Marsha Henderson

Afamelanotide and Narrowband UV-B Phototherapy for the Treatment of Vitiligo: A Randomized Multicenter Trial

IMPORTANCE Narrowband UV-B (NB-UV-B) phototherapy is used extensively to treat vitiligo. Afamelanotide, an analogue of α-melanocyte-stimulating hormone, is known to induce tanning of the skin. OBJECTIVE To evaluate the efficacy and safety of combination therapy for generalized vitiligo consisting of afamelanotide implant and NB-UV-B phototherapy. DESIGN, SETTING, AND PARTICIPANTS This study was performed in 2 academic outpatient dermatology centers and 1 private dermatology practice. We enrolled men and women 18 years or older with Fitzpatrick skin phototypes (SPTs) III to VI and a confirmed diagnosis of nonsegmental vitiligo that involved 15% to 50% of total body surface area. Vitiligo was stable or slowly progressive for 3 months. Patients were randomized to combination therapy (n = 28) vs NB-UV-B monotherapy (n = 27). After 1 month of NB-UV-B phototherapy, 16 mg of afamelanotide was administered subcutaneously to the combination therapy group monthly for 4 months while NB-UV-B phototherapy continued; the other group continued to receive NB-UV-B monotherapy. INTERVENTIONS Narrowband UV-B monotherapy vs combined NB-UV-B phototherapy and afamelanotide. MAIN OUTCOMES AND MEASURES Response on the Vitiligo Area Scoring Index and Vitiligo European Task Force scoring system. RESULTS Response in the combination therapy group was superior to that in the NB-UV-B monotherapy group (P < .05) at day 56. For the face and upper extremities, a significantly higher percentage of patients in the combination therapy group achieved repigmentation, and at earlier times (face, 41.0 vs 61.0 days [P = .001]; upper extremities, 46.0 vs 69.0 days [P = .003]). In the combination therapy group, repigmentation was 48.64% (95% CI, 39.49%-57.80%) at day 168 vs 33.26% (95% CI, 24.18%-42.33%) in the NB-UV-B monotherapy group. Notable adverse events included erythema in both groups and minor infections and nausea in the combination therapy group. Comparison between Fitzpatrick SPTs showed patients with SPTs IV to VI in the combination therapy group had improvement in the Vitiligo Area Scoring Index at days 56 and 84 (P < .05); no significant difference was noted in patients with SPT III. CONCLUSIONS AND RELEVANCE A combination of afamelanotide implant and NB-UV-B phototherapy resulted in clinically apparent, statistically significant superior and faster repigmentation compared with NB-UV-B monotherapy. The response was more noticeable in patients with SPTs IV to VI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01430195.

Systemic analyses of immunophenotypes of peripheral T cells in non-segmental vitiligo: implication of defective natural killer T cells.

Although it is widely believed that non‐segmental vitiligo (NSV) results from the autoimmune destruction of melanocytes, a clear understanding of defects in immune tolerance, which mediate this uncontrolled self‐reactivity, is still lacking. In the present study, we systemically evaluated circulating regulatory T (Treg) cells, including CD4+CD25+FoxP3+ Treg cells and invariant natural killer T (iNKT) cells, as well as naïve and memory CD4+ and CD8+ T cells and their cytokine production, in a cohort of 43 progressive NSV patients with race‐, gender‐, and age‐matched healthy controls. We found that the general immunophenotypes of CD4+ and CD8+ T cells and the percentage of CD4+CD25+FoxP3+ Tregs were comparable between NSV and healthy controls. However, percentages of peripheral iNKT cells were significantly decreased in NSV patients compared to that in healthy controls. Our data confirm the previous notion that the percentage of peripheral CD4+CD25+FoxP3+ Tregs remains unaltered in NSV and suggests the involvement of defective iNKT cells in the pathogenesis of NSV.

Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: The experience of an academic medical center in the United States

BACKGROUND Vitiligo is a disfiguring disease with limited treatment options. Surgical treatment is underused in the United States because of perceived risk of infection, costs, and difficulty of the procedure. OBJECTIVE We sought to determine the efficacy and safety of the melanocyte-keratinocyte transplantation procedure (MKTP) in an academic dermatology department in the United States. METHODS This prospective, uncontrolled, open-label study enrolled patients aged 18 years or older with a self-reported history of vitiligo and no new or expanding lesions for at least 6 months before surgery. Patients with a history of koebnerization or keloid formation were excluded. Patients underwent autologous MKTP. Repigmentation during a 3- to 6-month follow-up period was assessed categorically and by modified Vitiligo Area Scoring Index. Safety was assessed by frequency of adverse events. RESULTS Of the 28 patients who underwent 36 procedures, 23 patients who underwent 29 procedures completed the 3- to 6-month follow-up period. Data for these 29 procedures show excellent repigmentation (ie, 95%-100%) after the MKTP in 17%, and good repigmentation (ie, 65%-94%) in 31%. Fair (64%-25%) and poor (24%-0%) repigmentation were achieved in 10% and 41% of patients, respectively. Average percent change in Vitiligo Area Scoring Index was -45% (95% confidence interval -64% to -26%), signifying an improvement in pigmentation. LIMITATIONS Limitations include small sample size and lack of a control group. CONCLUSIONS The MKTP is an effective and well-tolerated procedure based upon categorical and Vitiligo Area Scoring Index assessments of repigmentation.

MicroRNA expression profiling identifies potential serum biomarkers for non-segmental vitiligo

To take out a personal subscription, please click here More information about Pigment Cell & Melanoma Research at www.pigment.org MicroRNA expression profiling identifies potential serum biomarkers for non-segmental vitiligo Yu-Ling Shi, Matthew Weiland, Jia Li, Iltefat Hamzavi, Marsha Henderson, Richard H. Huggins, Bassel H. Mahmoud, Oma Agbai, Xiaofan Mi, Zheng Dong, Henry W. Lim1,2, Qing-Sheng Mi and Li Zhou

Comparison of photodermatoses in African‐Americans and Caucasians: a follow‐up study

Only a few studies have compared frequencies of photodermatoses among different races and skin types. This is an extension of a study performed by Kerr and Lim and evaluates the frequency of photodermatoses in African‐Americans compared with Caucasians in the same institution during an 8‐year period.

Autologous Noncultured Melanocyte-Keratinocyte Transplantation Procedure in an African American Man With Postburn Leukoderma

A 26-year-old African American man was seen at the Dermatology Department at Henry Ford Hospital (Detroit, Michigan) complaining of leukoderma secondary to secondand third-degree burns involving more than 85% of his body. The injuries resulted from a car crash and subsequent fire 9 years earlier. Previous treatments included partial-thickness skin grafts, contracture releases, and scar revisions. While our patient had significant functional morbidities secondary to his accident, he noted postburn leukoderma as a major area of concern. He reported that the depigmented areas of the face, chest, and lower extremities were distressing and affected his social interactions. Consequently, he sought treatment to restore his natural skin color.

Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas

Background Persistence of pigmentation after a melanocyte‐keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy. Objective We sought to determine long‐term repigmentation of MKTP in vitiligo and other leukodermas. Methods A retrospective review of electronic medical records was conducted for all MKTPs performed at Henry Ford Hospital between January 2009 and April 2014. Repigmentation was assessed by a 5‐point grading scale (poor to excellent) and Vitiligo Area Scoring Index (VASI). Results One hundred patients had MKTP performed at 236 anatomically‐based lesions (ABLs); 63 patients with 157 ABLs had long‐term data available (12‐72 months; median, 24 months). Segmental vitiligo, nonsegmental vitiligo, and physical leukoderma demonstrated improvement in VASI scores: −75.6 ± 24.6%, −59.2 ± 36.6%, and −32.4 ± 33.5%, respectively. In vitiligo, at 24, 48, and 72 months after MKTP, 53%, 64%, and 53% of ABLs, respectively, maintained >75% repigmentation. Skin phototype, age, and anatomic location of ABLs had no significant effect on the outcome of treatment. Limitations Limitations of the study include the retrospective design with uncontrolled, postoperative adjuvant treatments and inconsistent compliance to scheduled follow‐up evaluations. Conclusions MKTP provides satisfactory long‐term repigmentation in the majority of appropriately selected patients with leukoderma. MKTP can maintain repigmentation for at least 72 months.

