Lucio Zapata

Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma

Background Melasma is a common pigmentary disorder that is often difficult to treat. Tranexamic acid (TA) has emerged as a promising treatment for melasma; however, few controlled studies exist. Objective To determine the efficacy of oral TA in patients with moderate‐to‐severe melasma. Methods Patients with moderate‐to‐severe melasma were treated with 250 mg of TA or placebo capsules twice daily for 3 months and sunscreen followed by 3 months of treatment with sunscreen only. The primary outcome measure was the modified Melasma Area and Severity Index (mMASI) score. Results A total of 44 patients were enrolled and 39 completed the study. At 3 months, there was a 49% reduction in mMASI score in the TA group versus 18% in the control group. Patients with severe melasma improved more than those with moderate melasma. Three months after treatment was stopped, there was a 26% reduction in mMASI score in the TA group compared with the baseline visit versus a 19% reduction in the placebo arm. No serious adverse events were noted in either group. Limitations Single‐center study enrolling predominantly Hispanic women. Conclusions Oral TA appears to be an effective treatment for moderate‐to‐severe melasma with minimal side effects.

Association of Quality of Life and Location of Lesions in Patients With Vitiligo

Association of Quality of Life and Location of Lesions in Patients With Vitiligo Vitiligo is a chronic depigmenting disorder of multifactorial etiology affecting 0.5% to 1% of the population. The white macules characteristic of vitiligo have been shown to have a profound impact on quality of life (QOL) in affected individuals.1,2 The goal of this cross-sectional study was to determine the location(s) of vitiligo lesions that has the greatest effect on QOL.

Antibody blockade of IL-15 signaling has the potential to durably reverse vitiligo

Human and mouse resident memory T cells are present in vitiligo lesions, and blocking IL-15 signaling provides long-lasting reversal of disease in a mouse model of vitiligo. Forcing memory T cells to forget In vitiligo, autoreactive T cells attack melanocytes, leading to white spots on the skin. Depigmentation typically recurs upon cessation of treatment, so new therapies are needed for permanent patient relief. Richmond and colleagues reasoned that targeting tissue-resident memory T cells may allow for durable therapy. They observed that T cells from patient lesional samples expressed the receptor for IL-15, an important survival cytokine. T cells in a mouse model of vitiligo also expressed the IL-15 receptor, and blocking IL-15 signaling with an antibody was able to reverse disease symptoms. A clinical trial to test this therapy is now in the works. Vitiligo is an autoimmune disease of the skin mediated by CD8+ T cells that kill melanocytes and create white spots. Skin lesions in vitiligo frequently return after discontinuing conventional treatments, supporting the hypothesis that autoimmune memory is formed at these locations. We found that lesional T cells in mice and humans with vitiligo display a resident memory (TRM) phenotype, similar to those that provide rapid, localized protection against reinfection from skin and mucosal-tropic viruses. Interleukin-15 (IL-15)–deficient mice reportedly have impaired TRM formation, and IL-15 promotes TRM function ex vivo. We found that both human and mouse TRM express the CD122 subunit of the IL-15 receptor and that keratinocytes up-regulate CD215, the subunit required to display the cytokine on their surface to promote activation of T cells. Targeting IL-15 signaling with an anti-CD122 antibody reverses disease in mice with established vitiligo. Short-term treatment with anti-CD122 inhibits TRM production of interferon-γ (IFNγ), and long-term treatment depletes TRM from skin lesions. Short-term treatment with anti-CD122 can provide durable repigmentation when administered either systemically or locally in the skin. On the basis of these data, we propose that targeting CD122 may be a highly effective and even durable treatment strategy for vitiligo and other tissue-specific autoimmune diseases involving TRM.

Sunscreen habits and skin cancer rates in patients with vitiligo in Australia

contact wet wraps, was comparable to other studies where wet wraps are left in situ continually throughout the day. The advantages of the short-contact protocol include enhanced patients’ comfort, as they could move around between the treatments, and the regular application of emollient. The brevity and simplicity of this protocol would lend itself well to use in a daycare facility, although this was not assessed in our study. Although one-quarter of patients were readmitted, the median time to re-presentation of 3.4 months suggests that there was a prolonged treatment response to wet-wrap therapy. This re-admission rate may reflect the chronic and severe nature of the skin disease of many of these patients. Rapid reductions in the SCORAD index and psoriasis area and severity index were recorded, which were comparable to or surpassed many systemic and biological treatment options. Given that both eczema and psoriasis have a significant impact on productivity, the cost of inpatient admission should be weighed against the rapid return of patients in this relatively young cohort to their normal daily function and work. In addition, some of our inpatients received wet wraps to complement biological therapy, particularly during the initiation of treatment. The limitations of this study include the observational design. Wet wraps were administered in combination with a package of inpatient care processes in the absence of a vehicle-only control group for comparison. Disease scores were calculated by unblinded investigators, introducing potential measurement bias. The number of patients who returned the DLQI questionnaire after discharge was low and this should be noted when interpreting these results. Finally, follow-up data were collected from an analysis of clinical records rather than face-to-face reviews, meaning that the outcome measures may be underestimated. In conclusion, short-contact wet wraps delivered in an inpatient setting resulted in rapid clinical improvement for adults with severe dermatoses and may be considered as an alternative to more traditional continuous-contact wetwrap protocols.

Quality of life in patients with vitiligo using the Short Form-36

Vitiligo is an acquired pigmentary disorder affecting 0.5-1% of the worlds population. Affected individuals often have low self-esteem, and poor quality of life (QOL) due to the disfigurement caused by the disease [1]. Vitiligos impact on QOL compared to other diseases using general health questionnaires like the Short Form 36 (SF-36) is not well understood. We performed a cross-sectional study of patients with vitiligo and controls using the SF-36 and compared our scores to studies of patients with depression, chronic lung disease, psoriasis, atopic dermatitis, arthritis, cancer, congestive heart failure, myocardial infarction, type 2 diabetes, hypertension, and healthy adults. This article is protected by copyright. All rights reserved.