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Ju HJ, Bae JM. Bridging Molecular Mechanism and Clinical Practice in Vitiligo Treatment: An Updated Review. Dermatology 2024; 240:474-486. [PMID: 38417409 DOI: 10.1159/000537810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Treatment of vitiligo seeks to achieve three goals: cessation of disease progression, regeneration of pigmentation, and prevention of recurrence. SUMMARY Number of nonsurgical interventions are available that suppress the autoimmune response and regenerate the melanocytes from the reservoir: phototherapy including psoralen and ultraviolet A, narrowband ultraviolet B, and 308-nm excimer and 311-nm Titanium:Sapphire lasers; topical agents including topical calcineurin inhibitors, topical corticosteroids, and topical 5-fluorouracil; and systemic agents including corticosteorids, mycophenolate mofetil, cyclosporine, methotrexate, minocycline, afamelanotide, and antioxidants. In recent years, a great advance has been made in the understanding of pathogenesis of vitiligo, and JAK inhibitors are being investigated as a new treatment. Minimally invasive procedures such as fractional lasers or microneedling can help achieve the optimal treatment outcome when used properly. KEY MESSAGES Our review describes various treatment modalities for vitiligo based on their molecular mechanism of action. Bridging the gap between molecular mechanisms and therapeutic options would be a valuable reference for physicians in clinical practice.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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2
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Arbache S, Hirata SH. Efficacy and Safety of 5-Fluorouracil Tattooing to Repigment Idiopathic Guttate Hypomelanosis: A Split-Body Randomized Trial. Dermatol Surg 2023; 49:603-608. [PMID: 37011024 DOI: 10.1097/dss.0000000000003793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUD Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment. OBJECTIVE Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions. METHODS This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events. RESULTS Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23-37 × post-treatment: 12, IQR 6-18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24-43 × post-treatment: 21, IQR 16-31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs ( p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events. CONCLUSION 5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.Clinicaltrials.gov : NCT02904564.
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Affiliation(s)
- Samir Arbache
- Evidence-Based Post Graduate Program, Department of Medicine, São Paulo Federal University (Universidade Federal de São Paulo-UNIFESP), São Paulo, Brazil
| | - Sergio Henrique Hirata
- Department of Dermatology, São Paulo Federal University (Universidade Federal de São Paulo-UNIFESP), São Paulo, Brazil
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3
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Pazyar N, Hatami M, Yaghoobi R, Parvar SY, Radmanesh M, Hadibarhaghtalab M. The efficacy of adding topical 5-fluorouracil to micro-needling in the treatment of vitiligo: A randomized controlled trial. J Cosmet Dermatol 2023; 22:1513-1520. [PMID: 36718813 DOI: 10.1111/jocd.15616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM Vitiligo is an autoimmune skin disorder characterized by circumscribed depigmented macules and patches caused by the loss of functional melanocytes. Although there is no definitive treatment for vitiligo, several treatment options have been associated with relative satisfactory outcomes. The purpose of this study was to compare the efficacy of micro-needling in conjunction with topical 5-fluorouracil (5-FU) versus topical tacrolimus ointment in treating vitiligo patches. PATIENTS AND METHODS This study included nineteen participants, each of whom received both treatments on two randomly selected vitiligo patches of approximately the same size and location. On one patch, a combination of weekly micro-needling and topical application of 5-FU solution was used every other day, while on the other, 0.1% tacrolimus topical ointment was applied twice daily. The G-score was used to compare treatment outcomes after 3 months. RESULTS The median duration of the disease in our population was 7 years. Six patients (32%) in the micro-needling plus topical 5-FU treated group showed a moderate to excellent response, indicating a significant improvement between both treatments (p-value = 0.019). In contrast, all other patches treated with topical tacrolimus showed poor improvement. Lower extremity and trunk responded more to treatment with micro-needling plus topical 5-FU than upper extremity and acral areas. Moreover, none of those who have had the disease for more than ten years have responded to treatment. Mild erythema, pinpoint bleeding, and irritation were detected only in the micro-needling treated group. CONCLUSION The current study showed that using micro-needling in conjunction with 5-FU could treat vitiligo patients more efficiently than tacrolimus monotherapy. Despite showing moderate to excellent improvement in patches treated with micro-needling and 5-FU, this well-tolerated office-based modality still requires additional research.
