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Dr. Thomas Matschurat, Steinkirchnerstraße 8, D 82166 Gräfelfing, Tel. 089-8982650

 
(A) Studien zu Phenylalanin und UV-Licht-Bestrahlung in deutscher Sprache 

(Reihenfolge der Auflistung der Studien: Deutsch: gemischt; Englisch in der Reihenfolg der Veröffentlichung)
 

L-Phenylalanin mit UV-Licht:

L-Phenylalanin ist eine Vorstufe von Tyrosin und eine Vorstufe von Melanin.

Experimentelle Untersuchung: 21 Ptn. wurden mit 100 mg/kg L-Phenylalanin oral und UVA-Bestrahlung behandelt. 10 dieser Ptn. wurden zusätzlich an den vitiliginösen Stellen mit einer 10%igen Phenylalanin-Creme behandelt, und diese Gp. hatte die besten Resultate. Bei keiner der Gpn. gab es Nebenwirkungen [Antoniou C et al. Vitiligo therapy with oral and topical phenylalanine with UVA exposure. Int J Dermatol 28(8):545-47, 1989].

 Experimentelle Untersuchung: 13 Kinder wurden mit L-Phenylalanin supplementiert und mit ultraviolettem Licht (UVA) bestrahlt. Bei 3 kam es zu einer Repigmentierung aller vitiliginösen Stellen, bei 6 Kindern zu einer 50 — 90%igen Besserung, und 4 besserten sich nicht. Keines der Kinder zeigte Nebenwirkungen [Schulpis CH et at. Phenylalanine plus ultraviolet light: preliminary report of a promising treatment for childhood vitiligo. Pediatr Dermatol 6(4):332-35, 1989

Experimentelle Untersuchung: 20 Ptn. wurden mit 50 mg L-Phenylalanin pro kg Körpergewicht und UVA-Bestrahlung behandelt. 85 % zeigten eine follikuläre und partiell konfluierende Repigmentierung, die 50 % der vitiliginösen Fläche nicht überschritt [Thiele B, Steigleder GK. [Repigmentation treatment of vitiligo with L-phenylalanine and UVA radiation.] Z Hautkr 62(7):519-23, 1987 (auf Deutsch)].

Experimentelle Untersuchung: Die Ptn. wurden 3 mal wöchentlich mit 50 mg Phenylalanin pro kg Körpergewicht behandelt und als Quelle für UVA dem Sonnenlicht ausgesetzt. 81 % besserten sich; 43 % sprachen innerhalb von 3 Monaten an. Ein Ptn. blieb zu lange in der Sonne. Die Repigmentierung war vorwiegend follikulär [Kuiters GR et al. Oral phenylalanine loading and sunlight as source of UVA irradiation in vitiligo on the Carribean island of Curacao NA. J Trop Med Hyg 89(3):149-55, 1986].

Experimentelle Untersuchung: Die Patienten erhielten 50 mg/kg Phenylalanin zusammen mit einer UV-Licht-Bestrahlung 30 — 45 Minuten nach der Einnahme (der Zeit der maximalen Konzentration im Blut). Nach 4 Mo. (32 Behandlungen) trat eine „vernünftige” Repigmentierung auf. Abgesehen von der Repigmentierung von unterpigmentierten Flecken konnten die Patienten mehr Sonne vertragen als gewöhnlich, besonders an der vitiliginösen Läsion [Cormane RH et al. Phenylalanine and UVA light for the treatment of vitiligo. Arch Dermatol Res 277(2):126-30, 1985]. 

 

(B) Studien zu Phenylalanin und UV-Licht-Bestrahlung in englischer Sprache

 (Reihenfolge: zuerst ältere, dann neuere Studien)

  
L-Phenylalanine and UVA/sunlight for vitiligo.
Arch Dermatol Res 1985;277(6):509    (ISSN: 0340-3696)
Cormane RH; Siddiqui AH

 
Phenylalanine and UVA light for the treatment of vitiligo.
Arch Dermatol Res 1985;277(2):126-30    (ISSN: 0340-3696)
Cormane RH; Siddiqui AH; Westerhof W; Schutgens RB
The administration of phenylalanine (Phe) combined with UVA exposure was found to be effective in vitiligo. Phe is an amino acid which constitutes part of the daily dietary protein, and when orally administered in a dose of 50 mg/kg body weight, it results in an elevated plasma level. Since peak concentrations of Phe in the blood are reached between 30 and 45 min after ingestion, UVA exposure was administered at this time. After 4 months (32 treatments) reasonable repigmentation preferentially occurred in the skin area of subcutaneous fat (adipose tissue). Apart from the repigmentation of hypo-pigmented macules, vitiligo patients can tolerate more sun than usual, especially at the vitiliginous lesion, and they experience no sunburn as a result of Phe-UVA therapy. Normal skin also tans very well.

