RESUMEN
BACKGROUND: There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus. AIM: To evaluate the clinical efficacy according to the duration of treatment and in vitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo. METHODS: In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser. RESULTS: After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P < 0.001 and P < 0.01, respectively) for the first 6 months. However, this superiority was not observed after the initial 6 months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone. CONCLUSIONS: A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6 months, but continuation of this therapy for > 6 months might not provide a better final outcome than monotherapy.
Asunto(s)
Inmunosupresores/uso terapéutico , Fototerapia/métodos , Tacrolimus/uso terapéutico , Vitíligo/terapia , Administración Tópica , Adolescente , Adulto , Anciano , Análisis de Varianza , Western Blotting , Niño , Preescolar , Terapia Combinada , Femenino , Humanos , Lactante , Oxidorreductasas Intramoleculares/metabolismo , Modelos Logísticos , Masculino , Melaninas/metabolismo , Melanocitos/metabolismo , Persona de Mediana Edad , Monofenol Monooxigenasa/metabolismo , Factores de Tiempo , Tripsina/metabolismo , Vitíligo/tratamiento farmacológico , Vitíligo/metabolismo , Adulto JovenRESUMEN
Dermatofibroma (DF) is a common benign fibrohistiocytic tumour with a predilection for the legs in middle-aged women. Giant DF, a rare clinical variant of DF, is characterized by its unusually large size. Granular cell change is typical of granular cell tumour, but can be observed in diverse cell lineages. Traumatic factors may be involved in the pathogenesis of giant DF and cellular granularity. We describe a 49-year-old Korean man with a giant DF showing granular cell differentiation, which may have been caused in part by multiple treatments with bee-venom acupuncture.