C.-C.E. Lan

Narrow‐Band UVB Treatment of Vitiligo in Chinese

Narrow‐band ultraviolet B (NBUVB) phototherapy has recently been reported to be an effective and safe treatment modality for vitiligo. In the present report, we evaluated the efficacy and safety of NBUVB therapy for vitiligo in Chinese patients. Seventy‐two vitiligo patients treated from 2000 to 2003, were included retrospectively (male: female=33:39, mean age: 38.5). Among them, 61 were non‐segmental type and 11 the segmental type. Treatments were given two to three times a week for a maximum period of one year with an initial dose of 0.2 J/cm2 and a 0–20% increment each session (mean accumulation dose: 155.3 J/cm2). Computer image analysis by Supervise classification was used to estimate the area of vitiligo involvement before and after treatment. An excellent response (75–100% area of repigmentation) was obtained in 9 patients (12.5%) and a good response (50–75%) in 24 (33.3%), a moderate response (25–50%) in 20 (27.8%), and a poor response (0–25%) in 19 (26.4%). In summary, 45.8% of our patients had more than 50% repigmentation. Burns were a side effect in 5 patients (7%) and transient erythema with itching or xerosis was noted in 5 patients (7%). These results indicate that NBUVB phototherapy is an effective and safe treatment choice for generalized vitiligo.

High-glucose environment reduces human β-defensin-2 expression in human keratinocytes: implications for poor diabetic wound healing.

Backgroundu2002 Wound healing is a dynamic and complicated process in which inflammation, re‐epithelialization and angiogenesis play important roles. Intriguingly, all three processes have been found to be defective during diabetic wound healing conditions. One common denominator associated with regulation of these events is human β‐defensin‐2 (hBD2). It has been shown that skin wounding induces cutaneous hBD2 expression, and diabetic wounds have been associated with inadequate hBD expression.

FK506 (tacrolimus) and endothelin combined treatment induces mobility of melanoblasts: new insights into follicular vitiligo repigmentation induced by topical tacrolimus on sun-exposed skin

Backgroundu2002 Topical tacrolimus (FK506) has been considered as a treatment option for treating vitiligo, a dermatosis characterized by disappearance of melanocytes (MCs). Previous reports have shown that a significant portion of treated patients demonstrated follicular repigmentation, indicating that the activation of MC precursor cells residing in the outer root sheath of hair follicles played an important role during the tacrolimus‐induced repigmentation process.

Narrow‐band UVB irradiation stimulates the migration and functional development of vitiligo‐IgG antibodies‐treated pigment cells

Backgroundu2002 The pathogenesis of vitiligo remains unclear. Most authorities favoured the autoimmune cause for the strong associations of vitiligo with multiple autoimmune diseases and the presence of autoantibodies in vitiligo patients. Narrow‐band UVB (NBUVB) irradiation has been considered to be an effective treatment for vitiligo with simple treatment procedure and decreased accumulated ultraviolet exposure doses.

Pigmented eccrine poromas: expression of melanocyte-stimulating cytokines by tumour cells does not always result in melanocyte colonization.

Backgroundu2003 Although eccrine poroma (EP) occurs preferentially in palmoplantar areas, pigmented variants of EP have not been documented on the palms and soles.

Late‐onset Behçet's disease does not correlate with indolent clinical course: report of seven Taiwanese patients

Backgroundu2002 Behçets disease (BD) is a recurrent multisystem disease of uncertain aetiology. The young adults are most often affected, usually during the third decade. Late occurrence of the disease is considered uncommon and less frequently investigated.

Psoriasis as initiator or amplifier of the systemic inflammatory march: impact on development of severe vascular events and implications for treatment strategy.

Backgroundu2002 Psoriasis is a systemic disease associated with metabolic disorders and vascular complications. Both psoriasis and metabolic disorders are associated with systemic inflammation. We hypothesized that the sequence of events between the onset of psoriasis and metabolic disorder may affect the risk for subsequent development of vascular complications.

Tacrolimus abrogates TGF-β1-induced type I collagen production in normal human fibroblasts through suppressing p38MAPK signalling pathway: implications on treatment of chronic atopic dermatitis lesions.

Atopic dermatitis (AD) is a commonly encountered inflammatory skin disease. Although acute lesions of acute AD are characterized by intense inflammation, the hallmarks of chronic AD lesions include lichenified fibrosis and thickening of the upper dermis. The increased expression of transforming growth factor beta 1 (TGF‐β1), a well‐known fibrogenic cytokine, is observed in chronic AD lesions. Tacrolimus (FK506) ointment has been reported to be effective for treating AD as well as some TGF‐β1‐induced fibrotic diseases.

