1
|
van Geel N, Speeckaert R, Taïeb A, Ezzedine K, Lim HW, Pandya AG, Passeron T, Wolkerstorfer A, Abdallah M, Alomar A, Bae JM, Bekkenk M, Benzekri L, Böhm M, Eleftheriadou V, Esmat S, Ghia D, Goh BK, Grimes P, Gupta S, Hamzavi IH, Harris JE, Oh SH, Huggins R, Katayama I, Lan E, Lee AY, Leone G, Le Poole C, Lui H, Maquignon N, Meurant JM, Monteiro P, Oiso N, Parsad D, Pliszewski G, Raboobee N, Rodrigues M, Rosmarin D, Suzuki T, Tanemura A, Thng S, Xiang F, Zhou Y, Picardo M, Seneschal J. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol 2023; 37:2173-2184. [PMID: 37746876 DOI: 10.1111/jdv.19451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.
Collapse
Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, BRIC, UMR 1312, Inserm, University Bordeaux, Bordeaux, France
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Albert Wolkerstorfer
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | - Augustin Alomar
- Department of Dermatology, Clinica Dermatologica Moragas, Barcelona, Spain
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marcel Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, VU University, Amsterdam, The Netherlands
| | - Laila Benzekri
- Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital and Research Hospital and South Mumbai Dermatology Clinic, Mumbai, India
| | - Boon Kee Goh
- Skin Physicians Pte Ltd, Mount Elizabeth Medical Centre, Singapore City, Singapore
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California, USA
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Ichiro Katayama
- Pigmentation Research and Therapeutics, Osaka Metropolitan University, Osaka, Japan
| | - Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Roma, Italy
| | - Caroline Le Poole
- Departments of Dermatology, Microbiology and Immunology, Robert H. Lurie Comprehensive Cancer Center Northwestern University, Chicago, Illinois, USA
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Durban, South Africa
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Parkville, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Tanemura
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Steven Thng
- Skin Research Institute of Singapore, ASTAR, Singapore City, Singapore
| | - Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin disorders, Hospital Saint-André, University of Bordeaux, CNRS UMR 5164, ImmunoConcept, Bordeaux, France
| |
Collapse
|
2
|
Seneschal J, Speeckaert R, Taïeb A, Wolkerstorfer A, Passeron T, Pandya AG, Lim HW, Ezzedine K, Zhou Y, Xiang F, Thng S, Tanemura A, Suzuki T, Rosmarin D, Rodrigues M, Raboobee N, Pliszewski G, Parsad D, Oiso N, Monteiro P, Meurant JM, Maquignon N, Lui H, Le Poole C, Leone G, Lee AY, Lan E, Katayama I, Huggins R, Oh SH, Harris JE, Hamzavi IH, Gupta S, Grimes P, Goh BK, Ghia D, Esmat S, Eleftheriadou V, Böhm M, Benzekri L, Bekkenk M, Bae JM, Alomar A, Abdallah M, Picardo M, van Geel N. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations. J Eur Acad Dermatol Venereol 2023; 37:2185-2195. [PMID: 37715487 DOI: 10.1111/jdv.19450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.
Collapse
Affiliation(s)
- Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, ImmunoConcept, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | | | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, BRIC, UMR 1312, Inserm, University Bordeaux, Bordeaux, France
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Steven Thng
- Skin Research Institute of Singapore, ASTAR, Singapore, Singapore
| | - Atsushi Tanemura
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Wheelers Hill, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Durban, South Africa
| | | | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | | | | | | | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Le Poole
- Department of Dermatology, Microbiology and Immunology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Roma
| | - Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ichiro Katayama
- Pigmentation Research and Therapeutics, Osaka Metropolitan University, Osaka, Japan
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California, USA
| | | | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital and Research Hospital and South Mumbai Dermatology Clinic, Mumbai, India
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine Cairo University, Cairo, Egypt
| | | | - Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Laila Benzekri
- Department of Dermatology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco
| | - Marcel Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, VU University, Amsterdam, The Netherlands
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Augustin Alomar
- Department of Dermatology, Clinica Dermatologica Moragas, Barcelona, Spain
| | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
3
|
Post NF, Van Broekhoven NX, Lommerts A, Bae JM, Bekkenk MW, de Castro CCS, Eleftheriadou V, Esmat S, Ezzedine K, van Geel N, Hamzavi I, Leone G, Pandya AG, Passeron T, Rodrigues MA, Seneschal J, Th'ng S, Wolkerstorfer A. Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study. Arch Dermatol Res 2023; 315:2289-2294. [PMID: 36964767 PMCID: PMC10462531 DOI: 10.1007/s00403-023-02611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.
Collapse
Affiliation(s)
- Nicoline F Post
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Noah X Van Broekhoven
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annelies Lommerts
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jung M Bae
- Department of Dermatology, St. Vincent's Hospital, Seoul, South Korea
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | | | - Samia Esmat
- Department of Dermatology, Cairo University, Giza, Egypt
| | - Khaled Ezzedine
- Department of Dermatology, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
| | - Thierry Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, Nice, France
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, University Hospital, Bordeaux, France
| | - Steven Th'ng
- Department of Dermatology, Skin Research Institute of Singapore, Singapore, Singapore
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Post NF, Rodrigues MA, Liong-A-Jin C, Lommerts A, Abdallah M, Bae JM, Bekkenk MW, Silva de Castro CC, Eleftheriadou V, Esmat S, Ezzedine K, van Geel N, Hamzavi I, Leone G, Pandya AG, Passeron T, Raboobee N, Seneschal J, Th'ng S, Wolkerstorfer A. Consensus on the safety and risks of laser and intense pulse light (IPL) treatments in vitiligo patients, an e-Delphi study. J Am Acad Dermatol 2023:S0190-9622(23)00499-1. [PMID: 36967022 DOI: 10.1016/j.jaad.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Nicoline F Post
- Department of Dermatology, Amsterdam University Medical Centers, The Netherlands.