 
Oral phenylalanine loading and sunlight as source of UVA irradiation in vitiligo on the Caribbean island of Curacao NA.
J Trop Med Hyg 1986 Jun;89(3):149-55    (ISSN: 0022-5304)
Kuiters GR; Hup JM; Siddiqui AH; Cormane RH
Recently, favourable results have been reported from oral L-phenylalanine (Phe) combined with UVA/sunlight irradiation (Phe-UVA) in the treatment of vitiligo. In the present pilot study vitiligo patients were treated on a thrice weekly scheme of 50 mg Phe.kg-1 body weight and exposed to sunlight as a source of UVA. An observed 81% response on the skin disorder correlates with earlier figures; 43% responded within 3 months. The self-controlled treatment includes the risk of over-irradiation, as possibly happened with one patient. The repigmentation was predominantly of follicular pattern. The assumption that Phe plays a central biochemical regulatory role in melanin, catecholamine and antibody synthesis forms an attractive challenge for the explanation of repigmentation.

 
Repigmentation treatment of vitiligo with L-phenylalanine and UVA irradiation]
[Repigmentierungsbehandlung der Vitiligo mit L-Phenylalanin und UVA-Bestrahlung (PAUVA).]
Z Hautkr 1987 Apr 1;62(7):519-23    (ISSN: 0301-0481)
Thiele B; Steigleder GK
20 patients suffering from vitiligo (17 with generalized, 3 with localized type) were treated with L-phenylalanine and UV-A irradiation (PAUVA). The dose of L-phenylalanine was 50 mg/kg per os. In 85% of the patients, this therapy resulted in a follicular and partially confluent repigmentation, which did not exceed 50% of the vitiliginous area.

 
Vitiligo therapy with oral and topical phenylalanine with UVA exposure.
Int J Dermatol 1989 Oct;28(8):545-7    (ISSN: 0011-9059)
Antoniou C; Schulpis H; Michas T; Katsambas A; Frajis N; Tsagaraki S; Stratigos J
Dermatologic Clinic of Athens University, Andreas-Sygros Hospital, Greece.
The administration of phenylalanine (Phe) combined with UVA exposure was found to be effective in treating vitiligo. Twenty-one patients with vitiligo were divided in two groups: eleven patients were treated with oral L-Phe in a dose of 100 mg/kg body weight and with UVA exposure and ten patients were treated with oral L-Phe in a dose of 100 mg/kg body weight and with UVA exposure. In addition, in the second group, a cream containing 10% L-Phe was applied to the vitiliginous areas. The best results occurred in the second group. No side effects were found in either group.

 
Phenylalanine plus ultraviolet light: preliminary report of a promising treatment for childhood vitiligo.
Pediatr Dermatol 1989 Dec;6(4):332-5    (ISSN: 0736-8046)
Schulpis CH; Antoniou C; Michas T; Strarigos J
Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece.
L-Phenylalanine is a promising agent for the treatment of vitiligo when taken orally and followed with ultraviolet light (UVA) irradiation. Of 13 children so treated, 3 experienced repigmentation of all vitiliginous areas, 6 showed 50% to 90% improvement, and 4 failed to respond. None of the children experienced side effects during the treatment

 
[Treatment of vitiligo using phenylalanine and UVA irradiation]
[Behandlung der Vitiligo mit Phenylalanin und UVA-Bestrahlung.]
Hautarzt 1990 Nov;41(11):636    (ISSN: 0017-8470)
Biella U; Haustein UF , Klinik fur Hautkrankheiten, Karl-Marx-Universitat, Leipzig
Dr. Th. Matschurat, Steinkirchnerstraße 8, D 82166 Gräfelfing,Tel. 089-8982650, Fax. -89826598

 
L-phenylalanine and UVA irradiation in the treatment of vitiligo.
Dermatology 1994;188(3):215-8    (ISSN: 1018-8665)
Siddiqui AH; Stolk LM; Bhaggoe R; Hu R; Schutgens RB; Westerhof W
Department of Dermatology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands.
In order to evaluate the efficacy of L-phenylalanine (L-Phe) in combination with UVA therapy for vitiligo an open trial (149 patients, 18 months) and a small double-blind trial (32 patients, 6 months) were conducted. Oral L-Phe loading resulted in peak plasma levels of L-Phe after 30-60 min and a slight increase in the plasma tyrosine level. Response to L-Phe plus UVA irradiation was positive, and various grades of repigmentation not exceeding 77% in the open and 60% in the blind trial were observed. An increased L-Phe dose resulted in increased L-Phe plasma levels but not in improved clinical results. The optimal L-Phe dose appears to be lower than 50 mg/kg/day. Although it is difficult to draw firm conclusions from the present investigation, we think that L-Phe may have a place in the treatment of vitiligo.

