Amal T. Abdel-Rahman

Effect of one session of ER:YAG laser ablation plus topical 5Fluorouracil on the outcome of short-term NB-UVB phototherapy in the treatment of non-segmental vitiligo: a left-right comparative study.

Background: NB‐UVB phototherapy is a very important modality in treating vitiligo but the treatment course usually exceeds 1 year. Skin ablation with mechanical dermabrasion with 5Fluorouracil (5FU) was introduced to treat vitiligo in 1983. This was modified replacing the mechanical dermabrasion by erbium‐YAG (ER:YAG) laser ablation and resulted in better prognosis in periungual vitiligo.

Treatment of periungual vitiligo with Erbium‐YAG‐laser plus 5‐flurouracil: a left to right comparative study

Despite the multiple treatment modalities available for vitiligo, none of them gives satisfactory results in the periungual type. In this study we tried to explore and evaluate the effects of the combination treatment of erbium:YAG laser resurfacing and topical 5‐flurouracil in periungual vitiligo.

Effect of PUVA therapy on melanocytes and keratinocytes in non‐segmental vitiligo: histopathological, immuno‐histochemical and ultrastructural study

Psoralen ultraviolet A (PUVA) is an important modality in treating vitiligo. Its effect on melanocytes and keratinocytes is not sufficiently studied. In this work, we investigated 30 cases of non‐segmental vitiligo regarding the changes of melanocytes and keratinocytes in both vitiliginous and nearby areas before and after PUVA therapy.

The effect of latanoprost on vitiligo: a preliminary comparative study

Latanoprost (LT), a prostaglandin F 2alpha (PGF2a) analogue used in the treatment of glaucoma, was found to induce skin pigmentation in guinea pigs in addition to its known periocular and iridal pigmentation side effects. This study aims to evaluate the efficacy of topical LT in the induction of skin repigmentation in patients with vitiligo and to compare its potency with narrow band ultraviolet (UV) B (NB‐UVB). The result of their combination was also assessed. This study involved 22 patients with bilateral and symmetrical vitiligo lesions, stable for the last three months, divided into three groups: group I, to evaluate LT vs. placebo; group II, to evaluate LT vs. NB‐UVB; and group III, to evaluate the effect of their combination. The response to treatment was evaluated by taking photographic records of the treated lesions with follow‐up photography every two weeks. After three months, assessment of the degree and extent of repigmentation was performed. Follow‐up assessment was done six months after termination of the trial for the persistence of pigmentation, recurrence, or development of any side effects. LT was found to be better than placebo and comparable with the NB‐UVB in inducing skin repigmentation. This effect was enhanced by the addition of NB‐UVB. LT could be a promising treatment for vitiligo, especially the periocular variant. Its effect on skin repigmentation could be enhanced by NB‐UVB exposure.

Clinical study of nail changes in vitiligo

Both vitiligo and alopecia areata (AA) are associated together, associated with other autoimmune diseases, and autoimmunity is one of the important theories in their etiology. Nail changes are a known association with AA, thus we hypothesized that nail changes can be found in vitiligo patients. On revising the literature, only two types of nail changes were described in association with vitiligo. Our aim was to study the frequency and types of nail changes among vitiligo patients in comparison with normal healthy volunteers. This multi‐centric study was carried on 91 patients with vitiligo, as well as 91 normal healthy control subjects who were age‐ and sex‐matched. Nails were examined for changes in nail plates as regards striations, texture, curvature, dystrophy, and pigmentation. The presence or absence of the thumb lunula was also reported. Nail changes were observed in 62 patients (68.1%) and 46 (50.5%) control subjects with a statistically significant difference (P = 0.016). Longitudinal ridging and absent lunula were significantly higher in patients than in the controls (P = 0.001 and 0.037, respectively). Other reported nail abnormalities in the current study included punctate leukonychia, pitting, flag sign, and Terrys nails. Awareness of this association will widen the clinicians perspective to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo.

A new morphometric technique for assessment of melanization in skin of guinea pigs.

The degree of melanization is an important finding in many skin disorders. An objective measurement of melanin density is needed to achieve an accurate evaluation.

