The occurrence of vitiligo after psoralens and ultraviolet A therapy

Todes-Taylor, Nancy; Abel, Elizabeth A.; Cox, Alvin J.

doi:10.1016/s0190-9622(83)70164-7

Cited by 32 publications

(16 citation statements)

References 30 publications

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“…Although PUVA is the most common treatment for vitiligo (25) and should be included in the second category, its effect is usually limited, and recurrence or induction of vitiligo lesions often occurs, as seen in Case 1 (26). With respect to the pathogenesis of this disease, the first type of treatment appears to be the most important, especially if therapy results in the suppression of autoimmunity.…”

Section: Discussionmentioning

confidence: 99%

Suplatast Tosilate (IPD®), a New Immunoregulator, Is Effective in Vitiligo Treatment

Nihei

Nishibu

Kaneko

1998

The Journal of Dermatology

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The major type of vitiligo is considered to be an autoimmune disorder. Anti-melanocyte antibodies are frequently detected in sera of patients with this disease. Interleukin (IL)-4 released from Th2 cells is an important factor in stimulating autoantibody production by B-cells. In this study, seven patients with vitiligo treated with suplatast tosilate (IPD), three showed repigmentation and improvement of their lesions after administration of the drug. IPD halted the continuous spread of the lesions in three of the other patients, and, in two of them, also reduced microsome test and thyroid test titers. The efficacy of IPD in treating vitiligo was thought to be due to the suppressive effect of this drug on IL-4 production. No side effect was observed. Thus IPD may represent a new alternative in vitiligo treatment due to its inhibition of autoimmunity by the suppression of IL-4.

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Section: Discussionmentioning

confidence: 99%

Suplatast Tosilate (IPD®), a New Immunoregulator, Is Effective in Vitiligo Treatment

Nihei

Nishibu

Kaneko

1998

The Journal of Dermatology

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“…1,2 Leucoderma punctatum, a confetti-like hypopigmentation, as a distinct entity was first described by Falabela et al 3 A 21-year-old woman presented with multiple asymptomatic, punctiform, achromic spots of 1-month duration, distributed predominantly on extensor aspect of extremities. 1,2 Leucoderma punctatum, a confetti-like hypopigmentation, as a distinct entity was first described by Falabela et al 3 A 21-year-old woman presented with multiple asymptomatic, punctiform, achromic spots of 1-month duration, distributed predominantly on extensor aspect of extremities.…”

Section: Confetti-like Hypopigmentation: a Rare Complication Of Commomentioning

confidence: 96%

Confetti‐like hypopigmentation: a rare complication of common phototherapeutic modality

Bhatnagar

Kanwar

Parsad

et al. 2007

Acad Dermatol Venereol

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Confetti-like hypopigmentation: a rare complication of common phototherapeutic modalityEditor Hypopigmentation and vitiligo occurring during psoralen and ultraviolet A (PUVA) therapy have been described in the literature. 1,2 Leucoderma punctatum, a confetti-like hypopigmentation, as a distinct entity was first described by Falabela et al. 3 A 21-year-old woman presented with multiple asymptomatic, punctiform, achromic spots of 1-month duration, distributed predominantly on extensor aspect of extremities. She had vitiligo vulgaris and was being treated with trimethylpsoralen 0.6 mg/kg, three times per week, followed by UVA exposure for 3 months before appearance of these lesions. Before starting PUVA treatment she was given 8 months' treatment of narrowband ultraviolet B (NBUVB), during which no similar lesion was observed. She was shifted to PUVA as there was minimal improvement of vitiligo with NBUVB. She had skin type V and had 40% repigmentation of the vitiliginous lesions over this period. Her disease was stable during therapy. On examination she had several small hypopigmented to depigmented macules, round to oval in shape, with well-defined margins and measuring about 1.5 mm, which were distributed over the repigmented areas ( fig. 1). These lesions were distributed over extensor aspect of the extremities and were predominantly perifollicular. There was no history of phototoxic reaction or inflammatory lesions. Skin biopsy was taken from a representative lesion, which showed patchy loss of pigment in basal keratinocytes with mild hyperkeratosis of the epidermis. The photochemotherapy was subsequently discontinued.Falabela et al. 3 first described leucoderma punctatum in 1988, in 13 vitiligo patients during and after PUVASOL (oral psoralen followed by solar UV exposure) treatment as leucoderma distinct from idiopathic guttate hypomelanosis and vitiligo. Later, Park et al. 4 reported four cases of generalized punctate leucoderma after UVB phototherapy for psoriasis. Most of the cases were females. Dogra et al. 5 first reported a case of leucoderma punctatum appearing after systemic PUVA therapy. Recently, it has been reported after topical PUVA treatment for segmental vitiligo by Park et al. 6 The typical skin lesions described are multiple discrete well-defined macules of size varying from 0.5 to 1.5 mm, most commonly located on the upper and lower extremities. Special stains for melanocytes show a decreased number of functional melanocytes. In ultrastructural study by Falabella et al., 3 cellular damage within keratinocytes and melanocytes was evident in form of intracellular oedema and intracytoplasmic vacuolar degeneration. Although pathogenesis is not well understood, the most likely cause is PUVA and UVB phototoxiciy-induced damage to melanocytes. Park et al. 4 also suggested that cumulative UVB phototoxicity may be the cause of leucoderma punctatum. In this case, perhaps the exposure to both NBUVB and PUVA was the cause of phototoxicity and appearance of these lesions. It is important to be aware o...

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“…106 The reported association of vitiligo with psoriasis and erythema dyschromicum perstans 107 is probably fortuitous. [117][118][119] Ganciclovir, used in the treatment of graft-versus-host disease (GVHD), produced extensive vitiligo in one patient. [117][118][119] Ganciclovir, used in the treatment of graft-versus-host disease (GVHD), produced extensive vitiligo in one patient.…”

Section: Disorders Of Pigmentation • Chapter 10mentioning

confidence: 99%

Disorders of pigmentation

Weedon

2010

Weedon's Skin Pathology

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The occurrence of vitiligo after psoralens and ultraviolet A therapy

Cited by 32 publications

References 30 publications

Suplatast Tosilate (IPD®), a New Immunoregulator, Is Effective in Vitiligo Treatment

Suplatast Tosilate (IPD®), a New Immunoregulator, Is Effective in Vitiligo Treatment

Confetti‐like hypopigmentation: a rare complication of common phototherapeutic modality

Disorders of pigmentation

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