 
[Vitiligo therapy with phenylalanine/UV A. Catamnestic studies after five years]
[Vitiligo-Therapie mit Phenylalanin/UV A. Katamnestische Untersuchungen nach funf Jahren.]
Hautarzt 1994 Jul;45(7):460-3    (ISSN: 0017-8470)
Greiner D; Ochsendorf FR; Milbradt R
Zentrum der Dermatologie und Venerologie Abteilung II, J.W. Goethe-Universitat, Frankfurt am Main.
Since 1983 the administration of phenylalanine combined with UVA exposure (PAUVA) has been a well-known therapy for vitiligo. We have found no retrospective studies on this therapy. To document the long-term results and side effects, we performed a retrospective study on 41 patients who had received PAUVA therapy about 5 years ago. Examination was possible in 25 of the 41 patients, and 11 of them (44%) had permanent repigmentation. Depigmentation either during or after PAUVA therapy was recognized in 16 of the 25 patients (64%). In 52% of cases the patients were satisfied with the therapy and would repeat it; 68% would recommend it. Positive features in prognosis, i.e. indicative of good repigmentation, were vitiligo extending over less than 25% of the body surface, onset of vitiligo before the age of 21, generalized and symmetrical distribution and a long duration of UV therapy. None of our patients developed long-term side effects. PAUVA therapy is demonstrably a therapeutic alternative for certain patients.

 
Oral and topical L-phenylalanine, clobetasol propionate, and UVA/sunlight--a new study for the treatment of vitiligo.
J Drugs Dermatol 2002 Sep;1(2):127-31    (ISSN: 1545-9616)
Camacho F; Mazuecos J
Departamento de Dermatologia Medico-Quirurgica y Venereologia Hospital Universitario Virgen Macarena Avda. Doctor Fedriani s/n 41009, Sevilla, Spain. camachodp@medynet.com.
BACKGROUND: Vitiligo is a hypopigmented skin condition that usually requires a combination of treatment options. AIM: To demonstrate the effectiveness of topical and oral L-phenylalanine in combination with light plus 0.025% clobetasol propionate at night. PATIENTS AND METHODS: We have performed an open trial on a group of 70 patients with evolutive vitiligo. Participants were treated with oral (100 mg/Kg/day) and topical (gel at 10%) L-phenylalanine, exposed to sunlight (spring-summer) or UVA lamps (autumn-winter), and given 0.025% clobetasol propionate at night. All patients were revisited every 6 months while in the study, with a maximum of 4 revisits. Biochemical studies were performed at the beginning of the treatment and at each revisit. RESULTS: Overall, 90.9% of participants showed improvement, with 68.5% of patients achieving an improvement of 75% or more. This 75% improvement rate was reached 87.9% of the time on the face, 60.4% on the trunk, and 54.6% on the limbs. However, there was a moderate response to the treatment in patients with focal and segmental vitiligo. There was a slight additional improvement in patients receiving UVA lamp light. No biochemical abnormalities were found in any patients. CONCLUSION: L-phenylalanine in combination with 0.025% clobetasol propionate and sunlight during sunny months or UVA lamps in winter, appears to improve evolutive vitiligo without side effects, and therefore is especially recommended on the face or for children.


Kupfer in der Pathobiochemie der Vitiligo

 
Neutron activation analysis of trace elements in skin. VII. Copper and zinc in vitiligo, moles and seborrhoeic warts.
Br J Dermatol 1973 Apr;88(4):347-53    (ISSN: 0007-0963)
Molokhia MM; Portnoy B 

  
[Effects of heliotherapy on copper exchange in vitiligo]
[Wirkungsmechanismus der Heliotherapie auf den Kupferaustausch bei Vitiligo-Kranken.]
Z Physiother 1972 Nov-Dec;24(6):461    (ISSN: 0003-9357)
Zlatkov NB; Petkov I; Genov D; Bozhkov D 

 
Copper pathochemistry in vitiligo.
Clin Chim Acta 1972 Mar;37:207-11    (ISSN: 0009-8981)
Genov D; Bozhkov B; Zlatkov NB

 
[Copper metabolism disorders in vitiligo]
[Les troubles du metabolisme du cuivre dans le vitiligo.]
Ann Dermatol Syphiligr (Paris) 1972;99(1):29-40    (ISSN: 0003-3979)
Huriez C; Bizerte; Dequidt; Bialais

 
[Copper metabolism in vitiligo patients after heliotherapy]
[Kupferstoffwechsel bei Kranken mit Vitiligo nach Heliotherapie.]
Dermatologica 1971;143(2):115-20    (ISSN: 0011-9075)
Zlatkov NB; Petkov I; Genov D; Boshkov B

