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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. Photodermatol Photoimmunol Photomed 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Esmat SM, Bassiouny D, Hegazy R, Shalaby S, Ragab N, Ibrahim S, Mogawer RM. Early localized vitiligo, a medical emergency: Long-term follow-up study. Dermatol Ther 2021; 35:e15219. [PMID: 34812544 DOI: 10.1111/dth.15219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T-cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty-five patients with recent onset (<6 months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6 months plus topical treatments and NB-UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4 years. Eighty-four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65 ± 2.19 months. Complete repigmentation was achieved in a mean duration of 6.88 ± 0.2 months. At the end of the 4-year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.
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Affiliation(s)
- Samia M Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Bassiouny
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- 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
| | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bassiouny D, Hegazy R, Esmat S, Gawdat HI, Ahmed Ezzat M, Tawfik HA, Hegazy AA, Ibrahim S. Cosmetic camouflage as an adjuvant to vitiligo therapies: Effect on quality of life. J Cosmet Dermatol 2020; 20:159-165. [PMID: 32406129 DOI: 10.1111/jocd.13459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vitiligo is a pigmentary disorder associated with considerable psychological imbalance. Partial response to therapy and long duration for repigmentation are common. Meanwhile, camouflage may help through concealing vitiligo lesions and improving patient confidence and self-esteem. AIM To assess the Dermatology Life Quality Index (DLQI) in vitiligo patients, and to determine the patients' acceptance and willingness to utilize camouflage regularly and the impact of using camouflage as an adjuvant modality. PATIENTS/METHODS The study was carried out on 100 vitiligo patients who underwent thorough history taking, clinical examination, and DLQI assessment. Forty patients were randomly chosen, taught how to apply camouflage, and followed up over 1 month of regular application. RESULTS Dermatology Life Quality Index in the 100 vitiligo patients was found to be 12.2 ± 3.9, denoting the very large effect on quality of life vitiligo has. It was significantly worse in female patients, adolescents, students, and high-socioeconomic level patients, in visible sites and genitalia, and in unstable cases. There was a significant positive correlation between the DLQI and disease duration (r = 0.75, P < .001) and VES (r = 0.79, P < .001). The 40 cases on camouflage showed a significant percent reduction in their DLQI when compared to noncamouflage users (P: .00). CONCLUSIONS Dermatology Life Quality Index is significantly affected by vitiligo. Camouflaging is a technique that needs to be taught to the patient to overcome the anticipated problems that drive them away from using it; especially, it significantly improves their DLQI in their devastating disease.
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Affiliation(s)
- Dalia Bassiouny
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Ahmed Ezzat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Amira Aly Hegazy
- Lecturer of Public Health and Community Medicine, Kasr Alainy medical school, Cairo University, Egypt
| | - Sarah Ibrahim
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Esmat S, Bassiouny D, Saleh MA, AbdelHalim D, Hegazy R, ElHawary M, Gawdat H, Gouda H, Khorshied M, Samir N. Studying the effect of adding growth factors to the autologous melanocyte keratinocyte suspension in segmental vitiligo. Dermatol Ther 2020; 33:e13368. [PMID: 32243651 DOI: 10.1111/dth.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
Addition of different growth factors to the medium used in autologous melanocyte-keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3'5' cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB-UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point-counting technique and complications were recorded. Excellent response (90%-100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P = .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B; P value: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.
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Affiliation(s)
- Samia Esmat
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Bassiouny
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwah A Saleh
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia AbdelHalim
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa ElHawary
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Gawdat
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Gouda
- Department of Clinical Pathology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mervat Khorshied
- Department of Clinical Pathology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nesrin Samir
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bassiouny D, Esmat S. Autologous non-cultured melanocyte-keratinocyte transplantation in the treatment of vitiligo: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018; 11:521-540. [PMID: 30464567 PMCID: PMC6208871 DOI: 10.2147/ccid.s151503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autologous non-cultured melanocyte–keratinocyte transplantation procedure (MKTP) is one of the simplest cellular grafting techniques. Various modifications were done over the years to make the technique easier and more economical which led to its great popularity among dermatologists. Proper patient selection and good technical skills are essential for achieving success with this technique. In this review, different patient-related and procedure-related factors that affect the outcome are discussed. This review may guide dermatologists to select suitable candidates, and explains what to expect in each case and indicates different techniques which can be used. The expected complications and stability of acquired pigmentation, which are an essential part of the pretreatment patient counseling, are also discussed.
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Affiliation(s)
- Dalia Bassiouny
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt,
| | - Samia Esmat
- Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Abdallah M, El-Mofty M, Anbar T, Rasheed H, Esmat S, Al-Tawdy A, Fawzy MM, Abdel-Halim D, Hegazy R, Gawdat H, Bassiouny D, Ibrahim MA, Sany I, El-Bassiouny M, Khalil M, Abdel-Aziz A, El Maadawi ZM, Mostafa WZ. CXCL-10 and Interleukin-6 are reliable serum markers for vitiligo activity: A multicenter cross-sectional study. Pigment Cell Melanoma Res 2017; 31:330-336. [DOI: 10.1111/pcmr.12667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marwa Abdallah
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | | | - Tag Anbar
- Dermatology and Venereology Department; Minya University; Al- Minya Egypt
| | - Hoda Rasheed
- Dermatology Department; Cairo University; Cairo Egypt
| | - Samia Esmat
- Dermatology Department; Cairo University; Cairo Egypt
| | | | | | | | - Rehab Hegazy
- Dermatology Department; Cairo University; Cairo Egypt
| | - Heba Gawdat
- Dermatology Department; Cairo University; Cairo Egypt
| | | | - Mona A. Ibrahim
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | - Iman Sany
- Dermatology Department; Cairo University; Cairo Egypt
| | - Mahy El-Bassiouny
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | - Mohamed Khalil
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
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ELZawahry B, Bassiouny D, Hegazy R, Gawdat H, Shalaby S, Saleh M. 291 Effect of rituximab therapy on total CD25 + and CD4 + CD25 + cells of pemphigus vulgaris patients. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zaher H, Bassiouny D, Abdel Hay R, Samir N, Ragab N, Sayed S. Dermoscopic and Immunohistochemical Changes in Acquired Melanocytic Nevi following Narrow-Band Ultraviolet B Therapy. Dermatology 2016; 232:273-8. [PMID: 27193800 DOI: 10.1159/000445780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acquired melanocytic nevi (AMN) have been reported to undergo morphological and dermoscopic changes following exposure to narrow-band ultraviolet B (NB-UVB) radiation. OBJECTIVE To study the morphological, dermoscopic and immunohistochemical changes in AMN following NB-UVB radiation. METHODS Suberythemogenic NB-UVB sessions were delivered to 40 patients with AMN. For each patient, a minimum of 2 nevi were selected. One nevus was surgically removed from each patient prior to sessions as control; for the other nevus, dermoscopic images were captured before and after NB-UVB sessions. The images were evaluated for changes. At the end, another nevus was surgically removed for immunohistochemical assessment of Ki-67 and melan-A. RESULTS Our study showed a statistically significant increase in the size of AMN following NB-UVB radiation. Benign dermoscopic changes were observed. Statistically significant positive correlations were found between some dermoscopic findings and the total cumulative dose of NB-UVB. Immunohistochemical analysis did not show any significant change in the exposed AMN. CONCLUSION AMN irradiated with repeated suberythemogenic doses of NB-UVB showed benign morphological and dermoscopic changes, and this was confirmed by our immunohistochemical study.
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Affiliation(s)
- Hesham Zaher
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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