Vitiligo: recent insights and new therapeutic approaches.

Vitiligo represents a selective destruction of the melanocytes. It is a relatively common, probably autoimmune disorder that affects people of all backgrounds and both genders. No particular group seems to be preferentially affected. Half of vitiligo patients have an onset before the age of 18 years. In regions where leprosy is endemic, individuals with vitiligo are often stigmatized due to similarities in appearance between the two diseases. We will review this important subject, emphasizing the latest therapeutic advances.

Melasma.

Melasma is a common disorder of hyperpigmentation that is present most commonly in reproductive age women with brown or black skin colors. The lesions of melasma are characteristically distributed in a symmetric manner on the sun-exposed areas of the face and neck. The precise pathogenesis of the disorder is unknown, but a number of etiologic agents have been implicated as its cause. These include ultraviolet radiation, hormonal alterations such as those evident during pregnancy, thyroid dysfunction, and phototoxic and anti-seizure drugs. The pathophysiology of melasma is believed to involve excess production of melanin or an increase in the number of melanocytes in the skin. This is confirmed by histological analysis of melasma, which shows an increased number of melanocytes along with an enhanced capability of these cells to produce melanin. Lack of an understanding of the precise pathogenesis of the condition has led to a large number of treatments for melasma. These therapies include hypopigmenting agents, chemical peels, lasers, and dermabrasion. Further investigations into this disorder may lead to more specific and effective treatments in the future.

A case of airborne allergic contact dermatitis by rubber additives.

The authors report a case of acute eyelid dermatitis, arised during the wintertime, and showing symmetric purpuric erythema of both eyelids along with a moderate infiltration and minimal fine scaling. Clinical history and data highlighted that this dermatitis could be related to the contact with the rubber additives contained in a hot-water bottle. In fact, patch test revealed a sensitization to mercaptobenzothiazole (MBT) and MBT mix.For this reason, the use of hot water bottle was forbidden to the patient and the dermatitis rapidly ended up. The aim was our study is to investigate carefully the cause of dermatitis that is often hidden.

Differential expression and secretion of RANTES and MCP-1 in activated peripheral blood mononuclear cell cultures of atopic subjects.

RANTES and MCP-1 represent a link between the activation of monocytes, lymphocytes, basophils, mast cells and eosinophils in inflammatory disorders, such as the late phase allergic reaction. These C-C chemokines also play a role in regulating Th cell cytokine production and leukocyte trafficking. In this study, we determined the expression and secretion of RANTES and MCP-1 from PHA-activated PBMC of healthy and atopic subjects with no symptoms. Levels of RANTES from PHA-activated PBMC of atopic patients were higher, at 18 and 24 h incubations (42+/-5.5 and 48+/-4), compared to controls (20+/-4 and 35+/-4), respectively; while MCP-1 was not (12+/-3 and 17+/-3) compared to controls (10.5+/-3 and 15+/-2), respectively. This effect was also revealed on RANTES mRNA expression, as determined by reverse transcriptase polymerase chain reaction (RT-PCR) analysis. In addition, PHA-activated PBMC of atopic subjects produce more IL-4 (five times more) than healthy subjects, while IFN-gamma did not vary. RANTES, compared to MCP-1, may have more influence on signal transduction pathways, either in physiologic or inflammatory states and may induce profound effects on the regulation of cell activity. The differential production of RANTES and MCP-1 may lead to diverse regulation of the function and development of cells involved in the allergic response. These studies emphasize the importance of chemokine selectivity during inflammation.

Cutaneous necrotizing vasculitis. Relation to systemic disease.

Cutaneous necrotizing vasculitis (CNV) is a complex multisystem disease generally involving the skin and mucous membranes, often accompanied by renal, gastrointestinal, pericardial, neurological, and articular signs and symptoms. CNV may be idiopatical or occur in association with a drug, infection, or underlying disease. CNV has been shown in patients with chronic infections (viral, bacterial, protozoa, helminthic), serum sickness, a variety of collagen vascular diseases (systemic lupus erythematous, Sjögren's syndrome, rheumatoid arthritis, Behçet's disease) hyperglobulinemic states, cryoglobulinemia, bowel bypass syndrome, ulcerative colitis, cystic fibrosis, primary biliary cirrhosis and HIV infection. Association with malignancies is not frequent. Lymphoproliferative disorders (Hodgkin's disease, mycosis fungoides, lymphosarcoma, adult T-cell leukemia, multiple mieloma) and solid tumors (lung cancer, colon carcinoma, renal, prostate, head and neck cancer and breast cancer) may be associated with CNV. Whenever possible, treatment is directed at the elimination of the cause. In other cases after adequate laboratory screening local and systemic therapy are recommended.

UV-B radiation microphototherapy. An elective treatment for segmental vitiligo.

BACKGROUND: Vitiligo is a common disease of unknown cause that produces disfiguring white patches of depigmentation. Previous studies have suggested the effectiveness of UV-B radiation in generalized vitiligo (GV) therapy, but there was no evidence to support the same role for segmental vitiligo (SV). OBJECTIVE: The purpose of this study was to use UV-B radiation exclusively on vitiligo patches of individuals affected by SV to evaluate the effectiveness of this therapy. SUBJECTS AND METHODS: Eight individuals with SV were treated for 6 months with a new device called BIOSKIN that can produce a focused beam of UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and once a month thereafter for 6 months. The response to treatment was estimated in two comparable photographs using planimetry. A control group of eight individuals matched for sex and age was treated with placebo, using the same device but not releasing any kind of detectable light. RESULTS: After 6 months of microphototherapy five subjects of the eight studied achieved normal pigmentation on more than 75% of the treated areas. In particular, three of these were totally repigmented. Two individuals achieved 50-75% pigmentation of the treated areas, and only one showed less than 50% repigmentation. In the control group only one patient showed moderate repigmentation (less than 50%). CONCLUSION: UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice in the limited (segmental) forms of vitiligo.