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Affiliation(s)
- Nader Pazyar
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hatami
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Yaghoobi
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of medical sciences, Shiraz, Iran
| | - Mohammad Radmanesh
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Hadibarhaghtalab
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Utilization of Our Toolkit: A Systematic Review and Meta-analysis of Surgical Therapies in Vitiligo Treatment. Dermatol Surg 2022; 48:815-821. [DOI: 10.1097/dss.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease. Dermatol Surg 2021; 47:e66-e70. [PMID: 33587385 DOI: 10.1097/dss.0000000000002879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND 5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. OBJECTIVE We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. METHODS We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). CONCLUSION In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
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Bertolani M, Rodighiero E, de Felici del Giudice MB, Lotti T, Feliciani C, Satolli F. Vitiligo: What's old, what's new. Dermatol Reports 2021; 13:9142. [PMID: 34659674 PMCID: PMC8451070 DOI: 10.4081/dr.2021.9142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/05/2021] [Indexed: 02/04/2023] Open
Abstract
Vitiligo is an acquired pigmentary disorder afflicting 0.5-2% of the world population for both sexes and all races with a capricious and unpredictable course. It has a complex etiology and varies in its manifestation, progression and response to treatment. Even if the precise aetiology and pathobiology of the disease are complex and still debated, recent evidence supports that vitiligo is a T CD8+ cell-mediated autoimmune disease triggered by oxidative stress. To date no clinical, biological and histological criteria allow us to establish the prognosis with certainty. The choice of the best therapy for adult and childhood vitiligo is based on various factors, such as the patient's age, psychological condition and expectations, distribution and extension of skin lesions, type of vitiligo (stable or not) and availability and cost of therapeutic options. Since vitiligo has a deep psychological impact on patients and their quality of life, treating the disease is very important. As dermatologists, we have important goals in the treatment of vitiligo patients: stabilization of the disease progression, repigmentation of the lesions and especially the persistence of the aforementioned repigmentation. Although several medical and surgical therapeutic options have been proposed, no definite cure has yet been developed and the long-term persistence of repigmentation is unpredictable. We review the different therapeutic options with particular attention on the recurrence rate.
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Affiliation(s)
| | - Eleonora Rodighiero
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
| | | | - Torello Lotti
- Unit of Dermatology and Regenerative Medicine, University of Rome G. Marconi, Rome, Italy
- Department of Dermatology and Communicable Diseases, Ministry of Health, Moscow – Russia First Medical Moscow State University, Higher Education Institution I. M. Sechenov, Russian Federation
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Italy
- Dermatologic Unit, University Hospital of Parma, Italy
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7
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Buch J, Patil A, Kroumpouzos G, Kassir M, Galadari H, Gold MH, Goldman MP, Grabbe S, Goldust M. Idiopathic guttate hypomelanosis: Presentation and Management. J COSMET LASER THER 2021; 23:8-15. [PMID: 34304679 DOI: 10.1080/14764172.2021.1957116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Idiopathic guttate hypomelanosis (IGH) is a benign, typically asymptomatic, acquired leukoderma characteristically affecting mature individuals. Although the etiopathogenesis is unclear, chronic sun exposure and senile degeneration are important triggers. Researchers have been engaged in a continuous effort to unveil the gray areas encompassing different aspects of IGH pathogenesis. IGH is a clinical diagnosis; however, histopathology and dermoscopy may aid in quetionable cases. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium. Here we discuss the pathogenesis, presentation, and management of IGH.
