Narrow-band UV-B micro-phototherapy: a new treatment for vitiligo.

BACKGROUND: Vitiligo is a common, acquired, often familial, melanocytopenic disorder with focal depigmentation of the skin. There are several new treatments, that appear to have higher success rates than previous therapies for the treatment of vitiligo. Among these, the most promising one appears to be narrow-band UV-B therapy. OBJECTIVE: The aim of this open study is to evaluate the efficacy of the BIOSKIN micro-phototherapy in the treatment of vitiligo in 734 patients. SUBJECTS AND METHODS: Seven hundred and thirty-four individuals affected by vitiligo (segmental and non-segmental) were treated for 12 months with a new device called BIOSKIN that can produce a focused beam of narrow UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and every month thereafter for 12 months. The response to treatment was estimated in two comparable photographs using planimetry. The duration of the clinical study was of 2 years and 8 months. At the end of this period 734 patients had received each a mean of 24 sessions of treatment during a period of 12 months. RESULTS: Five hundred and ten subjects (69.48%) of the 734 achieved normal pigmentation on more than 75% of the treated areas. In particular, 112 of these were totally repigmented. One hundred and fifty-five (21.12%) individuals achieved 50-75% pigmentation of the treated areas, and 69 (9.40%) showed less than 50% repigmentation. No patients showed acute or chronic relevant adverse effects. CONCLUSION: BIOSKIN 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 for vitiligo limited to less than 30% of the skin surface.

Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water.

BACKGROUND: Leopoldine spa water is a hypotonic water rich in sulphate that has been used occasionally for balneological treatments in psoriatics. We evaluated the anti-inflammatory effects of this salso-sulphate water on the skin of subjects with psoriasis. PATIENTS AND METHODS: We selected 10 volunteer subjects (23-58 years old), who presented symmetrical, bilateral psoriasis involving at least 40% of the body surface. All the subjects were subjected to the following treatment schedule: (i) immersion of both arms in water twice a day [the right arm was immersed in Leopoldine spa water at its natural source temperature (27.2 degrees C) for 30 min, and the left arm was immersed in double-distilled water for 30 min at a constant temperature of 27 degrees C]; (ii) both arms were exposed to the sun for 60 min after each immersion; and (iii) vaseline containing moisturizing creams were applied liberally. The treatment was continued for 4 weeks and was well tolerated by all subjects. Response to treatment was assessed by means of the modified Psoriasis Area and Severity Index (PASI). Six of the 10 subjects volunteered to undergo a cutaneous biopsy of lesional skin both before and 4 weeks after treatment to allow for assessment of modifications of the cutaneous infiltrate in the areas treated. RESULTS: At the end of 4 weeks the average pretreatment PASI score of the left arms was 5.72 (range 4-9.6) while the right arms had a mean PASI of 5.56 (range of 3.2-9). At the end of the study the average PASI score was 0.78 for the arms treated with Leopoldine spa water and 2.83 for the arms treated with double-distilled water. The mean PASI improvement score for the Leopoldine spa water treated arms was 85.9% while the double-distilled water treated arms showed a PASI improvement score of 50.5%. An immunohistological study showed significant differences between the cutaneous samples taken 4 weeks after treatment and those taken before treatment with Leopoldine spa water. There were significant decreases in the numbers of epidermal CD4+ and CD8+ T lymphocytes and CD1a+ Langerhans cells (microscopic field at x 22 objective), as well as a decrease in the epidermal keratinocyte expression of intercellular adhesion molecule-1 and interleukin-8 and the dermal expression of CD4+ and CD8+ T lymphocytes. CONCLUSIONS: These data show the potential anti-inflammatory effects of Leopoldine mineral waters on human skin affected by psoriasis.

Inhibitory effects of Leopoldine spa water on inflammation caused by sodium lauryl sulphate.

BACKGROUND: Sulphur mineral waters may have anti-inflammatory effects on human skin. We evaluated the anti-inflammatory effects of Leopoldine spa water, a salso-sulphate water (Table 1), on human skin tested with sodium lauryl sulphate (SLS). PATIENTS AND METHODS: Ten healthy, Caucasian volunteers 28-53 years old were enrolled in this study. SLS was tested on the right arm, in two concentrations (0.5% and 1%) dissolved in both double-distilled nonpyrogenic water and Leopoldine spa water in four separate test tubes; 0.02 mL of each solution was applied via the testing apparatus (Vand der Bend chambers, four squares measuring 1 x 1 cm), which was fixed and remained in contact with the skin surface. The anti-inflammatory effect was measured via the variations of redness (chromometry, parameter a*), using a Minolta CR 200 chromometer. RESULTS: At base condition the values of a* of the areas that were tested ranged from 7.11 to 9.30 with a mean of 7.97. In regard to the reaction caused by SLS dissolved in double-distilled water, the values of a* ranged from 8.98 to 9.53, mean 9.24, for 0.5% SLS and from 12.81 to 14.33, mean 13.59, for 1% SLS. The a* values for the cutaneous reaction caused by SLS dissolved in Leopoldine spa water ranged from 7.22 to 9.60 (mean 8.20) for 0.5% SLS and from 10.8 to 12.36 (mean 11.68) for the 1% SLS. CONCLUSIONS: These data show the potential anti-inflammatory effects of Leopoldine mineral water on human skin affected by modest inflammatory reactions caused by the direct application of the chemical irritant SLS. Leopoldine spa water can, thus, be considered a natural therapeutic alternative for the treatment of inflammatory skin conditions.

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.

Treatment pearls from Europe.

Discussing the need for psychological treatment of a dermatological condition with children and families can be a daunting task. Families must be given accurate information about the role of psychological or behavioral factors in the exacerbation or maintenance of their child's condition; however, this information must be presented in a way that families and children do not feel criticized or judged. This article discusses nondrug treatments of skin diseases.