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The present study was aimed at evaluating correlations between clinical response and the histochemical and immunohistochemical changes in vitiligo patches treated with narrow-band UVB phototherapy. Eighteen patients, 13 females and 5 males, aged between 15 and 67 years, affected by vitiligo were recruited and 14 patients completed the study. Before starting the narrow-band UVB treatment three biopsies were carried out on the lesional, perilesional and healthy skin of each patient, excluding the face. After 9 months treatment an additional biopsy was performed on repigmented skin areas adjacent to the lesional biopsy site. For the histochemical evaluation, the Masson-Fontana argentaffin reaction was carried out; for the immunohistochemical study, two antigens were studied: tyrosinase and HMB 45. Clinical improvement was assessed by evaluating the repigmented surfaces, expressed in percentages of the respective vitiligo areas. The results obtained confirm the effectiveness and safety of narrow-band UVB phototherapy for vitiligo, in terms of both good clinical-histological results and absence of important side effects. In addition to attesting the efficacy of narrow-band UVB phototherapy, immunohistochemical tests also appeared to have a potential interest for prognostic purposes.

Chronic actinic dermatitis (CAD) groups together all chronic photodermatosis with light photosensitivity. We report the case of a 69-year-old man who, for over one year, had presented a reddish-brown erythema and shedding, with thickened and hypo-elastic skin on the face, scalp, neck and on the back of the hands and forearms. Patch tests were positive to isoeugenolo 1% and photo-patch tests showed a positivity to phenotiazine 2%. After a short and ineffective treatment with beta-carotene and photo-protectors, the clinical picture was resolved with the administration of oral steroids but with a relapse of the dermatitis once the dosage was lowered. We therefore started treatment with cyclosporine-A (4.5 mg/kg/die), which resulted in a rapid improvement of the clinical picture, but with a reappearance of the manifestations when the dosage was lowered. The treatment was resumed and we observed that the dose of 1.5/mg/kg/die resulted morbus-static. The patient is still being treated with this drug at this dosage. The result is that the disease is under control and no side effects are present. As we consider CAD an invalidating disease it seems to us that Cy-A could be taken into consideration as an alternative to traditional treatments.

The literature reports about thirty cases of bullous pemphigoid (BP) which developed in patients affected by multiple sclerosis (MS), although a relationship between these two diseases has not yet been identified. We report two cases of female patients affected by MS who subsequently developed BP. Two women came to our observation because of the presence of a bullous dermatitis. One, aged 54, had been affected by rapidly evolving MS for three years while the other, aged 60, had been suffering from MS since the age of 43. The clinical suspicion of BP was confirmed by cytodiagnostic examination, histology and immunofluorescence. Parenteral steroid therapy produced a rapid improvement of the clinical picture in both cases with a relapse after one year. On the basis of the cases observed, in which BP appeared in the absence of known potential triggering causes, and following a revision of the literature, we agree with those authors who assert that the two diseases could, even though only sporadically, be correlated and we think that the neurological disease could be the cause of the manifestations through immunological pathogenetic mechanisms.