Helium‐neon laser and topical tacrolimus combination therapy: novel treatment option for vitiligo without additional photocarcinogenic risks

© 2008 The Authors JEADV 2009, 23, 317–368 Journal compilation

Unusual presentation of inflammatory linear verrucous epidermal naevus mimicking linear psoriasis successfully treated with oral retinoid.

Editor, Inflammatory linear verrucous epidermal naevus (ILVEN) is a rare disease that was first described by Unna in 1896. Subsequently, Altman and Mehregan described six characteristic features of ILVEN: (i) early age of onset, (ii) predominance in females (4 : 1 female–male ratio), (iii) frequent involvement of the left leg, (iv) pruritus, (v) marked refractoriness to therapy and (vi) a distinctive psoriasiform and inflammatory histologic appearance. The histopathologic presentation of ILVEN can be very similar to psoriasis, and therefore, when psoriasis occurs in a localized linear distribution, the accurate diagnosis may represent a clinical conundrum. We encountered a 29-year-old Taiwanese woman who presented with asymptomatic skin lesions in a linear distribution over her right arm since her teenage years. Physical examination revealed linearly arranged erythematous plaques with verrucous surface extending from the dorsum of the right hand to the arm and shoulder (Fig. 1a). No other remarkable skin lesions were noted, and no relevant family history could be traced. A skin biopsy was subsequently performed. The microscopic findings showed psoriasiform hyperplasia with parakeratosis, thinning of the granular layer (Fig. 2a) and focal spongioform pustules of Kogoj (Fig. 2b). Both linear psoriasis and ILVEN were considered. However, we initially considered linear psoriasis as the most likely diagnosis due to the clinical presentation and course of illness. The patient was prescribed topical calcipotriol/clobetasol propionate ointment. Two weeks after treatment, slight flattening of skin lesions over her right hand was found. However, residual plaques showed poor response despite four more weeks of treatment. Subsequently, the patient was lost to follow-up. The patient came back to our dermatology clinic 2 years later requesting further management. Topical medication was prescribed but the response was again disappointing. After discussing available therapeutic options with the patient, topical psoralen plus ultraviolet A (PUVA) therapy was administered. Partial flattening of skin lesions with prominent hyperpigmentation was found after 6 months. However, scattered erythematous scaly plaques remained unresponsive to treatment, and the patient was concerned with the pigmentation associated with photochemotherapy (Fig. 1b). Therefore, oral retinoid (acitretin 25 mg twice daily) was given after discussing alternative treatment options with the patient. After 3 months of regular treatment, the entire skin lesions showed remarkable improvement with prominent erythema (Fig. 1c). Due to remarkable flattening of skin lesions and potential tetratogenity, oral retinoid was discontinued. At follow-up visit 6 months after retinoid treatment was stopped, the skin lesions showed sustained response with fading of erythema resulting in almost complete resolution (Fig. 1d). The therapeutic response to systemic retinoid but not topical PUVA therapy prompted us to reevaluate our initial diagnosis. We performed additional Ki67 immunohistochemical staining. As expected, the epidermis from typical psoriatic lesions showed remarkable increase of Ki67-antigen-positive nuclei (Fig. 2c). On the other hand, the epidermis of our patient prior to treatment demonstrated no increase in Ki67 expression (Fig. 2d). Therefore, we concluded that instead of linear psoriasis, our patient has an unusual presentation of ILVEN. Although the diagnostic criteria for ILVEN were established in 1971, the diagnosis is still difficult in cases that do not fulfil the aforementioned classic criteria. As demonstrated in our experience, Ki67 immunohistochemical staining may be a valuable auxiliary tool for differential diagnosis in questionable situations. Ki-67 is a non-histone nuclear protein closely associated with cell proliferation. Antibodies detecting Ki-67 may serve as a marker in actively proliferating diseases such as psoriasis. In the normal epidermis, only basal cells undergo proliferation, whereas in psoriasis, a large number of basal and suprabasal keratinocytes are in the proliferative phase, and therefore, increased Ki67 expression can be observed in typical lesions of psoriasis. Previously, it has been shown that the proliferation marker Ki-67 tends to be lower in ILVEN, making it a potential marker to distinguish linear psoriasis from ILVEN. Our current experience also supports this notion. In summary, ILVEN may be difficult to differentiate from linear psoriasis both clinically and histologically. Ki67 immunohistochemical stain should be considered as an auxiliary diagnostic tool when such situation is encountered. Systemic retinoid therapy may be the treatment of choice for ILVEN since it has an