Incidence of skin malignancies in patients with vitiligo or psoriasis who received narrowband ultraviolet B phototherapy (308 nm/311 nm): A retrospective review of 3730 patients.

BACKGROUND: Previous studies regarding the risk of skin malignancy with NBUVB have been performed in Caucasian patients, but few studies have been conducted in Asians. AIM: The aim of the study was to determine the risk of skin cancer in Asian patients with psoriasis and vitiligo receiving NBUVB phototherapy. METHODS: We performed a 9-year retrospective study including all patients with psoriasis and vitiligo receiving NBUVB (either 311 nm wavelength through cabin phototherapy or 308 nm through excimer lamp phototherapy) at the National Skin Centre. We matched the identification numbers of patients to the National Registry of Diseases Office database and collected data on all skin cancers diagnosed. RESULTS: A total of 3730 patients were included. During the course of the study, 12 cases of skin cancer were diagnosed, of which 10 were basal cell carcinomas, and 2 were squamous cell carcinomas. No cases of melanoma were detected in the study. The age-standardized incidence of skin cancer in psoriasis and vitiligo patients who received phototherapy was 47.5 and 26.5, respectively, which is higher than the incidence of skin cancers in the general population. Risk of skin malignancy was positively correlated with the cumulative (p = .008) and maximum dose of phototherapy (p = .011) as well as previous systemic treatments (p = .006). LIMITATIONS: Limitations include a relatively short follow-up period as well as the lack of quantification of solar exposure. CONCLUSIONS: NBUVB phototherapy in Asian skin increases the risk of skin malignancy. The risk of skin malignancy is higher with psoriasis patients, greater cumulative and maximal dose of phototherapy as well as the use of systemic therapy. Despite the increased risk, the absolute number of skin malignancies remains low, especially for vitiligo patients, with no cases of melanoma diagnosed-a reassuring finding that phototherapy remains a safe alternative in the treatment of psoriasis and vitiligo.

Standardizing serial photography for assessing and monitoring vitiligo: A core set of international recommendations for essential clinical and technical specifications.

BACKGROUND: Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time. OBJECTIVE: The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography. METHODS: Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached. RESULTS: The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described. CONCLUSIONS: This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment.

Comorbidities Associated with Severity of Atopic Dermatitis in Young Adult Males: A National Cohort Study.

Atopic dermatitis (AD) is a systemic inflammatory disorder. However, the relationship between severity of AD and metabolic and atopic conditions is not well studied. The aim of this study was to elucidate the relationship between severity of AD and comorbidities, such as metabolic conditions (increased body mass index, hypertension, hyperlipidaemia, and type II diabetes mellitus) and other atopic manifestations (allergic rhinitis, asthma and food allergies). A retrospective population-based national study of a cohort of young adult males conscripted into military service in Singapore over a 5-year period was performed, utilizing military electronic medical records. A dose-dependent effect was found between the association of comorbidities and severity of AD. Metabolic and atopic conditions were significantly correlated with having moderate-to-severe AD. An association of metabolic and atopic conditions with severity of adult AD was found, which suggests that chronic severe AD may result in increased disease burden and morbidity.

Microneedle-Assisted Topical Delivery of Photodynamically Active Mesoporous Formulation for Combination Therapy of Deep-Seated Melanoma.

Topical treatment using photodynamic therapy (PDT) for many types of skin cancers has largely been limited by the inability of existing photosensitizers to penetrate into the deep skin tissue. To overcome these problems, we developed a mesoporous nanovehicle with dual loading of photosensitizers and clinically relevant drugs for combination therapy, while utilizing microneedle technology to facilitate their penetration into deep skin tissue. Sub-50 nm photodynamically active mesoporous organosilica nanoparticles were synthesized with photosensitizers covalently bonded to the silica matrix, which dramatically increased the quantum yield and photostability of these photosensitizers. The mesopores of the nanoparticles were further loaded with small-molecule inhibitors, i. e., dabrafenib and trametinib, that target the hyperactive mitogen-activated protein kinase (MAPK) pathway for melanoma treatment. As-prepared empty nanovehicle was cytocompatible with normal skin cells in the dark, while NIR-irradiated drug-loaded nanovehicle showed a synergistic killing effect on skin cancer cells mainly through reactive oxygen species and caspase-activated apoptosis. The nanovehicle could significantly inhibit the proliferation of tumor cells in a 3D spheroid model in vitro. Porcine skin fluorescence imaging demonstrated that microneedles could facilitate the penetration of nanovehicle across the epidermis layer of skin to reach deep-seated melanoma sites. Tumor regression studies in a xenografted melanoma mouse model confirmed superior therapeutic efficacy of the nanovehicle through combinational PDT and targeted therapy.

