SummaryBackground and objectivesThis study aimed to compare the efficacy of vitiligo treatments with and without ablation therapy.Patients and methodsWe conducted a systematic review and meta‐analysis of literature published before September 15, 2017. Comparative studies of vitiligo patients treated with and without ablation therapy were included. The primary outcome was ≥ 50 % repigmentation. Secondary outcomes were ≥ 75 % repigmentation and patient scores on a subjective visual analogue scale.ResultsFifteen studies with a total of 401 participants were included. The ablation‐based combination therapy group had significantly superior results to the control group (odds ratio [OR] for ≥ 50 % repigmentation: 10.490, 95 % confidence interval [CI]: 4.632–23.757; OR for ≥ 75 % repigmentation: 5.812, 95 % CI: 2.194–15.393). Patients receiving ablation‐based combination therapy were significantly more satisfied with the efficacy than the control group (standardized mean difference: 1.073, 95 % CI: 0.528–1.619). Subgroup analysis showed that the erbium laser group, CO2 laser group and fractional CO2 laser group achieved significantly better repigmentation than the control groups.ConclusionsAccording to objective and subjective evaluations, treatments for vitiligo are more effective when combined with ablation therapy than when used alone.
Typical cutaneous non-tuberculous mycobacteria (NTM) infections show a histopathology pattern of granulomas with admixed Langhans giant cells, and abscesses may be observed in acute lesions. Herein, we describe a patient carrying a high titer of autoantibodies to interferon (IFN)-γ with disseminated Mycobacterium kansasii infection presenting with emperipolesis and Rosai-Dorfman disease (RDD)-like histopathological features characterized by remarkable, large, pale-staining "RD cells", which were CD68 and S100 positive and CD1a negative. The patient was misdiagnosed with RDD initially, but exhibited a poor response to all interventions. A re-biopsy revealed Langhans-type multinucleated giant cells; multiple definite acid-fast bacilli were also found. M. kansasii was isolated from cultured tissues. Anti-NTM treatment was initiated. After treatment, all lesions resolved almost completely within the following month. High-titer anti-IFN-γ autoantibodies were detected during follow up, leading to the diagnosis of adult-onset immunodeficiency syndrome. In conclusion, patients carrying high-titer autoantibodies to IFN-γ who also have a disseminated cutaneous M. kansasii infection may present with RDD-like histopathological features, which may be a pitfall in the diagnosis of disseminated cutaneous NTM infections.
ZusammenfassungHintergrund und ZieleZiel dieser Studie war ein Vergleich der Wirksamkeit von Vitiligotherapien mit und ohne Ablationverfahren.Patienten und VerfahrenSystematische Übersichtsarbeit und Metaanalyse der vor dem 15. September 2017 publizierten Literatur. Eingeschlossen wurden Vergleichsstudien mit Vitiligopatienten, die mit und ohne Ablationsverfahren behandelt wurden. Primärer Endpunkt der Studie war die Repigmentierung ≥ 50 %. Sekundäre Endpunkte waren eine Repigmentierung ≥ 75 % und Patienten‐Scores auf einer subjektiven visuellen Analogskala.ErgebnisseEs wurden fünfzehn Studien mit insgesamt 401 Teilnehmern eingeschlossen. Die Gruppe mit ablationsbasierter Kombinationstherapie wies gegenüber der Kontrollgruppe signifikant bessere Ergebnisse auf (Odds Ratio [OR] bei ≥ 50 % Repigmentierung: 10,490, 95 %‐Konfidenzintervall [KI]: 4,632–23,757; OR bei ≥ 75 % Repigmentierung: 5,812, 95 %‐KI: 2,194–15,393. Patienten, die eine ablationsbasierte Kombinationstherapie erhielten, waren signifikant zufriedener mit der Wirksamkeit als die Kontrollgruppe (standardisierte mittlere Differenz: 1,073, 95 % KI: 0,528–1,619). Eine Subgruppenanalyse zeigte, dass die Erbium‐ und die CO2‐Laser‐Gruppe sowie die Gruppe mit fraktioniertem CO2‐Laser eine signifikant bessere Repigmentierung als die Kontrollgruppen erreichten.SchlussfolgerungenSowohl nach objektiven als auch nach subjektiven Kriterien sind Vitiligotherapien in Kombination mit einer Ablationstherapie wirksamer als bei alleiniger Verwendung.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.