| | | | - Cyetta Liong-A-Jin
- Department of Dermatology, Amsterdam University Medical Centers, The Netherlands
| | - Annelies Lommerts
- Department of Dermatology, Amsterdam University Medical Centers, The Netherlands
| | - Marwa Abdallah
- Department of Dermatology, Andrology & Venereology, Ain Shams University, Cairo, Egypt
| | - Jung Min Bae
- Department of Dermatology, The Catholic University of Korea, Seoul, South Korea
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, The Netherlands
| | | | | | - Samia Esmat
- Department of Dermatology, Cairo University, Egypt
| | - Khaled Ezzedine
- Department of Dermatology, Université Paris-Est Créteil Val de Marne - Université Paris, France
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
| | - Thierry Passeron
- Department of Dermatology and INSERM U1065, University Hospital of Nice, France
| | | | - Julien Seneschal
- Department of Dermatology and pediatric dermatology, University hospital in Bordeaux, France
| | - Steven Th'ng
- Department of Dermatology, Skin Research Institute of Singapore
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, The Netherlands
| |
Collapse
|
5
|
Narayan VS, Alagha E, Ouwerkerk W, Uitentuis SE, Lommerts JE, Esmat S, Mogawer RM, Ragab N, Chuah SY, Thng S, Wolkerstorfer A, Luiten RM, Bekkenk MW. NB-UVB phototherapy response of different body regions in non-segmental vitiligo. J Eur Acad Dermatol Venereol 2023; 37:e782-e785. [PMID: 36734628 DOI: 10.1111/jdv.18946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Vidhya S Narayan
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Elnaz Alagha
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands.,National Heart Centre Singapore, Hospital Drive, Singapore City, Singapore
| | - Sanne E Uitentuis
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Janny E Lommerts
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Rania M Mogawer
- Department of Dermatology, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Nanis Ragab
- Department of Dermatology, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Sai Yee Chuah
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Steven Thng
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Rosalie M Luiten
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Ibrahim S, El-Tahlawi S, Mogawer RM, El Ansary M, Esmat S, El-Hawary M. Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case-control study. J Cosmet Dermatol 2022; 21:7170-7177. [PMID: 36208004 DOI: 10.1111/jocd.15446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/07/2022] [Accepted: 10/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Autoimmune and metabolic disturbances have been reported in association with vitiligo, highlighting possible systemic associations that should be considered. AIMS To assess the possible association of metabolic syndrome (MetS) as well as insulin resistance (IR) with vitiligo in different age groups. METHODS This case-control study included 142 patients with vitiligo aging ≥ 6 years and 142 age- and sex-matched controls. Participants were assessed for MetS using the International Diabetes Federation (IDF) criteria in addition to IR via homeostasis model assessment of IR (HOMA-IR). The study was registered at Clinical Trials.gov, Identifier: NCT03622320, on August 9, 2018. RESULTS As per the IDF criteria, patients with vitiligo showed significantly more frequent association with high fasting plasma glucose levels, high blood pressure readings, central obesity, dyslipidemia, and MetS than controls (p = 0.020, p = 0.034, p = 0.014, p < 0.001, and p = 0.002, respectively). Moreover, patients with vitiligo have significantly higher levels of fasting insulin and HOMA-IR (p ≤ 0.001). Results obtained from patients with vitiligo and controls with coexistent MetS/IR demonstrated vitiligo as a risk factor for both MetS and IR. Univariate and multivariate logistic regression highlighted that older age was the significant independent predictor for MetS and IR. CONCLUSION Patients with vitiligo showed a significantly higher incidence of MetS than controls. Vitiligo per se can be considered a risk factor for MetS and IR. Therefore, regular follow-up and early metabolic derangement diagnoses are mandatory.
Collapse
Affiliation(s)
- Sarah Ibrahim
- Faculty of Medicine, Dermatology Department, Cairo University, Cairo, Egypt
| | - Samar El-Tahlawi
- Faculty of Medicine, Dermatology Department, Cairo University, Cairo, Egypt
| | - Rania M Mogawer
- Faculty of Medicine, Dermatology Department, Cairo University, Cairo, Egypt
| | - Mervat El Ansary
- Faculty of Medicine, Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Faculty of Medicine, Dermatology Department, Cairo University, Cairo, Egypt
| | - Marwa El-Hawary
- Faculty of Medicine, Dermatology Department, Cairo University, Cairo, Egypt
| |
Collapse
|
7
|
Narayan V, Alagha E, Ouwerkerk W, Uitentuis S, Lommerts J, Mogawer R, Esmat S, Chuah S, Thng S, Wolkerstorfer A, Luiten R, Bekkenk M. 534 NB-UVB therapy response of different body regions in vitiligo. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.549] [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: 11/19/2022]
|
8
|
Esmat S, Assaf MI, Mohye Eldeen R, Gawdat HI, Saadi DG. Evaluation of needling/microneedling as an adjunct to phototherapy in the treatment of stable acral vitiligo: a comparative clinical and immunohistochemical study. J DERMATOL TREAT 2022; 33:2621-2628. [PMID: 35373693 DOI: 10.1080/09546634.2022.2062279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to NB-UVB phototherapy in the treatment of stable refractory patches of acral vitiligo, based upon clinical and immunohistochemical assessment of melanocyte count and distribution in response to needling/microneedling. MATERIALS AND METHODS Twenty patients with stable acral vitiligo (≥2 patches) were enrolled. One of the two index patches was randomized to receive needling or microneedling in conjunction with NB-UVB. Patients received phototherapy sessions 3 times weekly, while needling was carried out on biweekly basis for 6 months. Assessment was done clinically using point counting method, VESTA, and global patients' satisfaction, and immunohistochemically by quantitative assessment of melanocyte count by Melan-A. RESULTS No statistically significant difference was observed between NB-UVB monotherapy and either of the combined therapy regimens as regards the mean percentage change in vitiligo surface area (p = .451), mean change in absolute melanocyte count from baseline (p = .589), and mean VESTA (p = .916). Patches subjected to adjuvant microneedling/needling were afflicted by koebnerization in 50% and 20% of cases, respectively. CONCLUSION Neither microneedling nor needling appear to confer an added therapeutic value to NB-UVB phototherapy in the treatment of stable acral vitiligo. Moreover, both carry the risk of koebnerization.
