Repigmentation of gray hair: A case report with a brief review of literature

A case of gray hair nearly 99% was seen to be converted to more than 99% of the pigmented hair, after using full sleeves shirts for 2 years, with 1‑year follow‑up, with the same results, and on screening the literature, we find it first such case in the world literature of almost complete repigmentation of both the forearms after using full sleeves shirts for 2 years and a follow-up of 1 year.

Gingival Melanin Depigmentation With Diode Laser - Case Report / Despigmentación Melánica Gingival con Láser de Diodo - Relato de Caso

ABSTRACT: The pigmented lesions of the oral cavity may be endogenous or exogenous. Endogenous lesions are benign and usually caused by melanin, and they are called gingival melanin pigmentations. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary and mandibular portions. After local anesthesia, we started depigmentation with high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory postoperative results.

RESUMEN: Las lesiones pigmentadas de la cavidad oral pueden ser endógenas o exógenas. Las endógenas son benignas y generalmente causadas por la melanina, denominándose pigmentaciones melánicas gingivales. Entre las opciones para la despigmentación de estas regiones, se destaca la laserterapia, por ser un procedimiento poco invasivo. Este trabajo tuvo como objetivo relatar un caso clínico de la técnica de despigmentación gingival utilizando láser de diodo de alta intensidad en la región anterior de los maxilares para ablación del tejido pigmentado con la finalidad de mejorar la estética gingival. El paciente presentaba como queja estética el aspecto oscurecido de la encía en la región anterior de la maxila y de la mandíbula. Tras aplicar anestesia local, se inició la despigmentación con láser de diodo de alta intensidad, siendo que la ablación se realizó a partir de la encía insertada hacia la encía marginal libre. El paciente regresó tras 30 y 180 días, presentando encía saludable y con ausencia de repigmentación melánica. Así fue posible concluir que el láser de diodo mostró ser una buena alternativa para la despigmentación melánica, ya que se presentó como un procedimiento con menor morbidad y buen resultado postoperatorio.

Comparative Study Between Follicular Unit Extraction (FUE) And Non Cultured Melanocyte Transfer (NCMT) In Stable Vitiligo Patients

Background: Vitiligo is an acquired, hypomelanotic disorder characterized by circumscribed depigmented macules in the skin resulting from the loss of functional melanocytes from the cutaneous epidermis. It also causes significant psychological and social distress. Aims and Objectives: To compare the efficacy of follicular unit extraction and non cultured melanocyte transfer in patients of stable vitiligo with respect to repigmentation, vitiligo noticeability and global treatment success. Material and Methods: A total of 15 patients with stable vitiligo (as per IADVL guidelines) were enrolled in the study. In the same patient follicular unit extraction (FUE) was done in the vitiliginous lesions and the hair was transplanted approximately 3-5 mm apart on the left side of the body, while another vitiliginous lesion in the same patient was selected for non cultured melanocyte transfer (NCMT) which was done on the dermabraded area on the right side of the body. These patients were followed-up for a period of 6 months, initially at every 2 weeks or till first signs of repigmentation, then monthly follow-ups for two times and then followed-up in every 2 months. Visual analogue scale was used for assessment of repigmentation, VNS scale was used to evaluate vitiligo noticeability and global treatment success was calculated. Results: There were 2 (13.3%) females and 13 (86.7%) males in our study, showing a male preponderance. Majority of the patients were in the age group 21-40 years (66.7%). There was statistically significant increase in the mean pigmentation at each follow-up in comparison to the earlier follow-up in both the groups (p<0.05). The mean pigmentation and mean pigmentation difference, between the two groups was also comparable (p>0.05). Excellent pigmentation was seen in 60% patients of FUE and 73.3% patients of the NCMT group. Vitiligo was ‘not noticeable’in 33.3% patients of FUE and 40.0% patients of NCMT group. Global treatment success was 80% in both the groups. Bony prominence, greying and loss of follicles in FUE group; and graft displacement and herpes zoster in NCMTgroup were the factors responsible for low pigmentation. Conclusion: From the above study, we conclude that repigmentation was seen in both the groups, with equal efficacy seen between the two methodologies. Thus, any method can be applied for repigmentation with due considerations to complications of each method used.

