A 23-year-old Hispanic woman with Fitzpatrick type IV skin presented with vitiligo vulgaris affecting 75% of her face, including complete depigmentation of the eyelids, chin, cheeks, and perioral skin. This had developed progressively over a 2-year period. As is the standard practice of our vitiligo clinic, thyroid function testing, blood cell counts, and vitamin B 12 levels were taken; all were within normal limits. Mometasone furoate ointment was applied twice daily for 3 months with no signs of follicular repigmentation either on visual examination or with the use of the Wood light.
CASE 2A 24-year-old man with Fitzpatrick type II skin presented with a history of vitiligo vulgaris for 12 years. At the time of presentation, he had depigmentation of 60% of his body surface area, including the eyelids, chin, axillae, elbows, hips, knees, and back. Thyroid function findings, blood cell counts, and vitamin B 12 levels were all
Corticosteroids and photochemotherapy, using a combination of psoralen and ultraviolet A (PUVA) exposure, are the most widely prescribed therapies for vitiligo. These treatments are not uniformly effective and many patients have inadequate responses. Calcipotriene has been shown to be effective in adults and children with psoriasis when used as monotherapy and in combination with corticosteroids and phototherapy. We hypothesized that since the mechanisms of action for calcipotriene and corticosteroids are different, patients may develop more repigmentation with a combination of the two agents, while decreasing the side effects from both agents. Twelve patients with vitiligo (average age 13.1 years) were advised to use topical corticosteroids in the morning and topical calcipotriene in the evening. Of the 12 patients, 83% responded to therapy, with an average of 95% repigmentation by body surface area. Four of the patients who responded had previously failed trials of topical corticosteroids alone. All of the patients in this group had repigmentation. Eyelid and facial skin responded best to this therapy. None of the patients had adverse reactions to the treatment. Our results show that topical calcipotriene in combination with corticosteroids can repigment vitiligo, even in those patients who were previous topical corticosteroid failures.
No single factor reliably predicts specialty choice; it is a complex decision-making process. There are modifiable factors (debt) and nonmodifiable factors (gender) that influence specialty choice. The study's findings suggest that positively influencing the modifiable risk factors will increase the probability but not the certainty of osteopathic medical students' choosing a PCS.
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