Collapse
Affiliation(s)
- Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magda I Assaf
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Department of Pathology, School of Medicine, NewGiza University, Giza, Egypt
| | - Riham Mohye Eldeen
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
9
|
Ismail SI, Hegazy RA, Gawdat HI, Esmat S, Mahmoud E, Rashed L, Hegazy AA, Saadi DG. Differentiating active from stable vitiligo: the role of dermoscopic findings and their relation to CXCL-10. J Cosmet Dermatol 2022; 21:4651-4658. [PMID: 35298096 DOI: 10.1111/jocd.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/04/2021] [Revised: 12/11/2021] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing vitiligo activity/stability status is pivotal in the management of patients with vitiligo. CXCL10 is a chemokine released in the tissues and sera of patients with vitiligo and an indicator of disease activity. AIM This study aimed to assess the role of dermoscopy in detecting active and stable vitiligo by comparing the dermoscopic signs in vitiligo with Vitiligo Disease Activity Score (VIDA) score, clinical activity, and CXCL10 activity. METHODS Ninety-seven patients with vitiligo were enrolled in this cross-sectional study. Vitiligo activity/stability was assessed using VIDA scores, clinical examination, dermoscopy, and serum CXCL10 levels measured by enzyme-linked immunosorbent assay technique. Dermoscopic scores were calculated using BPLeFoSK score. RESULTS The dermoscopic score was concordant with the VIDA score in 83.5% of patients (n = 81), clinical assessment in 97.9% (n = 95), and serum CXCL10 level in 70.1% (n = 68). Dermoscopic signs of ill-defined border, satellite lesions, and micro-Koebner and starburst appearance were more common in active vitiligo, while a well-defined border was more common in stable lesions. CONCLUSION Dermoscopic examination is a practical, reliable, noninvasive, semi-objective tool in the assessment of vitiligo activity/stability that helps reach an informed decision on the disease status to choose the appropriate therapeutic modality.
Collapse
Affiliation(s)
- Sarah I Ismail
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa Mahmoud
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health and Community Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
10
|
Esmat S, Shokeir HA, Samy NA, Mahmoud SB, Sayed SSED, Shaker E, Hilal RF. Automated Microneedling Versus Fractional CO2 Laser in Treatment of Traumatic Scars: A Clinical and Histochemical Study. Dermatol Surg 2021; 47:1480-1485. [PMID: 34468410 DOI: 10.1097/dss.0000000000003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES Microneedling has shown satisfactory effects in scar rejuvenation. Comparisons of its results with fractional laser are limited. This study aims to compare the efficacy and safety of automated microneedling versus fractional carbon dioxide (CO2) laser in treatment of traumatic scars on clinical and histochemical bases. MATERIALS AND METHODS Thirty patients with traumatic facial scars were randomized to treatment with 4 monthly sessions of either automated microneedling or fractional CO2 laser. Assessment of scars was performed at baseline and 3 months after the last treatment session, clinically by the modified Vancouver Scar Scale (mVSS) and histochemically by quantitative assessment of collagen and elastic fibers. RESULTS Both groups showed improvement in mVSS, collagen, and elastin contents after treatment. Percentage improvement of collagen and elastin content was higher after treatment by a laser compared with microneedling, in case of the collagen content. Percentage increase in the collagen content after treatment was higher in atrophic scars of the laser group than those of the microneedling group. CONCLUSION In this small study, microneedling was as safe as fractional CO2 laser for rejuvenation of traumatic scars with comparable clinical effects. Fractional CO2 laser is more powerful in stimulating neocollagenesis. Automated microneedling is effective for treatment of hypertrophic scars.
Collapse
Affiliation(s)
- Samia Esmat
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Hisham Ali Shokeir
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt
| | - Nevien Ahmed Samy
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt
| | - Sara Bahaa Mahmoud
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Safinaz Salah El Din Sayed
- Department of Histology, Cairo University, Cairo, Egypt; Department of Dermatology, Students' Hospital, Cairo University, Cairo, Egypt
| | - Enas Shaker
- Department of Histology, Cairo University, Cairo, Egypt; Department of Dermatology, Students' Hospital, Cairo University, Cairo, Egypt
| | - Rana Fathy Hilal
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| |
Collapse
|
11
|
Esmat S, Z Elramly A, Shahin D, Hilal RF. Combining Low Power Fractional CO 2 With QS-NdYAG Toning in the Treatment of Melasma Reduces the Incidence of Punctate Leukoderma. Lasers Surg Med 2021; 53:1325-1340. [PMID: 34164829 DOI: 10.1002/lsm.23441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/11/2020] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Q-switched Nd:YAG (QS-Nd:YAG) toning (low fluence, large spot size, and high frequency) has been used successfully for the treatment of melasma, especially in dark skin phototypes. Punctate leukoderma was found to be a frequent complication that reduced the safety of this procedure. Combining low power fractional CO2 laser, which is another effective melasma laser therapy, might improve the efficacy and safety of this procedure. The aim of this study was to evaluate the effect of combining low power fractional CO2 laser with QS-Nd:YAG toning in the treatment of melasma. STUDY DESIGN/MATERIALS AND METHODS A randomized comparative split-face study included a total of 30 patients with bilateral, symmetrical melasma. All patients received QS-Nd:YAG toning on one randomly selected side of the face, while the other side randomly received either low power fractional CO2 alone (group A) or combined QS-Nd:YAG toning with low power fractional CO2 (group B). QS-Nd:YAG toning sessions were scheduled every two weeks for nine consecutive sessions, and low power fractional CO2 sessions were received every 4 weeks for three consecutive sessions. The assessment was done using the modified melasma area and severity index (mMASI) score, spectrophotometry (melanin index [MI] and erythema index [EI]), photography, blinded physician assessment, and patient satisfaction (at baseline, 1 week and 8-12 weeks after the last treatment sessions). RESULTS A significant reduction in the mMASI score and MI was obtained with all treatment regimens. On comparing different modalities, group A reduction in mMASI and MI was significantly greater on the side receiving QS-ND:YAG toning (64.03% and 8.27%, respectively), than the side receiving low power fractional CO2 laser alone (36.02%. 