Therapeutic Effects of 308 nm Excimer Laser in the Treatment of Vitiligo on the Head and Neck Area

Background: The excimer laser has recently been introduced as a new therapeutic modality for vitiligo. However, to date, there have only been a few clinical reports evaluating the therapeutic effects of excimer laser treatment for vitiligo of the head and neck area. Objective: This study was conducted to evaluate the effects of excimer laser therapy on vitiligo of the head and neck area against various clinical parameters. Methods: The 87 patients enrolled in this study were treated with excimer laser monotherapy. We observed the grade of repigmentation after 20 sessions of treatment, and analyzed mean grade of repigmentation with regard to various clinical parameters, to discover determinant factors on therapeutic outcome. Results: Thirty-four of the 87 patients (39.1%) achieved more than 50% repigmentation after or within 20 sessions. The response to treatment was related to the duration of evolution of the vitiligo, type of vitiligo, history of previous treatments, and existence of poliosis within the lesion (respectively, p=0.006, 0.001, < 0.001, 0.004). No relationship could be established between response to the treatment and the following variables: localization of the treated lesion and age of onset (respectively, p=0.42, 0.99). Peri-lesional hyperpigmentation was a relatively common side effect, but other adverse effects were limited and transient. Conclusion: Excimer laser therapy is an effective and safe therapy for vitiligo of the face and neck area. Promising results from excimer laser therapy can be expected in patients who have a short duration of evolution of the vitiligo below 1 year, a focal or generalized type of vitiligo, no previous history of treatment, and a vitiliginous lesion without poliosis.ope