Comparison of Repigmentation of Stable Vitiligo via Punch Grafting, Thin-thiersch’s grafting and Suction Blister Grafting

Background: Vitiligo is defined as an acquired melanocytopenia of obscure aetiology and is characterized by circumscribed hypomelanosis and depigmentation of skin and hair which is often progressive. The aim of present study is to compare between 3 surgical modalities i.e. miniature punch grafting, thin split-skin thickness grafting and suction blister grafting and to experiment a novel method according to the site, size and location of the lesion and to study the extent of re-pigmentation after doing these procedures and comparison of the results in patients of stable vitiligo. We also aim to assess the complications and disadvantages of different surgical techniques. Methods: The study was conducted on total 60 vitiligo patients, who were divided into 3 groups of 20 each, in the age group of 15-60 years, attending Dermatology Department of Katihar Medical College in the span of 2 yearsResults. Results are comparable overall but vary considerably according to site of lesions. Punch grafting is very good for mobile areas like elbow, ankle and other joints;  Thin – thiersch’s skin grafting gives better results for flat areas like trunk, thigh, arms and face while Suction blister grafting gives satisfactory results for lips vitiligo and also over small, oval lesions over flat sites. Conclusions: Thus, it can be finally concluded from this study that the surgical modality for treating a case of vitiligo cannot be generalized. Every patient should be evaluated individually according to anatomical site involved, size and shape of lesion, time required to achieve pigmentation, infrastructure available and patient’s preferences.

Tratamiento del vitiligo con esencias florales de Bach. Presentación de casos / Vitiligo treatment with Bach floral essences. Cases presentation

Se realiza una presentación de casos, de 2 pacientes en edades pediátricas con diagnóstico clínico de vitiligo. El objetivo del estudio fue exponer los resultados del tratamiento de esta dermatosis con esencias florales de Bach. Los pacientes estudiados fueron: RLT de 6 años, masculino, negro, remitido por lesiones en placas máculo- acrómicas, de 2 cm de diámetro, distribuidas en nuca y región lateral izquierda del cuello; el otro paciente OJTS, de 13 años, masculino, negro, que es remitido, por presentar lesiones en placas máculo-acrómicas, bordes precisos de 1 a 2 cm, de diámetro localizadas en región frontal y mejilla izquierda. Se les realizó interrogatorio, examen clínico general por el dermatólogo y el pediatra. Previo consentimiento informado se indicó tratamiento con esencias forales de Bach (Crab Apple, Willow y Walnut) y seguimiento posterior. Ambos niños llevan 5 años asintomáticos.

It is made the case presentation of two pediatric-aged patients with clinical diagnosis of vitiligo. The aim of the study was exposing the results of this dermatosis treatment with Bach floral essences. The studied patients were: RLT, aged 6 years, male, black, remitted because of lesions in macula-achromatic plaques, of 2 cm diameter, located in nape and left lateral region of the neck; the other patient, OJTS, aged 13 years, male, black, is remitted for presenting lesions in macula-achromatic plaques, precise edges, ranging from 1 to 2 cm of diameter, located in frontal region and left cheek. The dermatologist and the pediatrician made questioning and clinical general examination. After obtaining the informed consent a treatment with Bach floral essences (Crab Apple, Willow, and walnut) and they were followed up. Both children are asymptomatic already for 5 years.