2.64%, respectively). On the other hand, reduction of mMASI score and MI showed no statistical significance between the side receiving QS-Nd:YAG toning alone and the combined modality. Punctate leukoderma occurred in four cases (13%) on the side receiving QS-Nd:YAG toning. CONCLUSION QS-Nd:YAG toning is significantly more effective than low power fractional CO2 in the treatment of melasma when used separately. Although combining low power fractional CO2 with QS-Nd:YAG toning does not increase its efficacy, it minimizes the incidence of the undesirable punctate leukoderma complication and achieves lower recurrence. This combination can thus be recommended as a safe and effective measure for the treatment of melasma. © 2021 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Samia Esmat
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
| | - Amany Z Elramly
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
| | - Dina Shahin
- Ministry of Health, Cairo University, Cairo, 11562, Egypt
| | - Rana F Hilal
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
| |
Collapse
|
12
|
Anbar T, Hay RMA, Hegazy RA, Esmat S, Diab HM, Amer H, Salah S, Anbar MT, Sayed KS. Analysis of symmetricity in the three different (sagittal, transverse and frontal) planes in generalized nonsegmental vitiligo. Indian J Dermatol Venereol Leprol 2020; 87:22-28. [PMID: 33109833 DOI: 10.4103/ijdvl.ijdvl_979_19] [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: 06/01/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nonsegmental vitiligo is defined as being "often symmetrical", however, no work has tackled the point as to how valid it is to depend upon the concept of symmetricity in generalized nonsegmental vitiligo. AIMS To investigate vitiligo symmetry, taking into account sites of predilection, the clinical characteristics of patients were studied. METHODS This multicentric study included 712 nonsegmental vitiligo patients with 2876 examined lesions. Three models were drawn for each patient. Sagittal, transverse and frontal planes were drawn to divide the body into right/left, upper/lower and anterior/posterior halves respectively. Patients were examined by Wood's light and analyzed for symmetry. RESULTS Bilateral involvement was present in 78% (P < 0.001). Studying the similarity of clinical involvement in the upper and lower body parts revealed that such similarity was present in 38%, with a significant positive association in some areas. Studying clinical similarity in the anteroposterior distribution pattern revealed a significant positive association in 11%. LIMITATIONS Relatively low number of patients. CONCLUSIONS We found significant bilateral symmetry in the lesions of 78% of vitiligo patients. Our work could aid in drawing the anticipated vitiligo map in patients with active disease, helping in increasing our understanding of the clinical behaviour of this disease.
Collapse
Affiliation(s)
- Tag Anbar
- Department of Dermatology, Al-Minya University, Al-Minya, Cairo, Egypt
| | - Rania M Abdel Hay
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba M Diab
- Department of Dermatology, Ain Shams University, Cairo, Egypt
| | - Hala Amer
- Department of Dermatology, Al-Hod Al-Marsoud Hospital, Cairo, Egypt
| | - Sahar Salah
- Department of Dermatology, Al-Minya University, Al-Minya, Cairo, Egypt
| | | | - Khadiga S Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
13
|
El Hawary M, Bassiouny DA, Esmat S, Sobhi R, Saleh MA, AbdelHalim D, Hegazy R, Gawdat H, Ragab N, Samir N, Sany I. Recipient site preparation by cryoblebbing in melanocyte keratinocyte transplantation procedure over the fingers in vitiligo: A pilot study. Dermatol Ther 2020; 33:e14199. [PMID: 32798282 DOI: 10.1111/dth.14199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/14/2020] [Revised: 07/15/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
Surgical treatment of vitiligo lesions over the fingers has poor outcome. In this intra-patient comparative study, 12 patients with stable non-segmental vitiligo (NSV) affecting the middle three fingers of one hand were included. Three variations were used in treatment of finger vitiligo lesions: minipuch grafting, melanocytes keratinocyte transplantation procedure (MKTP) preceded by cryoblebbing or full CO2 laser resurfacing of the recipient site. Liquid nitrogen was used to create blebs in one finger 24 hours before therapy. On the following day, the second finger was treated by minipunch grafting and the third finger was resurfaced by CO2 laser. A suspension was prepared and 0.1 mL was injected into each cryobleb. It was also applied to the resurfaced skin. All patients underwent topical PUVA therapy and were followed-up for 12 months. Ten cases with 52 lesions completed the follow-up period. About 4/18 lesions treated by cryoblebbing followed by MKTP showed ≥75% repigmentation while only 1/17 lesions treated by laser resurfacing + MKTP and 1/17 lesions treated by minipunch grafting showed 30% and 10% repigmentation, respectively. No complications occurred in MKTP treated lesions. Cryoblebbing of the recipient site seems to improve the outcome of MKTP in lesions over the fingers in stable NSV.