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Affiliation(s)
- Jeta Buch
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Anant Patil
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - George Kroumpouzos
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Martin Kassir
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Hassan Galadari
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Michael H Gold
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mitchel P Goldman
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Stephan Grabbe
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mohamad Goldust
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Arbache S, Arbache ST, Hirata SH. Is it possible to repigment iatrogenic and traumatic hypochromic lesions? A case series using the MMP ® drug delivery technique with 5-fluorouracil and bleomycin. Int J Dermatol 2021; 61:71-83. [PMID: 34173672 DOI: 10.1111/ijd.15725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We present the results of 11 patients with hypochromic lesions treated with antifibrotic agents delivered through the MMP® technique. METHODS Eleven patients with hypochromic lesions because of external injuries were treated at a single clinic with 5-fluorouracil (5-FU) and/or bleomycin using the MMP® drug delivery technique. Treatment sessions were repeated at 30-day intervals until patient satisfaction. The primary outcome was repigmentation of the lesions, assessed independently by two dermatologists and by the patient. RESULTS The MMP® technique injected 0.048 mg/cm2 of 5-FU or 0.0028 U/cm2 of bleomycin. The accumulated 5-FU and bleomycin density per patient ranged from 0.02 to 0.77 mg and 0.0022 to 0.2800 U/ml, respectively. Patients were treated with 1 to 6 MMP® sessions with 5-FU (3 patients), bleomycin (6 patients), or both drugs (2 patients). After the last session, all patients had a significant improvement (>75%) of the lesions compared to baseline. There were no procedure-related short- or long-term adverse effects in any of the participants up to their last follow-up visit. CONCLUSIONS The injection of antifibrotic agents using the MMP® technique was effective and safe in the treatment of hypochromic lesions. This can be a new therapeutic option for these lesions.
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Affiliation(s)
- Samir Arbache
- Department of Medicine, Evidence Based Post Graduate Program, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, SP, Brazil
| | | | - Sergio H Hirata
- Department of Dermatology, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, SP, Brazil
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Asilian A, Kazemipour S, Mokhtari F, Iraji F, Shahmoradi Z, Mohaghegh F, Mozafarpoor S, Talakoub M. Effectiveness of dermabrasion plus 5-fluorouracil vs suction blister in treating vitiligo: A comparative study. Dermatol Ther 2021; 34:e14750. [PMID: 33403790 DOI: 10.1111/dth.14750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
Vitiligo is a prevalent destructive melanocyte skin disease that negatively affects the patients' life in terms of self-esteem. Suction blister and dermabrasion plus 5-fluorouracil are effective treatments for vitiligo. The present study was conducted to compare the outcomes of these two techniques. The present clinical trial was conducted on 36 patients with persistent refractory vitiligo which defined as the lack of any new or progressed lesion during the previous year as well as no responding to conventional therapies of vitiligo including topical treatments and phototherapy. Individuals with two vitiligo patches, with similar baseline Vitiligo Area Severity Index (VASI) scores were randomly allocated to dermabrasion plus 5-fluorouracil or suction blister treatments. VASI and repigmentation scores were measured and compared at the baseline, four, and 12 weeks after performing the procedures. Both of the approaches accompanied with significant improvement in both entities of VASI and repigmentation scores (P value < .05) at the end of the study, besides the trend of VASI and repigmentation scores between the two groups revealed insignificant difference (P > .05). The short-term follow-up of the patients was the limitation of this study. The present findings suggested that both surgical techniques of dermabrasion plus 5-fluorouracil and suction blister posed acceptable outcomes within 12-week follow-up.
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Affiliation(s)
- Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samira Kazemipour
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mokhtari
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Iraji
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mohaghegh
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Talakoub
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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The efficacy of fractional carbon dioxide laser combined with narrow-band ultraviolet B phototherapy for non-segmental vitiligo: a systematic review and meta-analysis. Lasers Med Sci 2020; 36:165-173. [PMID: 32572662 DOI: 10.1007/s10103-020-03069-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Fractional carbon dioxide (CO2) laser has been used with conventional treatments for vitiligo, demonstrating more effectiveness compared with conventional treatments alone. Especially, fractional CO2 laser combined with narrow-band ultraviolet B (NB-UVB) was shown to induce more improvement compared with NB-UVB monotherapy for treating stable non-segmental vitiligo. However, the effectiveness of fractional CO2 laser plus NB-UVB for the treatment of non-segmental vitiligo remains controversial. Therefore, this study aimed to confirm the safety and efficacy of fractional CO2 laser combined with NB-UVB compared with NB-UVB monotherapy in stable non-segmental vitiligo. We searched the data from different databases, including Cochrane, Embase, and PubMed up to January 2020. Four randomized controlled trials (RCTs) for comparison between fractional CO2 laser plus NB-UVB and NB-UVB monotherapy in patients with stable non-segmental vitiligo were included. We performed meta-analyses for repigmentation improvement and patient satisfaction as well as subgroup analyses based on acral or non-acral vitiligo, according to the PRISMA guidelines. The combination treatment showed more superior results than NB-UVB monotherapy (≥ 75% repigmentation, RR 4.60, 95% CI 1.19-17.74; ≥ 50% repigmentation, RR 2.24, 95% CI 0.45-11.17; < 25% repigmentation, RR 0.81, 95% CI 0.60-1.08). Also, fractional CO2 laser plus NB-UVB significantly improved acral and non-acral vitiligo compared with NB-UVB monotherapy (standard mean difference (SMD) 1.24, 95% CI 0.66-1.82; SMD 1.14, 95% CI 0.67-1.60, respectively), while it increased markedly patient satisfaction compared with NB-UVB monotherapy (SMD 1.12, 95% CI 0.66-1.58). Collectively, this meta-analysis suggested that fractional CO2 laser combined with NB-UVB might be more effective for treating non-segmental vitiligo than NB-UVB monotherapy.