Combination Therapy of Topical CCB (Combination of Calcipotriol and Betamethasone Dipropionate) Gel and Narrowband Ultraviolet B (NBUVB) in the Treatment of Vitiligo: An Intraindividual Right-Versus-Left Comparison Study with Topical Betamethasone Dipropi / 대한피부과학회지

BACKGROUND: In the treatment of vitiligo, topical corticosteroids are known to be effective, but are associated with serious adverse effects. Many studies have shown that topical calcipotriol is a promising therapeutic modality in vitiligo. In some studies, combined calcipotriol and betamethasone dipropionate ointment has been shown to be a more effective and well tolerated treatment for vitiligo. The combination therapy seems to synergistically act as an immunosuppressive and a pigment restorative agent. OBJECTIVE: We investigated the clinical efficacy of CCB (Combination Calcipotriol and Betamethasone dipropionate) gel compared with that of betamethasone dipropionate alone in the repigmentation of vitiligo. METHODS: In an intraindividual right-left comparison study (n=20), a CCB gel was applied once daily to a lesion on one side, and betamethasone dipropionate cream was applied to a lesion on the other side. The degree of repigmentation was assessed according to the Vitiligo Area Scoring Index (VASI) at baseline, 4, 12, 24, and 48 weeks. RESULTS: The CCB gel treated group showed a remarkably improved therapeutic outcome compared to the betamethasone dipropionate monotherapy group: the percentages of VASI relative to the baseline at CCB gel treated sites were 82.73+/-8.17%, 70.45+/-14.05%, 62.73+/-17.52%, and 56.24+/-18.49% at 4, 12, 24, and 48 weeks after treatment, respectively; while those of the other sites receiving betamethasone dipropionate were 89.55+/-7.24%, 84.55+/-10.60%, 77.73+/-14.38%, and 73.48+/-12.93%. Adverse effects such as atrophy and burning sensations were much less after CCB gel treatment than after betamethasone monotherapy. CONCLUSION: CCB gel is more effective and tolerable than betamethasone dipropionate monotherapy in repigmentation therapy for vitiligo.

Estética gengival: repigmentação da melanina / Gingival aesthetics: melanin repigmentation

Objetivo: Mostrar aos profissionais os meios de corrigir a pigmentação melânica do tecido gengival, como finalidade estética, destacando, no entanto, a possibilidade da sua recidiva. Método: Participaram deste estudo clínico duas pacientes do sexo feminino, com idade de 28 e 22 anos que procuraram tratamento estético especializado na disciplina de periodontia da FOP/UPE, por se sentirem incomodadas com as manchas escuras na gengiva. Após exame e diagnóstico, as pacientes receberam esclarecimentos sobre a condição apresentada e, depois de conscientizadas, tiveram orientação de higiene bucal e raspagem para adequação do meio pré e pós-cirúrgico, sendo definida a técnica da gengivectomia / gengivoplastia. Resultado: os dados obtidos após acompanhamento do primeiro caso com 120 dias não comprovaram recidiva da pigmentação, no entanto, no segundo caso com 90 dias, verificou-se o aparecimento de pequenos pontos de repigmentação em diferentes áreas do tecido gengival. Conclusão: Pode-se concluir que a pigmentação retorna em alguns indivíduos com mais rapidez, mesmo tendo sido executada a mesma técnica com o mesmo operador, porque a melanina é um pigmento, que está na genética dos indivíduos com características diferenciadas.

Purpose: To show professionals the means to correct the melanin pigmentation of the gingival tissue for aesthetic purposes, highlighting, however, the possibility of recurrence. Method: The subjects in the trial were two females, aged 28 and 22 years, who sought specialized cosmetic treatment in the discipline of periodontics at FOP / UPE because they were unhappy about the dark spots on their gums. After examination and diagnosis, patients were informed about their condition and given the appropriate orientation on oral hygiene and scaling for the pre- and postoperative preparation of the oral cavity, the chosen technique being gingivectomy and gingivoplasty. Results: In the first case no recurrence of the pigment was observed after 120 days of follow-up, but in the second case at 90 days small spots of repigmentation were to be seen in different areas of the gingival tissue. Conclusion: It may be concluded that the pigment returns more rapidly in some subjects, even when the same procedure has been carried by the same operator, because melanin is a pigment that is part of the genetic makeup of individuals with different characteristics.