Collapse
Affiliation(s)
- Marwa El Hawary
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Ahmed Bassiouny
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Sobhi
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwah Adly Saleh
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia AbdelHalim
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Gawdat
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nanis Ragab
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nesrin Samir
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Sany
- The Department of Dermatology, Kasr El-Ainy Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Lyons AB, Ghia D, Abdallah M, Abdel-Malek Z, Esmat S, Ezzedine K, Grimes P, Harris JE, Lui H, Manga P, Mi QS, Pandya A, Parsad D, Passeron T, Picardo M, Seneschal J, Silpa-Archa N, Taieb A, Xiang F, Lim HW, Hamzavi IH. Proceeding Report of the Second Vitiligo International Symposium-November 9-10, 2018, Detroit, Michigan, USA. Pigment Cell Melanoma Res 2020; 33:637-641. [PMID: 31984599 DOI: 10.1111/pcmr.12867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital, Mumbai, India.,Mulekar Vitiligo Clinic, Mumbai, India
| | - Marwa Abdallah
- Departmant of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
| | - Zalfa Abdel-Malek
- Department of Dermatology, University of Cincinnati, Cincinnati, OH, USA
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Egypt
| | - Khaled Ezzedine
- EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPEC-Univ Paris-Est, Creteil, France.,Department of Dermatology, Hospital Henri Mondor, Créteil, France
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, CA, USA.,Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Prashiela Manga
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Qing-Sheng Mi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Amit Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Thiery Passeron
- Department of Dermatology, CHU Nice, Université Côte d'Azur, Nice, France.,INSERM U1065, C3M, Université Côte d'Azur, Nice, France
| | - Mauro Picardo
- San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases, INSERM U1035, BMGIC, University of Bordeaux, France
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases, INSERM U1035, BMGIC, University of Bordeaux, France
| | - Flora Xiang
- Department of Dermatology, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | | |
Collapse
|
17
|
van Geel N, Hamzavi I, Kohli I, Wolkerstorfer A, Lim HW, Bae JM, Lui H, Harris JE, Pandya AG, Thng Tien Guan S, Abdallah M, Esmat S, Seneschal J, Speeckaert R, Grine L, Kang HY, Raboobee N, Xiang LF, Bekkenk M, Picardo M, Taieb A. Standardizing serial photography for assessing and monitoring vitiligo: A core set of international recommendations for essential clinical and technical specifications. J Am Acad Dermatol 2019; 83:1639-1646. [PMID: 31678332 DOI: 10.1016/j.jaad.2019.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/15/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time. OBJECTIVE The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography. METHODS Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached. RESULTS The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described. CONCLUSIONS This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment.
Collapse
Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Albert Wolkerstorfer
- Department of dermatology, institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John E Harris
- Department of Dermatology, The University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty Of Medicine Cairo University, Cairo, Egypt
| | - Julien Seneschal
- INSERM U 1035, University of Bordeaux; Department of Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | | | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Westville, South Africa
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Marcel Bekkenk
- Department of dermatology, institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Alain Taieb
- INSERM U 1035, University of Bordeaux; Department of Dermatology, Bordeaux University Hospitals, Bordeaux, France
| |
Collapse
|
18
|
El‐Mofty M, Mostafa WZ, Esmat S, Zayed A, Mashaly H, Hussien MF, Ismail SI. Site‐oriented depigmentation in vitiligo patients using Q‐switched Nd:YAG laser (1,064/532 nm), cryotherapy and chemical peels: A comparative study. Dermatol Ther 2019; 32:e13052. [DOI: 10.1111/dth.13052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/15/2019] [Accepted: 07/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Medhat El‐Mofty
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Wedad Z. Mostafa
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Amira Zayed
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Heba Mashaly
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Marwa F. Hussien
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| | - Sarah I. Ismail
- Department of Dermatology, Faculty of MedicineCairo University Cairo Egypt
| |
Collapse
|
19
|
van Geel N, Wolkerstorfer A, Ezzedine K, Pandya AG, Bekkenk M, Grine L, Van Belle S, Lommerts JE, Hamzavi I, Harris JE, Eleftheriadou V, Esmat S, Kang HY, Kumarasinghe P, Lan CCE, Parsad D, Raboobee N, Flora Xiang L, Suzuki T, Prinsen CA, Taieb A, Picardo M, Speeckaert R. Validation of a physician global assessment tool for vitiligo extent: Results of an international vitiligo expert meeting. Pigment Cell Melanoma Res 2019; 32:728-733. [PMID: 30945409 DOI: 10.1111/pcmr.12784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/13/2018] [Revised: 03/10/2019] [Accepted: 03/27/2019] [Indexed: 11/26/2022]
Abstract
Currently, vitiligo lacks a validated Physician Global Assessment (PGA) for disease extent. This PGA can be used to stratify and interpret the numeric scores obtained by the Vitiligo Extent Score (VES). We investigated the interrater reliability of a 5-point PGA scale during an international vitiligo workshop. Vitiligo experts from five different continents rated photographs of non-segmental vitiligo patients with varying degrees of extent with the PGA score. Good interrater agreements (intraclass correlation coefficient >0.6) were observed between the raters overall and within each continent. All hypotheses to evaluate construct validity were confirmed. Median VES values per category were for limited 1.10 [IQR: 0.21-1.67], moderate 3.17 [IQR: 1.75-6.21], extensive 9.58 [IQR: 6.21-13.03] and very extensive 42.67 [IQR: 21.20-42.67]. Defined categories for vitiligo extent can be valuable for inclusion criteria and may impact future reimbursement criteria.
Collapse
Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Albert Wolkerstorfer
- Department of Dermatology, Institute for Pigment Disorders and Infection, Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor Hospital, UPE-Université Paris-Est, Créteil, France
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marcel Bekkenk
- Department of Dermatology, Institute for Pigment Disorders and Infection, Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Sarah Van Belle
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Janny E Lommerts
- Department of Dermatology, Institute for Pigment Disorders and Infection, Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - John E Harris
- Department of Dermatology, The University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hee Young Kang
- Department of dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Prasad Kumarasinghe
- Department of Dermatology, Fiona Stanley Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Westville, South Africa
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tamio Suzuki
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Cecilia A Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alain Taieb
- Department of Dermatology, INSERM U 1035, Bordeaux University Hospitals, University of Bordeaux, Bordeaux, France
| | | | | | | |
Collapse
|
20
|
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.