 
[Cupremia disorders in vitiligo]
[Les troubles de la cupremie dans le vitiligo.]
Bull Acad Natl Med 1970 Apr 14;154(13):271-81    (ISSN: 0001-4079)
Huriez C; Bizerte; Dequidt; Jacobesco MF
Treatment of vitiligo in children with copper sulfate]
[Lechenie vitiligo u detei sernokisloi med'iu.]
Vestn Dermatol Venerol 1979 Mar;(3):48-50    (ISSN: 0042-4609)
Bagaeva MI

 
[Complex treatment of patients with vitiligo]
[Kompleksnaia terapiia bol'nykh vitiligo.]
Sov Med 1973 Feb;36(2):123-7    (ISSN: 0038-5077)
Borisenko KK

 
Serum caeruloplasmin in vitiligo.
Indian J Med Sci 1970 Oct;24(10):678-9    (ISSN: 0019-5359)
Lal S; Rajagopal G; Subramanyam K 

  

Einige Studien zu Vitamin B12 und Folsäure bei der Behandlung der Vitiligo

(In der Reihenfolge der Veröffentlichung)

 
[Vitamin B 12 deficiency and vitiligo]
[Vitamin-B12-Mangel und Vitiligo.]
Blut 1969 Jul;19(4):223-5    (ISSN: 0006-5242)
Bleifeld W; Gehrmann G

 
[Vitamin B 12 resorption studies in vitiligo]
[Vitamin-B12-Resorptionsstudien bei Vitiligo.]
Dtsch Med Wochenschr 1967 Jun 9;92(23):1072-4    (ISSN: 0012-0472)
Bleifeld W; Gehrmann G

 
Pernicious anemia, vitiligo, and infertility.
J Am Board Fam Pract 1990 Jul-Sep;3(3):217-20    (ISSN: 0893-8652)
Gulden KD
Wilkes Family Health Center, North Wilkesboro, NC.
Though rarely encountered in women of childbearing age, untreated pernicious anemia has been found to be a cause of infertility. Once treated, conception often occurs within months. The case presented here is a woman who had a restoration of fertility after initiation of vitamin B12 treatment for vitiligo-associated pernicious anemia. Previous reports have shown the occurrence of pregnancy in treated pernicious anemia, but none has indicated the presence of vitiligo in the same patient. Pernicious anemia is a rare but treatable cause of infertility in women.

 
Folic acid and vitamin B12 in vitiligo: a nutritional approach.
Cutis 1992 Jul;50(1):39-42    (ISSN: 0011-4162)
Montes LF; Diaz ML; Lajous J; Garcia NJ
Department of Dermatology, University of Alabama, Birmingham Medical Center.
When compared with the normal population, patients with vitiligo often showed diminished blood levels of folic acid. In a group of fifteen patients with vitiligo, folic acid levels were below normal in the serum of eleven patients, in the whole blood of five patients, and in the erythrocytes of six patients. Vitamin B12 serum levels were below normal in five of the fifteen patients. Ascorbic acid plasma levels were also lowered in four of the patients. In eight patients prolonged oral administration of folic acid with simultaneous parenteral treatment with vitamin B12 and oral ascorbic acid was followed by definite repigmentation without side effects.

 
Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure.
Acta Derm Venereol 1997 Nov;77(6):460-2    (ISSN: 0001-5555)
Juhlin L; Olsson MJ
Department of Dermatology, University Hospital, Uppsala, Sweden.
The aim of this 2-year study was to test the hypothesis that folic acid, vitamin B12 and sun exposure could be helpful in treating vitiligo. One hundred patients with vitiligo were treated with oral folic acid and vitamin B12 after being informed that sun exposure might enhance repigmentation. They were requested to keep a record of sun exposure in summer and UVB irradiation in winter. The minimal treatment time suggested was 3-6 months but should be longer if improvement was achieved. Clear repigmentation occurred in 52 patients, including 37 who exposed their skin to summer sun and 6 who used UVB lamps in winter. Repigmentation was most evident on sun-exposed areas, where 38% of the patients had previously noted repigmentation during summer months. Total repigmentation was seen in 6 patients. The spread of vitiligo stopped in 64% of the patients after treatment. Folic acid and vitamin B12 supplementation combined with sun exposure can induce repigmentation better than either the vitamins or sun exposure alone. Treatment should continue as long as the white areas continue to repigment. Further studies are needed to determine ideal minimal dosages of vitamins and UV exposure, as well as treatment time.

