Yoon-Kee Park

Treatment of stable vitiligo with autologous epidermal grafting and PUVA.

BACKGROUND Previous reports have shown the benefits of epidermal grafting for vitiligo. OBJECTIVE Our purpose was to evaluate the effectiveness and complications of epidermal grafting in combination with PUVA on stable vitiligo refractory to conventional treatments. METHODS In 100 patients with stable refractory vitiligo we performed epidermal grafting with suction blisters followed by PUVA treatment. The grafted sites were examined for repigmentation for up to 5 years. RESULTS Excellent repigmentation was observed at all grafted sites, especially on the face except for the lip and the alae nasae. PUVA treatment resulted in spreading of the pigmentation. Poor results were observed on the neck, axillae, and overlying bony prominences. Hyperpigmentation of the recipient and donor sites was frequently observed. Only six patients had recurrence and/or adjacent new lesions. Depigmentation developed at the donor site in only one patient with generalized vitiligo. Long-term observation in these patients indicates that repigmentation obtained by this method is permanent. CONCLUSION Although epidermal grafting in combination with PUVA has some limitations, it is an easy, safe, inexpensive, and effective treatment for various types of stable refractory vitiligo.

Epidermal Changes in Active Vitiligo

Light and electron‐microscopic studies were performed on the vitiligo and adjacent, normal appearing skin from 97 patients with actively spreading vitiligo and 19 patients with stable vitiligo. The vitiliginous skin revealed complete loss of pigment and melanocytes. In addition to degenerative changes in melanocytes, vacuolar changes of basal cells, epidermal infiltration of lymphocytes, dermal infiltration of lymphocytes, and melanophages in the upper dermis were also seen in the normal appearing skin adjacent to vitiliginous skin. These epidermal and dermal changes are more prominent in the skin of actively spreading vitiligo than in stable vitiligo. These findings suggest that the adjacent, normal appearing skin of actively spreading vitiligo shows some characteristic histopathologic findings, especially in the epidermis, indicating that cellular immunity could be involved in the pathogenesis of vitiligo.

Clinical characteristics of progressive vitiligo.

BACKGROUND Vitiligo is an acquired hypopigmentary disorder with a progressive clinical course. Various clinical characteristics and their significance in the progression of vitiligo were evaluated. METHODS A clinical study was carried out on 400 patients who had visited the Vitiligo Special Clinic of Severance Hospital, Yonsei University College of Medicine. Questionnaires were completed regarding progression, sex, family history, clinical type, onset age, duration of disease, Koebners phenomenon, leukotrichia, and mucosal involvement, and the results were recorded. RESULTS Progression of vitiligo was seen in 355 patients (88.8%); 45 patients (11.2%) did not show progression. No difference in sex, onset age, or leukotrichia was noted between the two groups; however, patients with positive family histories, nonsegmental clinical type, longer duration, Koebners phenomenon, and mucous membrane involvement showed more progression of vitiligo. CONCLUSIONS Clinical characteristics such as family history, clinical type, duration of disease, Koebners phenomenon, and mucous membrane involvement, may be relevant in predicting the progression or prognosis of vitiligo.

The change of melanocyte cytotoxicity after systemic steroid treatment in vitiligo patients

Although there is evidence of a strong association between antimelanocyte autoantibodies and vitiligo, the etiology of vitiligo is still unclear. To elucidate the biological significance of antimelanocyte autoantibodies in vitiligo, we measured the percent cytotoxicity of melanocyte mediated by autoantibody and complement in normal controls (n = 31) and in the patients with active, progressive vitiligo (n = 37). Significant differences in percent cytotoxicity of melanocyte were seen between the control and vitiligo groups (P = 0.0001). There were no significant differences in the percent cytotoxicity of melanocyte between the patients (n = 24) with more than 1 year duration and those (n = 13) with less than 1 year duration. The change of percent cytotoxicity between pre- and post-treatment groups (n = 29) with systemic steroid showed significant differences (P = 0.0243). These findings support the hypothesis that a decrease in the antibody-mediated cytotoxicity against melanocytes may play a role in the improvement of vitiliginous lesions after systemic steroid treatment.

PERIPHERAL BLOOD LYMPHOCYTE IMBALANCE IN KOREANS WITH ACTIVE VITILIGO

Background. An immune‐mediated destruction of melanocytes is the most popular current theory of vitiligo. There have been a few published reports on the assessment of lymphocyte population in vitiligo, and they showed mixed results. The purpose of our investigation was to assess peripheral lymphocyte subpopulations in Koreans with actively spreading vitiligo.

Itraconazole-induced acute hepatitis

Siu, In October 1991, a 4(i-year-old Cauca.sian woman took norfloxacin 400 mg twice daily for 7 days, lor a urinary tract infection. As she completed the course of treatment she noticed an itchy rash on her back and abdomen. The rash consisted of profuse, clustered vesicles on an inflanimiitory base, predominantly localized to the lower back, infraniammary areas and abdomen. There were no bucca! iesion,s. Two weeks after its onset the eruption changed in character and became pustular. Histopathology showed intraepidermal bullae with acantholysis. and a mixed perivascular infiltrate of lymphocytes, histiocytes and neutrophils (Fig, 1), Both direct and indirect immunofluorescence (the latter was performed on two occasions) were negative for all immunoreactants.

BIOLOGIC CHARACTERISTICS OF CULTURED HUMAN VITILIGO MELANOCYTES

Background. Vitiligo is a pigmentary disorder of unknown cause characterized by depigmented patches due to destruction of melanocytes. Recently, the inherent cellular defect theory has been discussed. To investigate the biologic characteristics of cultured melanocytes from normal and vitiligo subjects, this study had the purpose to examine the functional and ultrastructural characteristics of these melanocytes and to observe the morphologic and functional changes of melanocytes in response to ultraviolet B irradiation.

The Effect of Cimetidine on Verruca Plana Juvenilis: Clinical Trials in Six Patients

Cimetidine is an H2‐receptor antagonist which is mainly used to treat gastrointestinal diseases. Recently, many authors have suggested that cimetidine has the ability to reverse acquired tolerance to dinitrochlorobenzene (DNCB).

Hydroa vacciniforme with unusually severe scar formation: Diagnosis by repetitive UVA phototesting

Hydroa vacciniforme is a rare, chronic, photosensitive disorder manifested in childhood by recurrent vesicles that heal with scarring. Reproduction of vesicles with repetitive UVA phototesting may be an important diagnostic aid. Recurrent eruption resulted in severe scarring of the face and a flexion contracture of the finger in our patient. The clinical features and laboratory evaluation of hydroa vacciniforme are reviewed.

Treatment of Vitiligo with Oral 5-Methoxypsoralen

Thirty‐six patients with vitiligo were treated with oral 5‐methoxypsoralen (5‐MOP) and subsequently exposed to UVA irradiation. The patients were treated once or twice weekly over a period of 2–10 months, taking 40–60 mg of 5‐MOP 2 hours before exposure to UVA light. The amount of exposure to UVA light was slowly increased according to the patients tolerance.