Search

Background:Melasma is the most common and distressing pigmentary disorder presenting to dermatology clinics. Various treatment protocols for melasma have been suggested in the previous literature and applied in various clinical settings. However, no satisfactory therapy has been widely accepted.Objective:To evaluate the efficiency and safety of a combination treatment with fractional Q-switched ruby laser (QSRL) and intense pulsed light (IPL) for melasma in Chinese population.Methods:Fifty-three Chinese melasma patients were enrolled in this study. Each patient underwent 2 courses of treatments at 2-week interval. One course was composed of 3 successive sessions of 694-nm fractional QSRL at intervals of two weeks followed by one IPL. The efficacy was evaluated by non-invasive measurements and subjective assessments. The adverse effects were recorded.Results:Mean melanin index (MI) and erythema index (EI) significantly decreased from 216.1 and 381.8 pre-treatment to 167.8 and 310.3 post-treatment, respectively. Mean melasma area and severity index (MASI) decreased dramatically from 14.66 before treatment to 5.70 after the final treatment. These values remained at low levels at 3-month follow-up. The percentage of patients who achieved moderate or significant improvements was 73.6%. Adverse effects of QSRL and IPL were minimal.Conclusion:The combination treatment of fractional QSRL and IPL would be a promising modality for managing melasma in Chinese patients. [ABSTRACT FROM AUTHOR]

Background:Vitiligo is an acquired depigmenting disease with uncertain etiopathogenesis and the treatment modalities need to be consistently updated.Aim:To evaluate a triple-combination treatment with oral α-lipoic acid (ALA), betamethasone injection, and narrowband ultraviolet B (NB-UVB) on vitiligo.Methods: Patients with non-segmental and progressive vitiligo lesions were randomly assigned to two groups. The treatment group and the control group were respectively treated with oral ALA and placebo, in combination with betamethasone injection and NB-UVB. The effectiveness and adverse events were evaluated by investigators and patients before and after treatment.Results:Fifty non-segmental progressive vitiligo patients were enrolled in the study. The treatment period was 6 months. In treatment group, over 40% patients achieved > 50% improvement and ≥ 5 satisfaction score by 3-month therapy (M3). This percentage increased to 90% at M6. Treatment group achieved better efficacy than control group at M3, while no difference was seen at M6.Conclusion:The combined treatment with oral ALA, betamethasone injection, and NB-UVB was effective and safe on non-segmental progressive vitiligo. ALA could accelerate the initial response of repigmentation. [ABSTRACT FROM PUBLISHER]

ABSTRACT A 8-year-old Chinese boy with generalized pustular psoriasis (GPP) refractory to cyclosporine and methylprednisolone was treated successfully with two infusions of infliximab 3.3 mg/kg. He remained in remission for 21 months. Direct sequencing of IL36RN gene showed a homozygous mutation, c.115 + 6T>C. Juvenile GPP is a rare severe form of psoriasis occasionally associated with life-threatening complications. Like acitretin, cyclosporine and methotrexate, infliximab has been reported to be effective for juvenile GPP in case reports. However, there is a lack of data in the optimal treatment course of infliximab for juvenile GPP. Prolonged administration of these medications may cause toxic or fatal complications. We suggest that short-term infliximab regimen should be recommended as a choice for acute juvenile GPP refractory to traditional systemic therapies. WBC count and CRP are sensitive parameters to reflect the disease activity and evaluate the effectiveness of treatment. Monitoring CD4 T lymphocyte count, preventing and correcting CD4 lymphocytopenia are important in the treatment course of juvenile GPP. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is an acquired cutaneous hypopigmentary disorder, which characterized by solitary or multiple depigmented maculae or patches. The 308-nm excimer laser has been used as phototherapy on vitiligo.Objective: To evaluate the efficacy and safety of 308-nm excimer laser on vitiligo.Methods: Randomized controlled trials were searched to conduct a systematic review. The keywords were identified as laser/excimer laser/quasimolecule/XeCl” and “vitiligo”.Results: Seven studies with 390 vitiligo patients were included. No significant differences were seen between 308-nm excimer laser and 308-nm excimer lamp on either ≥75% or ≥50% re-pigmentation rate, or between 308-nm excimer laser and narrowband-ultraviolet B (NB-UVB) on either 100% or ≥75% re-pigmentation rate. More patients or lesions achieved ≥50% re-pigmentation rate by 308-nm excimer laser treatment than by NB-UVB treatment. The side effects of 308-nm excimer laser were slight and tolerable.Conclusions: The 308-nm excimer laser showed equivalent efficacies to 308-nm excimer lamp control and NB-UVB control concerning ≥75% re-pigmentation rate of vitiligo patches. More studies with high methodological quality, low risk of bias and more sample size are needed to confirm the conclusion. [ABSTRACT FROM PUBLISHER]

