Topical Ectoin Versus Topical Dexpanthenol for Managing Acute Radiodermatitis Associated With Breast Cancer Radiotherapy: A Randomized Double-Blind Study.

Background: Radiodermatitis is a common side effect of breast cancer radiotherapy; however, there is no current consensus regarding an effective standard therapy. Objective: To evaluate the efficacy of topical ectoin versus dexpanthenol in the management of acute radiodermatitis after breast cancer radiotherapy. Methods: Fifty patients randomly used dexpanthenol 5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during and for 2 weeks after radiotherapy. The study was stratified by the radiotherapy schedule and was double-blind. Radiodermatitis grade, radiation-associated symptoms, and adverse events were assessed weekly during radiotherapy and 2 weeks thereafter. Skin-related quality of life (QOL) scores were measured using the Skindex-16 questionnaire. Results: Both agents were effective in preventing severe radiodermatitis (≥G3). Ectoin had a lower radiodermatitis grade level than dexpanthenol, with a significant difference at week 2 (P = 0.008). Radiation-associated pain (P = 0.003) and itching (P = 0.001) were lower with ectoin than dexpanthenol. Side effects were not significantly different between the 2 treatments (P = 0.107). Ectoin showed less QOL impairment than dexpanthenol. The radiation schedule was an independent predictor for radiodermatitis persistence. Conclusion: Ectoin showed some clinical benefit over dexpanthenol in improving radiation dermatitis and the radiation schedule is a predictor of radiodermatitis persistence.

Efficacy of topical calcipotriol betamethasone dipropionate as a new adjuvant therapy to follicular unit extraction technique in treatment of stable vitiligo: clinical, dermoscopic and immunohistological study.

BACKGROUND: Follicular unit extraction (FUE) grafting is a surgical procedure which provides the vitiliginous patches with undifferentiated stem cells of the hair follicles. It has been postulated that adjuvant therapy enhances the results. This is the first study to assess two different adjuvant therapies vs FUE alone. AIMS: To study the efficiency of FUE alone or combined with either topical calcipotriol betamethasone dipropionate (CBD) or NB-UVB phototherapy in cases of nonsegmental stable vitiligo. To assess the role of dermoscopy in monitoring the pattern and degree of repigmentation. PATIENTS/ METHODS: 53 patients with 94 lesions with stable nonsegmental vitiligo were divided into three groups. Group 1 (n = 16) with 30 lesions received FUE alone. Group 2 (n = 18) with 32 lesions received FUE plus topical CBD. Group 3 (n = 19) with 32 lesions received FUE plus NB-UVB phototherapy. Assessment was done by grades of repigmentation, color match, percent of size reduction, and immunohistochemical evaluation of perilesional CD8+T lymphocytes. RESULTS: The fastest onset of repigmentation was observed in both groups 2 and 3 in the second week (16.7%, 10.5%, respectively).Group 2 achieved the best response by all methods of assessment. Perifollicular diffuse repigmentation was the commonest dermoscopic pattern in 60 lesions (63.8%). There was a statistically significant decrease in perilesional CD8+T lymphocytes after 4 months. CONCLUSION: FUE is an effective method of surgical treatment of stable vitiligo, and topical CBD as a new adjuvant therapy is successful in targeting the immunological background of vitiligo. Dermoscopy has an essential role in monitoring the repigmentation response.

Microdermabrasion and topical tacrolimus: A novel combination therapy of vitiligo.

BACKGROUND: Topical immunomodulators have been successfully used as monotherapy or in combination with other therapeutic modalities in treating vitiligo. To the best of our knowledge, no previous studies have evaluated the combination of tacrolimus 0.03% ointment and microdermabrasion as a therapeutic modality to hasten response time and improve repigmentation rate in vitiligo vulgaris. AIMS: To explore the efficacy and safety of the combination of MDA and topical tacrolimus (0.03%) as a novel therapeutic approach for stable vitiligo vulgaris. METHODS: Thirty-five patients with vitiligo were enrolled in this randomized placebo-controlled study. Three vitiligenous patches were chosen in each patient. The first lesion (A) was treated by tacrolimus 0.03% ointment, the second lesion (B) was treated by tacrolimus and microdermabrasion, and the third lesion (C) was treated by petrolatum as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiligenous patches were assessed at baseline and monthly for 6 months. RESULTS: Moderate to excellent response was observed in 65.7% of lesions B, compared with 25.8% of lesions A (P = .001). Improvement in VASI score was significantly better in patients treated by the combination therapy (P = .000). Disease duration has a negative impact on therapeutic response. Patients were more satisfied with the combination treatment. CONCLUSION: Microdermabrasion combined with tacrolimus 0.03% ointment represents a new therapeutic option for the treatment of vitiligo which appears to be an easy, safe, and effective.