The efficacy of bimatoprost ophthalmic solution combined with NB-UVB phototherapy in non-segmental and segmental vitiligo: a single-blind randomized controlled study.

Bimatoprost ophthalmic solution 0.03% (PGF2α analogues) combined with narrowband ultraviolet B (NB-UVB) was reported to be an effective treatment for vitiligo. To investigate the efficacy and safety of treatment for non-segmental/segmental vitiligo compared among bimatoprost ophthalmic solution 0.01% combined with NB-UVB phototherapy, bimatoprost monotherapy, and placebo. This single-blind randomized controlled study enrolled stable Thai vitiligo patients with at least three similarly sized lesions in the same anatomical area. The treatment duration was 6 months with 1- and 2-month post-treatment follow-ups. The 3 selected lesions on each patient were randomized to receive combination therapy, monotherapy, or placebo. The Vitiligo Area Scoring Index (VASI) was used to evaluate lesion response. Of the 25 initially enrolled subjects, 19 patients were analyzed. There were 13 and 6 non-segmental and segmental vitiligo cases, respectively. Eight and 11 cases had face/neck and non-face/neck lesions, respectively. Non-segmental vitiligo and non-face/neck vitiligo patients in the combination group had significant improvement in VASI score at 3 months, 6 months, and at the 2-month follow-up. No side effects were observed/reported. Bimatoprost combination therapy was shown to be safe and effective for treating Thai patients with non-segmental vitiligo in non-face/neck areas of the body.

Using the patient-acceptable symptom state to evaluate patients' perspectives of living with psoriasis: A cross-sectional study.

BACKGROUND: Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patient-acceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state. OBJECTIVES: To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients. METHODS: Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health-related quality of life (HRQoL) were collected. RESULTS: Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL. CONCLUSIONS: PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise.

Relationship Between Depression and Quality of Life Among Vitiligo Patients: A Self-assessment Questionnaire-based Study.

BACKGROUND: Vitiligo is a common chronic autoimmune disease that is characterized by progressive loss of skin color due to melanocyte destruction. In addition to the physical effects of vitiligo, this condition exerts adverse psychological effects and causes social stigmatization. Earlier studies reported that individuals with vitiligo suffer from poor quality of life (QoL), but data about the QoL of Thai vitiligo patients is scarce. OBJECTIVE: This study aimed to investigate the QoL and prevalence of depression in Thai vitiligo patients, association between QoL and depression, and factors associated with QoL and depression among Thai people with vitiligo. METHODS: This cross-sectional self-assessment questionnaire-based study was conducted at the phototherapy and vitiligo clinics of the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand). QoL was assessed using the Dermatology Life Quality Index (DLQI) questionnaire, and depression was evaluated via the Patient Health Questionnaire (PHQ-9). RESULTS: Among the 104 vitiligo patients that were recruited, the mean DLQI score was 7.46, and the prevalence of depression (PHQ-9 ≥9) was 13.5%. Factors significantly associated with a higher mean DLQI score were skin phototype IV compared to phototype III, active disease, new lesions within the last three months, lesions involving upper extremities, and PHQ-9 ≥9 (p<0.05). Moderate correlation was found between DLQI score and PHQ-9 score (Pearson's correlation coefficient: 0.524, p<0.001). Factors significantly associated with depression were working status and developing new lesions within the last three months (p<0.05). Patients with new lesions were 4.12 times more likely to be depressed than those without new lesions (OR: 4.12, 95%CI: 1.20-14.16; p=0.025). CONCLUSION: Developing new lesions, active disease, dark skin phototype (IV), and lesion on upper extremity had significant adverse effects on QoL. Vitiligo patients who were employed and who had new vitiligo lesions are significantly more likely to be depressed.

The necessity of antinuclear antibody investigation in pre-phototherapy vitiligo patients: A retrospective study.

BACKGROUND: Narrowband UVB (NBUVB) phototherapy is the cornerstone treatment for vitiligo. Before its initiation, some experts recommend antinuclear antibody (ANA) screening out of concern for either photosensitivity to NBUVB or autoimmune disease exacerbation during treatment. As vitiligo is considered an autoimmune disorder, ANAs can be positively found in the disease without any clinical importance. The necessity for ANA investigations for pre-phototherapy vitiligo patients is therefore questioned. METHODS: We conducted a retrospective study to investigate vitiligo patients who had been checked for ANA before commencing NBUVB phototherapy. Demographic data-including vitiligo type and age of onset-were collected. Samples of ANA, anti-thyroglobulin, and anti-thyroid peroxidase were obtained. The phototherapy treatment protocol and cutaneous reactions to the phototherapy were also recorded. RESULTS: Among 85 Thai vitiligo patients, the ANA prevalence was 35.3%. The speckled ANA pattern was the most common, and the large majority of patients (80%) had a titer of ≤1:100. Factors associated with positive ANA were female gender and positive anti-thyroglobulin. There were no statistical differences between the phototoxic reactions or phototoxic doses of NBUVB of the ANA-positive vitiligo and ANA-negative vitiligo groups. No cases of SLE were detected in ANA-positive group. CONCLUSIONS: ANA positivity was not correlated with the incidence or dose of phototoxic reaction in phototherapy treated vitiligo, and it may not a predictive factor for SLE diagnosis in vitiligo. ANA might therefore not need to be routinely checked in pre-phototherapy in vitiligo, unless there are clinical suspicions of an autoimmune disease. However, ANA might be involved in part of the cutaneous photoadaptation response to phototherapy.