Survival and melanogenic potential of reversibly immortalized human melanocytes mediated by SV40T antigen gene and Cre/loxP system in Guinea pigs / 中华皮肤科杂志

Objective To study the survival and melanogenic potential of human melanocytes reversibly immortalized via SV40T antigen gene and Cre/loxP system in Guinea pigs. Methods The supernatants of retrovirus vector Cre-ERT2 were used to infect melanocytes which had been successfully transfected by SV40TAg gene (MCT), then the expression of Cre recombinase was induced with tamoxifen in infected cells; subsequently, the surviving cells, which were named as MCTC, were subjected to expansion culture. Guinea pigs were utilized to establish animal models of vitiligo, then MCTC and primary melanocytes were transplanted respectively into the animal models. The repigmentation at the transplanted area was observed with naked eyes successively until 3 months after the transplantation when tissue samples were obtained from implanted area and nonimplanted area of guinea pigs and subjected to Masson-Fontana silver stain and Hematoxylin-eosin stain for the analysis of melanocyte distribution and melanin deposition in epidermis. Results Repigmentation started 4 weeks after the transplantation, and dark or brown patches, which ranged in size from 0.5 to 1 cm, were observed in the implanted area 3 months after the transplantation. The repigmentation rate was of no significant difference between pigs transplanted with MCTC and those with primary melanocytes (82.5% vs 76.7%, P > 0.05). Pathological examination revealed melanin deposition in the basal layer of epidermis and some hair follicles in transplanted area. Conclusions SV40T antigen gene combined with Cre/loxP site-specific recombinase system can induce the reversible immortalization of human melanocytes, and the immortalized melanocytes have a favorable profile of biological safety and similarity in survival rate and melanogenic potential to primary melanocytes.

Therapeutic Effects of Narrow-band UVB Phototherapy in the Treatment of Vitiligo / 대한피부과학회지

BACKGROUND: Recently, narrow-band UVB phototherapy is introduced for vitiligo treatment. It is easier to be applicable because of no need for topical and/or systemic photosensitizers, and comparably or more effective than PUVA without systemic side effects. Moreover, it is more safely applicable to children and pregnant women. However, to date, there is not so large series of clinical reports about its use in vitiligo treatment as to evaluate therapeutic effects. OBJECTIVE: This study was to evaluate the effects of narrow-band UVB phototherapy for vitiligo in various aspects of clinical parameters. METHODS: Treatment of patients in this study with narrow-band UVB was started between November 2001 and November 2002. Narrow-band UVB phototherapy was given as monotherapy once or twice a week. The starting dose was 280-300mJ/cm2, with dose increments at each subsequent treatment. RESULTS: 78 patients were able to be evaluated in this study. Their ages ranged from 3 to 67 years (mean, 33.7 years). 69 patients had Fitzpatrick skin type IV, 5 had skin type III and 4 had skin type V. 36 of the 78 patients (46.2%) achieved more than 75% repigmentation (grade 4). The better repigmentation grade, the shorter vitiligo duration (p=0.0464). Compared with other sites, lesions on the hands and feet showed poorer improvement(grade 1: 10/13 and 4/4 respectively, p= 0.0015). Adverse effects were limited and transient. CONCLUSION: Narrow-band UVB therapy is an effective and safe therapy for vitiligo. Long-term adverse and therapeutic effects compared to other treatment modalities remain to be determined.

Narrow-band UVB as a Tool of Vitiligo Treatment / 대한피부과학회지

BACKGROUND: Many modalities of treatment for vitiligo have been elucidated and yet the treatment of vitiligo remains to be a challenge. OBJECTIVES: The purpose of this article is to review our results and experiences with narrow-band ultraviolet B phototherapy for vitiligo. METHOD: We studied 9 patients with vitiligo who received narrow band UVB phototherapy for 6 months in our department. This is a retrospective analysis of our experiences and results. RESULTS: Nine patients were able to be evaluated for the purpose of this analysis. Their ages ranged from 6 to 68 years(mean, 18.4 years). Six patients of 9 patients achieved more than 75% repigmentation with a mean of 25 sessions of phototherapy. The remaining three patients had 50%, 40% and 30% repigmentation after 44, 40, and 45 sessions of phototherapy, respectively. Adverse effects were mild. CONCLUSION: Narrow-band UVB is a useful and well-tolerated therapy for vitiligo in comparsion with other therapies.