Treatment of vitiligo using targeted UVB-Intense Pulsed Light (IPL)- phototherapy: evaluation of variables affecting therapeutic success.

BACKGROUND: Targeted UVB intense pulsed light (IPL)-phototherapy has gained interest for repigmentation of vitiligo as it allows selective treatment, sparing the surrounding skin. However, optimal treatment frequency and duration are not known. OBJECTIVES: We compared the efficacy and safety of two treatment protocols, weekly and every two weeks, for a maximum of 12 months. Variables affecting treatment response were evaluated. PATIENTS & METHODS: 22 patients (16 female, 6 male; aged 15 - 67 years) with generalised vitiligo were evaluated retrospectively. UVB-IPL had been administered weekly (13 patients, group A), or every second week (9 patients, group B). In cases of no response, treatment stopped after 6 months. Regimentation was evaluated qualitatively and quantitatively. RESULTS: After 6 months, 12/13 patients (A), 3/9 patients (B) showed repigmentation. Due to lack of success, treatment was stopped after 6 months in 1 group A patient and 6/9 group B patients. After 12 months, lesions on the face and trunk in group A showed a mean of 70 ± 27% and 60 ± 29% repigmentation, respectively. Moderate to good repigmentation was seen in 78% of group A patients on the ulnar region on the forearms and the shins. Side effects were minimal. Treatment success depended on treatment frequency, number of treatments and the anatomical site of lesions. CONCLUSIONS: UVB-IPL phototherapy seems to be effective and well-tolerated in non-segmental vitiligo. A treatment frequency of weekly intervals rather than every two weeks appears preferable. Our observations will help in designing a sufficiently powered prospective clinical trial to test this hypothesis.

Diagnostic procedures for venous problems.

Venous diseases are a common worldwide problem. Numerous methods for the evaluation of the venous system are available. The major objectives include the diagnosis and medically relevant classification of varicose vein disease, as well as the identification and assessment of hemodynamic disturbances. In addition, it is necessary to characterize and classify disturbances of the deep venous system and to differentiate between primary and secondary varicose veins. The physician should also exclude or detect and classify concomitant peripheral arterial occlusive disease, and an accompanying disorder of lymphatic drainage. The diagnostic evaluation of venous disorders, depending on the severity of the disease, includes as standard the use of Doppler sonography. Light reflection rheography (LRR), photoplethysmography (PPG), venous occlusion plethysmography and phlebodynamometry (PD) complete the hemodynamic evaluation. The standard imaging technique now routinely used is duplex color scanning. More complex imaging studies include ascending and descending phlebography computed tomography or magnetic resonance imaging. In selected cases invasive investigations or serological tests may complement the diagnostic work-up.