ABSTRACT
Systemic photoprotection aims to negate the negative effects of ultraviolet radiation-induced DNA damage. Systemic supplements may be used as a monotherapy or in combination with topical sunscreens. Using the keywords 'carotenoids', 'flavonoids', 'systemic photoprotection', 'polyphenols' and 'polypodium leucotomos extract', we searched the databases MEDLINE and EMBASE to find relevant English-language articles. Few trials have supported the use of any of these supplements as monotherapy, impeding the recommendation of these systemic supplements as an alternative to sunscreen for photoprotection. Nicotinamide has exhibited clinically relevant benefits in reducing nonmelanoma skin cancers in trials and could be recommended as an adjunctive therapy for the most vulnerable indviduals. Further research is required, which needs to be of higher statistical power, using more clinically meaningful outcome measures with comparison to the current gold standard of care (topical photoprotection) to support the use of alternative therapies in clinical practice.
Subject(s)
Dietary Supplements , Plant Extracts/therapeutic use , Skin Neoplasms/prevention & control , Sunscreening Agents , Antioxidants/therapeutic use , Carotenoids/therapeutic use , Dermatologic Agents/therapeutic use , Flavonoids/therapeutic use , Humans , Ultraviolet Rays , alpha-MSH/analogs & derivatives , alpha-MSH/therapeutic useABSTRACT
Vitiligo is an autoimmune skin condition characterized by depigmented macules and patches, and has a huge psychosocial impact on patients. Treatment of vitiligo aims to prevent the spread of disease and facilitate repigmentation of affected lesions. The mainstay of treatment for unstable vitiligo has been topical agents (corticosteroids, calcineurin inhibitors) and phototherapy. However, systemic treatments are increasingly being shown to have a significant impact on the course of the disease as monotherapy or adjunctive therapy. Of note, oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors and certain supplements have been used in the systemic treatment of vitiligo. We review the underlying evidence supporting the use of each of these systemic treatments.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Calcineurin Inhibitors/therapeutic use , Neoadjuvant Therapy/methods , Phototherapy/methods , Vitiligo/pathology , Vitiligo/therapy , Administration, Oral , Administration, Topical , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Calcineurin Inhibitors/administration & dosage , Calcineurin Inhibitors/adverse effects , Combined Modality Therapy , Cyclosporine/administration & dosage , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effects , Dermatologic Agents/therapeutic use , Humans , Janus Kinase Inhibitors/administration & dosage , Janus Kinase Inhibitors/adverse effects , Janus Kinase Inhibitors/therapeutic use , Methotrexate/administration & dosage , Methotrexate/adverse effects , Methotrexate/therapeutic use , Minocycline/administration & dosage , Minocycline/adverse effects , Minocycline/therapeutic use , Outcome Assessment, Health Care , Phototherapy/adverse effects , Psychology , Vitiligo/psychology , alpha-MSH/administration & dosage , alpha-MSH/adverse effects , alpha-MSH/analogs & derivatives , alpha-MSH/therapeutic useSubject(s)
Anesthesia, Local/adverse effects , Mohs Surgery/adverse effects , Patient Satisfaction , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Anesthesia, Local/psychology , Attitude of Health Personnel , Female , Humans , Male , Middle Aged , Mohs Surgery/psychology , Patient Safety , Skin Neoplasms/psychologyABSTRACT
Necrobiotic xanthogranuloma (NXG) is a rare granulomatous condition that is often associated with a paraproteinaemia and in some cases multiple myeloma. Treatment is therefore aimed at the underlying associated haematological abnormality. However, isolated NXG cases have been reported. We report a case of isolated NXG that responded very well to systemic psoralen ultraviolet A (PUVA) treatment. The rationale for this treatment was the successful use of PUVA treatment in other necrobiotic conditions such as granuloma annulare and necrobiosis lipoidica.