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Fekete L, Fekete GL, Iantovics LB, Fekete JE, Bacârea V. Evaluation of the clinical and sociodemographic features of patients with vitiligo from the central region of Romania. Front Med (Lausanne) 2025; 12:1544184. [PMID: 40115779 PMCID: PMC11922702 DOI: 10.3389/fmed.2025.1544184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 02/13/2025] [Indexed: 03/23/2025] Open
Abstract
Background In this study, we aimed to investigate and analyze the clinical and sociodemographic features and possible correlation with factors associated with the development of vitiligo in a cohort of patients suffering from this disease in the central region of Romania. Methods Patients diagnosed with vitiligo from private outpatient clinics in the region and from the outpatient clinic of the Dermatology Clinic in Târgu Mureş participated in the study. The study period was between March 2021 and March 2022. Both sets of patients adhered to the same specified inclusion and exclusion criteria. Included just patients who received a complete dermatological clinical examination. They were asked by experienced physicians about epidemiological and clinical data of the disease, using the questions about vitiligo from the validated questionnaire edited by the Vitiligo Research Foundation from the United States of America. The patients who were given incomplete responses were excluded. This questionnaire contains 30 questions with multiple answers, about the patients with vitiligo, divided into seven subgroups as follows: group 1. Origins (demographic data), 2. History of vitiligo, 3. Vitiligo description, 4. Vitiligo treatments, 5. Skin condition, 6. Other conditions (comorbidities), 7. Impact (cost of treatments). Our study consisted of 114 patients, all of whom were Caucasians with Fitzpatrick skin types ranging from I-III. Results We have analyzed the found data and compared the result with the data found in the literature. Most of the clinical and epidemiological characteristics of vitiligo in our patients were similar to those in other studies. A few of the characteristics linked to the possible appearance of the disease were present in higher percentages like the presence of the disease in the family, lighter color of the eyes, gray colored hair, the presence of the halo naevus, the predisposition to sunburn, the skin trauma as starting cause and the presence of increased level of thyroid disease. Conclusion Based on our results, we can conclude a profile of a potential patient who can develop vitiligo. To our knowledge, this study is the first of its kind from our country, however, our inferences remain limited by the single center, a relatively small sample size, recall bias, and a self-decided classification of some clinical aspects, which are potential limitations of this study.
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Affiliation(s)
- Laszlo Fekete
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Târgu Mureş, Romania
- CMI Dermamed Private Medical Office, Târgu Mureş, Romania
| | - Gyula Laszlo Fekete
- Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Târgu Mureş, Romania
| | - Laszlo Barna Iantovics
- Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Târgu Mureş, Romania
| | - Júlia Edit Fekete
- National Institute of Public Health, Regional Center for Public Health, Târgu Mureş, Romania
| | - Vladimir Bacârea
- Department of Research Methodology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Târgu Mureş, Romania
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Hlača N, Vičić M, Kaštelan M, Dekanić A, Prpić-Massari L. Analysis of granulysin expression in vitiligo and halo-nevus. Sci Rep 2024; 14:16580. [PMID: 39020008 PMCID: PMC11254913 DOI: 10.1038/s41598-024-67494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
Vitiligo and halo nevus are immune-mediated skin diseases that have a similar pathogenesis and involve cellular cytotoxicity mechanisms that are not yet fully understood. In this study, we investigated the expression patterns of the cytolytic molecule granulysin (GNLY) in different cytotoxic cells in skin samples of vitiligo and halo nevus. Skin biopsies were taken from perilesional and lesional skin of ten vitiligo patients, eight patients with halo nevus and ten healthy controls. We analysed the expression of GNLY by immunohistochemistry in CD8+ and CD56+ NK cells. A significantly higher accumulation of GNLY+, CD8+ GNLY+ and fewer CD56+ GNLY+ cells was found in the lesional skin of vitiligo and halo nevus than in the healthy skin. These cells were localised in the basal epidermis and papillary dermis, suggesting that GNLY may be involved in the immune response against melanocytes. Similarly, but to a lesser extent, upregulation of GNLY+ and CD8+ GNLY+ cells was observed in the perilesional skin of vitiligo and halo nevus compared to healthy controls. In this study, we demonstrated for the first time an increased expression of CD8+ GNLY+ T lymphocytes and CD56+ GNLY+ NK cells in lesions of vitiligo and halo nevus, indicating the role of GNLY in the pathogenesis of both diseases.