Collapse
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,
| |
Collapse
|
21
|
Esmat S, Zeid OA, Abdel Halim DM, Fawzy MT, Abdel Latif M, Lazarova V, Assaf M. Tissue expression of aquaporin 3 in different sites of vitiligo: an immunohistochemical study. J Eur Acad Dermatol Venereol 2018; 32:e455-e456. [PMID: 29729115 DOI: 10.1111/jdv.15049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- S Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - O A Zeid
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - D M Abdel Halim
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M T Fawzy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Abdel Latif
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - V Lazarova
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Assaf
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
22
|
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
| | | | | | | | | |
Collapse
|
23
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
24
|
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
Collapse
Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
| |
Collapse
|
25
|
Esmat S, Abdel Halim DM, Hegazy RA, Sayed S, Saleh MA. Matrix metalloproteinase in acral and non-acral vitiligo. Photodermatol Photoimmunol Photomed 2017; 34:211-213. [PMID: 28976023 DOI: 10.1111/phpp.12352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Samia Esmat
- Department of Dermatology, Cairo University, Cairo, Egypt
| | | | - Rehab A Hegazy
- Department of Dermatology, Cairo University, Cairo, Egypt
| | - Safinaz Sayed
- Department of Histology, Cairo University, Cairo, Egypt
| | - Marwah A Saleh
- Department of Dermatology, Cairo University, Cairo, Egypt
| |
Collapse
|
26
|
El Mofty M, Esmat S, Hunter N, Mashaly HM, Dorgham D, Shaker O, Ibrahim S. Effect of different types of therapeutic trauma on vitiligo lesions. Dermatol Ther 2016; 30. [PMID: 27998025 DOI: 10.1111/dth.12447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/04/2016] [Revised: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
New treatment modalities for vitiligo acting by changing certain cytokines and metalloproteinases are newly emerging. The aim of this work is to To assess the efficacy of trichloroacetic acid (TCA) chemical peel, dermapen, and fractional CO2 laser in treatment of stable non-segmental vitiligo and to detect their effects on IL-17 and MMP-9 levels. Thirty patients with stable vitiligo were recruited in a randomized controlled study. They were randomly categorized into three equal groups. Group 1: TCA peel, Group 2: dermapen machine, and Group 3: Fractional CO2 laser. Skin biopsies were taken from treated areas and from control areas for which MMP-9 and IL-17 tissue levels were measured using ELISA. The 30 vitiligo patients had low basal tissue MMP-9 levels and high baseline IL-17 tissue levels. As regards the three different used modalities, all of them caused rise in MMP-9 as well as IL-17 levels and almost their levels were much more elevated with repetition of the previously mentioned traumatic procedures. TCA 25% peel proved to be the most effective modality both clinically and laboratory and it can be used prior or with other conventional therapies in the treatment of vitiligo.
Collapse
Affiliation(s)
- Medhat El Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla Hunter
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba M Mashaly
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Dorgham
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olfat Shaker
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
27
|
Esmat S, Mostafa W, Hegazy RA, Shalaby S, Sheth V, Youssef R, El-Mofty M. WITHDRAWN: Phototherapy: The Vitiligo Management Pillar. Clin Dermatol 2016. [DOI: 10.1016/j.clindermatol.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Abstract
Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but narrowband ultraviolet B remains the safest and most commonly used treatment. Acting on multiple steps in vitiligo pathogenesis, narrowband ultraviolet B is one of the few therapies that can effectively induce stabilization and stimulate repigmentation. Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations. Individual patient characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype, should all be considered, along with combination therapies.
Collapse
Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt.
| | - Wedad Mostafa
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Vaneeta Sheth
- Newton-Wellesley Dermatology Associates, Wellesley, MA
| | - Randa Youssef
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Medhat El-Mofty
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| |
Collapse
|
29
|
Esmat S, Abdel-Halim MRE, Fawzy MM, Nassef S, Esmat S, Ramzy T, El Fouly ES. Are normolipidaemic patients with xanthelasma prone to atherosclerosis? Clin Exp Dermatol 2015; 40:373-8. [PMID: 25683563 DOI: 10.1111/ced.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
- S. Esmat
- Department of Dermatology; Kasr Al Ainy Hospital; Cairo University; Cairo Egypt
| | | | - M. M. Fawzy
- Department of Dermatology; Kasr Al Ainy Hospital; Cairo University; Cairo Egypt
| | - S. Nassef
- Vascular Medicine Division; Department of Internal Medicine; Kasr Al Ainy Hospital; Cairo University; Cairo Egypt
| | - S. Esmat
- Department of Internal Medicine; Kasr Al Ainy Hospital; Cairo University; Cairo Egypt
| | - T. Ramzy
- Department of Medical Biochemistry; National Research Center; Cairo Egypt
| | - E. S. El Fouly
- Department of Dermatology; National Research Center; Cairo Egypt
| |
Collapse
|
30
|
Eleftheriadou V, Thomas K, van Geel N, Hamzavi I, Lim H, Suzuki T, Katayama I, Anbar T, Abdallah M, Benzekri L, Gauthier Y, Harris J, Silva de Castro CC, Pandya A, Goh BK, Lan CCE, Oiso N, Al Issa A, Esmat S, Le Poole C, Lee AY, Parsad D, Taieb A, Picardo M, Ezzedine K. Developing core outcome set for vitiligo clinical trials: international e-Delphi consensus. Pigment Cell Melanoma Res 2015; 28:363-9. [PMID: 25645179 DOI: 10.1111/pcmr.12354] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Esmat S, Elgendy D, Ali M, Esmat S, El-Nabarawy EA, Mahmoud SB, Shaker O. Prevalence of photosensitivity in chronic hepatitis C virus patients and its relation to serum and urinary porphyrins. Liver Int 2014; 34:1033-9. [PMID: 24575939 DOI: 10.1111/liv.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/21/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS HCV is a major cause of chronic liver disease in Egypt. The aim was to study the prevalence of photosensitivity among asymptomatic HCV-infected patients and its possible relation to porphyrins levels and whether it can be considered an alarm for early diagnosis of the disease, which is the most important goal in the management. METHODS This study included 100 accidentally discovered HCV positive cases and 100 HCV negative healthy controls. All patients and controls were subjected to: Detailed history and clinical examination, dermatological examination including evaluation of reaction to solar exposure, measurement of serum AST, ALT, albumin, bilirubin, serum and urinary porphyrins levels. RESULTS The prevalence of photosensitivity among HCV-positive cases (33%) was significantly higher compared to 10% in the control group. Serum porphyrins were positive in 46 cases (46%), twenty-three cases (23%) had positive urinary porphyrins, while only four controls (4%) showed positive serum porphyrins and one (1%) showed positive urinary porphyrins, the difference was statistically significant. Cases with photosensitivity showed significantly higher prevalence of serum and urinary porphyrins existence as well as serum porphyrins levels. Levels of viraemia showed statistically significant relation to levels of porphyrins. CONCLUSION Asymptomatic chronic HCV infection cases showed significantly high prevalence of photosensitivity, which is related to the associated disturbance of porphyrins metabolism. Photosensitivity can thus be considered an early marker of HCV infection. Patients discovered to have recently acquired photosensitivity should be screened for HCV infection especially in endemic areas like Egypt.