자외선 A의 조사와 indomethacin 투여가 마우스의 접촉과민반응에 미치는 영향

의학과/박사[영문] [한글] 자외선이 피부의 세포면역기능에 미치는 효과는 자외선 조사에 의한 피부암 유발연구로 시작되어 종양이식에 관한 연구에 이르기까지 그동안 많은 연구가 수행되어왔다. 자외선 에 노출된 마우스의 피부에 접측과민물질을 국소도포하여 접촉과민반응을 유발시킬 경우 접촉과민반응의 현저한 저하를 관찰할 수 있으며 이러한 접촉과민반응에 영향을 미치는 자외선은 자외선 B 혹은 Psoralen Ultraviolet A (PUVA)라는 보고들이 대부분이었다. 그러나 자외선 A도 자외선 B나 PUVA와 마찬가지로 접촉과민반응에 중요한 역할을 하는 랑게르한스세포(Langerhans cell)수를 변화시킨다는 보고가 있으며 최근에는 대량의 자외 선 A도 접촉과민반응의 전신저하를 유발한다는 보고가 있다. 자외선 A는 자외선 B와는 달 리 피부 깊숙히 침투하여 진피내의 모세혈관 및 세포성분의 변화를 유발하므로 자외선 B 와는 다른 기전으로 접촉과민반응의 전신저하를 유도할 수 있을 것으로 생각된다. 또한 arachidonic acid의 cyclo-oxygenase 억제제인 indomethacin을 국소도포시 접촉과 민반응이 저하된다는 보고도 있다. 이에 저자는 자외선 A조사가 마우스의 접촉과민반응에 미치는 효과와 그 작용기전에 관여하리라고 생각되는 매개물질을 연구하고자 자외선 A조 사에 따른 접촉과민반응의 변화 및 prostaglandin E의 변화와 표피 랑게르한스세포수의 변화를 관찰하고, indomethacin의 전신투여가 정상 및 자외선 A를 조사받은 마우스에서의 접촉과민반응에 미치는 영향을 연구한바 다음과 같은 결론을 얻었다. 1. 대량(800J/㎠)의 자외선 A를 마우스 등에 조사한 후 조사하지 않은 배를 2-4-dinitr o-1-fluorobenzene (DNFB)으로 감작한 결과 조사 1일 감작한 경우나 5일 후 경우 모두 비 슷한 접촉과민반응의 전신저하를 관찰할 수 있었다. 2. 대량의 자외선 A를 마우스 등에 조사한 후 prostaglandin E의 혈장치를 radioimmuno assay로 측정한 결과 통계학적으로 유의한 증가를 보였다. 3. Arachidonic acid의 cyclo-oxygenase 억제제인 indomethacin을 전신투여한 마우스에 서 접촉과민반응을 유발하였을 때 접촉과민반응의 저하를 관찰할 수 있었으며, indometha cine전신투여 및 자외선 A를 병합 조사한 마우스에서도 indomethacin 단독투여군과 비슷 한 접촉과민반응의 저하를 관찰할 수 있었다. 4. 대량의 자외선 A조사에 의한 표피 랑게르한스세포수의 변화는 조사 1일 후 부터 통 계학적으로 유의한 세포수의 감소를 조사 부위인 등과 귀에서 관찰할 수 있었고 조사 20 일 후에 세포수가 거의 정상으로 회복되었다. 그러나 조사받지 않은 배에서는 통계학적으 로 유의한 랑게르한스세포수의 감소를 관찰할 수 없었다. 이상의 결과를 종합해 볼 때 대량의 자외선 A조사에 의하여 접촉과민반응의 전신저하가 유발되었고 자외선 조사후 prostaglandin E가 증가하는 것과 다량증가된 prostaglandin E가 접촉과민반응에서 면역억제기능이 있음을 고려해 볼 때 prostaglandin E가 자외선 B 의 경우와 마찬가지로 자외선 A에의한 접촉과민반응의 저하에 관여하는 것으로 생각된다. 그리고 indomethacin의 전신투여로 인해 접촉과민반응의 저하가 유발되는 것을 볼 때 i ndomethacin에 의한 cyclo-oxygenase억제로 인해 증가될 수 있는 arachidonic acid 및 li po-oxygenase 대사물인 hydroperoxyeicosatetranoic acid (HETE)등이 접촉과민반응의 저 하에 관여하는 매개물질들로 생각되며 cyclo-oxygenase대사물들은 접촉과민반응의 유도에 관여하는 매개물질들 중의 일부라고 추측할 수 있었다. Change in Contact Hypersensitivity Induced by Ultraviolet A Irradiation and Indomethacin Treatment Seung Kyung Hann Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Yoon-Kee Park, M.D., Ph.D.) The immunologic consequences of cutaneous ultraviolet B (UVB) radiation have recently received considerable attention in both human and laboratory animal studies. In mice, chronic exposure to UVB induces and promotes the growth of skin cancer, and pretreatment with UVB also prevents mice from processing epicutaneously applied hapten during the induction of contact hypersensitivity. Irradiation with high doses of UVB results in systemic suppression and psoralen ultraviolet A (PUVA) can also induce similar immunosuppression. Recently immunosuppression has also been reported following high doses of ultraviolet A (UVA) exposure. Contact hypersensitivity suppression by topical indornethacin treatment has been reported. To study the effect of large dose (800 J/㎠) of UVA irradiation on contact hypersensitivity change and its soluble mediator to affect contact hypersensitivity and the effect of systemic treatment of indomethacin on contact hypersensitivity, the following items were evaluated: the change of contact hypersensitivity following UVA irradiation; the change in prostaglandin E, one of the possible soluble mediators in contact hypersensitivity suppression, following UVA irradiation; the change in contact hypersensitivity following indomethacin treatment, cyclo-oxygenase inhibitor in arachidonic metabolism; the change in contact hypersensitivity following combined indomethacin and UVA treatment and finally the changes in the number of Langerhans cell after UVA irradiation. The results are summarized as follows: 1. With DNFB painting on the UVA non-irradiated abdomen following UVA irradiation on the backs of mice systemic suppression of contact hypersensitivity was observed. 2. The plasma level of prostaglandin E in UVA irradiated mice increased the first day after irradiation and then gradually decreased up to 10 days following irradiation. 3. The contact hypersensitivity of indomethacin only treated mice was depressed. The contact hypersensitivity of combined indomethacin and UVA treated mice was depressed as much as indomethacin only treated mice. 4. With respect to numeric changes of the epidermal Langerhans cells after UVA exposure, the lowest Langerhans cell count occurred 1 day after irradiation. Recovery of the Langerhans cell count did not start until 10 days after UVA exposure. However, the cell count had almost recovered by 20 days after UVA exposure. From the above results, it may be concluded that the cause of systemic suppression of contact hypersensitivity in mice after high dose of UVA exposure appears to be an increased level of prostaglandin E in plasma. However, since the biological characteristics of UVA are different from those of UVB, the cause of systemic suppression by UVA could be the release of other soluble mediators from the skin, except prostaglandin, which inhibit the efferent pathways of contact hypersensitivity. Considering the suppression of contact sensitivity by systemic indomethacin treatment, arachidonic acid and hydroperoxyeicosatetranoic acid (HETE), the metabolites of lipooxygenase in arachidonic acid metabolism, may be the possible mediators of suppression of contact hypersensitivity in mice. The metabolites of cyclo-oxygenase may be the possible mediators of induction of contact hypersensitivity. The decreased Langerhans cell count in irradiated-only skin suggests that the Langerhans cell count decreases following direct UVA exposure.restrictio

