Light and electron microscopic studies of the effect of combined topical calcipotriol and PUVA therapy on patients with vitiligo

Vitiligo is an acquired depigmenting disorder that is characterized by loss of melanocytes from the epidermis. A large variety of therapeutic agents are being tried for the treatment of vitiligo, but an optimal treatment is not yet available. This study was conducted to estimate the efficacy of combination of topical calcipotriol and PUVA therapy in patients with vitiligo. Twenty-one patients with vitiligo were enrolled in this study, and were classified into three groups: group 1 [control group], nonlesional [normal] skin biopsies from all included patients in the study; group 2 [pretreated group], biopsies from lesional [vitiligo] skin from all included patients in the study; and group 3 [post-treated group], all included patients in the study, randomly divided into three subgroups: group 3a, included seven patients treated with topical calcipotriol cream [0.005%] twice daily for six months; group 3b, included seven patients treated with PUVA for six months; and group 3c, seven included patients treated with combined topical calcipotriol cream and PUVA twice daily for 6 months. Skin biopsies were taken, fixed, processed, and stained to assess histological changes [H and E], melanin pigment distribution [Masson-Fontana stain], and intercellular adhesion molecule 1 [ICAM-1] expression in the dermis and epidermis [immunohistochemical techniques]. Moreover, for statistical analysis, the mean area percentage of melanin pigment distribution in the epidermis, optical density of ICAM-1 expression in the epidermis and dermis of the immunostained sections, and number of melanosomes [using electron microscope] in the basal and spinous keratinocytes were measured and counted, respectively, in each of the studied groups. Vitiligo biopsies treated with combination of topical calcipotriol and PUVA showed disappearance of mononuclear cell infiltration, highly significant increase in the amount of melanin pigment concentration, highly significant decrease in ICAM-1 expression in the epidermis and dermis, and significant increase in the number of melanosomes when compared with the vitiligo group. Moreover, reappearance of melanocytes and regeneration of keratinocytes ultrastructure were observed. Combined topical calcipotriol and PUVA therapy showed complete repigmentation in vitiligo skin associated with regeneration of keratinocytes and reappearance of melanocytes in a shorter duration when compared with topical calcipotriol or PUVA therapy alone

Características clínico-epidemiológicas de pacientes en fototerapia por psoriasis en el Hospital Hernán Henríquez Aravena entre los años 2007 y 2009 / Clinical-epidemiological characteristics of phototherapy psoriasis patients in Hernan Henriquez Aravena Hospital between 2007-2009

La psoriasis es un trastorno crónico común de la piel, se caracteriza por pápulas eritematosas y escamas blancas, aunque el diagnóstico diferencial de la psoriasis es amplio, en la gran mayoría de los casos sólo se necesita la anamnesis y el examen físico. En el tratamiento, la luz ultravioleta (UV) ha sido reconocida como beneficiosa a través de sus efectos antiproliferativos y anti- inflamatorios. El propósito nuestro trabajo es describir las características clínicas y epidemiológicas de esta patología en pacientes sometidos a fototerapia en el Hospital Hernán Henríquez Aravena de Temuco entre septiembre de 2007 y diciembre 2009.Se realizó un estudio retrospectivo en el que se revisaron fichas clínicas y informes de fototerapia de 60 pacientes portadores de psoriasis. El tipo clínico más común fue la psoriasis en placa con un 90 por ciento de los casos, seguida de psoriasis eritrodérmica con un 5 por ciento, el tipo de piel más común fue el Tipo 2 con un 87,7 por ciento de los casos. En cuanto a la severidad, la psoriasis moderada fue el 46,8 por ciento de los casos, con un índice de severidad y área de psoriasis (PASI) promedio del grupo estudiado de 11,61 siendo el tipo de psoriasis con mayor gravedad el tipo eritrodérmica (p=0,008). La asociación entre severidad y tipo de piel fue significativa siendo los tipos de piel 1 el que presentó mayor severidad (p=0,012). Nuestro estudio demostró algunas asociaciones significativas entre severidad y tipo de psoriasis, y con tipo de piel. Además de una frecuencia similar en ambos sexos coincidiendo con lo reportado en la literatura.

