Combination therapy of orally administered glycyrrhizin and UVB improved active-stage generalized vitiligo

Glycyrrhizin has been used clinically for several years due to its beneficial effect on immunoglobulin E (IgE)-induced allergic diseases, alopecia areata and psoriasis. In this study, glycyrrhizin, ultraviolet B light (UVB) or a combination of both were used to treat active-stage generalized vitiligo. One hundred and forty-four patients between the ages of 3 and 48 years were divided into three groups: group A received oral compound glycyrrhizin (OCG); group B received UVB applications twice weekly, and group C received OCG+UVB. Follow-ups were performed at 2, 4, and 6 months after the treatment was initiated. The Vitiligo Area Scoring Index (VASI) and the Vitiligo Disease Activity (VIDA) instrument were used to assess the affected body surface, at each follow-up. Results showed that 77.1, 75.0 and 87.5% in groups A, B and C, respectively, presented repigmentation of lesions. Responsiveness to therapy seemed to be associated with lesion location and patient compliance. Adverse events were limited and transient. This study showed that, although the three treatment protocols had positive results, OCG and UVB combination therapy was the most effective and led to improvement in disease stage from active to stable.

Vitiligo - Part 2 - classification, histopathology and treatment

In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.

Clinical pattern of vitiligo

All new cases of vitiligo reporting to Dermatology Outpatient of Combined Military Hospital, Panu Aqil, were included in the study. Of the 230 patients, 124 were male [53.9%] and 106 were female [46.1%]. Males were more commonly affected. The disease affected all age groups. Mean age at presentation was 27.02 +/- 18.34 years and age at presentation ranged from 5.5 months to 82 years. The mean age at onset was 22.03 +/- 16.97 years with majority 30.4% [n=70], developing vitiligo in first decade of life. Generalized vitiligo was the most common type [n=132, 57.4%] followed by focal [n=53, 23%] and aero-facial vitiligo [n=16, 7%]. Head and neck was the most common initial site of onset [n=100, 43.48%]. Koebner phenomenon was observed in 72 patietns [31.3%], family history was present in 64 patients [27.8%] and 16 patients [7%] had associated diseases

Vitiligoid lichen sclerosus: a reappraisal.

BACKGROUND: Many case studies of lichen sclerosus (LS) have reported an association of vitiligo. However, such an association is not reported from larger case studies of vitiligo, which happens to be a common disease. Autoimmune etiology suspected in both LS and vitiligo has been considered as the reason for their association in some patients. It has also been suggested that lichenoid inflammation in LS may trigger an autoimmune reaction against melanocytes. AIMS: To test this association, we reviewed clinical and histological features of 266 cases of vitiligo and 74 cases of LS in a concurrent study of both diseases. METHODS: All outpatients seen in our department between 2003 and 2006 and who were diagnosed as having LS or vitiligo on the basis of clinical and pathologic features were included in the study. RESULTS: Vitiligoid lesions were seen along with stereotypical LS lesions in three patients but all the three lesions had histological features of LS. Oral/genital areas were affected in 57 out of the 74 LS cases and of those, 15 were initially suspected to have vitiligo. These cases with a clinical appearance of vitiligo and histological features of LS were considered as 'vitiligoid LS', a superficial variant proposed by J. M. Borda in 1968. Association of LS was not observed in the 266 cases of vitiligo. CONCLUSION: Exclusive oral/genital depigmentation is a common problem and histological evaluation is essential to differentiate vitiligoid LS from true vitiligo. The association of vitiligo with LS may have been documented due to the clinical misdiagnosis of vitiligoid LS lesions as vitiligo as histological investigations were not undertaken in any of the reported cases.

Standard guidelines of care for vitiligo surgery.

Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. PHYSICIAN'S QUALIFICATIONS: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. FACILITY: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. INDICATIONS FOR VITILIGO SURGERY: Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure, about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year). Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time), and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. ANESTHESIA: Lignocaine (2%) with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. POSTOPERATIVE CARE: Proper postoperative immobilization and care are very important to obtain satisfactory results.

[What is new in the treatment of vitiligo]

Vitiligo is a frequent hypomelanosis that affects 1% of the world population, and 0,95% of the Tunisian population. The objective of our study is to describe through a recent review of the literature, the different therapeutic modalities, now used in vitiligo. We have used a clinical approach to guide therapeutic indications. We have performed a review of the articles, dealing with the treatment of vitiligo and published during the 10 previous years. We have used a Medline research with these key-words: "vitiligo and treatment". Randomized studies were privileged and 29 articles were analysed. We have initially presented all validated therapeutic means now used in vitiligo. We have then proposed, according to this recent review of the literature, clinical indications according to vitiligo type, extension of lesions and if vitiligo involves adults or children. We dispose of multiple chemical, physical and surgical treatments of vitiligo. Vitiligo with partial melanocyte defect can be treated especially by the different modalities of phototherapy [PUVA therapy, PUVASOL, UVB therapy TL01, Laser excimer]. Surgical treatments were also described, with there principal indications. Ethiopathgenic treatments [local steroids, Tacrolimus, Calcipotriol, Vitix] were especially indicated in vitiligo with complete epidermic and follicular achromy. Finally, different therapeutic associadons were reported in the litterature, showing synergic effect of some treatments. Phototherapy remains the best treatment of vitiligo type I. In vitiligo type II and III, ethiopathogenic treatments may be efficient, alone or associated with phototherapy

