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Objective:To investigate clinicopathological features of hypopigmented mycosis fungoides (HMF) and hypopigmented interface T-cell dyscrasia (HITCD) .Methods:A total of 41 patients with cutaneous hypopigmented lymphoproliferative diseases, who had complete clinicopathological data, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2015 to September 2020, and the clinicopathological and immunophenotypic features were analyzed. Comparisons of normally distributed measurement data were carried out using t test, comparisons of categorical data using Chi-square test or Fisher′s exact test, and comparisons of ranked data between 2 groups using rank-sum test. Results:All of the 41 patients clinically presented with irregular hypopigmentation, some of which was accompanied by erythema or furfuraceous scales. In terms of pathological features, 21 patients showed infiltration and aggregation of atypical lymphoid cells in the epidermis, which was consistent with typical pathological features of mycosis fungoides, and they were diagnosed with HMF; 20 patients showed vacuolar degeneration of the basal layer, accompanied by infiltration of lymphoid cells and mild epidermotropism, and they were diagnosed with HITCD. All immune cells expressed T-cell phenotype, and epidermal lymphocytes expressed a CD8-dominated phenotype in 14 (67%) cases of HMF and 13 (65%) of HITCD. In the epidermis, the total number of lymphocytes was significantly higher in the HMF group than in the HITCD group ( t= 1.81, P= 0.012) ; in the dermis, the number of CD4 + lymphocytes and CD8 + lymphocytes, and the total number of lymphocytes were all significantly higher in the HMF group than in the HITCD group ( t= 2.64, 1.51, 2.60, P= 0.012, 0.002, 0.001, respectively) . All patients were treated with narrow-band ultraviolet B radiation. Among 34 patients who completed the follow-up, 30 achieved complete clearance of skin lesions without recurrence, including all patients with HITCD, and 4 with HMF achieved partial regression of the lesions. Conclusions:Compared with HMF, HITCD presents different pathological characteristics and benign biological behaviors. Thus, HITCD should be distinguished from HMF as an independent disease. Phototherapy alone is effective for the treatment of HITCD.
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Narrowband ultraviolet B has been applied to the treatment of vitiligo for more than 10 years in China.Currently,there are no consistent standards for clinical treatment parameters,and patients cannot benefit from non-standard treatment,which is liable to cause erythema,blisters,photoaging and other adverse reactions.Based on the Vitiligo Working Group recommendations for narrowband ultraviolet B phototherapy for vitiligo,relevant literature and clinical experiences,the authors discuss parameters of narrowband ultraviolet B phototherapy for vitiligo from the aspects of treatment frequency,initial dosing,dose adjustment during consecutive treatment or after missed treatment,response plateau,treatment course and maximum acceptable number of phototherapy,so as to improve the efficacy of narrowband ultraviolet B phototherapy for vitiligo.
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Objective To evaluate the association between clinical efficacy of and response to narrow-band ultraviolet B (NB-UVB) phototherapy in patients with confirmed vitiligo,and to identify factors influencing phototherapy response.Methods From January 2017 to March 2018,a total of 104 patients with vitiligo,who received NB-UVB phototherapy at the Department of Dermatology,Hangzhou Third Hospital,Zhejiang University of Traditional Chinese Medicine,were enrolled into this study.Among them,there were 55 males and 49 females,with an average age of 32.06 years (range:4-64 years).Their course of disease ranged from 2 months to 27 years,and the average course of disease was 8.15 years.The phototherapy sessions required to achieve initial repigmentation and to enter the plateau phase during which repigmentation ceased to increase with treatment sessions (plateau photothereapy sessions),as well as effective phototherapy sessions (the difference between the phototherapy sessions required to achieve initial repigmentation and those to enter the plateau phase) were recorded.Rank sum test was used to analyze the difference in the above phototherapy sessions between patients with different response,and multiple linear regression analysis to identify factors influencing plateau photothereapy sessions and effective phototherapy sessions.Results All the 104 patients were followed up.Among them,2 patients achieved complete repigmentation,1 showed no response to the phototherapy,and the remaining 101 patients were enrolled into the analysis.Among the 101 patients,52 achieved ≥ 50％ repigmentation (high efficacy group),and 49 achieved ＜ 50％ repigmentation (low efficacy group).Compared with the low efficacy group,the high efficacy group showed significantly less phototherapy sessions required to achieve initial repigmentation (M [P25,P75],8 [7,10] vs.10[8,13],Z =3.125,P =0.002),but significantly more plateau phototherapy sessions (41 [29,60] vs.35 [26,44],Z =-3.375,P ＜ 0.001) and effective phototherapy sessions (32 [18,51] vs.24 [8,36],Z =-4.407,P ＜ 0.001).Multiple linear regression analysis showed that the total number of plateau phototherapy sessions was positively correlated with vitiligo area (β =0.360,t =2.698,P =0.008) and duration of disease (β =0.215,t =2.325,P =0.022),but negatively correlated with vitiligo disease activity score (VIDA) (β =-2.665,t =3.969,P ＜ 0.001).Moreover,the number of effective phototherapy sessions was positively correlated with vitiligo area (β =0.358,t =2.582,P =0.011) and duration of disease (β =0.216,t =2.276,P =0.025),but negatively correlated with VIDA (β =-2.669,t =-3.935,P ＜ 0.001) and phototherapy sessions required to achieve initial repigmentation (β =-1.011,t =-4.508,P ＜ 0.001).Conclusions During the treatment with NB-UVB,the less the number of phototherapy sessions required to achieve initial repigmentation is,the more the number of effective phototherapy sessions is,and the better the efficacy of NB-UVB phototherapy is.Vitiligo area,duration of disease and clinical staging may provide the basis for predicting phototherapy sessions required to enter the plateau phase.