Psoriasis is a common chronic disorder of the skin which is generally characterized by red papules and white scales. Differential diagnosis of Psoriasis is wide, but it is possible to reach a proper diagnosis with the clinical history and physical examination. For the treatment Ultraviolet light (UV) has been recognized as beneficial, through both antoproliferative and antiinflamatory effects. The purpose of our work is to describe the clinical and epidemiologic features of this pathology in patients with diagnosis of psoriasis submitted for phototherapy in Hospital Hernan Henríquez Aravena of Temuco, between September 2007 and December 2009. A retrospective study was conducted in which there were review medical records and phototherapy protocols of 60 patients with diagnosis of psoriasis. The most common clinical type was the Plaque Psoriasis with 90 percent of the cases, followed by Erythrodermic Psoriasis with 5 percent. The most common skin type was type 2 with 87.7 percent of the cases. Regarding severity, moderate psoriasis presented in 46.8 percent of the cases, with an average Psoriasis area ans severity index (PASI) score of the studied group of 11.61, the type of mayor severity was the Erythrodermic psoriasis (p=0,008). The association between severity and type of skin was significant, being the patients with skin type 1 the ones that presented an increased disease severity (p = 0.012). Our study showed some significant associations between severity and type of psoriasis, and type of skin. Besides the similarity of frequence between genders coincides with previous literature reports.

Qual é o tipo de fototerapia mais comumente indicada no tratamento da psoríase?: UVB banda estreita e PUVA: comportamento da prescrição / What is the most common phototherapy prescription for psoriasis: NB-UVB or PUVA? Prescription behavior

FUNDAMENTOS: Formas moderada e grave de psoríase requerem fototerapia e/ou medicações sistêmicas. Tanto UVB banda estreita quanto fototerapia UVA com psoralênicos (PUVA) podem ser utilizadas no tratamento dessas formas de psoríase, sendo comprovada a efetividade de ambas as terapias. OBJETIVOS: Avaliar as indicações de dois tipos de fototerapia no tratamento da psoríase refratária à terapia tópica: UVB banda estreita e PUVA. MÉTODOS: Entre janeiro de 2006 e dezembro de 2007, os pacientes encaminhados a dois serviços de fototerapia foram incluídos neste estudo. Dados sobre os casos e tipos de prescrição foram coletados de maneira retrospectiva. RESULTADOS: Dentre os 67 pacientes estudados, 51 (76 por cento) foram tratados com UVB banda estreita. As razões para sua indicação foram presença de psoríase em gotas (22 por cento), presença de finas placas (15 por cento), uso de drogas fotossensibilizantes (15 por cento), idade abaixo de 20 anos (9 por cento), fototipo I (9 por cento) e doença hepática (6 por cento). Os 16 (24 por cento) restantes foram tratados com PUVA. A principal indicação dessa terapia foi gravidade da doença (15 por cento), seguida de fototipo IV (9 por cento). CONCLUSÕES: As prescrições de UVB banda estreita excederam as de PUVA devido ao menor número de contraindicações, menor possibilidade de efeitos colaterais, e ainda por ser uma opção mais prática.

BACKGROUND: Moderate and severe forms of psoriasis require phototherapy and / or systemic medications. Both UVA and UVB can be used to treat cases of moderate and severe psoriasis, and the effectiveness of both has been proven. OBJECTIVE: to access the prescription behavior relating to two types of phototherapy for treating psoriasis refractory to topical treatment: narrowband UVB (NB-UVB) or psoralen plus UVA phototherapy (PUVA). METHODS: Between January 2006 and December 2007, patients referred to two phototherapy services were included in this study. Data on the cases and on the type of prescription were collected retrospectively. RESULTS: Among the 67 studied patients, 51 (76 percent) were treated with narrowband UVB. The reasons for the indication were the presence of the guttate type of psoriasis (22 percent), the presence of thin plaques (15 percent), the use of drugs that affected photosensitivity (15 percent), age less than 20 years (9 percent), skin type I (9 percent), and liver disease (6 percent). The remaining 16 (24 percent) were treated with PUVA. The main indication for this therapy was the severity of the disease (15 percent), followed by the presence of skin type IV (9 percent). CONCLUSIONS: Prescriptions of narrowband UVB exceeded those of PUVA because of fewer contraindications and fewer possible side effects, and because it was a more practical option.