 

Studien zu Vitiligo und oxidativer Stress bzw. Antioxidantientherapie

  
The role of oxidants and antioxidants in generalized vitiligo.
J Dermatol 2003 Feb;30(2):104-8    (ISSN: 0385-2407)
Yildirim M; Baysal V; Inaloz HS; Kesici D; Delibas N
Department of Dermatology, Faculty of Medicine University of Suleyman Demirel, Isparta, Turkey.
Oxidative stress may be induced by increasing the generation of reactive oxygen species (ROS) and other free radicals. The generation of ROS is known to be associated with a decrease in antioxidant levels. In the present study, the role of oxidative stress was assessed in the pathogenesis of generalized vitiligo. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione (GSH) levels in erythrocytes and serum malondialdehyde (MDA) and nitric oxide (NO) levels were investigated in 24 patients with generalized vitiligo and 20 healthy controls. Our results indicated that significantly increased levels of erythrocyte SOD, serum MDA, and NO were associated with a marked reduction of erythrocyte GSH-Px and GSH activities in patients with generalized vitiligo (p<0.05). Our observations suggest that the presence of an imbalance in the oxidant-antioxidant system might play a role in the pathogenesis of vitiligo. Our results further support the concept that free radical-mediated damage may be the initial pathogenic event in melanocyte degeneration in generalized vitiligo.

 
The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA.
Eur J Dermatol 2002 Jan-Feb;12(1):24-6    (ISSN: 1167-1122)
Akyol M; Celik VK; Ozcelik S; Polat M; Marufihah M; Atalay A
Department of Dermatology, Medical Faculty of Cumhuriyet University, 58140-Sivas, Turkey. makyol@cumhuriyet.edu.tr.
Solar-simulated UV-irradiation causes changes in the enzymic antioxidant defence system in the human epidermis. The aim of this study was to investigate the effects on the skin lipid peroxidation and clinical improvement in vitiligo patients treated with PUVA. The first group of patients was treated for six months with psoralen plus UV-A (n = 15). The second group of patients was treated for six months with psoralen plus UV-A vs vitamin E (900 IU daily perorally) (n = 15). There was no significant difference in the clinical improvement between the group of patients who were treated with PUVA and vitamin E and the group of patients treated with PUVA alone (p > 0.05). Statistical analysis revealed a significant difference between the levels of lipoperoxides before and after treatment in the first group (p <. 0.05), but there was no significant difference between the levels of lipoperoxides before and after treatment in the second group (p > 0.05). According to our results, vitamin E may prevent oxidative distress resulting from PUVA therapy, but does not affect the clinical improvement of the vitiligo lesions.
Role of antioxidants in the survival of normal and vitiliginous avian melanocytes.
Cell Mol Biol (Noisy-le-grand) 1999 Nov;45(7):1065-74    (ISSN: 0145-5680)
Bowers RR; Nguyen B; Buckner S; Gonzalez Y; Ruiz F
Department of Biology and Microbiology, California State University, Los Angeles, 90032, USA. rbowers@calstatela.edu.
Mutant feather melanocytes from Barred Plymouth Rock (BPR) and White Leghorn (WL) chickens are currently being used as avian models of vitiligo. Feather melanocytes in BPR and WL chickens die prematurely in vivo due to low (50-66%) antioxidant glutathione and superoxide dismutase levels when compared to the wild type Jungle Fowl (JF) melanocytes. Excess superoxide anions, generated by xanthine:xanthine oxidase (X:XO), caused a 15-20% increase in mortality after 1 and 2 hrs. in all three genotypes of in vitro melanocytes as compared to control values that received no X:XO. Overall, the JF wild type melanocytes had the lowest mortality rate, WL melanocytes had the highest mortality rate and the BPR melanocytes had an intermediate mortality rate. Superoxide anion and hydroxyl radical production in the WL feather were double the production in the JF wild type feather. The production of reactive oxygen species in BPR was intermediate to the other two genotypes. In an effort to mimic the low antioxidant levels of the BPR and WL feathers in the JF feather, JF in vitro feather melanocytes were treated with buthionine sulfoximine (BSO), a glutathione synthesis inhibitor. With BSO added to the medium, the JF mortality rates increased by 20-25%, reaching the mortality levels of the mutant BPR melanocytes. The addition of iron to the JF melanocyte X:XO medium increased their mortality rate by 20%, probably via the Fenton reaction. Thus, antioxidants play an extremely important role in both the viability of normal avian melanocytes and the premature death of the vitiliginous avian melanocytes. A working hypothesis, supported in part by the current results, is that the premature death of the mutant melanocytes could be precipitated in the poorly vascularized feather by low antioxidant protection due to both low turnover of tissue fluids which contain SOD and to genetically determined low levels of internal antioxidant protection in these melanocytes. This same mechanistic hypothesis could apply as "a" cause of premature melanocyte cell death in human vitiligo wherein the vitiliginous melanocytes may have a genetic defect in their antioxidant protection system and blood flow to an area may be restricted.