Quantitative study of epidermal LC in vitiligo

의학과/석사[한글] 백반증의 기전과 Langerhans세포(LC)의 숫적변화에 대해서 여러가지 많은 보고들이 있으나 아직 정설이 없는 상태이다. 더우기 백반증병변 및 바로 인접한 정상피부에서의 표피 LC수의 변화에 관한 문헌보고는 찾아 볼 수 없는 실정이다. 이에 저자들은 전신성 백반증환자 18명을 대상으로 백반증 병변피부와 인접정상피부에서 표피LC수의 차이를 조사하기 위하여 본 연구를 착수하였다. 본 연구에서 Adenosine triphosphatase ( ATPase )염색법으로 LC를 염색하고, eye piece micrometer로 표피LC밀도를 mm**2당 세포수로 계산하여 다음과 같은 결과를 얻었다. 1. 병변표피에서의 ATPase양성 LC수는 신체부위별로 차이가 많아서 1mm**2당 세포수는 581±21개 내지 1647±110개였으며, 평균 세포수는 1006.7±337개였다. 2. 인접정상표피에서의 ATpase양성 LC수 역시 신체부위별로 차이가 많아서 1mm**2당 세포수는 668± 65개였으며, 1241±31개 였으며, 평균세포수는 944±258개였다. 3. 백반증환자의 인접정상표피의 ATPase 양성 LC수는 통계학적으로 유의한 차이가 없었다. 이상의 결과로 보아 ATPase 양성 LG수의 변화와 백반증의 병인론과는 유의한 관계가 없는 것으로 사료된다. Quantitative Study Of Epidermal LC in Vitiligo Seung Kyung Hann Department of Medical Science, The Graduate School, Yonsei University (Directed by Professor Yoon-Kee Park, M.D.) There has not been an established theory regarding mechanism of vitiligo, although many articles about the relationship between mechanism of vitiligo and numeric change of epidermal Langerhans cell (LC) have been reported. In addition the reports about numeric change of LC between vitiliginous skin (VS) and adjacent normal apperring skin (ANAS) are impossible to find. Epidermal LC densities in VS and ANAS were studied in 18 patients withigeneralized vitiligo. Adenosine triphosphatase (ATPase) stain was used to characterize LC. Epidermal LC densities were calculated by means of an eye piece micrometer and expressed per mm**2. The results were as follows: 1. There was significant body site variation of LC densities on VS and the range of densities of LC per mm**2 were from 581±21 to 1647±110 and the mean density of LC per mm**2 was 1006.7±337. 2. There was also significant body site variation of the densities on ANAS and the range of densities of LC per mm**2 were from 668±165 to 1241±31 and the mean density of LC per mm**2 was 944±258. 3. The LC densities of VS was similar to that of ANAS (p: not significant). In conclusion quantitative change of epidermal LC in vitiligo doesn't seem to have significant relation with pathogenesis of vitiligo. [영문] There has not been an established theory regarding mechanism of vitiligo, although many articles about the relationship between mechanism of vitiligo and numeric change of epidermal Langerhans cell (LC) have been reported. In addition the reports about numeric change of LC between vitiliginous skin (VS) and adjacent normal apperring skin (ANAS) are impossible to find. Epidermal LC densities in VS and ANAS were studied in 18 patients withigeneralized vitiligo. Adenosine triphosphatase (ATPase) stain was used to characterize LC. Epidermal LC densities were calculated by means of an eye piece micrometer and expressed per mm**2. The results were as follows: 1. There was significant body site variation of LC densities on VS and the range of densities of LC per mm**2 were from 581±21 to 1647±110 and the mean density of LC per mm**2 was 1006.7±337. 2. There was also significant body site variation of the densities on ANAS and the range of densities of LC per mm**2 were from 668±165 to 1241±31 and the mean density of LC per mm**2 was 944±258. 3. The LC densities of VS was similar to that of ANAS (p: not significant). In conclusion quantitative change of epidermal LC in vitiligo doesn't seem to have significant relation with pathogenesis of vitiligo.restrictio