[Epidemiological and clinical features of juvenile vitiligo: about 106 cases]

Vitiligo is acquired circumscribed leukoerma. Half of all cases begin before the age of 20 years. Our study was to specify the epidemiological and clinical features of juvenile vitiligo [JV]. Through a retrospective study we collected all cases of vitiligo aged less than 16 years, followed during 9 years, between 1997 and 2005 in the Dermatology department of the la Rabta hospital. For every patient, we have focused the epidemiologic, clinical and therapeutic data. One hundred and six cases of JV were enrolled. The mean age was 10 years, with sex ratio [M/F] about 0.49. The mean duration of disease was about 1.5 years. A positive family history of vitiligo and autoimmune disease was noted respectively in 13.2%et 1.9%of our patients. Vulgaris presentation was observed in 53.77%of cases. More patients in our study were treated with topical steroid. There was a paucity of published data regarding JV, they reported some characteristics [female preponderance, higher incidence of family history of vitiligo, autoinimune and/or endocrine disease, increased segmental presentation]. Despite these features, it is premature to conclude that JV is a distinct subset of vitiligo

socio-demography and clinical profile of vitiligo in Sudan

Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 0.1% and 2%. The disease has different clinical types but generally, it consists of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. To define the socio-demography and clinical profile of vitiligo in Sudan. This study is a cross-sectional, clinico-epidemiological and hospital-based study, done in Khartoum Dermatologic Hospital [KDH]. The data were collected between June 2007 and November 2007. The total number of patients with vitiligo in the study was 113. Male patients were 47 [42%]. Children were 13 [11%], adults were 90 [80%] and elderlies were 10 [9%]. The mean age of onset of the disease was found to be 11.5 yrs in 22.5% of the patients. Patients with acute [< 1 yr] disease were 6 [5.4%], while those with chronic [>/= 1 yr] disease were 107 [94.6%]. The most commonly affected tribe was Algaa/'liyeen tribe [27%]. The commonest precipitating factor for vitiligo has been found to be emotional disturbances [in 27% of patients]. Commonest symptom of the disease was depigmented patch/es [64.8%]. Severe [>/= 10%] involvement of skin surface area was found in 59% of patients, while mild [<10%] involvment was found in 41% Koebner sign was found to be present in 42% of patients. The disease was active in 47.3% of patients. The bilaterally symmetrical pattern of distribution was the commonest pattern [in 85%]. The commonest clinical type of vitiligo was the generalized type [82.3%]. 35% of patients with vitiligo had positive family history. The clinical profile of vitiligo in Sudan was not so different from that found worldwide

Vitiligo: compendium of clinico-epidemiological features.

Vitiligo, an autoimmune disorder characterized by localized and/or generalized depigmentation of the skin and/or mucous membranes, is a well-recognized entity. The imperatives of its epidemiology both in rural India and in global reckoning have been highlighted frequently. Its morphology is striking and is characterized by asymptomatic ivory/chalky white macule(s) that may be frequently surrounded by a prominent pigmented border, the 'trichrome vitiligo'. However vitiligo may have morphological variations in the form of: trichrome, quadri-chrome, penta-chrome, blue and inflammatory vitiligo. Its current topographical classification into segmental, zosteriform and nonsegmental, areata, vulgaris, acrofacialis and mucosal represent its well acclaimed presentations. Its adult and childhood onset is well appreciated as also its presentation in males and females. Occasionally, it may be possible to identify triggering factors. Vitiligo may be associated with cutaneous, ocular and systemic disorders, the details of which are discussed in this article.

The classification of segmental vitiligo on the face

Segmental vitiligo usually has an onset early in life and spreads rapidly within the affected area. Among 1,300 patients with vitiligo, 191 patients with segmental vitiligo involving the face were evaluated. In this study, the distribution of segmental vitiligo on the face could be classified into 5 patterns which have distinctive features. This classification of facial segmental vitiligo can provide some indication of the future distribution of early lesions if they have begun to spread.

Propuesta de una clasificación pronóstica en vitiligo / Propose of a prognosis classification in vitiligo

El principal interrogante al evaluar un paciente con vitiligo, es la posibilidad de repigmentación que éste pueda tener. En el presente trabajo intentamos usar algunos factores pronósticos que puedan ayudar en la caracterización de subgrupos de pacientes con vitiligo. Los parámetros considerados como factores pronósticos fueron: edad, localización, superficie corporal comprometida, enfermedades asociadas, familiares con vitiligo, presencia de repigmentación con o sin tratamiento, tiempo de evolución. Esta propuesta de clasificación permitirá escoger un diferente tratamiento, tomando en cuenta el potencial del mismo en función de las posibilidades de respuesta del mismo; y además permitiría realizar ensayos terapéuticos más confiables y reproducibles al homogeneizar los pacientes estudiados, haciendo a su vez los datos obtenidos más confiables