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Vitiligo is frequently treated with the combination of phototherapy and melanocyte transplantation. However, the additional benefit of phototherapy is unclear. Moreover, the optimal type and regimen of phototherapy are unknown. The objective of this systematic review was to identify whether phototherapy improves the outcome of melanocyte transplantation in vitiligo. We searched and screened for eligible studies in the databases of MEDLINE, EMBASE and CENTRAL. We included all clinical studies investigating melanocyte transplantation combined with phototherapy. After screening and selection of abstracts and full-texts, we found 39 eligible clinical studies with 1624 patients. The eligible studies investigated several phototherapy modalities, such as NBUVB (n = 9), PUVA (n = 19), UVA (n = 1), MEL (n = 4) and active sunlight exposure (n = 9). Four studies directly compared phototherapy versus no phototherapy and two studies confirmed the benefit of phototherapy for melanocyte transplantation. We found no significant differences in repigmentation in studies directly comparing phototherapy modalities. The overall quality of the studies was moderate to poor and high heterogeneity between studies was found. We found limited evidence that phototherapy improves the outcome of melanocyte transplantation in vitiligo. There is insufficient evidence to recommend a specific type or regimen of phototherapy. More studies should be performed investigating the additional benefit of different phototherapies and the preferred moment of phototherapy.

BackgroundUltraviolet (UV) light is an essential tool to assess the extent, spreading and staging of vitiligo. Different UV light set‐ups are used for vitiligo photography, including the following: (i) hand‐held Wood’s lamps; (ii) soft boxes with UV lamps; (iii) UV flash attached to the camera; and (iv) high output UV flash.ObjectiveOur objective was to compare UV light set‐ups for vitiligo photography regarding image quality and ease of use.MethodsPatients with vitiligo lesions with unclear borders were included. Two images were made with all four UV set‐ups per patient, for a large and a small area. Image quality was scored separately by three blinded vitiligo experts on five criteria: overall quality, clearness of borders, contrast and sharpness and for larger areas the shadows. The two professional medical photographers were asked to score the ease of use for each set‐up.ResultsA total of 88 photos were assessed from 11 patients. For larger areas, the frequency of a ‘good’ or ‘very good’ overall quality rating was 12.1% (Wood’s), 6.1% (soft boxes), 15.2% (camera flash) and 78.8% (high output flash). For smaller areas, the score ‘good’ or ‘very good’ was given to 54.5%, 3%, 66.6% and 84.8% in the same order. For the shadow criteria, each set‐up scored below 40% on a 'good' or 'very good' score. The high output flash was scored as most easy to use by the photographers.ConclusionWhen comparing four different UV light set‐ups for vitiligo photography, we concluded that the UV set‐ups strongly influenced the quality scores of the obtained images. The high output flash scored best for both small and large areas and for ease of use. For small areas, Wood’s lamp and camera flash were acceptable. All set‐ups scored badly for shadows, and more research is needed to find the optimal exposure to avoid shadows.

Background The treatment of non‐segmental vitiligo (NSV) remains a challenge. Current treatments often achieve suboptimal clinical results. To improve these treatment results, several new therapies are being developed and investigated. There is, however, little evidence on the actual need for novel therapies. Objective To assess patients’ perspective on current and novel therapies for vitiligo. Methods A prospective questionnaire study was conducted in a large cohort of vitiligo patients that consecutively visited the outpatient clinic of the Amsterdam University Medical Centre between April 2017 and January 2019. Patients were requested to fill in a digital questionnaire on patient characteristics, disease burden, quality of life, efficacy and satisfaction of current treatments and aspects regarding new treatments. Results A total of 325 vitiligo patients completed the questionnaire (60% response rate). Of the respondents, 94% believed that new and improved treatments are needed and 86% would be willing to participate in clinical trials investigating a new therapy. Sixty‐nine per cent would agree on taking weekly injections if it led to effective treatment results. Of the patients that had received therapy before, 49% reported that the current treatments were not effective and 50% was not satisfied with the current treatments. Sixty‐seven per cent of the patients experienced facial lesions as an extreme burden, whereas this was, 25%, 12% and 10% for lesions on the hands, trunk and feet, respectively. The emotional burden score was significantly higher in dark skin types compared with light skin types (respectively, 8 vs 5, U P < 0.05). Conclusion There is a substantial need for new vitiligo therapies. A considerable number of patients in our study are dissatisfied with current treatments and are emotionally burdened by the disease. Moreover, the vast majority demands novel treatments and is willing to participate in clinical trials.

