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Bishnoi A, Parsad D. Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12968. [PMID: 38632705 DOI: 10.1111/phpp.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. AIMS AND METHODS This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. RESULTS AND DISCUSSION The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital-based and home-based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra-violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti-nuclear antibodies and tailoring approaches for non-photo-adapters are also examined. CONCLUSION In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ceresnie MS, Warbasse E, Gonzalez S, Pourang A, Hamzavi IH. Implementation of the vitiligo area scoring index in clinical studies of patients with vitiligo: a scoping review. Arch Dermatol Res 2023; 315:2233-2259. [PMID: 37029284 DOI: 10.1007/s00403-023-02608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023]
Abstract
The vitiligo area scoring index (VASI) is a validated, reliable clinician-reported outcome measure widely used to assess the extent of skin depigmentation seen in patients with vitiligo and to measure patient responses to therapies for vitiligo in clinical trials. However, its implementation in studies is inconsistent and makes comparing results across different studies difficult. The aim of this scoping review is to summarize interventional clinical studies that applied the VASI to measure vitiligo and identify variability in VASI implementation. A systematic search of Ovid Medline, Embase, Web of Science, Cochrane, and ClinicalTrials.gov was performed. Interventional studies published between January 1946 and October 2020 that used the VASI as an outcome measure for assessing vitiligo response were reviewed for methodological approach. Great heterogeneity was found within the 55 included interventional studies that used VASI as an outcome measure. A total of 9 VASI subtypes were described by the authors within 10 intervention categories. VASI determined study eligibility in one study. Body surface area was most frequently established using inconsistent methods. We found unclear or ambiguously scaled assessments of depigmentation. Most VASI outcomes were reported as mean absolute difference, percentage VASI improvement, and percentage of patients who achieved the VASI endpoint. The VASI score was over 100 in one study. Our scoping review revealed many VASI methodology variations in interventional clinical studies of vitiligo. While VASI is a standard method to measure vitiligo changes, substantial heterogeneity in methodology limits reliable comparison and interpretation of findings from different clinical trials. Our findings may be used as a foundation to standardize the VASI outcome measure methodology, allowing for improved clinician training and rigorous data analysis across vitiligo research groups worldwide.
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Affiliation(s)
- Marissa S Ceresnie
- Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Elizabeth Warbasse
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sarah Gonzalez
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Aunna Pourang
- Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA.
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Abdel-Naser MB, Seltmann H, Altenburg A, Zouboulis CC. Endothelins and α-melanocyte-stimulating hormone are increased in plasma of patients treated with UVA1 and psoralen plus UVA. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:611-613. [PMID: 35353376 DOI: 10.1111/phpp.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M Badawy Abdel-Naser
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Holger Seltmann
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Awad SS, Moftah NH, Rashed LA, Touni AA, Telep RAA. Evaluation of the effect of narrow band-ultraviolet B on the expression of tyrosinase, TYRP-1, and TYRP-2 mRNA in vitiligo skin and their correlations with clinical improvement: A retrospective study. Dermatol Ther 2020; 34:e14649. [PMID: 33314655 DOI: 10.1111/dth.14649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022]
Abstract
Narrowband-ultraviolet B (NB-UVB) is considered one of the main therapeutic tools in vitiligo, which is able to induce repigmentation and halt depigmentation. However, little remains known about the effect of NB-UVB on TYR gene family, the main pigmentary genes, in vitiligo patients. To assess the effect of NB-UVB on expression of some genes related to the pigmentary problem of vitiligo; tyrosinase (TYR), tyrosinase related protein 1 (TYRP1) and tyrosinase related protein 2 (TYRP2), mRNA levels of those genes were quantitatively evaluated by Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) in skin biopsies obtained from 30 patients with nonsegmental vitiligo and five healthy controls. Vitiligo patients were classified into two groups; group 1, involving 12 untreated vitiligo patients and group 2, including 18 vitiligo patients treated by NB-UVB. The levels of TYR, TYRP-1, and TYRP-2 mRNAs in untreated group were significantly lower than in control subjects (P < .001). In NB-UVB treated group, the three genes were significantly higher than in group 1 (P < .001), however, they were still significantly lower than in the control subjects (P < .001). A significant positive correlation was detected between TYR and TYRP-2 genes in group 2 (P = .03). This study demonstrated that mRNA level of TYR, TYRP-1, and TYRP-2, which decreased in vitiligo, was significantly increased upon treatment with NB-UVB. Accordingly, the mechanism of depigmentation in vitiligo disease and repigmentation by NB-UVB treatment may be related to the changes in the expression of these genes.
