A functional single-nucleotide polymorphism in the ERCC1 gene alters the efficacy of narrowband ultraviolet B therapy in patients with active vitiligo in a Chinese population.

BACKGROUND: T lymphocytes have been shown to cause the destruction of melanocytes in vitiligo pathogenesis. Narrowband ultraviolet B (NB-UVB), as an effective therapeutic strategy in vitiligo, can lead to the formation of DNA photoproducts such as cyclobutane pyrimidine dimers (CPDs) in perilesional lymphocytes and thus induce skin immunosuppression. The repair of DNA photoproducts is performed mainly through the nucleotide excision repair (NER) pathway. We hypothesized that single-nucleotide polymorphisms (SNPs) in NER genes might influence the repair capacity of CPDs and thus contribute to variations in phototherapy efficiency. OBJECTIVES: To detect genetic polymorphisms in NER genes and their relationship with the efficacy of NB-UVB therapy in patients with active vitiligo. METHODS: We investigated the association of NER SNPs (XPA A23G, XPC Ci11A, XPC C2919A and ERCC1 C118T) with phototherapy efficacy in 86 patients with vitiligo who received NB-UVB treatment. Furthermore, we examined the impact of ERCC1 C118T on the apoptosis of T lymphocytes and CPD accumulation after NB-UVB irradiation. RESULTS: We found that patients with vitiligo with the ERCC1 codon 118 CC genotype showed better efficacy after NB-UVB irradiation than those with the ERCC1 118 TT and CT genotypes, whereas no such association was documented among the genotypes of XPA A23G, XPC Ci11A or XPC C2919A. Additionally, the apoptosis rates and CPD levels of lymphocytes after NB-UVB irradiation in patients with the ERCC1 118 CC genotype were significantly higher than those in patients with the ERCC1 118 TT and CT genotypes. CONCLUSIONS: The ERCC1 118 CC genotype confers better efficacy of NB-UVB therapy in patients with active vitiligo.

Phototherapy for the treatment of vitiligo in Asian children.

Vitiligo is a common acquired progressive depigmenting condition that can have devastating psychological effects in dark-skinned patients. We performed a retrospective review of patients younger than 16 years of age with a clinical diagnosis of vitiligo treated using phototherapy at the National Skin Center, Singapore, over a 5-year period. Seventy-one Asian patients ages 5 to 15 years when they underwent phototherapy were identified. There was a higher proportion of Indian patients in our cohort than in the population. The duration of disease ranged from 2 months to 12 years. More than half of the patients had generalized vitiligo and more than one-third had segmental vitiligo. Patients with generalized vitiligo had a better response than those with segmental vitiligo. Reported response rates were highest for narrowband ultraviolet B (UVB) phototherapy, followed by targeted phototherapy combining ultraviolet A1 (UVA1) and UVB; 308-nm excimer lamp phototherapy and paint psoralen-UVA photochemotherapy had marginally lower reported response rates. The duration of treatment ranged from 3 to 40 months and the total number of treatments ranged from 20 to 209 sessions. Reported side effects were mild and included itching, scaling, erythema, pain, sunburn, blistering, and phototoxicity. We consider phototherapy to be a safe and efficacious modality for the treatment of vitiligo in Asian children.

A retrospective study of 231 Japanese vitiligo patients with special reference to phototherapy.

Although the outcomes of various treatment modalities for vitiligo have been studied extensively, the influence of the participant's characteristics on treatment response has not been thoroughly investigated. Therefore, we retrospectively investigated treatment effects and their association with clinical characteristics in Japanese patients with vitiligo. The charts of patients with vitiligo treated in our institution were reviewed. Clinical response was evaluated as a marked response rate, defined as repigmentation in >75% of the initial lesional area. 162 patients were treated with phototherapy, while 69 were treated with topical mono-therapy. The patients treated with phototherapy and those treated with both phototherapy and topical treatment demonstrated significantly higher clinical response rates compared to patients treated solely with topical mono-therapy (marked response rate: 19.1% vs. 5.8%, P<0.05; and 23.5% vs. 5.8%, P<0.01, respectively). Among the phototherapy-treated patients, younger subjects (≤15 years old) were more responsive to phototherapy compared to older patients (37.0% vs. 15.6%; P=0.015). The disease subtypes did not affect treatment response. In conclusion, phototherapy appears to have a therapeutic effect superior to topical mono-therapy on both focal and generalized vitiligo, especially in younger patients. Thus, any type of psychosocially devastating lesions in a pediatric patient may be a good target for phototherapy.

Quality of life among Malaysian patients with vitiligo.

BACKGROUND: Vitiligo is a chronic disease and can have significant impairment on patients' quality of life (QoL). Studies have shown that limitations in QoL are similar in magnitude to patients with other chronic skin diseases like psoriasis. The objective of this study was to assess the quality of life (QoL) of patients with vitiligo attending the dermatology clinic of a tertiary hospital in Malaysia. METHODS: All patients with a clinical diagnosis of vitiligo who were seen at our dermatology clinic and phototherapy daycare center from September 15 to November 20, 2009 were invited to participate. RESULTS: A total of 102 patients with vitiligo were included in this survey (56.9% females, 43.1% males; mean age 43.6). The mean DLQI score ± SD was 6.40 ± 5.17. The highest mean DLQI score was seen in the patient group aged 30-59 years (mean score 7.05). Malays had significantly higher DLQI scores compared with Indians (P = 0.026). CONCLUSION: Patients in our cohort showed a moderate limitation of QoL, comparable to that of other chronic skin diseases. Management should focus not only on medical treatment but also psychological aspects, hence better QoL and treatment outcomes.

