M, Noda Cabrera A. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. Br J Dermatol 2009; 160:409-14. [DOI: 10.1111/j.1365-2133.2008.08906.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Faas L, Venkatasamy R, Hider R, Young A, Soumyanath A. In vivo evaluation of piperine and synthetic analogues as potential treatments for vitiligo using a sparsely pigmented mouse model. Br J Dermatol 2008; 158:941-50. [DOI: 10.1111/j.1365-2133.2008.08464.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Casacci M, Thomas P, Pacifico A, Bonnevalle A, Paro Vidolin A, Leone G. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311-313 nm) in the treatment of vitiligo--a multicentre controlled study. J Eur Acad Dermatol Venereol 2007; 21:956-63. [PMID: 17659006 DOI: 10.1111/j.1468-3083.2007.02151.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients. METHODS The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side. RESULTS At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3). CONCLUSIONS It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly.
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Affiliation(s)
- M Casacci
- Dermatology Clinic, Huriez Hospital, University of Lille 2, France
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Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy ? evidence-based analysis of the literature. J Dtsch Dermatol Ges 2007; 5:467-75. [PMID: 17537039 DOI: 10.1111/j.1610-0387.2007.06280.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Tobias Forschner
- Department of Dermatology, Venereology and Allergy, Charité Universitätsmedizin Berlin, Germany.
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Soumyanath A, Venkatasamy R, Joshi M, Faas L, Adejuyigbe B, Drake AF, Hider RC, Young AR. UV Irradiation Affects Melanocyte Stimulatory Activity and Protein Binding of Piperine. Photochem Photobiol 2006. [DOI: 10.1111/j.1751-1097.2006.tb09809.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parsad D, Kanwar AJ, Kumar B. Psoralen-ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo. J Eur Acad Dermatol Venereol 2006; 20:175-7. [PMID: 16441626 DOI: 10.1111/j.1468-3083.2006.01413.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- D Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Soumyanath A, Venkatasamy R, Joshi M, Faas L, Adejuyigbe B, Drake AF, Hider RC, Young AR. UV Irradiation Affects Melanocyte Stimulatory Activity and Protein Binding of Piperine. Photochem Photobiol 2006. [DOI: 10.1562/2006-04-21-ra-882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Skin transplants can be a useful and efficacious method to treat vitiligo. The aim is to repopulate areas lacking melanocytes with functional cells taken from normally pigmented areas. Several procedures have been devised and tested: some consist in the simple transfer of epidermis sampled and implanted as is, whereas others are based on the transplantation of disaggregated and manipulated cells. The therapeutic success of the former methods is partly determined by the ability and experience of the surgeon performing the operation, whereas the results of the latter methods mainly depend on the laboratory facilities and abilities of the personnel who manipulate the cells to be transplanted. The transplantation of cultured cells is the most fascinating and promising procedure but requires the observance of still not completely predictable procedures. The use of biological material of animal origin and the use of factors to stimulate cell proliferation, such as growth factors and promoting agents, are other points that require attention.
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Affiliation(s)
- Elisa Pianigiani
- Department of Dermatologic Sciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy
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Hartmann A, Lurz C, Hamm H, Bröcker EB, Hofmann UB. Narrow-band UVB311 nm vs. broad-band UVB therapy in combination with topical calcipotriol vs. placebo in vitiligo. Int J Dermatol 2005; 44:736-42. [PMID: 16135141 DOI: 10.1111/j.1365-4632.2004.02154.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recently, it has been shown that UVB phototherapy may be more effective than UVA in the treatment of vitiligo. Currently, however, no studies have compared the efficacy of UVB311 nm and broad-band UVB therapy. Calcipotriol has recently been reported to be effective adjunctive treatment for vitiligo, enhancing the efficacy of 8-methoxypsoralen plus UVA (PUVA) therapy. METHODS Ten patients were enrolled in the study; nine completed the 12 months of therapy. The upper part of the body was treated twice weekly with UVB311 nm and the lower part with broad-band UVB. Calcipotriol was applied onto the vitiligo lesions of the right side of the body and placebo on the left side. Repigmentation was documented by photography, planimetry, and Vitiligo Disease Activity (VIDA) score. The quality of life was measured by the Dermatology Life Quality Index (DLQI). RESULTS After 7-16 weeks, six of the nine patients showed initial repigmentation on the side treated with UVB311 nm. After 6 months of treatment, none of the patients showed repigmentation on the areas treated with broad-band UVB, which prompted us to apply UVB311 nm all over the body. At the end of 12 months, two patients showed > 75% repigmentation, two showed 51-75%, two showed 26-50%, and three showed 0-25%. In all patients with progressive vitiligo (seven of the nine patients), disease activity was stopped. Remarkably, vitiligo lesions treated with calcipotriol initially showed delayed repigmentation compared with control areas; however, there was no therapeutic difference between calcipotriol and placebo, both in combination with UVB311 nm, by the end of the study. The DLQI score improved significantly by an average of 28%. Conclusion UVB311 nm therapy was effective in the treatment of vitiligo, whereas broad-band UVB had no effect. Combination with calcipotriol ointment was not superior to UVB311 nm monotherapy. The quality of life significantly improved with narrow-band UVB311 nm phototherapy.
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Affiliation(s)
- Anke Hartmann
- Department of Dermatology, University of Würzburg, Germany.
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Leone G, Iacovelli P, Paro Vidolin A, Picardo M. Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study. J Eur Acad Dermatol Venereol 2003; 17:531-7. [PMID: 12941087 DOI: 10.1046/j.1468-3083.2003.00818.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To study the efficacy and safety of monochromatic excimer light (MEL) on 37 vitiligo patients referred to our clinic. METHODS In a pilot study, 37 patients (17 males, 20 females) with acrofacial (n=21), focal (n=11), segmental (n=1), and generalized (n=4) vitiligo were treated twice weekly with MEL for a maximum period of 6 months. RESULTS Thirty-five patients (95%) showed signs of repigmentation within the first eight treatments. The treatment resulted in good repigmentation in 16 patients, and excellent repigmentation in 18 patients. Adverse events were limited to transient erythema. In addition, some patients (n=3) not responding to prior narrow-band UVB (NB UVB) phototherapy showed good results with MEL in our series. CONCLUSIONS Treatment with 308 nm MEL for vitiligo may be more effective in obtaining rapid repigmentation than phototherapy with NB UVB. The results in this study are similar to those recently reported with a 308 nm excimer laser, but 308 MEL could present some advantages: the possibility of treating larger areas compared to the 308 nm excimer laser, with shorter treatment times and better patient compliance. The overall good results and the early appearance of repigmentation contribute to reducing the cumulative exposure to UV radiation.
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Affiliation(s)
- G Leone
- Servizio di Fototerapia, Istituto Dermatologico San Gallicano, IRCCS, Via Elio Chianesi, 53, 00144 Roma, Italy.
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