Collapse
Affiliation(s)
- Serag Esmat
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | |
Collapse
|
32
|
El Mofty M, Mostafa W, Esmat S, Youssef R, Azzam O, Hunter N, El Hanafi G, Fawzi M. Narrow band Ultraviolet B 311 nm in the treatment of vitiligo: two right-left comparison studies. Photodermatol Photoimmunol Photomed 2006; 22:6-11. [PMID: 16436175 DOI: 10.1111/j.1600-0781.2006.00189.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM Evaluation of narrow band ultraviolet B (NB UVB 311 nm) in the treatment of vitiligo by two independent studies. The first study compared NB UVB with a well-established therapeutic modality, psoralen ultraviolet A (PUVA), and the second study was conducted to find out whether psoralen might add to its efficacy. METHODS In the first study, 15 patients were exposed on the left half of their body to UVB 311 nm and then exposed on their right half to UVA after ingestion of psoralen. In the second study, 20 patients were exposed to UVB 311 nm on the left side of the body, followed by ingestion of psoralen and exposure to NB UVB 311 nm 90 min later to the right side of the body. In both studies, while exposing one side, the other was protected by an UV-proof gown. Thus two right-left comparative studies were carried out simultaneously, namely: UVB 311 nm vs. PUVA and UVB 311 nm vs. PUVB 311 nm. RESULTS In the first study, comparison of PUVA and NB UVB 311 nm showed no difference either in the degree of response or in the incidence of complications. In the second study, comparison of PUVB and UVB showed equal clinical improvement on both sides. The cumulative dose needed to achieve the same response on the PUVB side was lower than that on the UVB side, but the difference was not statistically significant. The incidence of phototoxic reactions was significantly higher on the PUVB treated body half. CONCLUSION NB UVB 311 nm has similar repigmentary effects as PUVA. The addition of psoralen does not increase its efficacy.
Collapse
Affiliation(s)
- M El Mofty
- Phototherapy Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Tinea infections are among the most common dermatological conditions throughout the world. Griseofulvin is a classical oral fungistatic antibiotic, active against Epidermophyton floccosum, Trichophyton and Microsporum species, the causative fungi of tinea corporis. To evaluate the efficacy of topical griseofulvin in the treatment of tinea circinata using three different vehicles for drug delivery. Sixteen patients with tinea circinata were instructed to apply either griseofulvin gel form in group A or a similar placebo gel for control group; a niosomal gel formulation of griseofulvin for group B or; a liposomal gel formulation of griseofulvin for group C. Patients were evaluated both clinically and mycologically after 3 weeks. Marked improvement was seen for groups A, B and C both clinically and mycologically while no improvement was observed in the placebo group. Mild and transient irritation was reported in four patients. Our results show that topical griseofulvin preparations may be effective and safe in treating tinea circinata and that further large-scale studies may establish the high efficacy of the niosomal gel formulation.
Collapse
Affiliation(s)
- Mohamed A A Kassem
- Department of Pharmaceutics, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | | | | |
Collapse
|
34
|
Esmat S, El Sherif H, Anwar S, Fahmy I, Elmenyawi M, Shaker O. Lipoprotein (a) and nitrites in Behcet's disease: relationship with disease activity and vascular complications. Eur J Dermatol 2006; 16:67-71. [PMID: 16436346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2005] [Indexed: 05/06/2023]
Abstract
Our objective was the assessment of serum lipoprotein(a) {Lp(a)} and nitrites in Behcet's disease (BD) patients and their relation to vascular events and disease activity. Thirty cases of BD and 14 healthy volunteers were included. Serum levels of Lp(a) were estimated using enzyme-linked immunosorbent assays. Serum nitrites were measured according to the method of Benjamin and Vallence. Compared to controls, BD patients had significantly lower concentrations of serum nitrites, and significantly higher concentrations of Serum Lp(a). Significantly higher levels of serum Lp(a) were observed in patients with vascular complications, while significantly lower levels of serum nitrites were found during disease activity and in patients with erythema nodosum like lesions. Increased serum lipoprotein (a) may contribute to the increased incidence of vascular complications in Behcet's disease. Decreased nitrites can be considered as a marker of disease activity that may be related to endothelial dysfunction.