Simultaneous improvement and worsening of vitiligo lesions during the course of NB-UVB phototherapy; vitiligo may not act as one unit

Re‐pigmentation and stabilization are the two ultimate goals of any re‐pigmenting plan designed for vitiligo management. Furthermore, whether the improvement of some vitiligo lesions could be considered a guarantee for a similar response and/or stabilization of the rest of the lesions or not, remains to be clarified. To evaluate the behavior of non‐segmental vitiligo (NSV), while on narrow band‐ultraviolet B (NB‐UVB) phototherapy. 25 patients with stable generalized NSV were included and received NB‐UVB twice weekly. For the sake of ensuring accuracy of follow up, up to four lesions were randomly chosen in each patient and regularly measured using the point counting technique. The over‐all point counting technique of all included patients showed a significant reduction (18.5 ± 8.4 cm2 to 8.2± 3.1 cm2) after 6 months of therapy (p < .001). Nine patients (36%), showed mixed response in the different lesions. Improvement was documented in some lesions, while other lesions showed no response or even worsening. No significant correlations were detected between the behavior of vitiligo during NB‐UVB and any of the demographic or clinical data of the patients. NB‐UVB is a pillar in the management of vitiligo, however close follow‐up of the patient as a whole and his lesions, by both subjective and objective measures are mandatory to detect activity as early as possible, as vitiligo at many times may not act as one unit. This early detection of activity and the subsequent change in the treatment policy may ultimately change the final outcome of treatment.

The changes in melanocyte number and melanin density occurring in vitiligo patches during 180 days of narrow band-ultraviolet B therapy

BackgroundNarrow band-ultraviolet B (NB-UVB) has been used in the treatment of vitiligo for years, but the sequence of events of repigmentation, occurring throughout the period of NB-UVB treatment for restoring melanocytes and melanin density, is not clear. ObjectiveThis study aimed to follow up the changes in melanocyte number and melanin density in vitiliginous patches during NB-UVB therapy for vitiligo patients. Patients and methodsThis study included 25 patients with nonsegmental vitiligo. NB-UVB therapy was given twice weekly for 6 months. Four skin biopsies were obtained from each patient at days 0, 30, 90, and 180. Biopsies were stained using hematoxylin and eosin stain, Masson–Fontana stain, and human melanoma black-45 (HMB-45) antibody. Qualitative and quantitative measurements were determined for both melanocyte number and melanin density. ResultsThere was a significant increase in the number of HMB-45-negative melanocytes (P<0.000) at day 30 of therapy compared with day 0. At day 90, there was a significant increase in the number of HMB-45-positive melanocytes (P<0.001) and melanin (P<0.001) compared with days 0 and 30. As regards HMB-45-negative cells at day 90, there was a significant increase in its number compared with day 0 (P<0.001) with no significant increase compared with day 30 (P=0.13). At day 180, there was a significant increase in the number of HMB-45-positive melanocytes (P<0.001) and melanin (P<0.001) but with a significant decrease in HMB-45-negative melanocytes (P<0.001) compared with days 30 and 90. ConclusionWe concluded that the sequence of events of repigmentation started with the appearance of inactive melanocytes, which were first detected at day 30, followed by the appearance of active melanocytes, melanin, and clinical repigmentation at day 90, which reached its highest levels at day 180. Moreover, we concluded that the presence of inactive melanocytes at day 30 might represent an index of favorable prognosis.

Syringes versus Chinese cups in harvesting suction-induced blister graft: a randomized split-body study

Suction blister grafting (SBG) is a technique where the pigmented epidermis is harvested from the donor site by induction of a blister using different suction methods as syringes, Chinese cups, suction device, etc. However, pain, time consumption, incomplete blister formation, and failure of blister development are the main limitations.

The effect of different speeds of centrifugation on platelet-rich plasma preparation

BackgroundPlatelet-rich plasma (PRP) therapy is an easy, safe, autologous, and cheap biologic treatment commonly used in various medical fields, including dermatologic therapy and plastic surgery, with good results. There are different methods of PRP preparation using either laboratory or commercial products. However, there is no standardized method for PRP preparation. ObjectiveTo evaluate the effect of different speeds of centrifugation on PRP preparation. Patients and methodsA volume of 10 ml of whole venous blood was collected from 20 healthy volunteers (10 female and 10 male), aged 20–40 years. These samples were divided into two tubes and left to precipitate (sample 1) and the platelet concentration was measured in the supernatant. The sample was then resuspended and the first tube was centrifuged at low speeds of 200, 300, and 500 rpm, and the second tube was centrifuged at 700, 900, 1100, and 3000 rpm (samples 2–8, respectively) and the platelet concentration was measured and compared in the obtained PRP.Platelet concentration was measured in the two PRP samples obtained from two more volunteers (both male) using the commercial Regen kit and compared with those obtained by means of the laboratory method from samples obtained from the same volunteers. ResultsThe platelet concentration was the highest in the PRP obtained in samples 1 and 2, followed by that obtained in samples subjected to lower speeds of centrifugation (300 and 500 rpm), and it was significantly higher compared with that obtained using a ready-to-use kit. Moreover, the white blood cell concentration was higher in the PRP obtained using laboratory method compared with that obtained using the kit method. ConclusionLaboratory preparation of PRP, especially that obtained without centrifugation, or using lower centrifugation speed, yields higher platelet concentration. Centrifugation at low speed is preferable as it saves time, avoids sample contamination, and preserves platelets.