G. Orecchia

Age of onset in vitiligo: relationship with HLA supratypes.

HLA class I (A, B, C), class II (DR, DQ) histoglobulins and HLA class III (C4A, C4B and Bf) complement factors were analysed in 87 patients with vitiligo and in controls. Two HLA supratypes seem to mark different age of onset of vitiligo: HLA‐BfS, C4A3, C4B1, DR5 (W11), DQW3 is characteristic of the pediatric form; while HLA‐BfS, C4A3, C4B1, DR7, DQW2 marks the adult form of disease. The importance of defining HLA supratype, not single alleles, is discussed.

Vitiligo Is Associated with a Significant Increase in HLA-A30, Cw6 and DQw3 and a Decrease in C4AQ0 in Northern Italian Patients

HLA polymorphisms of class I (HLA-A, B, C) of class II (HLA-DR, DQ) and of class III (C4A, C4B, BF) were investigated in 93 Northern Italian patients affected with vitiligo and in 388 controls. Vitiligo patients had significant increases in HLA-A30 (corrected p, pc = 0.0144), Cw6 (pc = 0.0189), DQw3 (pc less than 0.0003) and a significant decrease in C4AQ0 (pc = 0.003). Nonfamilial vitiligo is marked by increases in HLA-A30 and DQw3. Extensive vitiligo is marked by increases in HLA-A30 and Cw6. These findings suggest that immunogenetic mechanisms may be responsible for vitiligo and that unique HLA phenotypes may influence the expression of vitiligo in this population.

Photochemotherapy with Topical Khellin and Sunlight in Vitiligo

In order to evaluate the efficacy of topical khellin the vitiligo macules of one side only were painted in 41 patients with a 2% solution of khellin in acetone and propylene glycol (90 and 10%, respectively) and exposed to sunlight for a period of 4 months with 3 weekly applications and with exposure times up to 90 min. The macules of the other side were treated in 36 of the 41 patients with acetone and propylene glycol only and sun-exposed with the same schedule, while in the remaining 5 patients they were neither treated with khellin or placebo nor sun-exposed. No significant difference was evidenced between the khellin and placebo-treated sides: no excellent result (repigmentation more than 75% of the affected area) was found, and good results (repigmentation more than 50%) were found in 24.9% of khellin- plus sunlight-treated macules and in 22.3% of placebo- plus sunlight-treated macules.

Treatment of severe alopecia areata with squaric acid dibutylester in pediatric patients.

Abstract: Topical squaric dibutylester (SADBE) is currently used in Europe to treat alopecia areata In adults. We attempted to determine this drugs effectiveness and convenience in treating children with severe aiopecia areata who are psychologically disturbed and resistant to other therapies. Twenty‐eight children under 13 years of age who had extensive and Song‐standing alopecia areata and were not responsive to conventional therapies were sensitized on the head with 2% SADBE in acetone and treated with weekly applications for 12 months. Nine patients (32.1%) achieved complete or cosmeticaliy acceptable regrowth, and another six (21.4%) had significant regrowth. No correlation was found between response and sex, age of onset of illness, extent, duration, or clinical type of disease. In 14 patients followed for a period ranging from 18 months to 8 years SADBE remained efficacious for reiapses as weSi. This study demonstrates that SADBE is a valid and suitable treatment for children, particuiarly those who are resistant to conventional therapies.

Treatment of alopecia areata with diphencyprone.

26 patients with alopecia areata were treated topically with diphencyprone. 10 had alopecia universalis, 7 alopecia totalis and 9 had alopecia areata. The treatment lasted from 4 to 14 months. In 13 patients a little response was obtained; only in 1 case it was satisfactory. Factors that appear to influence these results are discussed.

Treatment of Multiple Relapsing Warts with Diphenciprone

44 patients with multiple recalcitrant warts were treated with weekly applications of diphencyprone. 20 patients were cured completely and 17 improved with reduction in the number or dimension of warts. Plantar warts responded less satisfactorily. Sensitization is not always tolerated by patients and the risk of eczema spreading to other sites must be considered. However, topical immunotherapy has to be considered as an alternative means of treatment in selected patients. The mode of action is discussed.

Clinical Experience on the Treatment of Alopecia areata with Squaric Acid Dibutyl Ester

Squaric acid dibutyl ester was used in the treatment of 26 cases of alopecia areata (AA). The results are related to different types of AA.

Prevalence of atopy in vitiligo : a preliminary report

59 patients suffering from vitiligo were investigated anamnestically and clinically with intradermal (prick tests) and laboratory tests (RAST and total IgE count) for the presence of atopy. Clinical manifestations (allergic rhinitis, asthma) and intense positive prick tests and RAST with an increase in total IgE count were found in 13 patients (22%). This frequency was significantly higher than that found in the normal population in our area (11.9%; p = 0.0212). These patients had a significantly higher incidence of vitiligo in their families (76.9 vs. 29.7% of the non-atopic; p less than 0.025), an earlier onset (14.1 vs. 24 years of the nonatopic) and a rapid worsening of the disease.

Normal-Range Plasma Catecholamines in Patients with Generalized and Acrofacial Vitiligo: Preliminary Report

BACKGROUND There is a body of evidence that neutral factors may play a role in the pathogenesis of vitiligo. OBJECTIVE We look for the existence of a relationship between vitiligo and monoaminergic systems. METHODS We use high-pressure liquid chromatography to measure the plasma level of catecholamines, their precursor 3,4-dihydroxyphenylalanine and their metabolites 3-methoxy-4-hydroxy phenylglycol (MHPG), normetanephrine (NMN), metanephrine and homovanillic acid (HVA). Forty patients with the generalized (n = 31) and acrofacial (n = 9) types of vitiligo are studied. RESULTS Significant differences are not found either between males and females or between the entire group of patients and the controls. HVA and NMN levels significantly correlate with age (r = 0.332, p < 0.05, and r = 0.331, p < 0.05, respectively). Significant correlations are also seen either between noradrenergic or between dopaminergic parameters (norepinephrine vs. MHPG, r = 0.326, p < 0.05; dopamine vs. HVA, r = 0.540, p < 0.01). When the patients are grouped on the basis of vitiligo type or age of disease onset, the plasma mean levels of the neural compounds are always nonsignificantly different from those of the controls. However, both catecholamines and metabolites show higher, although not significant, concentrations in patients with a shorter duration of disease. CONCLUSION Monoaminergic systems seem unlikely to be related to vitiligo, at least to the generalized and acrofacial types. However, variations cannot be excluded in genetically predisposed individuals during the onset or the active phases of disease.

Alopecia areata: More on Topical Sensitizers

Our experience on treating alopecia areata with topical sensitizers (diphencyprone, squaric acid dibutylester) is reported: staging, prognosis, side effects, follow-up, and psychological attitude of the patients towards this therapy and wigs are the focused aspects. The possible mechanisms of action of these allergens are discussed, reporting the case of a female patient with concomitant appearance of hair regrowth and psoriatic plaques in the same area after SADBE therapy.