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11
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Ebrahim HM, Albalate W. Efficacy of microneedling combined with tacrolimus versus either one alone for vitiligo treatment. J Cosmet Dermatol 2020; 19:855-862. [DOI: 10.1111/jocd.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Howyda M. Ebrahim
- Dermatology, Venereology and Andrology Department Faculty of Medicine Zagazig University Zagazig Egypt
| | - Waleed Albalate
- Dermatology, Venereology and Andrology Department Faculty of Medicine Zagazig University Zagazig Egypt
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Abdelwahab M, Salah M, Samy N, Rabie A, Farrag A. Effect of Topical 5-Fluorouracil Alone versus Its Combination with Erbium:YAG (2940 nm) Laser in Treatment of Vitiligo. Clin Cosmet Investig Dermatol 2020; 13:77-85. [PMID: 32021372 PMCID: PMC6988583 DOI: 10.2147/ccid.s225881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
Purpose To compare the efficacy of topical 5-FU as monotherapy to combined therapy of topical 5-FU and Er:YAG (2940 nm) laser in the treatment of non-segmental vitiligo (NSV). Methods This is a prospective randomized comparative study. Thirty patients diagnosed with NSV were recruited from the dermatology outpatient clinics of the Medical Research Centre of Excellence, the National Research Centre and the National Institute of Laser Enhanced Sciences. Our study group was divided into two subgroups, Group 1 was subjected to ablative Er:YAG and 5-FU cream and Group 2 applied topical 5-FU cream. Three treatment sessions were repeated every 4 to 6 weeks and patients were followed up to 9 months. Repigmentation was assessed by digital photography and subsequent computer based image analysis. Results Repigmentation of Group 1 patients ranged from 0 to 70% (mean 12±7%) whilst in Group 2 this ranged from 0 to 5% (mean 1.4±0.8%). In Group 1 repigmentation was mild in 22/30 (73.3%) and moderate to severe in 3/30 (10%) starting after 3 months and persisted or increased during the period of follow up to 9 months. Groups 1 and 2 were subdivided into A and B, vitiligo involving non-resistant and resistant areas respectively. Group 1A showed more repigmentation (mean 13.8±8.5%) than Group 1B (mean 9.8±4.5%) and Group 2A showed more repigmentation (mean 1.5±1%) than Group 2B (mean 1.3±0.5%). Conclusion The combination of Er:YAG with 5-FU is safe and effective in treating and improving outcome in vitiligo especially of non-resistant areas. Computer based image analysis of vitiliginous lesions and assessing post-therapy response is an easy, quick, and reliable method. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/RNPmA6PkfGo
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Affiliation(s)
- Mahetab Abdelwahab
- Department of Dermatology and Venereology, Medical Division, National Research Centre, Cairo, Egypt
| | - Manal Salah
- Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Nevien Samy
- Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Ahmad Rabie
- Department of Dermatology and Venereology, Medical Division, National Research Centre, Cairo, Egypt
| | - Abdelrazik Farrag
- Department of Pathology, Medical Division, National Research Centre, Cairo, Egypt
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Zohdy HAEW, Hussein MS. Intradermal injection of Fluorouracil versus triamcinolone in localized vitiligo treatment. J Cosmet Dermatol 2019; 18:1430-1434. [PMID: 30444065 DOI: 10.1111/jocd.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/20/2018] [Accepted: 10/19/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Vitiligo is an autoimmune disease with a prevalence of 1.22% in Egypt. Intralesional steroids use in localized vitiligo treatment still a matter of debate. Fluorouracil was tried in vitiligo treatment after lesion dermabrasion, ablative laser, or micro-needling. The study aimed to compare the efficacy of intradermal fluorouracil and triamcinolone acetonide without any adjuvant therapy in localized vitiligo treatment. PATIENTS AND METHODS Sixty patients with localized non-segmental stable vitiligo were assigned randomly and equally into groups. Patients subjected to intradermal injection of either fluorouracil (50 mg/mL), triamcinolone acetonide (3 mg/mL) or an equal mixture of both drugs. All patients had four treatment sessions every 2 weeks were followed up for 6 months. RESULTS Intradermal fluorouracil showed the best overall improvement (median 52.27, IQR 36.25-68.18) when compared with triamcinolone (median 13.86, IQR 3.83-33.32) and the drug mixture (median 17.15, IQR 7.48-41.67). During follow-up, the vitiliginous patches continued to repigment for 6 months in fluorouracil and the drug mixture groups. The improvement stopped 1 month after the last session in the triamcinolone group. CONCLUSION The intradermal fluorouracil injection is an effective treatment of localized vitiligo. The intradermal steroid has a short-acting therapeutic effect, but the mixture of drugs added no therapeutic effect.