  
Alterations of mitochondria in peripheral blood mononuclear cells of vitiligo patients.
Pigment Cell Res 2003 Oct;16(5):553-9    (ISSN: 0893-5785)
Dell'Anna ML; Urbanelli S; Mastrofrancesco A; Camera E; Iacovelli P; Leone G; Manini P; D'Ischia M; Picardo M
Laboratorio di Fisiopatologia Cutanea, Istituto Dermatologico San Gallicano (IRCCS), Rome, Italy.
The possible role for a defective mitochondrial functionality in the pathogenesis of vitiligo was investigated by measuring intracellular levels of reactive oxygen species and of antioxidants, the activity of Krebs cycle enzymes, as well as the effects of inhibitors of the electron transport chain, in peripheral blood mononuclear cells from patients with active or stable disease vs. normal subjects. Plasma glyoxal levels were also determined in the same groups of subjects as an index of systemic oxidative stress. In patients with vitiligo in active phase, we observed an increased intracellular production of reactive oxygen species with a consequent imbalance of the prooxidant/antioxidant equilibrium, whereas plasma did not show apparent alterations in glyoxal levels, ruling out a systemic oxidative stress. In patients with stable disease, the balance between pro-oxidants and anti-oxidants seems to be maintained. Moreover, a marked increase in the expression of mitochondrial malate dehydrogenase activity and a specific sensitivity to electron transport chain complex I inhibitor were observed. Overall, these data provide further evidence for an altered mitochondrial functionality in vitiligo patients.

 
Epidermal oxidative stress in vitiligo.
Pigment Cell Res 1998 Apr;11(2):81-5    (ISSN: 0893-5785)
Passi S; Grandinetti M; Maggio F; Stancato A; De Luca C
Centro Invecchiamento Cellulare, Istituto Dermopatico dell'Immacolata (IRCCS), Roma, Italy.
Epidermal levels of enzymatic and non-enzymatic antioxidants such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), vitamin E (Vit E), ubiquinol (CoQ10H2), and reduced glutathione (GSH), as well as polyunsaturated fatty acids of phospholipids (PL-PUFA), were evaluated in the affected epidermis of 15 patients with active vitiligo (AVP) and in the corresponding epidermis of 15 healthy phototype matched controls. The epidermal levels of CoQ10H2, Vit E, GSH, and CAT activity were significantly reduced in AVP and were associated with a marked increase of oxidized glutathione, whereas SODs and GSH-Px activities and ubiquinone concentration remained similar to control values. Antioxidant deficiency, in particular the decline of lipophilic antioxidants, i.e., CoQ10H2 and Vit E, accounts well for PL-PUFA reduction observed in vitiligo epidermis, mainly affecting C18:3 n-3, C20:3 n-6, C20:4 n-6, and C22:6 n-3 fatty acids and suggesting the occurrence of a lipoperoxidative process. In conclusion, both an imbalance of the intracellular redox status and a significant depletion of enzymatic and non-enzymatic antioxidants feature the epidermis of AVP, and represent a fingerprint of an abnormal oxidative stress leading to epidermal cell injury.

 
Study on the antioxidant status of vitiligo patients of different age groups in baroda [In Process Citation]
Pigment Cell Res 2004 Jun;17(3):289-94    (ISSN: 0893-5785)
Agrawal D; Shajil EM; Marfatia YS; Begum R
Department of Biochemistry, Faculty of Science, M.S. University of Baroda, Vadodara, Gujarat, India.
One of the major hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis. Pollution plays a major role in the production of free radicals. Gujarat, a highly industrialized state in India has a high prevalence of vitiligo patients. No previous studies were done on the age-dependent antioxidant status of vitiligo patients in Baroda city, Gujarat. Blood samples were collected from vitiligo patients of different age groups (5-15, 16-25, 26-35, 36-45 yr) and from age matched healthy volunteers. Antioxidant enzymes in blood such as catalase, superoxide dismutase, glutathione peroxidase and non-enzymatic antioxidants such as reduced glutathione and plasma vitamin E were estimated. Lipid peroxidation levels in erythrocytes and the reducing equivalent system, i.e. glucose-6-phosphate dehydrogenase were also measured. Significant increase in superoxide dismutase activity and lipid peroxidation levels in erythrocytes was observed in all age groups of vitiligo patients as compared with age-matched healthy controls, wherein an increase of 55% (P < 0.02) was observed in superoxide dismutase activity and lipid peroxidation levels in 36-45 yr age group. Whole blood glutathione levels, erythrocyte glutathione peroxidase and glucose-6-phosphate dehydrogenase activity were decreased significantly, whereas erythrocyte catalase activity and plasma vitamin E levels were not different in vitiligo patients as compared with age-matched healthy controls. No specific age group showed a significant difference. This is the first report on the age-dependent antioxidant status of vitiligo patients in Baroda. The disease affects individuals of any age group as shown in this study and systemic oxidative stress might precipitate the pathogenesis of vitiligo in susceptible patients.