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Objective To compare the efficacy and acceptance of home versus hospital narrowband ultraviolet B (NB-UVB) phototherapy for vitiligo.Methods Eighty patients with vitiligo were collected at the Department of Dermatology of Hangzhou Third Hospital from August 2016 to September 2017,and randomly and equally divided into two groups to be treated with home (home NB-UVB group) or hospital NB-UVB phototherapy (hospital NB-UVB group) twice a week for 36 sessions.After the treatment,the efficacy,adverse reactions and patient acceptance were evaluated.Results Finally,39 patients in the home NB-UVB group and 37 in the hospital NB-UVB group completed the treatment.The response rates in the face and neck,trunk and extremities were 62.5％,48.6％ and 42.3％ respectively in the home NB-UVB group,and were 66.7％,55.9％ and 48.6％ respectively in the hospital NB-UVB group.There were no significant differences in the response rate,cumulative dosage required for initial repigmentation and cumulative dosage at the end of treatment at the same body site between the 2 groups.The incidence of adverse reactions was significantly higher in the home NB-UVB group than in the hospital NB-UVB group (61.5％ vs.24.3％,P ＜ 0.05),and the duration of a single treatment was significantly shorter in the home NB-UVB group than in the hospital NB-UVB group (27.95 min vs.129.73 min,P ＜ 0.05).Multiple linear regression analysis showed that the patient acceptance in the home NB-UVB group significantly increased along with the improvement of efficacy (β =0.483,t =4.573,P ＜ 0.001),but decreased along with the increase of treatment duration (β =-0.569,t =-5.831,P ＜ 0.001).However,the patient acceptance in the hospital NB-UVB group significantly increased along with the improvement of efficacy (β =0.758,t =7.547,P ＜ 0.001),but was not correlated with the treatment duration (β =-0.204,t =-2.030,P =0.05).Conclusions The home and hospital NB-UVB phototherapy can complement each other for the treatment of vitiligo.Appropriate therapy should be chosen for different patients,so as to enhance patient compliance,which is an essential condition for the improvement of efficacy.
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To evaluate the efficacy of different courses of Narrowband Ultraviolet B phototherapy ( NB-UVB) in the treatment of vitiligo .50 vitiligo patients who had finished 3 courses of phototherapy and met the inclusion criteria were included in our study .Each course contained at least 30 times of phototherapy , and between two courses , there was a rest of 3~6 months .The repigmentation of each vitiligo lesion after every course of phototherapy was recorded .To the same lesion , the efficacy difference between the first course and the second course was not statisti -cally significant.But the efficacy of the first course was better than the third course (P<0.05),while the efficacy of the second course was also better than the third course ( P<0.05 ) .There was no significant difference among the three courses concerning the average single irradiation dose .In conclusion , when using NB-UVB in treating vitili-go, the efficacy of first course was equivalent to the second course , but it reduced in the third course .Whenever a plateform stage occurs , a rest of more than 3 months is long enough for the vitiligo lesion to recover initial light sen-sitivity.
