Comparative study on some oxidative stress parameters in blood of vitiligo patients before and after combined therapy.

Currently accepted that oxidative stress is a triggering event in the melanocytic destruction and is probably involved in the etiopathogenesis of vitiligo disease. Despite numerous investigations, contradictory results were reported about the levels of oxidative stress biomarkers measured in the skin and blood of vitiligo patients. By Electron Paramagnetic Resonance spectroscopy (EPR) and spectrophotometry, we have investigated and compared some oxidative stress biomarkers in the blood of vitiligo patients' before and after UVB Narrow Band 311 nm phototherapy combined with the antioxidant nutritional supplement containing - Vitamin C, Vitamin B1, L -Cysteine, Lipoic Acid, and polyunsaturated fatty acids. Before therapy was found significantly higher levels of CAT activity and MDA compared to the patients after therapy and control group (p < 0.05). Moreover, levels of Asc* radicals in patients before therapy were significantly lower than those measured in controls and patients undergoing therapy (p < 0.05). Our finding, the combined therapy applied to vitiligo patients provoked an increase in the Asc* levels and a decrease in MDA products and also initial repigmentation in the vitiligo spots, made us believe that a combined antioxidant therapy, enriched with vitamin C could lead to improvement of the oxidant-antioxidant balance in vitiligo patients treated with UVB 311 phototherapy.

A prospective study of adverse drug reactions in a dermatology department.

The objective of this study was to evaluate the clinical pattern and risk factors for adverse drug reactions (ADRs) in patients hospitalized in a specialized dermatology department. A prospective study was conducted in the Clinic of Dermatology and Venereology in Stara Zagora for a 5-year period. ADRs were classified by type, severity and causality. Case-causality was scored according to Naranjo et al. (1981). A total of 1041 admissions were analyzed. ADRs occurred in 147 patients. Cutaneous reactions represented the most common ADRs followed by endocrine/metabolic, cardiovascular and gastrointestinal disorders. The prevalent clinical patterns of cutaneous ADRs were exanthematous and urticarial. ADRs were almost evenly distributed as type A and type B reactions. Drug classes most frequently responsible for ADRs were glucocorticosteroids (GLCs) and antiinfective agents. The factors significantly associated with ADRs were the use of GLCs (OR 11.11; 95% CI 6.69-18.43), antiinfective agents (OR 1.48; 95% CI 1.04-2.11) and older age. Patients hospitalized in a dermatology department may develop ADRs with multiorgan clinical presentation. The most important risk factors for ADRs in this sample of patients were the use of GLCs, antiinfective agents and older age. The study establishes a specific ADR risk profile of patients with dermatological disorders in a hospital setting.

Vitiligo-related neuropeptides in nerve fibers of the skin.

Skin distribution of substance P (SP)-, somatostatin (SOM)-, calcitonin gene-related peptide (CGRP)- and neuropeptide Y (NPY)-like immunoreactivity (LI) in vitiligo patients was studied by an indirect immunofluorescence technique. Immunocytochemical characteristics of the epidermis, dermal-epidermal junction, papillary and reticular dermis and skin appendages were analyzed in lesional and marginal vitiligo areas, as well as in healthy skin. In healthy pigmented skin, SP-, SOM-, CGRP-, and NPY-LI nerve fibers were observed with specific distributional patterns. In uninvolved vitiligo skin, thin SP-containing fibers were evident in dermal papillae, extending into the epidermis, and SP-LI fibers were seen around blood vessels and sweat glands. SOM-LI varicose nerve fibers were associated with Meissner corpuscles in the dermal papillae, while CGRP-LI was demonstrated in the free subepidermal nerve terminals and in sensory nerve fibers around blood vessels, hair follicles and sweat glands. Autonomic NPY-nerve fibers innervated the eccrine sweat glands and blood vessels. The distribution of these neuropeptides in both marginal and lesional areas of vitiliginous skin was the same as in the skin of healthy control subjects, except for an increased immunoreactivity against NPY and, to a lesser extent, against CGRP in the skin depigmentation lesions. The elevated NPY levels in skin affected by vitiligo suggest that this peptide may serve as a neurochemical marker in the pathogenesis of the disease, thus supporting the neuronal theory of vitiligo.

Markers for vitiligo related neuropeptides in human skin nerve fibers.

Skin distribution of substance P (SP)-, somatostatin (SOM)-, calcitonin-gene-related peptide (CGRP)- and neuropeptide-Y (NPY)-like immunoreactivity in vitiligo patients was studied by an indirect immunofluorescence technique. Immunocytochemical characteristics of the epidermis, dermoepidermal junction, papillary and reticular dermis, and skin appendages were analyzed in lesional and marginal vitiligo areas as well as in healthy skin. SP-, SOM-, CGRP-, and NPY-immunoreactive nerve fibers were observed in healthy pigmented skin, with patterns specific for immunoreactive distribution. Thin SP-containing fibers were observed in dermal papillae, extending into the epidermis, and SP-immunoreactive nerve fibers were seen around blood vessels and sweat glands. SOM-immunoreactive varicose nerve fibers were associated with Meissner's corpuscles in dermal papillae, while CGRP-like immunoreactivity was demonstrated in free subepidermal nerve terminals and sensory nerve fibers around blood vessels, hair follicles and sweat glands. Autonomic NPY-containing nerve fibers innervated eccrine sweat glands and blood vessels. The distribution of these neuropeptides was the same in healthy controls, except for an increased immunoreactivity to NPY and to a lesser extent to CGRP. These results suggest that NPY may serve as a neurochemical marker in the pathogenesis of the disease, thus supporting the neuronal theory of vitiligo.

Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness.

BACKGROUND: About 21% of the patients coming yearly to the DMZ Clinic at the Dead Sea for climatotherapy suffer from atopic dermatitis. This is a common, chronic, and relapsing disease which necessitates drug treatment (topical corticosteroids, antimicrobials, antihistamines, or immunomodulators), phototherapy, or climatotherapy. Objective and methods As the improvement in the condition of patients after 4 weeks of climatotherapy at the Dead Sea is remarkable, we undertook to evaluate the demographic factors that have the strongest impact on this beneficial effect, in adults and children. The major factors studied were: gender, previous medical history, previous stays at the Dead Sea, skin type, skin involvement, age, and duration of treatment. Results A retrospective study of 1718 patients revealed that previous treatments at the Dead Sea and stays longer than 4 weeks caused a clearance greater than 95%, the length of sun exposure was no longer than 5 h daily, and there was no impact of the percentage of skin involvement on the clearance of patients staying more than 4 weeks. CONCLUSION: s Climatotherapy of atopic dermatitis at the Dead Sea is a highly effective modality for treating this disease. It is also a highly cost-effective method, as the patients take no medications and experience no side-effects. Successful climatotherapy of atopic dermatitis requires strict medical supervision throughout the whole length of the patient's stay on shore.

Clinical evaluation of a more rapid and sensitive Psoriasis Assessment Severity Score (PASS), and its comparison with the classic method of Psoriasis Area and Severity Index (PASI), before and after climatotherapy at the Dead-Sea.

BACKGROUND: The Psoriasis Area and Severity Index (PASI) is used to quantify the extent of the disease, and to evaluate its improvement with treatment. It is considered to be a slow, rough, nonsensitive, and complex tool, with high interobserver variability and low reproducibility. OBJECTIVES AND METHODS: To develop a simpler, more sensitive, and more rapid end-point determination for evaluating the psoriatic condition, and to compare its sensitivity with that of the classic PASI score in psoriatic patients undergoing 4-week climatotherapy at the Dead-Sea (Israel). RESULTS: This study describes a new, rapid, and simple Psoriasis Assessment Severity Score (PASS), whose readings are spread over a longer scale, making the test more sensitive than PASI, and allow better differentiation. CONCLUSIONS: The comparison between the classic PASI and our new PASS emphasizes the weight of the "sensitivity to change" (responsivity) in selecting a better evaluation method for psoriatic patients.

Safety of solar phototherapy at the Dead Sea.

BACKGROUND: Climatotherapy at the Dead Sea is effective for patients with psoriasis, atopic dermatitis, vitiligo, and other diseases. Although impressive improvement has been reported for patients with psoriasis, with a clearance rate of more than 80% after a 4-week stay, questions regarding the safety of this treatment have arisen. OBJECTIVE AND METHODS: We compare the mean UVB radiation intensities absorbed by psoriatic patients undergoing a 4-week climatotherapy under supervision at the DMZ Rehabilitation Clinic of Ein-Bokek (The Dead Sea, Israel), with similar climatotherapy studies in Sweden and Switzerland. We also compare the climatotherapy radiation dosages with the UVB intensities absorbed by psoriatic patients in radiation cabins at seven university clinics. RESULTS: According to our individually computerized DMZ protocol, a psoriasis patient with skin type IV is exposed during a 4-week climatotherapy to a mean 3.11 J/cm2 (148 MED) of UVB, similar to that in Sweden and Switzerland. The range of the in-clinic annual phototherapy in the seven medical centers studied varied from 1.17 to 37.80 J/cm2 (56 to 1800 MED). CONCLUSION: When all relevant factors are taken into account, the mean UVB exposure dose at the Dead Sea is one of the lowest reported for clearance of psoriatic plaques.

Climatotherapy of psoriasis and hypertension in elderly patients at the Dead-Sea.

The responses of various age-groups of psoriatic patients to a four-week period of climatotherapy at the Dead-Sea was compared in three separate studies. In the first study, plaque clearance following climatotherapy was evaluated in a group of 688 psoriatics, as a function of age, sex and duration of the disease. Neither the age of the patient when treated, nor the duration of the disease, appeared to influence the degree of plaque clearance. However, when the age at onset of the disease was evaluated as the comparative parameter-a decrease in the rate of response with increasing patients' age was recorded. In the second study, the type and incidence of side effects after climatotherapy was studied in 502 patients aged over 65, and in more than 4,500 younger psoriatics. There was no difference in the type and frequency of side effects between the two age-groups. The most frequent side effects were: slight sun burn (8.2%), sun allergy (5.0%), common cold (3.4%), leg oedema (2.0%), diarrhea (1.4%) and herpes simplex (0.8%). In all cases the side-effects disappeared within a few days. In the third study, the reduction in the diastolic and systolic blood pressures in a group of 1,142 hypertensive psoriatics was evaluated as a function of time. It was demonstrated that while there was no significant age-dependent difference in lowering their diastolic blood pressure throughout the study, differences in lowering systolic measurements between the younger (< 40 y) and older (> 65 y) hypertensive patients were highly significant. On the basis of these studies we conclude that psoriatics aged 65 and over benefit from climatotherapy at the Dead-Sea no less than younger patients, and that, irrespective of age, high blood pressure is not a contraindication for this treatment in psoriatic patients at the Dead-Sea.