  
Oxidant-antioxidant enzymes and lipid peroxidation in generalized vitiligo.
Clin Exp Dermatol 2004 Jul;29(4):406-9    (ISSN: 0307-6938)
Koca R; Armutcu F; Altinyazar HC; Gurel A
Department of Dermatology, Zonguldak Karaelmas University, Faculty of Medicine, Zonguldak, Turkey. rafkoca@yahoo.com.
Vitiligo is a common pigmentary disorder of the skin with selective destruction of melanocytes. The pathogenetic mechanisms in vitiligo have not been completely clarified. The aim of our investigation was to evaluate the oxidative stress in the pathogenesis of generalized vitiligo. Twenty-seven patients with generalized vitiligo and 24 phototype-, age-, and sex-matched healthy controls were included in this study. We analysed serum levels of malondialdehyde (MDA), nitric oxide (NO), and serum activities of superoxide dismutase (SOD) and xanthine oxidase (XO) in the patients with vitiligo and in the controls. We found significantly higher levels of MDA and XO activity (P < 0.001 and P < 0.05, respectively), and a significantly lower level of serum SOD activity (P < 0.05) in patients with vitiligo compared with the controls. However, the increase in the level of serum NO was insignificant (P > 0.05). These results suggest that lipid peroxidation of cellular membrane of melanocytes by free radicals may have a significant role in the pathogenesis of generalized vitiligo.



UV-Behandlung bei Vitiligo (insbesondere UV-B-Schmalband 311 nm):

  
Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A.
Arch Dermatol 1997 Dec;133(12):1525-8    (ISSN: 0003-987X)
Westerhof W; Nieuweboer-Krobotova L
The Netherlands Institute for Pigmentary Disorders, Amsterdam, The Netherlands. snip-ww@knoware.nl.
OBJECTIVE: To compare the efficacy and safety of 2 treatment modalities, topical psoralen plus UV-A (PUVA) with unsubstituted psoralen and 311-nm UV-B radiation, in patients with vitiligo. DESIGN: This intervention study was designed as a before-and-after trial with 2 arms, in which patients were consecutively included. PATIENTS: Male (n = 99) and female (n = 182) patients, who predominantly had skin type III, with extensive, generalized vitiligo of more than 3 months' duration. INTERVENTIONS: Two patient groups were investigated. The first group of patients was treated for 4 months with either topical PUVA (n = 28) or 311-nm UV-B radiation (n = 78). The second group of patients, treated twice weekly with 311-nm UV-B radiation, was followed up for 3 (n = 60), 6 (n = 27), 9 (n = 37), or 12 months (n = 51). RESULTS: Thirteen (46%) patients in the first group treated with topical PUVA showed repigmentation after 4 months. Fifty-two patients (67%) in the 311-nm UV-B treatment group showed repigmentation after 4 months. After 3 months, 5 patients (8%) in the second group showed more than 75% repigmentation of lesional skin compared with 32 patients (63%) after 12 months. As in other treatment modalities, the face showed good repigmentation, whereas hands and feet responded poorly. No adverse effects were encountered with treatment with narrowband UV-B radiation, contrary to those seen with topical PUVA treatment. The cumulative UV-B dose was very small compared with that of the topical PUVA treatment. CONCLUSIONS: According to our results, the treatment of patients with vitiligo with 311-nm UV-B radiation is as efficient as with topical PUVA and has fewer adverse effects.

 
 
[Phototherapy with UV-B in vitiligo]
[Phototherapie mit UV-B bei Vitiligo.]
Z Hautkr 1990 Nov;65(11):1022-4, 1029    (ISSN: 0301-0481)
Koster W; Wiskemann A
Universitats-Hautklinik Hamburg.
We report on 14 patients suffering from extentise vitiligo, who underwent phototherapy with UVB. After 12 months of treatment, 8 (57.1%) of the patients showed repigmentation of more than 75%. Especially the patients with facial lesions of the skin types V and VI achieved a nearly complete and cosmetically very satisfying repigmentation.