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Affiliation(s)
- Nika Hlača
- Department of Dermatovenerology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
| | - Marijana Vičić
- Department of Dermatovenerology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Marija Kaštelan
- Department of Dermatovenerology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
| | - Andrea Dekanić
- Department of Pathology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
| | - Larisa Prpić-Massari
- Department of Dermatovenerology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
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Hlača N, Žagar T, Kaštelan M, Brajac I, Prpić-Massari L. Current Concepts of Vitiligo Immunopathogenesis. Biomedicines 2022; 10:biomedicines10071639. [PMID: 35884944 PMCID: PMC9313271 DOI: 10.3390/biomedicines10071639] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 12/11/2022] Open
Abstract
Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The prevalence of vitiligo varies by geographical area, affecting 0.5% to 2% of the population. The disease imposes a significant psychological burden due to its major impact on patients’ social and emotional aspects of life. Given its autoimmune background, vitiligo is frequently associated with other autoimmune diseases or immune-mediated diseases. Vitiligo is a multifaceted disorder that involves both genetic predisposition and environmental triggers. In recent years, major predisposing genetic loci for the development of vitiligo have been discovered. The current findings emphasize the critical role of immune cells and their mediators in the immunopathogenesis of vitiligo. Oxidative-stress-mediated activation of innate immunity cells such as dendritic cells, natural killer, and ILC-1 cells is thought to be a key event in the early onset of vitiligo. Innate immunity cells serve as a bridge to adaptive immunity cells including T helper 1 cells, cytotoxic T cells and resident memory T cells. IFN-γ is the primary cytokine mediator that activates the JAK/STAT pathway, causing keratinocytes to produce the key chemokines CXCL9 and CXCL10. Complex interactions between immune and non-immune cells finally result in apoptosis of melanocytes. This paper summarizes current knowledge on the etiological and genetic factors that contribute to vitiligo, with a focus on immunopathogenesis and the key cellular and cytokine players in the disease’s inflammatory pathways.
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Nedelcu R, Dobre A, Brinzea A, Hulea I, Andrei R, Zurac S, Balaban M, Antohe M, Manea L, Calinescu A, Coman A, Pantelimon F, Dobritoiu A, Popescu C, Popescu R, Balasescu E, Ion D, Turcu G. Current Challenges in Deciphering Sutton Nevi-Literature Review and Personal Experience. J Pers Med 2021; 11:jpm11090904. [PMID: 34575681 PMCID: PMC8470687 DOI: 10.3390/jpm11090904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023] Open
Abstract
Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.
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Affiliation(s)
- Roxana Nedelcu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Alexandra Dobre
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Correspondence: ; Tel.: +40-740-853-353
| | - Alice Brinzea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
- National Institute for Infectious Diseases, Outpatient Clinic, 021105 Bucharest, Romania
| | - Ionela Hulea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Razvan Andrei
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
- Synevo Medical Laboratory, 014192 Bucharest, Romania
| | - Sabina Zurac
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Mihaela Balaban
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Mihaela Antohe
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Lorena Manea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
- Department of Dermatovenerology, Centre Hospitalier Régional D’orléans, 45100 Orléans, France
| | - Andreea Calinescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Anastasia Coman
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | | | - Adina Dobritoiu
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Catalin Popescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Raluca Popescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Elena Balasescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Daniela Ion
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Gabriela Turcu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
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Halo Nevi Are Not Trivial: About 2 Young Patients of Regressed Primary Melanoma That Simulates Halo Nevi. Case Rep Dermatol Med 2021; 2021:6672528. [PMID: 33859847 PMCID: PMC8009706 DOI: 10.1155/2021/6672528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Halo nevi are often considered benign, and the possibility of malignancy is not always clear to practitioners. We present two case reports suggesting that a halo nevus appearance can be seen in melanoma, even in young adults. A literature search for halo nevi revealing melanoma shows that this is a very rare condition. Case presentation. This report of two young patients indicates the importance of obtaining a detailed history to detect warning signs such as itching, pain, spontaneous bleeding, and previous alterations according to the patient, including a previously totally black colour in an already fully regressed melanoma. Conclusions The risk of a halo nevus being malignant is higher if there is only one unique halo nevus and no personal or familial history of vitiligo. We postulate that a regressing atypical nevus or a regressing melanoma may be induced by an immunologic reaction as halo nevus type of clinical picture.
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Ramachandran V, Kim KM, Zhang L. Disseminated Nonsegmental Vitiligo Associated With Halo Nevi and Premature Gray Hair. Cureus 2021; 13:e13868. [PMID: 33859916 PMCID: PMC8038926 DOI: 10.7759/cureus.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Halo nevi (HN) are acquired melanocytic nevi circumferentially surrounded by a depigmented patch. HN are commonly associated with vitiligo and can be associated with uveal, mucosal, or cutaneous melanoma in certain patient populations. HN may also have localized leukotrichia of terminal hair overlying the nevus. We report a less common triad of rapid-onset HN, nonsegmental vitiligo, and premature hair graying (PHG) of scalp hair.