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Doghaim NN, El-Tatawy RA, Ismail MA, Ali DAM, El Attar YA. Study the effect of erbium:YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB-UVB phototherapy. J Cosmet Dermatol 2019; 19:122-130. [PMID: 31571367 DOI: 10.1111/jocd.13134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/04/2019] [Accepted: 08/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. OBJECTIVE To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. METHODS The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. RESULTS There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. CONCLUSION Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.
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Ghasemloo S, Gauthier Y, Ghalamkarpour F. Evaluation of using fractional CO 2 laser plus NB-UVB versus NB-UVB alone in inducing marginal repigmentation of vitiligo lesions. J DERMATOL TREAT 2019; 30:697-700. [PMID: 30592235 DOI: 10.1080/09546634.2018.1564232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Vitiligo is a common depigmenting skin disorder, characterized by patchy loss of skin color and finding effective treatment has remained a challenging issue. Methods: A paired (half-body) randomized clinical trial study was done to compare the efficacy and the safety of narrowband ultraviolet B (NB-UVB) plus fractional CO2 versus NB-UVB alone in stimulation of marginal repigmentation of vitiliginous patches. One side of the body was randomly treated with a fractional CO2 laser and NB-UVB twice weekly, while the other side was exposed only to NB-UVB with the same manner. Results: Thirty patients with the nonsegmental stable vitiligo and mean age of 43 ± 15 years completed a 16-week treatment period with NB-UVB on one side of the body and fractional CO2 laser therapy with NB-UBV on the other side. In addition to the higher rate of response in the combination side compared to the monotherapy side of the body (p < .001), repigmentation was greater in the combination side rather than the NB-UVB monotherapy side (p = .002). In the combination treated side, marginal repigmentation pattern was more frequently seen than perifollicular pattern (p < .001) and more frequently than monotherapy side (p < .001). Conclusion: The fractional CO2 laser combined with NB-UVB seems to be a more effective therapeutic option for treatment than NB-UVB alone for inducing marginal repigmentation.
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Affiliation(s)
- Sara Ghasemloo
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Yvon Gauthier
- b Vitiligo and Melasma Research Association , Bordeaux , France
| | - Fariba Ghalamkarpour
- a Skin Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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16
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Arbache S, Roth D, Arbache ST, Hirata SH. Original Method to Repigment Achromic Laser Tattoo Removal Scars. Case Rep Dermatol 2019; 11:140-144. [PMID: 31182948 PMCID: PMC6547281 DOI: 10.1159/000500709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022] Open
Abstract
Laser tattoo removal is expensive, painful, and time-consuming. Even with the use of the right laser equipment, it is often impossible to eliminate all pigments. Incomplete tattoo removal, one of the undesired effects of laser treatment, is widely disseminated in the media and accepted by most patients. However, few patients know that laser tattoo removal can cause permanent scars. Some patients who develop achromic scars can feel disappointed with the results of laser tattoo removal and take legal action against the physician responsible for the treatment. This paper describes our experience with a drug delivery treatment called MMP® (“Microinfusão de Medicamentos na Pele,” Portuguese acronym for “Microinfusion of Drugs in the Skin”) that repigments and improves the final esthetic results of achromic laser tattoo removal scars.