Background For clinical care and research in vitiligo, photographs with the use of ultraviolet ( UV ) light or Wood's lamp are often made. Conventional cameras are insensitive to UV light. The use of a UV camera ( UV photography) might improve image quality and ameliorate the assessment of target lesions in vitiligo. Objectives To determine image quality and the validity and reliability of UV photography for the assessment of vitiligo target lesions. Methods Images of patients with vitiligo were made with UV photography and a conventional camera, and lesions were drawn on graph paper and transparent sheets. Image quality was scored by vitiligo experts and medical interns. The intraclass correlation coefficients ( ICC s) of the lesion size determined with UV photography combined with digital surface measurement and the other techniques were hypothesized to be above 0.6. The ICC s between UV images taken by the same physician and between two different physicians were calculated for determining inter‐ and intra‐reliability. Results In total, 31 lesions of 17 patients were included. Image quality was assessed as good or very good for 100% and 26% for UV photography and the conventional camera, respectively. ICC s of UV photography and the conventional camera, drawing the lesions on transparent sheets and graph paper, were 0.984, 0.988 and 0.983, respectively, confirming our hypotheses. The ICC s of the intra‐rater and inter‐rater were 0.999 and 0.998, respectively. Conclusions The results of this study indicate that the use of UV photography for the assessment of vitiligo lesions improves image quality and is valid and reliable.

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BACKGROUND When treating Merkel cell carcinoma (MCC), the relation between wide local excision (WLE) margin and recurrence or survival is unclear. Mohs micrographic surgery (MMS) is an alternative surgical option for MCC, but it is unknown whether the local recurrence rate differs between MMS and WLE. OBJECTIVE To systematically assess the available literature to determine the recurrence and survival rates when treating MCC with MMS and different clinical excision margins. MATERIALS AND METHODS The MEDLINE, EMBASE, and CENTRAL databases were searched. Two independent reviewers selected studies that defined clear excision margins and either recurrence or survival. When possible, individual cases were extracted from case series and included in the analyses. Other studies were reviewed narratively. RESULTS Overall, 1108 studies were identified; of which, 19 case series (168 cases) and 12 cohort studies were eligible. None of the cohort studies showed significant differences in recurrence or survival for either excision margins or MMS. Equally, logistic and Cox regression analyses of the case series revealed no significant differences in recurrence or survival between different excision margins and MMS. CONCLUSION Synthesis of the available data does not indicate differences in recurrence and/or survival rates for MCC between different clinical excision margins and MMS.M erkel cell carcinoma (MCC), first described by Toker 1 in 1972, is a rare and potentially lethal skin cancer with a possible neuroendocrine origin. Worldwide, the annual incidence has been increasing, and currently, it is estimated to affect 0.19 to 0.82 per 100,000 people. [2][3][4][5] Merkel cell carcinoma also has the propensity for rapid growth and metastasis, 2 with low 5year survival rates of approximately 60%. [2][3][4] Treatment modalities vary depending on tumor stage, comprising surgery, radiotherapy, chemotherapy, and/or immunotherapy. 6,7 For primary excision, wide local excision (WLE) or Mohs micrographic surgery (MMS) are usually recommended. 8-10 However, there is uncertainty about the optimal clinical excision margin for WLE, with recommendations varying from 1 to 3 cm, and how this relates to recurrence and survival. 9,11 Given the classic presentation of MCC as a sharply circumscribed and nodular lesion, it can be argued that an excision margin of 1 cm is sufficient; by contrast, its rapid growth and high risk of metastasis supports the case for a wider excision margin.Excision may also be performed by MMS, which, using frozen sections, allows for intraoperational assessment of 100% of the peripheral and deep histological margins. Using this technique, the surgeon can continue to excise tissue until all margins are free of tumor, ensuring radical excision with minimal margins and preferable cosmetic results. However, it remains unclear whether MMS and WLE produce different recurrence or survival rates. 12 A systematic review on this subject could contribute to international guidelines for the surgical strategy to treat MCC.The objec...

Introduction: Treatment of non-segmental vitiligo (NSV) remains a challenge. Efficacy of NB-UVB treatment may increase with more frequent use or in combination with topical agents. Currently, data on the most effective treatment regimen lacking. Our objective is to retrospectively compare NB-UVB treatment regimens for non-segmental vitiligo. Methods: Patients with NSV treated with NB-UVB therapy were included in two time periods. Group I received NB-UVB therapy twice a week (conventional treatment) and group II received NB-UVB thrice a week, combined with topical agents (intensified treatment). Patients completed a questionnaire regarding the degree and onset of repigmentation, satisfaction and side effects. Results: Repigmentation scores did not differ significantly between the two groups. Onset of repigmentation in the first three months seemed higher in group II, but this difference was not significant (23.4% vs 51.1%; p ¼ .11). In both groups the majority of the patients were moderately to very satisfied (group I: 70.2% group II: 73.3%). The occurrence of adverse effects was comparable.Conclusions: This study indicates that conventional and intensified treatment for NSV seem to be comparable. The intensified treatment might be more effective to speed up the onset of repigmentation, but larger prospective studies are needed to objectify these findings. ARTICLE HISTORY