F. Prestinari

Useful treatment of vitiligo in 10 children with UV-B narrowband (311 nm).

Abstract:  We report our experience with UV‐B narrowband (UV‐B–NB) therapy in children affected by vitiligo. We studied 10 Caucasian Italian children (six boys, four girls, mean age 9.7 years ± 2.67). Treatment mean term was 5.6 months; frequency was three times a week on nonconsecutive days or only twice a week, because of school or family duties. The percentage of repigmentation was evaluated by comparing photographs taken before, during, and after the treatment, and showed a repigmentation level higher than 75% in five patients (5/10, 50%) and between 26% and 75% in three patients (3/10, 30%). Of our patients, 80% had a satisfactory response to phototherapy. Adverse events were limited and transient. No significant relationships between repigmentation grades and variables such as skin type, positive family history, and disease extension were observed. Some areas responded better than others; the best results were shown on the face and neck. Perhaps we studied too few patients to be conclusive, but the results obtained so far seem to indicate that children affected by recent vitiligo have a better response to the therapy. We feel that UV‐B–NB therapy is a valuable and safe option for the treatment of pediatric vitiligo, and should be started as soon as possible.

Narrow-band ultraviolet therapy in early-stage mycosis fungoides: study on 20 patients

Background: In recent years, narrow‐band ultraviolet B (NB‐UVB, 311–313 nm) has been found to be beneficial for early‐stages mycosis fungoides (MF). The aim of this study is to investigate the effect of NB‐UVB in 20 patients with early‐stage MF.

A long-term time course of colorimetric assessment of the effects of imatinib mesylate on skin pigmentation: a study of five patients

Background  Imatinib mesylate (IM), the first‐line treatment of chronic myeloid leukaemia (CML), is a tyrosine kinase inhibitor that targets those proteins involved in BCR‐ABL signal transduction in CML, c‐kit (KIT) and platelet‐derived growth‐factor (PDGFR) receptor. The use of IM has been associated with cutaneous reactions. In the last 2 years numerous studies have focused the attention on hypopigmentations, depigmentations and photosensitivity developing after the initiation of IM therapy.

Vitiligo‐Like Lesions and Diffuse Lightening of the Skin in a Pediatric Patient Treated with Imatinib Mesylate: A Noninvasive Colorimetric Assessment

Abstract:  Imatinib mesylate is a drug that has been recently approved for the treatment for chronic myeloid leukemia. It acts as a potent and selective inhibitor of BCR‐ABL tyrosine kinase. It also inhibits both c‐kit and platelet‐derived growth factor receptor tyrosine kinases. Hypopigmentation of the skin in patients receiving this drug has been recently reported. We report a 17‐year‐old Caucasian patient affected by chronic myeloid leukemia in therapy with imatinib mesylate who developed hypopigmented vitiligo‐like patches and generalized lightening of the skin. In order to evaluate the lightening observed clinically, we measured the progressive skin color hypopigmentation by using a colorimeter over several months. The colorimetric evaluation confirmed the generalized and gradual lightening of patients skin over treatment with imatinib mesylate. We believe that this is the first reported instance of vitiligo‐like lesions in a pediatric patient treated with imatinib mesylate, and the second in a Caucasian patient.

Keratoacanthoma in vitiligo lesion after UVB narrowband phototherapy

The treatment of vitiligo is still a challenge. Among various therapeutic modalities, phototherapy with UVB narrowband (UVB‐NB) is presently considered a treatment of choice for this skin disease.

Sequential Treatment of Severe Atopic Dermatitis with Cyclosporin A and Low-Dose Narrow-Band UVB Phototherapy