Quantitative skin color measurements in acanthosis nigricans patients: colorimetry and diffuse reflectance spectroscopy

Tristimulus colorimetry and diffuse reflectance spectroscopy (DRS) are white‐light skin reflectance techniques used to measure the intensity of skin pigmentation. The tristimulus colorimeter is an instrument that measures a perceived color and the DRS instrument measures biological chromophores of the skin, including oxy‐ and deoxyhemoglobin, melanin and scattering. Data gathered from these tools can be used to understand morphological changes induced in skin chromophores due to conditions of the skin or their treatments. The purpose of this study was to evaluate the use of these two instruments in color measurements of acanthosis nigricans (AN) lesions. Eight patients with hyperinsulinemia and clinically diagnosable AN were seen monthly. Skin pigmentation was measured at three sites: the inner forearm, the medial aspect of the posterior neck, and anterior neck unaffected by AN. Of the three, measured tristimulus L*a*b* color parameters, the luminosity parameter L* was found to most reliably distinguish lesion from normally pigmented skin. The DRS instrument was able to characterize a lesion on the basis of the calculated melanin concentration, though melanin is a weak indicator of skin change and not a reliable measure to be used independently. Calculated oxyhemoglobin and deoxyhemoglobin concentrations were not found to be reliable indicators of AN. Tristimulus colorimetry may provide reliable methods for respectively quantifying and characterizing the objective color change in AN, while DRS may be useful in characterizing changes in skin melanin content associated with this skin condition.

Critical comparison of diffuse reflectance spectroscopy and colorimetry as dermatological diagnostic tools for acanthosis nigricans: a chemometric approach

Quantification of skin changes due to acanthosis nigricans (AN), a disorder common among insulin-resistant diabetic and obese individuals, was investigated using two optical techniques: diffuse reflectance spectroscopy (DRS) and colorimetry. Measurements were obtained from AN lesions on the neck and two control sites of eight AN patients. A principal component/discriminant function analysis successfully differentiated between AN lesion and normal skin with 87.7% sensitivity and 94.8% specificity in DRS measurements and 97.2% sensitivity and 96.4% specificity in colorimetry measurements.

Prospective Controlled Trial for the Treatment of Acne Keloidalis Nuchae With a Long-Pulsed Neodymium-Doped Yttrium-Aluminum-Garnet Laser:

Background: Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis with limited interventions of both high efficacy and low morbidity. Objective: To assess the efficacy of the long-pulsed 1064-nm neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser and topical steroids as a treatment for AKN compared to topical steroids alone. Methods: We conducted a single-blinded, randomised, within-patient right-left controlled trial (n = 13). Eight monthly laser treatments were performed on the treated half of the scalp, and triamcinolone 0.1% cream was applied to both sides twice daily. Treatment response was measured using a global assessment score (0 to 10). Results: The laser-treated side showed greater improvement in global assessment score. The mean change was −3.2 (−49.2%) on the treated side and −2.2 (−32.8%) on the control side (P = .144). Papules responded well to laser treatment, while larger plaques and nodules showed limited improvement. In the 10 patients with papules only, the difference in improvement between the treated and control sides was statistically significant (mean change was −3.5 [−59.3%] for the treated side and −1.8 [−29.5%] for the control side, P = .031). Limitations: This study was limited by a small sample size and a high dropout rate, as well as the lack of a standardised scoring system for AKN. Conclusion: The long-pulsed Nd:YAG laser in conjunction with topical steroids shows promising results in the treatment of AKN, particularly the papular component, and is well tolerated by patients.