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Affiliation(s)
- Samir Arbache
- Evidence-Based Post-Graduate Program, Department of Medicine, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, Brazil
| | | | - Samia Trigo Arbache
- Department of Surgical Dermatology, ABC University (Universidade do ABC), Santo André, Brazil
| | - Sergio Henrique Hirata
- Department of Dermatology, São Paulo Federal University (Universidade Federal de São Paulo - UNIFESP), São Paulo, Brazil
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Wambier CG, Perillo de Farias Wambier S, Pereira Soares MT, Breunig J, Cappel MA, Landau M. 5-Fluorouracil tattooing for idiopathic guttate hypomelanosis. J Am Acad Dermatol 2018; 78:e81-e82. [DOI: 10.1016/j.jaad.2017.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
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18
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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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Mokhtari F, Bostakian A, Shahmoradi Z, Jafari-Koshki T, Iraji F, Faghihi G, Hosseini SM, Bafandeh B. Potential emerging treatment in vitiligo using Er:YAG in combination with 5FU and clobetasol. J Cosmet Dermatol 2017; 17:165-170. [DOI: 10.1111/jocd.12373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Fatemeh Mokhtari
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Anis Bostakian
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Zabihollah Shahmoradi
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Tohid Jafari-Koshki
- Department of Biostatistics; Kermanshah University of Medical Sciences; Kermanshah Iran
- Department of Statistics and Epidemiology; Tabriz University of Medical Sciences; Tabriz Iran
| | - Fariba Iraji
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Gita Faghihi
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Sayed Mohsen Hosseini
- Department of Epidemiology and Biostatistics; School of Health; Isfahan University of Medical Sciences; Isfahan Iran
| | - Behzad Bafandeh
- Skin Diseases and Leishmaniasis Research Center; Department of Dermatology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
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Kovacs D, Abdel-Raouf H, Al-Khayyat M, Abdel-Azeem E, Hanna MR, Cota C, Picardo M, Anbar TS. Vitiligo: characterization of melanocytes in repigmented skin after punch grafting. J Eur Acad Dermatol Venereol 2014; 29:581-90. [PMID: 25089006 DOI: 10.1111/jdv.12647] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/23/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Punch grafting is a surgical technique mainly applied in therapy-resistant, stable and circumscribed vitiligo. OBJECTIVE (i) To characterize in detail the features of the repigmented skin among punch grafts; and (ii) to correlate the ex vivo results with clinical data and punch grafting outcome. METHODS We evaluated by immunohistochemistry and image analysis the expression of a panel of specific melanocyte markers including HMB45, MITF, c-kit, MART-1 and TRP1, the proliferation marker Ki67 and the cell-cell adhesion molecule E-cadherin in tissue samples collected from nine patients after punch grafting. RESULTS Cells positive for MITF, c-kit, MART-1 and TRP1 were detected in the repigmented skin of all biopsies, whereas no reactivity was observed for HMB45. Melanocytes were identified along the entire length of the sections, and their mature state was assessed by the immuno-reactivity for the differentiation marker MART-1, the absence of cells positively stained for Ki67 and by the co-expression of c-kit and TRP1, a marker of a differentiated and pigmented state. Clinically, smaller punch grafts aimed at repigmenting lesional areas on the face gave the faster clinical results with no side-effects. Patients subjected to bigger punch grafts on the knee exhibited a longer repigmentation time and presented cobble stoning. CONCLUSION Our results suggest that the repigmentation observed in the areas between the grafts is due to the activation of the melanocytes located in the donor sites. These cells start to horizontally migrate towards the lesional skin thanks to successively the enlargement of intercellular spaces in relation to a decrease of E-cadherin reactivity and the up-modulation of pro-melanogenic mediators. Production and transfer of melanin in the surrounding keratinocytes and their persistence were assessed by the reactivity for MITF, c-kit, MART-1 and TRP1 but not for the pre-melanosome marker (HMB45).
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Affiliation(s)
- D Kovacs
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute (IRCCS), Rome, Italy
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