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Affiliation(s)
- Sherif Shoukry Awad
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Noha Hassan Moftah
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Laila Ahmed Rashed
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ahmed Touni
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rowida Ahmed Amer Telep
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
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Bingül İ, Aydıngöz İE, Vural P, Doğru-Abbasoğlu S, Uysal M. The Evaluation of Endothelin-1 and Endothelin Receptor Type A Gene Polymorphisms in Patients with Vitiligo. Indian J Dermatol 2016; 61:118. [PMID: 26955120 PMCID: PMC4763630 DOI: 10.4103/0019-5154.174076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Endothelin-1 (EDN1) and EDN receptor type A (EDNRA) are implicated in melanocyte functions. Aim and Objectives: This study examines the role of EDN1 (G5665T and T-1370G) and EDNRA (C + 70G and G-231A) polymorphisms as a risk factor for vitiligo, and evaluates the relationship between genotypes and clinical characteristics of vitiligo patients. Materials and Methods: We analyzed genotype/allele distributions of EDN1 and EDNRA polymorphisms in 100 patients with vitiligo and 185 healthy controls by real-time polymerase chain reaction. Results: There was no notable risk for vitiligo afflicted by studied polymorphisms. However, the presence of EDNRA +70 variant G allele was found to be related with decreased risk for development of generalized type of vitiligo (odds ratio [OR]: 0.42, 95% confidence interval [CI] = 0.21–0.86, pcorr = 0.03) and showed protective effect against associated diseases seen in vitiligo (OR: 0.49, 95% CI = 0.27–0.88, pcorr = 0.034). Haplotype analysis demonstrated a strong (disequilibrium coefficient = 0.73, r2 = 0.405) linkage disequilibrium between EDN1 G5665T and T-1370G polymorphisms. The EDN1 5665/-1330 TT haplotype was over represented significantly in controls than in patients (P = 0.04). Conclusion: The studied polymorphisms do not seem to be a major risk for vitiligo. Haplotype analysis denoting protective effects against vitiligo may indicate an indirect interaction in the course of vitiligo. In addition, EDNRA + 70 polymorphism is protective against generalized type of vitiligo and associated diseases.
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Affiliation(s)
- İlknur Bingül
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - İkbal Esen Aydıngöz
- Department of Dermatology, Acıbadem University, School of Medicine, Istanbul, Turkey
| | - Pervin Vural
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Doğru-Abbasoğlu
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Müjdat Uysal
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Coimbra S, Santos-Silva A. Biomarkers of psoriasis severity and therapy monitoring. World J Dermatol 2014; 3:15-27. [DOI: 10.5314/wjd.v3.i2.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/13/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic, recurrent inflammatory cutaneous disease. Psoriasis patients alternate between periods of remission and periods of exacerbation of the disease. Usually, psoriasis severity is clinically evaluated using tools like Psoriasis Area and Severity Index that present some limitations and subjectivity. Clinicians select the therapy according to psoriasis severity, aiming that patients achieve longer remission periods and improve their quality of life. Biological markers for diagnosis and prognosis of psoriasis help to establish its severity and to monitor the therapeutic response; moreover, biomarkers of psoriasis assist clinicians in their therapeutic decision to treat psoriasis and to choose earlier and more adequate therapeutic strategies, avoiding or minimising worsening of psoriasis. With these markers, they would be able to monitor therapeutics, avoiding unnecessary therapeutic surcharge or changes to a more aggressive therapy. As any attempt to identify these biomarkers should be encouraged, in this review, we will debate published data concerning the proposal of biomarkers to evaluate severity and response to treatment of psoriasis vulgaris.
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Lee GY, Kim WS. The systemic effect of 830-nm LED phototherapy on the wound healing of burn injuries: A controlled study in mouse and rat models. J COSMET LASER THER 2012; 14:107-10. [PMID: 22373006 DOI: 10.3109/14764172.2011.649762] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present controlled study assessed the systemic effect of 830-nm LED phototherapy in rodent models. MATERIALS AND METHODS Two HR-1 hairless mice and 3 HWY/Slc hairless rats were divided into two groups: the treatment group (Tx Group, one mouse, two rats) and the control group (Con Group, one mouse, one rat). All animals received an identical 12 mm × 12 mm control burn over three sites on the dorsum with a fractional ablative CO(2) laser. Wounds were protected with a film-type dressing. The abdomen of the Tx Group subjects was irradiated with an 830-nm LED array immediately post CO(2) treatment and then at 1, 5 and 6 days post laser irradiation. Wound healing was assessed macroscopically from the clinical photography. RESULTS At the 2-day post-laser assessment, the healing process in the wounds in the Tx Group was already apparent compared with the Con Group. At the final evaluation (post-burn day 7), no site on the Con Group (six wounds) showed 100% healing, recovery was over 70% in four and lower than 50% in two sites. Of the nine Tx Group sites, 100% recovery was seen in three sites, over 70% in five sites and one wound was exacerbated through trauma. CONCLUSIONS LED phototherapy on the abdomen produced faster wound healing of the uniform burn wounds than in animals with the same burn wounds that did not receive LED phototherapy, strongly suggesting the systemic effect of phototherapy.
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Affiliation(s)
- Ga-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Dermatology, Seoul, 137-470, Republic of Korea
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Abstract
Repigmentation of vitiligo depends on available melanocytes from three possible sources: from the hair follicle unit which is the main provider of pigment cells, from the border of vitiligo lesions, and from unaffected melanocytes within depigmented areas; pigment cells at these locations originate a perifollicular, border spreading and a diffuse repigmentation pattern. In order for repigmentation to take place under stimulation with diverse therapies, melanocytes should be present in appropriate numbers. Melanocyte tissue stem cells located in the niche at the bulge region of the hair follicle are the most important sources for providing immature pigment cells that undergo terminal differentiation and originate repigmentation, but cytokines, UVR and other molecules acting in melanogenesis with adequate regulation mechanisms contribute to successful recovery in vitiligo. The presence of keratinocyte stem cells in the interfollicular epidermis raises the question on the possibility of melanocyte stem cells in a similar location and the development of future strategies for therapeutic purposes.
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Affiliation(s)
- Rafael Falabella
- Universidad del Valle, Carrera 38A # 5A-100, Centro Dermatológico de Cali - CDC, Calle 5B3 # 38-44, Cali, Colombia.
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