L. Nieuweboer-Krobotova

Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners

Background  Vitiligo is a common skin disease characterized by autoimmune melanocyte destruction. Recent genetic studies suggest a lower susceptibility to melanoma in patients with vitiligo; however, lifetime melanoma prevalence in patients with vitiligo has not previously been studied. Nonmelanoma skin cancer (NMSC) prevalence has been studied, but only in small studies and with contradictory results.

Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split-face study†‡

Melasma is a uichronic, often relapsing skin disorder, with poor long‐term results from all current therapies.

Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled pilot study

BACKGROUND Various treatments are currently available for melasma. However, results are often disappointing. OBJECTIVE We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard). METHODS Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment. RESULTS Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling. LIMITATIONS Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups. CONCLUSIONS Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies.

A randomized comparison of excimer laser versus narrow-band ultraviolet B phototherapy after punch grafting in stable vitiligo patients

Background  Ultraviolet radiation following punch grafting may stimulate the migration of melanocytes from the grafts into the vitiliginous skin, thereby increasing the rate of repigmentation. We compared the effects of the 308‐nm xenon chloride excimer laser (EL) vs. narrow‐band ultraviolet B (NB‐UVB) after punch grafting in patients with vitiligo.

Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo: effect of disease activity.

Background  Punch grafting is a simple and frequently used technique for the treatment of stable vitiligo, resistant to medical therapy. However, studies reporting long‐term results are exceptional.

Radiation-induced melanoma-associated leucoderma, systemic antimelanoma immunity and disease-free survival in a patient with advanced-stage melanoma: a case report and immunological analysis

Background  Melanoma is an immunogenic tumour. The development of skin depigmentation or melanoma‐associated leucoderma (MAL) has been associated with favourable clinical outcome in patients with metastatic melanoma, especially after immunotherapy. Evidence for clinically meaningful enhancement of melanoma‐directed autoimmunity, as indicated by MAL, after radiotherapy without immunotherapy has not yet been published.

Heme oxygenase-1 expression protects melanocytes from stress-induced cell death: implications for vitiligo

Abstract:  To study protection of melanocytes from stress‐induced cell death by heme oxygenases during depigmentation and repigmentation in vitiligo, expression of isoforms 1 and 2 was studied in cultured control and patient melanocytes and normal skin explants exposed to UV or bleaching agent 4‐TBP. Similarly, expression of heme oxygenases was followed in skin from vitiligo patients before and after PUVA treatment. Single and double immunostainings were used in combination with light and confocal microscopic analysis and Western blotting. Melanocyte expression of heme oxygenase 1 is upregulated, whereas heme oxygenase 2 is reduced in response to UV and 4‐TBP. Upregulation of inducible heme oxygenase 1 was also observed in UV‐treated explant cultures, in skin of successfully PUVA‐treated patients and in melanocytes cultured from vitiligo non‐lesional skin. Heme oxygenase encoding genes were subsequently cloned to study consequences of either gene product on cell viability, demonstrating that HO‐1 but not HO‐2 overexpression offers protection from stress‐induced cell death in MTT assays. HO‐1 expression by melanocytes may contribute to beneficial effects of UV treatment for vitiligo patients.

Heme oxygenase-1 expression protects melanocytes from stress-induced cell death: implications for vitiligo.

Abstract:  To study protection of melanocytes from stress‐induced cell death by heme oxygenases during depigmentation and repigmentation in vitiligo, expression of isoforms 1 and 2 was studied in cultured control and patient melanocytes and normal skin explants exposed to UV or bleaching agent 4‐TBP. Similarly, expression of heme oxygenases was followed in skin from vitiligo patients before and after PUVA treatment. Single and double immunostainings were used in combination with light and confocal microscopic analysis and Western blotting. Melanocyte expression of heme oxygenase 1 is upregulated, whereas heme oxygenase 2 is reduced in response to UV and 4‐TBP. Upregulation of inducible heme oxygenase 1 was also observed in UV‐treated explant cultures, in skin of successfully PUVA‐treated patients and in melanocytes cultured from vitiligo non‐lesional skin. Heme oxygenase encoding genes were subsequently cloned to study consequences of either gene product on cell viability, demonstrating that HO‐1 but not HO‐2 overexpression offers protection from stress‐induced cell death in MTT assays. HO‐1 expression by melanocytes may contribute to beneficial effects of UV treatment for vitiligo patients.

Home vs. outpatient narrowband ultraviolet B therapy for the treatment of nonsegmental vitiligo: a retrospective questionnaire study

MADAM, Narrowband ultraviolet B (NB-UVB) therapy is considered the first-line therapy for nonsegmental vitiligo. A major drawback, though, is the fact that this treatment requires months to years of frequent visits to a clinic-based phototherapy unit. For that reason home UVB therapy was introduced in 1979, mainly for psoriasis, and in the early 1990s for vitiligo as well. However, the safety, effectiveness and compliance associated with home treatment have been debated. This study is the first to provide data on the pros and cons of home vs. outpatient UVB therapy in patients with nonsegmental vitiligo. (a) (b)

Punchgraft testing in vitiligo; effects of UVA, NB-UVB and 632.8 nm Helium-Neon laser on the outcome

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