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Affiliation(s)
| | | | - Lisa Zhang
- Dermatology, Henry Ford Health System, Detroit, USA
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Patel R, Gautam M. Halo nevus and halo phenomenon in dermatology. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Public Knowledge and Attitudes towards Vitiligo: A Survey in Mekelle City, Northern Ethiopia. Dermatol Res Pract 2020; 2020:3495165. [PMID: 32549889 PMCID: PMC7281839 DOI: 10.1155/2020/3495165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background The overall well-being, sense of stigmatization, and treatment outcome of persons with vitiligo are largely dependent on their social acceptance and this is linked with perception and attitude of this disease in a given population. Therefore, this study assessed the knowledge and attitude of the public towards vitiligo. Methods A cross-sectional survey was carried out using a self-reported questionnaire distributed to adults living in Mekelle city, Northern Ethiopia from August to November 2019. Individuals who were 18 to 65 years of age and not suffering from vitiligo were included in the study. A self-administered questionnaire that contains a demographic, knowledge, and attitudes parts was used to collect data. Data were entered using Epi Data® version 3.1 and analyzed using SPSS® version 21. Results Of the total 368 subjects, 300 completed the questionnaires giving 81.5% response rate. The mean age was 30 ± 8.3 years and the male-to-female ratio was 1.14 : 1. Friends or families were reported as the most common source of information (70%) about vitiligo. The overall vitiligo knowledge was sufficient in 68.3% of the participants. Higher vitiligo-related knowledge scores were recorded by people older than 30 and below 50, those of secondary school graduated or more, urban-dwellers, persons who had heard about vitiligo, and persons having families or friends affected by vitiligo. Attitudes towards vitiligo were positive in 43.3% of participants. This was more prevalent among employed persons, those of secondary school graduated or more, and persons having families or friends affected by vitiligo. Moreover, sufficient knowledge was significantly related to positive attitudes towards the disease (p < 0.0001). Conclusion Even though the majority of the respondents had sufficient knowledge, we still found misconceptions and negative attitudes towards vitiligo. Therefore, it is still crucial to educate the public about vitiligo to ultimately improve the well-being of patients with vitiligo.
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Shah SD, Shah A, Ankad B, Mutalik S. Efficacy of 308-nm Monochromatic Excimer Light in the Management of Halo Nevi: An Open-Label, Pilot Study. J Cutan Aesthet Surg 2019; 12:17-24. [PMID: 31057264 PMCID: PMC6484574 DOI: 10.4103/jcas.jcas_138_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Halo nevus (HN) affects approximately 1% of the population. Presence of hypo- or depigmented lesion carries tremendous psychosocial disturbance in the mind-set of population in the Indian subcontinent. Hence, HN requires intervention by any modalities. Here authors attempted to evaluate the efficacy of monochromatic excimer light (MEL) in treating HN. Materials and Methods: A total of 29 patients with HN were included in the study. A xenon chloride lamp emitting noncoherent, monochromatic 308-nm light that represents the natural evolution of the excimer laser was used. The initial dose was 100 mJ/cm2, which was increased by 100 mJ/cm2 per session. All the patients were followed up for 6 months. Results: A total of 29 patients with 10 males and 19 females (male to female ratio of 1:1.9) completed the study. The age of onset of HN ranged from 5 to 47 years and the mean age of the patients was 23 years. HN was seen on the face, back, neck, chest, trunk, and extremities in 5 (17.2%), 6 (20.7%), 4 (13.7%), and 6 (20.7%) patients, respectively. Outstanding response was noticed in 14 patients (48.2%), whereas 6 (20.6%) patients showed excellent improvement. Only 2 (6.8%) patients showed no response after 10 consecutive sessions. Conclusion: HN causes apprehension in the Indian population because of the social stigma associated with depigmented patches on the body. Mere observation and only counseling in the treatment protocol are not sufficient. MEL is a noninvasive procedure, which results in excellent repigmentation of HN without scarring.
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Affiliation(s)
- Swapnil D Shah
- Department of Dermatology, Ashwini Rural Medical College, Hospital and Research Centre, Solapur, Maharashtra, India
| | - Amit Shah
- Shobhana Skin Cosmetic and Laser Clinic, Sangli, Maharashtra, India
| | - Bhalachandra Ankad
- Department of Dermatology, S. Nijalingappa Medical College and H. S. K. Hospital and Research Centre, Bagalkot, Karnataka, India
| | - Sharad Mutalik
- Department of Dermato-Cosmetology, Joshi Hospital, Pune, Maharashtra, India
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