Atopic Dermatitis (AD) is an allergic disease whose incidence is increasing in Europe and the USA. Its prevalence is rising, and it has been estimated that AD will develop in more than 20% of UK-born children by the age of 3–4 years [1]. AD can often affect the patients’ quality of life, first of all when they have persisting or recurring episodes of pruritus, they are irresponsive to conventional therapies, or they develop severe side-effects to drugs [2–4]. In mild and/or moderate cases, topical treatment with steroids and emollients, systemic antihistamines and/or photo-photochemotherapy (UVB 290– 320 nm or narrow-band 311–313 nm, PUVA 365 nm) usually suffices to control the clinical signs and symptoms [5–7]. In severe AD, however, treatments are often insufficient, and different strategies should be considered. Several placebo-controlled trials and open studies have proved that cyclosporin A (CsA) is effective in inducing remission in severe AD [1, 2, 8, 9], but relapses occur quickly after therapy withdrawal [10, 11]. In the present study, we evaluate the efficacy, the tolerability and the clinical remission in severe and/or irresponsive AD using a sequential treatment with oral short-term CsA followed by narrow-band UVB (NB-UVB, 311–313 nm) phototherapy. Seven patients (4 females, mean age 33 years, range 28–40; 3 males, mean age 29 years, range 20–40) with severe and inadequately controlled AD, which fulfilled the diagnostic criteria of Hanifin and Rajka [3], were included in the study. Disease activity was evaluated using a scoring index (SCORAD index) [1], combining extent, severity of clinical features and symptoms before, during and after therapy. Exclusion criteria were: abnormal renal or hepatic function, abnormal serum potassium and uric acid, blood hypertension, pregnancy or lactation, fertile female without contraception, primary or secondary immunodeficiencies, active or chronic infections, previous or concomitant malignancies, epilepsy, ocular diseases, drug or alcohol abuse, concomitant therapy with drugs interacting with CsA or nephrotoxic agents, malabsorption syndrome, previous treatments with systemic steroids, CsA or PUVA during the 4 weeks before the study. No topical or systemic treatment was given in the 4 weeks before and during the study. Topical emollients were continued. At the beginning of the therapy and at each visit, blood pressure was recorded and serum biochemistry and full blood count were monitored [9]. Prior to the treatment, the nature of the study was carefully explained to patients and their written informed consent was obtained. CsA treatment started at 4–5 mg/kg/day until clinical improvement was obtained (an average period of 4 weeks was required to induce remission); then, the daily dose was slowly reduced to 2–3 mg/kg/day for 4 weeks, and finally stopped. After a 4to 6-week wash-out period, at the time of the beginning of the relapse, the patients were treated by phototherapy with NB-UVB, 3 times a week, for 2 months (3 patients) and 3 months (4 patients). The patients received phototherapy in a UVB 100 Waldmann Lichttechnik irradiation box, provided with 8 fluorescent tubes (Philips TL-01 lamps, 311–313 nm). The starting dose was chosen by the clinician (182–200 mJ/cm2), and dose increments of about 50 mJ/cm2 were used for each treatment with stepwise increases depending upon the patient’s phototype and therapeutic response. During NB-UVB treatment, each patient was given protective spectacles. Table 1 shows the total numbers of treatments and the cumulative exposure doses received by each patient. As a precaution, the starting dose and dose increments were maintained below the levels cited in the literature, because of the previous treatment with CsA. The results obtained by evaluating the patients using the SCORAD index from the start of therapy with CsA, the end of this therapy, during the period of wash-out and at the end of the therapy with NB-UVB are shown in table 2. The SCORAD index mean values are summarized and illustrated in figure 1. The present study confirms that short-term treatment with oral CsA (4–5 mg/kg/day, 2–3 mg/kg/day for 8 weeks) is effective in inducing remission in severe AD, producing a rapid clinical response with a sustained improvement in the SCORAD index of 50% or more, relative to baseline. As in previous reports, also in the present study, CsA treatment did not induce long-term remission in our patients; the relapse occurred within 4–6 weeks, with gradual recurrence of erythema and itch. No significant adverse effects were noted during CsA therapy, except in a female patient who presented a transient increase in the urinary protein level compared with baseline. The levels returned to normal by reducing the dose by 30%. Our patients, all affected by severe AD, had a uniform clinical response, with a significant improvement of the SCORAD index. The NBUVB phototherapy allowed us to treat the relapses without sideeffects, obtaining a further improvement of the SCORAD index. Although NB-UVB (311–313 nm) phototherapy is a treatment with few immediate adverse effects, the long-term risk of skin cancer must be taken into account. Comparison of NB-UVB (311–313 nm) phototherapy, broad-band UVB (270–350 nm) phototherapy and oral 8-MOP PUVA in psoriatic patients has shown no increase in the

HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline

Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji. It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities. In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients. EPF has been described in immunocompetent adult caucasian patients only occasionally. The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate. We describe an HIV seronegative caucasian male with EPF, allergic to non‐steroidal anti‐inflammatory drugs and indomethacin, treated with oral doxicycline. The treatment led to the complete remission of the lesions within 2 months.