Recurrence of nevus depigmentosus after an autologous epidermal graft.

ope

Quality of life for Korean patients with vitiligo: Skindex-29 and its correlation with clinical profiles

Vitiligo considerably influences the psychological well-being of patients. Disease-induced disfigurement can cause patients to experience a high level of stigmatization, which can lead to psychosocial stresses and negative impacts on quality of life (QOL). This study aims to ascertain the QOL of vitiligo patients compared to patients with other mild skin disorders. We also attempt to study which clinical features of vitiligo are closely related to the patient's QOL. One hundred and thirty-three vitiligo patients and 112 patients with mild skin disorders were analyzed. All participants were asked to fill out questionnaires covering comprehensive clinical profiles and the Korean version of Skindex-29. Statistical correlation between Skindex-29 and each clinical profile were analyzed. The symptom scale of Skindex-29 was significantly lower in vitiligo patients than in controls, but the function scale and the emotion scale were significantly higher in the vitiligo group than in controls. However, the difference in function scales between groups was significant in female patients, but not in male patients. Several clinical profiles, such as duration of disease, severity scores and previous history of treatments, showed close correlations with the function scale. Family history of vitiligo, Köebner phenomenon, patients' perspectives on disease prognosis, and discordance of the severity scores between physicians and patients also influenced the Skindex-29 subscales differently. In conclusion, the present study suggests that patients with vitiligo were highly affected in the functional and emotional aspects of QOL, with some sex differences. Various clinical features may play an important role in the QOL of vitiligo patientsope

siRNA-mediated knock-down of COX-2 in melanocytes suppresses melanogenesis.

Cyclooxygenase-2 (COX-2) is an enzyme induced in response to multiple mitogenic and inflammatory stimuli, including UV light. UV-induced COX-2 expression induces production of prostaglandin E2 (PGE2) in keratinocytes, which mediates inflammation and cell proliferation. Until recently, studies regarding COX-2 and PGE2 in the skin have focused on keratinocytes and skin cancer and the effect of PGs produced by keratinocytes on melanocytes. However, the effects of COX-2 itself or COX-2 inhibitors on melanogenesis are not well known. Therefore, to establish the role of COX-2 in melanogenesis, we investigated the effects of knock-down of COX-2 in melanocytes on melanin production and the expression of melanogenic molecules through silencing of COX-2 expression with COX-2 short interfering RNA (siRNA). COX-2 knock-down in melanocytes decreased the expressions of tyrosinase, TRP-1, TRP-2, gp100 and MITF and also reduced tyrosinase enzyme activity. Furthermore, COX-2 siRNA-transfected melanocytes showed markedly reduced alpha-melanocyte stimulating hormone (α-MSH)-induced melanin production. In addition, α-MSH-induced COX-2 expression in both scrambled siRNA-transfected and COX-2 siRNA-transfected melanocytes was greater than α-MSH-untreated cells. Our results suggest that COX-2 might be a candidate target for the development of anti-melanogenic agents and α-MSH-induced pigmentation could be closely associated with COX-2 expression. COX-2 inhibitors might therefore be of particular use in whitening cosmetics for hyperpigmentation disorders such as melasma, postinflammatory hyperpigmentation and solar lentigo.ope

The possibility of misdiagnosis of generalized vitiligo as pigmentary disease

ope