value of DNA content and apoptotic index in the early diagnosis and follow-up of mycosis fungoides patients before and after PUVA

This study included 15 patients with early suspicious mycosis fungoides [MF] lesions both clinically and pathologically and 15 MF patients with stage IB or IIA, all were treated with PUVA. Skin biopsies taken from all patients before and after PUVA therapy were subjected to DNA analysis by image analysis and apoptotic index aiming at early diagnosis and evaluating the effect of PUVA on abnormalities found in patients before treatment. The results showed the presence of aneuploidy in early cases and emphasized the value of image analysis as a diagnostic aid. Moreover, it documented that cell death rate or apoptotic index [AI] and DNA ploidy are good criteria for therapeutic efficacy of PUVA

Vitiligo, la faceta inmunológica / Vitiligo: the inmunological facet

El vitiligo es un cuadro dermatológico de acromía, que en la actualidad no ha podido ser definido claramente ya que existen muchas hipótesis no comprobadas sobre su posible causa. El proceso de la destruccióndel melanocito conlleva una serie de cambios en la actividad del sistema inmune de los afectados, que han hecho pensar en un proceso autoinmune al menos como parte de los mecvanismos etiológicos, en el participan tanto la inmunidad humoral como la celular. Se han identificado antígenos específicos en las membranas de los melanocitos e inmunoglobulinas G reactivas hacia ellos, modificaciones en la actividad celular con disminución de células de Langerhans y alteración de las proporciones de diferentes subpoblaciones de células T. Asímismo existen un aumento marcado en la expresión de ICAM-1 y anormal expresión de los MHC clase II por parte de los melanocitos en las fases activas de la enfermedad. Estos factores, y el incremento de la producción de linfocinas proinflamatorias (IL-6 e IL-8) indican la presencia de una citoxidad inmunológicamente mediada, pero la autoinmunidad podría ser solo un epifenómeno, o consecuencia de la exposición de antígenos nuevos mmmodificados por noxas desconocidas, quizás virales, a la luz de hallazgos que implican al virus de inclusión citomegálica en la patogénesis. En esta revisión, se trata de dar un panorama de los conocimientos acumulados en el campo inmunológico sobre el vitiligo en los últimos 40 años

Micosis fungoides en fase tumoral: comunicación de un caso / Mycosis fungoides in tumoral stage: Case report

Se presenta un caso de micosis fungoides en fase tumoral que ha respondido favorablemente al manajo con cobalto luego de 15 sesiones con dosis fraccionadas de 200 rads diarios. Posteriormente, se ha manejado con puvaterapia, obteniendo excelentes resultados hasta el momento

Ten-year experience of phototherapy in Yonsei Medical Center

Phototherapy with PUVA or UVB has been used to treat a wide variety of diseases such as psoriasis, vitiligo, atopic dermatitis and mycosis fungoides, etc. The present study was performed to investigate the pattern of phototherapy in the phototherapy clinic of Yonsei Medical Center. One thousand six hundred ninety two patients who received PUVA or UVB phototherapy were included in this study. We analyzed the protocols for phototherapy between 1985 and 1994. The number of phototherapy per year increased sharply until 1991 and thereafter it has remained relatively constant. The most common age group at the start of phototherapy was the third decade. The most common indications for PUVA and UVB phototherapy were vitiligo and psoriasis, respectively. Most patients had received less than 50 treatments of PUVA and less than 200 J/cm2 of cumulative UVA. Most patients had received less than 50 treatments with UVB and cumulative UVB doses were variable. We had not found any malignancy in the skin. Since the maximum safe cumulative doses of UVA or UVB have not yet been established, it is difficult to decide when phototherapy should b discontinued. The data presented in this study needs to be further analyzed in correlation with photoaging and cancer development for the safe usage of phototherapy.

Alopecía areata: tratamiento / Alopecia areata: treatment

El tratamiento de la alopecía areata ha cambiado notablemente en la última década. Nuevas opciones terapéuticas están disponibles para los pacientes. Es deber del dermatólogo informar al paciente de todas las alternativas posibles para su caso, sus efectos colaterales y sus cifras de éxito. La decisión final es conjunta, entre el paciente, la familia del paciente (cuando corresponda) y el dermatólogo