  
Narrow-band UV-B micro-phototherapy: a new treatment for vitiligo.
J Eur Acad Dermatol Venereol 2003 Mar;17(2):171-7    (ISSN: 0926-9959)
Menchini G; Tsoureli-Nikita E; Hercogova J
Department of Dermosciences, University of Florence, Florence, Italy. g.menchini@dermatologia.it.
BACKGROUND: Vitiligo is a common, acquired, often familial, melanocytopenic disorder with focal depigmentation of the skin. There are several new treatments, that appear to have higher success rates than previous therapies for the treatment of vitiligo. Among these, the most promising one appears to be narrow-band UV-B therapy. OBJECTIVE: The aim of this open study is to evaluate the efficacy of the BIOSKIN micro-phototherapy in the treatment of vitiligo in 734 patients. SUBJECTS AND METHODS: Seven hundred and thirty-four individuals affected by vitiligo (segmental and non-segmental) were treated for 12 months with a new device called BIOSKIN that can produce a focused beam of narrow UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and every month thereafter for 12 months. The response to treatment was estimated in two comparable photographs using planimetry. The duration of the clinical study was of 2 years and 8 months. At the end of this period 734 patients had received each a mean of 24 sessions of treatment during a period of 12 months. RESULTS: Five hundred and ten subjects (69.48%) of the 734 achieved normal pigmentation on more than 75% of the treated areas. In particular, 112 of these were totally repigmented. One hundred and fifty-five (21.12%) individuals achieved 50-75% pigmentation of the treated areas, and 69 (9.40%) showed less than 50% repigmentation. No patients showed acute or chronic relevant adverse effects. CONCLUSION: BIOSKIN UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice for vitiligo limited to less than 30% of the skin surface.

 
UV-B radiation microphototherapy. An elective treatment for segmental vitiligo.
J Eur Acad Dermatol Venereol 1999 Sep;13(2):102-8    (ISSN: 0926-9959)
Lotti TM; Menchini G; Andreassi L
Department of Dermatology, University of Florence, Italy.
BACKGROUND: Vitiligo is a common disease of unknown cause that produces disfiguring white patches of depigmentation. Previous studies have suggested the effectiveness of UV-B radiation in generalized vitiligo (GV) therapy, but there was no evidence to support the same role for segmental vitiligo (SV). OBJECTIVE: The purpose of this study was to use UV-B radiation exclusively on vitiligo patches of individuals affected by SV to evaluate the effectiveness of this therapy. SUBJECTS AND METHODS: Eight individuals with SV were treated for 6 months with a new device called BIOSKIN that can produce a focused beam of UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and once a month thereafter for 6 months. The response to treatment was estimated in two comparable photographs using planimetry. A control group of eight individuals matched for sex and age was treated with placebo, using the same device but not releasing any kind of detectable light. RESULTS: After 6 months of microphototherapy five subjects of the eight studied achieved normal pigmentation on more than 75% of the treated areas. In particular, three of these were totally repigmented. Two individuals achieved 50-75% pigmentation of the treated areas, and only one showed less than 50% repigmentation. In the control group only one patient showed moderate repigmentation (less than 50%). CONCLUSION: UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice in the limited (segmental) forms of vitiligo.

 
Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index.
Arch Dermatol 2004 Jun;140(6):677-83    (ISSN: 0003-987X)
Hamzavi I; Jain H; McLean D; Shapiro J; Zeng H; Lui H
Division of Dermatology, Department of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada.
BACKGROUND: There is currently no quantitative tool for evaluating vitiligo treatment response using parametric methods. OBJECTIVE: To develop and apply a simple clinical tool, the Vitiligo Area Scoring Index (VASI), to model the response of vitiligo to narrowband UV-B (NB-UV-B) phototherapy using parametric tests. DESIGN: Prospective, randomized, controlled, bilateral left-right comparison trial. SETTING: North American tertiary care, university-affiliated phototherapy center. PATIENTS: Patients older than 18 years with stable vitiligo involving at least 5% of their total body surface in a symmetric distribution. INTERVENTION: Treatment with NB-UV-B was given 3 times a week to half of the body on all patients for either 60 treatments or 6 months. The contralateral side served as a no-treatment control. MAIN OUTCOME MEASURE: Repigmentation was assessed using the VASI, which was based on a composite estimate of the overall area of vitiligo patches at baseline and the degree of macular repigmentation within these patches over time. The VASI was validated separately against physician and patient global assessments. The overall reductions in VASI for NB-UV-B and control groups were modeled by multilevel regression with random effects and compared parametrically. RESULTS: The VASI scoring correlated well with both patient and physician global assessments (P =.05 and P<.001, respectively, using ordinal logistic regression). The extent of repigmentation after 6 months on the treated side was 42.9% (95% confidence interval, 26.7%-59.0%) vs 3.3% (95% confidence interval -19.3% to 30.0%) on the untreated side (P<.001). A significant difference between control and NB-UV-B groups was apparent within the first 2 months of therapy. The legs, trunk, and arms were much more likely to repigment than the feet and hands. CONCLUSIONS: The VASI is a quantitative clinical tool that can be used to evaluate vitiligo parametrically. Patients treated with NB-UV-B can be expected to achieve approximately 42.9% repigmentation of their vitiligo after 6 months of treatment, with the greatest response being achieved over the trunk and nonacral portions of the extremities.