Treatment outcomes of vitiligo in Asian children.

This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.

Interstitial Granulomatous Variant of Scleromyxedema-A Diagnostic Pitfall.

Scleromyxedema is a rare disorder where patients may develop systemic manifestations such as monoclonal gammopathy, inflammatory polyarthritis, and esophageal and neurological dysfunction. Histologically, there may be atypical variants of scleromyxedema showing features resembling interstitial granuloma annulare. We report an unusual case of scleromyxedema with interstitial granulomatous pattern and highlight potential diagnostic pitfalls when encountered with such a variant.

Retrospective study on the characteristics and treatment of late-onset vitiligo.

BACKGROUND: Late-onset vitiligo, defined as being aged 50 years and above at the point of clinical onset, remains poorly characterized till now. AIM: This study aims to describe the clinical characteristics and treatment response of patients with late-onset vitiligo. METHODS: We retrospectively reviewed the case records of all patients diagnosed with late-onset vitiligo, from January 1, 2010 to December 31, 2014. Information obtained included patient demographics, characteristics of vitiligo and treatment responses. RESULTS: Of the 3128 patients diagnosed with vitiligo over the 5-year period, 461 (14.7%) had late-onset disease. The study had more females (n = 260, 56.4%) than males, with an average onset age of 59.4 ± 7.4 years. Majority of patients were Chinese (n = 308, 66.8%) and 45 (9.8%) patients had an associated autoimmune disease. Focal vitiligo, defined as the localized presence of depigmented patches, was most common (n = 209, 45.3%). Treatment response was evaluated in 359 patients, of which 216 received monotherapy (topical creams: n = 210, 97.2%; phototherapy: n = 6, 2.8%) and 143 received both modalities. Fifty six (15.6%) patients received oral steroids. Patients who were treated with both topical creams and phototherapy yielded better clinical responses compared to those on monotherapy (P < 0.001) with 56.6% (n = 81) of them achieving good epidermal repigmentation, defined as >50% return of pigmentation compared to baseline (vs. n = 66, 30.6% in the monotherapy group). The choice of phototherapy (targeted, narrowband ultraviolet B or psoralen + ultraviolet A) did not significantly affect clinical response (P = 0.774). LIMITATIONS: This study is limited by its retrospective nature, the nonstandardized documentation resulting in the inability to determine disease progression and associated metabolic comorbidities and also by the gradual loss to follow-up of patients. CONCLUSION: Late-onset vitiligo is not uncommon and tends to be of the focal vitiligo subtype. Nonsegmented vitiligo is more prevalent than segmental vitiligo. Combination therapy with topical medications and phototherapy is superior to monotherapy.

Reflectance confocal microscopy is a useful non-invasive tool in the in vivo diagnosis of pigmented basal cell carcinoma in Asians.

BACKGROUND: The clinical differentiation between pigmented basal cell carcinoma (BCC) and other benign pigmented skin lesions can be challenging even with an additional dermoscopic evaluation, especially if the lesion is small. In vivo reflectance confocal microscopy (RCM) is an emerging, non-invasive imaging tool that allows near-microscopic evaluation of skin lesions. The features of RCM for pigmented BCC and seborrhoeic keratosis have previously been described. However, the use of RCM to differentiate between these clinically and dermoscopically challenging pigmented skin lesions among Asians has not yet been demonstrated. OBJECTIVES: We aimed to evaluate the usefulness of non-invasive RCM to differentiate between clinically and dermoscopically challenging pigmented skin lesions among Asians in a series of 11 lesions. METHODS: Nine patients with 11 clinically and dermoscopically difficult to distinguish pigmented skin lesions were evaluated by RCM to differentiate between pigmented BCC and benign lesions. In all cases, a histological confirmation of the RCM diagnosis was obtained. RESULTS: The clinical or dermoscopical characteristics were non-specific in all 10 cases. RCM detected features of pigmented BCC in nine patients and seborrhoeic keratosis in one patient. These were all confirmed by histological examination. CONCLUSIONS: This case series shows the value of non-invasive in vivo RCM imaging in the differentiation of malignant and benign pigmented lesions. Early diagnosis of small, pigmented BCC allows earlier excision with better prognosis. Future biopsies of benign lesions in cosmetic areas could also be avoided.

Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis.

BACKGROUND: Melasma is a common pigmentary disorder among Asians and treatment is challenging. Oral tranexamic acid (TA) has emerged as a potential treatment for refractory melasma. Large-scale studies on its use, outcomes, and safety are limited. OBJECTIVE: We sought to evaluate treatment outcomes and adverse effects of oral TA in melasma in an Asian population. METHODS: We conducted a retrospective analysis of patients who received oral TA for melasma in a tertiary dermatologic center from January 2010 to June 2014. RESULTS: In all, 561 patients (91.4% female, 8.6% male) were enrolled. Median duration of treatment was 4 months. The majority (503 [89.7%]) improved, 56 (10.0%) had no improvement, and 2 (0.4%) worsened. Patients without family history of melasma had better response rates than those with family history (90.6% vs 60.0%, P = .01). Of the 503 who improved, response was seen within 2 months of TA initiation, with a relapse rate of 27.2%. Adverse events occurred in 40 (7.1%). Most were transient, but 1 developed deep vein thrombosis requiring prompt discontinuation. She was later given the diagnosis of familial protein S deficiency. LIMITATIONS: This was a retrospective study. CONCLUSION: Oral TA may be an effective adjunct for refractory melasma. Careful screening for personal and familial risk factors for thromboembolism should be done before initiation.

Investigating factors associated with quality of life of vitiligo patients in Singapore.

Skin disease is often visible to others. People who have dermatological condition may also suffer from its psychological consequences. The purpose of this study is to explore the quality of life of patients with vitiligo and to identify factors associated with their quality of life. A descriptive correlational study was conducted with 222 patients with vitiligo recruited from two skin centres in Singapore from 2009 to 2011. Data were collected by a structured questionnaire. Three outcome variables were measured in the study: predisposal, clinical and psychological outcomes. Results showed that almost two-thirds of the participants reported vitiligo had moderate to extreme impact on their quality of life. Multiple regression analyses showed that patients who were depressed, had thyroid disease and had not used multiclear treatment were more likely to report poor quality of life. It is recommended that providing health care consultation for patients with vitiligo may help reduce depressive symptoms and maintain their psychological health, thus enhance their quality of life.

Investigating factors associated with depression of vitiligo patients in Singapore.

AIMS: To explore the depression level of a group of vitiligo patients in Singapore and to identify factors associated with depression. BACKGROUND: Unlike most internal illness, skin disease is often immediately visible to others and therefore people suffers from dermatological conditions may suffer psychological consequences. DESIGN: A descriptive survey was conducted during the period October 2009-August 2010 in Singapore; 145 vitiligo patients aged 21+ completed a structured questionnaire. METHODS: Three main outcome variables were employed in the study: demographic characteristics, clinical and psychosocial outcomes. RESULTS: Among the patients, 17·2% (n = 25) had been identified as depressed. Multiple logistic regression analyses were used to identify a model to predict vitiligo patients who will have depression. The results showed that females (p = 0·05), aged below 50 years old (p = 0·016), having 5+ years of illness (p = 0·021) and with low self-esteem (p = 0·002) and poor quality of life scores (p = 0·004) were significant risk factors for depression. CONCLUSION: Providing a suitable health care consultation for vitiligo patients may reduces depressive symptoms and maintaining their psychological health may be crucial for preventing suffering from depressive symptoms. Apart from the findings, these conclusions resonate with recent Singapore guidance on managing depression in vitiligo patients. This stresses the importance of prevention, early detection and stepped care with a multifaceted approach to management. RELEVANCE TO CLINICAL PRACTICE: It is important to regularly screen for depressive symptoms among vitiligo patients. Focusing on vitiligo patients with enhancing self-esteem and improving quality of life should help in both the prevention and recognition of onset of depression among vitiligo patients.