Collapse
Affiliation(s)
- Samia Esmat
- Department of Dermatology, Cairo University, Egypt.
| | | | | | | | | | | |
Collapse
|
35
|
El-Mofty M, Mostafa W, El-Darouty M, Bosseila M, Nada H, Yousef R, Esmat S, El-Lawindy M, Assaf M, El-Enani G. Different low doses of broad-band UVA in the treatment of morphea and systemic sclerosis. Photodermatol Photoimmunol Photomed 2004; 20:148-56. [PMID: 15144393 DOI: 10.1111/j.1600-0781.2004.00081.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous treatment modalities, some with potentially hazardous side effects, are currently used for morphea (M) and systemic sclerosis (SS) with limited success. Low-dose ultraviolet A (UVA) phototherapy (20 J/cm(2)) was found to be highly effective for sclerotic patches, even in patients with advanced and rapidly evolving lesions. OBJECTIVE To determine the effectiveness of different low doses of UVA in treating patients with M and SS. METHODS Sixty-three patients complaining of M and 15 patients complaining of SS received 20 sessions of UVA (320-400 nm) each. Patients were divided randomly into three groups that received 5, 10 and 20 J/cm(2), with cumulative UVA doses of 100, 200, and 400 J/cm(2), respectively. The efficacy of therapy was judged clinically (by sequential inspection and palpation) and histopathologically by morphometry in M cases. RESULTS Obvious clinical improvement, with no comparable differences between various low UVA doses, was noted in patients with M and SS, accompanied by histopathological changes towards normalization of collagen. CONCLUSIONS After 20 sessions, it appears that lower doses of UVA (5, 10 J/cm(2)) are as beneficial as the relatively higher dose (20 J/cm(2)) in the treatment of M and SS.
Collapse
Affiliation(s)
- M El-Mofty
- Department of Dermatology, Phototherapy Unit, Faculty of Medicine, Cairo University, Egypt
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
El-Mofty M, Mostafa W, Esmat S, Youssef R, Bousseila M, Nagi N, Shaker O, Abouzeid A. Suggested mechanisms of action of UVA phototherapy in morphea: a molecular study. Photodermatol Photoimmunol Photomed 2004; 20:93-100. [PMID: 15030594 DOI: 10.1111/j.1600-0781.2004.00080.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear. OBJECTIVES To detect the mechanism of action of UVA phototherapy in morphea through measuring its effect on the levels of different parameters related to collagen metabolism. METHODS Twenty-one cases of morphea were treated with low-dose broad-band UVA for 20 sessions. Twelve cases received 20 J/cm(2)/session with a cumulative dose of 400 J/cm(2) and nine cases received 10 J/cm(2)/session with a cumulative dose of 200 J/cm(2). The response was assessed clinically every week. Two skin biopsies were taken from the lesional skin of each patient before starting and after the end of therapy. Paraffin sections were examined for quantitative polymerase chain reaction measurement of collagen I, collagen III, collagenase, transforming growth factor-beta (TGF-beta) and interferon gamma (IFNgamma). RESULTS Eighteen patients reported remarkable softening of the skin lesions, with variable degrees ranging from moderate in 57.1% of them good in 19% to very good response in 9.5%. After treatment, all the studied parameters revealed statistically significant changes. There was a significant decrease in collagen I, collagen III and TGF-beta and a significant increase in collagenase (MMP-1) and IFNgamma. The relative change was found to be greatest in collagenase, followed by IFNgamma then TGF-beta and finally collagen I. The changes in collagen I, collagenase, IFNgamma and TGF-beta were found to increase gradually with the degree of clinical response. In all the parameters studied the relative change was significantly higher in cases treated with 20 J/cm(2)/session in contrast to those treated with 10 J/cm(2)/session although no statistically significant difference could be detected in the clinical response to those doses. CONCLUSIONS The efficacy of low-dose UVA phototherapy in the treatment of localized scleroderma is mainly obtained by the increased production of MMP-1 and IFNgamma, and to a lesser extent by decreasing TGF-beta and collagen production. Concerning the use of 10 or 20 J/cm(2)/session those effects are dose dependent, but the clinical response does not significantly differ.
Collapse
Affiliation(s)
- M El-Mofty
- Department of Dermatology, Phototherapy Unit, Faculty of Medicine, Cairo University, Egypt
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Mofty ME, Zaher H, Esmat S, Youssef R, Shahin Z, Bassioni D, Enani GE. PUVA and PUVB in vitiligo--are they equally effective? Photodermatol Photoimmunol Photomed 2001; 17:159-63. [PMID: 11499536 DOI: 10.1034/j.1600-0781.2001.170403.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS The combination of psoralens with different types of ultraviolet (UVL) sources in the treatment of vitiligo has led to different reports of success. The purpose of this trial is to compare in a random right-left comparison study the efficacy and side effects of oral 8-MOP plus UVA (PUVA) and oral 8-MOP plus UVB (broadband, 290-320 nm P-UVB) in the treatment of vitiligo. METHODS The study included 24 cases of extensive vitiligo involving more than 30% of the body surface area in a bilateral symmetrical distribution. Each patient received 0.7 mg/kg 8-MOP orally 2 h before the light session. The right side of the body was exposed to UVA (320-400 nm), while the left half was exposed to UVB (290-320 nm). The patients received 3 sessions/week for a total of 30 sessions. RESULTS Both PUVA and PUVB produced moderate (50-60%) improvement, with similar incidences of phototoxic reaction and skin thickening. However, the study revealed a significant difference in the number of sessions needed to improve produce erythema and perifollicular pigmentation as well as a moderate response, the response on the UVA side always being earlier. Furthermore, the amount of joules needed to achieve the same response was 10 times greater on the UVA side than on the UVB side. CONCLUSION The use of psoralen plus broadband UVB is as effective as PUVA in the treatment of vitiligo. However, the long-term side effects of psoralen plus UVB are unknown.
Collapse
Affiliation(s)
- M E Mofty
- Dermatology Department, Phototherapy Unit, Faculty of Medicine, Cairo University, Egypt
| | | | | | | | | | | | | |
Collapse
|