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Objective To assess the efficacy and safety of 308-nm excimer laser combined with topical tacrolimus 0.03％ cream for the treatment of childhood vitiligo on the face or neck.Methods Sixty-eight children aged ＜ or =14 years with vitiligo on the face or neck were enrolled in this study,and divided into two groups based on lesional sites,i.e.,skin group with lesions on the forehead,cheek,lower mandible,neck or in the periortic region and mucosa group with lesions in the perioral or periorbital region.All the patients received 308-nm excimer laser irradiation once or twice weekly and topical tacrolimus 0.03％ cream twice daily.Twenty sessions of irradiation served as a treatment course.Efficacy was evaluated at the end of the treatment course.The effects of erythema reaction and cumulative irradiation dose on efficacy were assessed.Results After 20 times of laser therapy,an excellent response was achieved in 78.4％ of the patients in the skin group,and 54.8％ in the mucosa group (P ＜ 0.05).During the treatment,the average frequency of erythema reaction lasting 48 hours or longer was significantly lower in the skin group than in the mucosa group (5.84 vs.9.12,P ＜ 0.01).After 10 and 20 times of laser therapy,the cumulative radiation dose was 4215 mJ/cm2 and 10 453 mJ/cm2 in the skin group,respectively,compared to 3364 mJ/cm2 and 7430 mJ/cm2 in the mucosa group,respectively (both P ＜ 0.01).Conclusions The 308-nm excimer laser combined with topical tacrolimus cream is effective and safe for the treatment of childhood vitiligo on the face or neck.Vitiligo on the forehead,cheek,lower mandible,neck and in the periortic region appears to respond better to this therapy with a weaker erythema reaction than that in the perioral or periorbital region.
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Objective To investigate the relationship between the efficacy of autologous epidermal grafting and the levels of epidermal cytokines in vitiligo. Methods A total of 57 patients with stable vitiligo receiving autologous epidermal grafting were included in this study. Before grafting, 17 patients were irradiated with narrow-band UVB on vitiliginous sites. Suction blister fluid was collected from the recipient site (vitiligous lesions) and donor site (normal skin) in these patients (including the 17 patients irradiated with NB-UVB). ELISA was used to detect the levels of endothelin-1 (ET-1 ) and stem cell factors (SCF) in suction blister fluid. Clinical efficacy was evaluated through a 3-month follow-up. Resttlts Among these 57 patients, 45 successfully responded to autologous epidermal grafting. In these 45 patients, the levels of ET-1 and SCF in vitiligous lesions were 728.97±286.12 ng/L and 329.97±114.13 ng/L respectively, significantly higher than those in nomal skin (503.16±251.44 ng/L, 224.73±107.91 ng/L, t = 5.443, 5.897, respectively, both P < 0.05 ). In those who responded poorly, significant difference was also observed in the level of SCF between the normal skin and vitiligous lesions (309.00±163.89 ng/L vs 204.22±83.25 ng/L, t = 3.03, P < 0.05), but not in the level of ET-1. Increased level of ET-1 was observed in both vitiligous lesions and normal skin of patients who responded well compared to those who responded poorly, while no difference was noticed in the level of SCF between these two groups of patients. The level of ET-1 was statistically higher in vitiligous lesions in patients exposed to NB-UVB than in those without exposure (t = 1.44, P > 0.05). In those patients who responded successfully, the level of ET-1 was lower in the 15 patients exposed to NB-UVB compared to the other 30 patients without exposure (548.48±230.22 ng/L vs 794.60±278.72 ng/L, P<0.05); no significant difference in the level of SCF was noted. Conclusions ET-1 and SCF may both play important roles in the repigmentation of vitiligo, with ET-1 exerting a more important role.
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Objective To observe the curative effect of narrow-band ultraviolet(NB-UVB)on stable vitiligo with autologous epidermis grafting.Methods A total of 82 patients with stable vitiligo were recruited and randomly divided into a control group and a treatment group.The patients in the treatment group were pretreated with NB-UVB before autologous epidermis grafting,while those in the control group were not.The pretreatment with NB-UVB was implemented twice a week for at least 4 weeks before the autologous epidermis grafting. A 3-month follow-up observation was conducted with regard to the effectiveness. Results Pretreatment with NB-UVB could significantly increase the survival rate of skin grafts and rate of repigment of leukoplakia,when compared with autologous epidermises transplantation alone.The rate of complete repigment raised significantly(P＜0.05),and so did the curative effect for vulgaris generalized vitiligo(P＜0.029).It was found that the curative effect on vitiligo was closely related to the frequency of NB-UVB radiation,location of leukoplakia,color of skin,and the time of repigment appearance. ConclusiOn Pretreatment with NB-UVB can significantly improve curative effect of autologous epidermis grafting on vitiligo.