Objective: To assess the effect and safety of NB-UVB for vitiligo using an evidence-based approach. Methods: Randomized controlled trials (RCTs) on the treatment of vitiligo with NB-UVB were identified by searching PubMed and the Cochrane Library. The primary outcome was re-pigmentation degree. Results: A total of seven RCTs involving 232 participants with vitiligo were included in this systematic review. The methodological qualities of included studies were generally moderate. Two trials compared narrow-band ultraviolet B (NB-UVB) with UVA control, showing no significant differences between two methods on the number of patients who achieved >60% re-pigmentation [relative risk (RR) = 2.50, 95% confidence interval (CI): 0.11–56.97,p > 0.05]. Two trials compared NB-UVB with psoralens plus UVA (PUVA) control, and no difference was seen between the two treatments on the number of patients who achieved >50 re-pigmentation (RR = 1.16, 95% CI: 0.64–2.11,p > 0.05) or >75% re-pigmentation (RR = 2.00, 95% CI: 0.89–4.48,p > 0.05). Three trials compared NB-UVB with 308-nm excimer light/laser (EL) control, and again no significant difference was found between the two methods (p > 0.05). The adverse events of NB-UVB in the included studies were slight and tolerated. Conclusion: NB-UVB showed equivalent efficacies to UVA, PUVA or 308-nm EL control in the treatment of vitiligo. Side effects of NB-UVB were acceptable. More RCTs were needed to validate the results. [ABSTRACT FROM PUBLISHER]

Vitiligo on extremities and/or bony prominences is very resistant to treatment. Twenty-five patients with symmetrical and stable vitiligo on extremities and/or bony prominences were enrolled. The treatment side received fractional carbon dioxide laser followed by topical compound betamethasone solution and narrowband ultraviolet B phototherapy. The control side received laser treatment plus phototherapy. The result of treatment side showed that 44% patients achieved over 50% re-pigmentation and patient satisfaction score was 5.12 ± 3.23, higher than those of control ( p < 0.05). Adverse events were slight and tolerable. The triple combination treatment could be used as an alternative modality for refractory vitiligo. [ABSTRACT FROM AUTHOR]

A man developed with multiple warts on his hands and the inner canthus of his left eye. We applied local hyperthermia on a single target lesion on his hand at a surface temperature of 44°C for 30 minutes on Days 1, 2, 3, 17, and 18. All the lesions treated with or without heat cleared 8 weeks after the last treatment. Treatment of a target lesion resolved all other untreated lesions, a fact suggestive that local hyperthermia could induce activation of specific immunity against human papillomavirus on the lesional skin, which lead to resolution of all the warts. [ABSTRACT FROM AUTHOR]

Background: Studies of lasers or intense pulsed light (IPL) on facial port wine stain (PWS) were frequently reported. Neck PWS was seldom concerned. Objective: This paper was aimed to identify the efficacy and safety of IPL in the treatment of neck PWS in Chinese patients. Methods: Twenty-nine Chinese patients with neck PWS were enrolled to receive IPL therapy for five sessions at an interval of 4- to 5 weeks. The parameters were set as cut-off filters of 560 nm, single pulse with pulse width of 6 ms and fluence of 20-24 J/cm2 or double pulse with pulse width of 4.5-5.0 ms, pulse delay of 15-30 ms, and fluence of 18-25 J/cm2. The efficacy was evaluated using subjective assessment and non-invasive measurement. The adverse effects were recorded. Results: Over 60% patients achieved more than 50% improvement and over 50% participants were very satisfied or satisfied with the treatment. The participants less than 18 years old achieved better efficacy than the participants over 18 years old. The red or purple lesions gained better response to IPL treatment than the pink lesions. Adverse effects were limited. Conclusion: IPL is effective in neck PWS of Chinese population. Adverse effects were minimal and acceptable. [ABSTRACT FROM AUTHOR]

Adult colloid milium is a rare cutaneous deposition disorder that frequently involves areas of chronic sun exposure. The most common clinical presentation exhibits multiple, firm, and amber-colored papules that cluster to form large plaques. Histologically, there are masses of amorphous, eosinophilic material expanding the papillary dermis, and at times extending into the mid-dermis, with adjacent solar elastosis. When this disorder affects the face, disfiguring is of great concern and treatment is often sought. Attempts to safely remove colloid milium are generally unsuccessful. Dermabrasion has been reported to be effective. The present authors present a case with extensive facial colloid milium successfully ablated by the fractionated CO2 laser. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 40-year-old man diagnosed with universal vitiligo and had been treated with topical nitrogen mustard. The patient underwent physical examination which revealed the presence of depigmented and hyperpigmented macules and patches on his neck, genitalia and extremities. Physicians asked patient to discontinue the use of nitrogen mustard after they discovered malignant nature of skin lesions on patient body during biopsy.

Information about the International Vitiligo Symposium, held November 16-18, 2012 in Shenyang, China is presented. The symposium featured a presentation by Robert A. Schwartz regarding anti-oxidant therapy for vitiligo. It also highlighted results from the treatment of melasma in the country using fractional ruby laser.