Role of phototherapy in patients with skin of color.

Phototherapy has proven to be one of the most versatile and effective treatment options for a variety of inflammatory and pigmentary skin diseases. However, the use of these treatment modalities in patients of color requires some special considerations. The modality chosen, the dosing of the treatment and duration of treatment are all issues to be considered for patients of color treated with ultraviolet phototherapy. In addition, there are some diseases which are more commonly seen in patients of color. These diseases may have better treatment outcomes using newer phototherapeutic options such as the long pulsed Nd:YAG laser or UVA1. As our population in the United States becomes more diverse it would behoove all dermatologists to acquaint themselves with the special circumstances of treating ethnic patients with phototherapy.

Photomedicine and phototherapy considerations for patients with skin of color.

BACKGROUND/PURPOSE: Patients with skin of color present unique challenges and opportunities for dermatologists in their disease states as well as their response to treatment. There are differences in dosing for patients with skin of color using standard phototherapeutic approaches as well as unique disease states that may respond to newer phototherapeutic options. Lastly, there are optical diagnostic options that allow investigators to differentiate erythema and pigmentation in a quantitative manner for clinical research purposes. METHODS: Review of the current literature with regard to vitiligo, hidradenitis suppurativa and optical diagnostic methods. CONCLUSIONS: Practitioners need to be aware of the various phototherapy and laser therapy options for patients with skin of color. New discoveries for the use of visible light as a form of treatment are on the horizon, and optical diagnostic techniques such as diffuse reflectance spectroscopy and colorimetry may add value clinically and within the research realm as objective measures of pigmentation and erythema.

Vitiligo update.

Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.

Using a 308-nm excimer laser to treat vitiligo in Asians.

BACKGROUND: Current vitiligo therapies require many months of treatment and often result in disappointing outcomes. Treatment with a 308-nm excimer laser has shown promising results in patients with vitiligo. OBJECTIVE: This controlled prospective trial studied the effectiveness of the 308-nm excimer laser for treating vitiligo in Asians. METHODS: Thirty-four patients (14 males and 20 females) with localized vitiligo were enrolled in the study. Vitiligo patches were treated using a 308-nm excimer laser. Lesions were treated twice weekly for 13 weeks. The treatment was started with 50 to 100 mJ/cm2 (according to site) and increased by 50 mJ/cm2 in every session until erythema appeared. Patients were treated for 25 sessions, or until 100% repigmentation, whichever was achieved first. The overall response rate was assessed clinically and by comparison of photographs before and after treatment by two independent investigators. RESULTS: Twenty-nine patients (12 males and 17 females) completed the study. Lesions on the face responded better than elsewhere on the body. The least responsive areas were the hands and feet. The average number of treatment sessions prior to repigmentation was 11. Untreated control patches remained unchanged. In higher skin phototypes the response was more favorable. There was no significant correlation between the age of the patients and their response to treatment. CONCLUSION: The use of the 308-nm excimer laser for the treatment of vitiligo is effective, relatively safe, and more convenient compared to other available modalities of treatment for stable vitiligo with small patches. However, similar to other modalities of treatment, the therapeutic effect is mainly dependent on the location of vitiligo lesions.

Aumento de antioxidantes en sangre y de las concentraciones de selenio en pacientes negros con fase activa de vitíligo / Increased in total blood antioxidant status and selenium levels in black patients with active vitiligo

Antecedentes; El estrés oxidativo es un fenómeno importante en la muerte de los melanocitos en el vitiligo. Recientemente se ha encontrado una acumulación de peróxido de hidrógeno (H2O2) y niveles bajos de catalasa en la epidermis de pacientes con vitiligo. Se han visto pocas alteraciones de los antioxidantes en la sangre de pacientes con vitiligo, excepto una elevación del selenio. No se han realizado estudios sobre el estrés oxidativo hasta ahora, en pacientes con un fototipo VI de piel (clasificación de Fitzpatrick). Objetivo: Estudiar el estado antioxidante en la sangre de pacientes negros con vitíligo generalizado activo. Métodos: Se evaluaron el estado antioxidante total Randox, y las concentraciones de selenio, ferritina, transferrina, ceruloplasmina, tocoferol y retinal en muestras de sangre de los pacientes de piel negra de las indias Occidentales Francesas (de Martinica) con lesiones activas recientes de vitíligo y de 8 voluntarios sanos equiparados en edad y sexo. Resultados: El estado antioxidante total de la sangre y las concentraciones de selenio aumentaron significativamente en los pacientes con vitiligo, en comparación con los controles equiparados en sexo y edad (p<0,01 y p<0,02, respectivamente). No se modificaron significativamente las concentraciones en sangre de ferritina, transferrina, ceruloplasmina, retinol y tocoferol. Conclusiones: Este es el primer trabajo sobre el estado antioxidante global en sangre en el vitíligo. El aumento del estado antioxidante total en sangre observado en pacientes negros fue un resultado inesperado que necesita confirmarse y explicarse por otros estudios. El aumento espontáneo de las concentraciones de selenio podría ser interesante, puesto que este elemento ha sido recomendado en el tratamiento del vitíligo (AU)

No disponible