Effect of Fluticasone Proprionate 0.05% on Narrow Band UV-B in Active Vitiligo
Patients With Active Non-segmental Vitiligo.Evaluation of the Efficacy of UVB and Fluticason Proprionate 0.05%1 moreRationale: Vitiligo vulgaris is a common acquired pigment disorder, which is characterised by the development of depigmented macules. It develops probably due to immunedestruction of melanocytes. Most effective therapies are immunsuppresive: local immunesuppressives like corticosteroids and calcineurin inhibitors phototherapy like PUVA and NB-UVB phototherapy. NB-UVB is the first choice A synergistic effect of UVA and topical corticosteroids (fluticasone proprionate 0.05% cream) has been described by Westerhof et al. in 1999. To our knowledge to date there are no publications comparing NB-UVB combined with a topical corticosteroid and NB-UVB alone. Objective: The objective of this study is to evaluate the clinical effects (onset and degree of repigmentation) of fluticasone proprionate 0.05% cream (thrice weekly) on NB-UVB phototherapy twice weekly for a period of 12 months. Study design: Prospective single blinded randomised controlled study. Study population: Consecutive patients ≥ 18 years, diagnosed with active vitiligo vulgaris who will receive NB-UVB phototherapeutic treatment at the Netherlands Institute for Pigment Disorders at the Academic Medical Centre (AMC), University of Amsterdam. Methods: The patient will be randomised for either NB-UVB phototherapy and fluticasone proprionate 0.05% cream or NB-UVB phototherapy alone for 12 consecutive months. Main study parameters/endpoints: The onset and degree of repigmentation is assessed by digital image analysis of a target lesion and blinded global physician assessment. Furthermore, the patients and doctors satisfaction will be assessed and changes of immunohistochemical parameters will be analysed in skin biopsies. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Subjects participating in the study will be asked to visit the institute 4 times. The time investment will be 20 minutes per visit. Additionally, patients will be asked for consent to take punch biopsies (3 mm) at the beginning and at the end of the treatment period. Hence, skin biopsies are not compulsory for participation in this study. Patients may chose to participate in the clinical non invasive part of the study. Known side effects of the NB-UVB phototherapy are redness, pruritus, xerosis cutis, burning sensation and conjunctivitis. These side-effects however, are largely dose-dependent and avoidable. Corticosteroid associated systemic side-effects (suppression of the adrenocortex) will be minimized by treating only a limited body surface [a maximum of 30% body surface] and by using an intermittent application scheme of three days a week in the long term treatment. The regions which are known to have a higher absorption are excluded (periorbital, axillary, inguinal and genital area). Both topical corticosteroids and NB-UVB are part of the Dutch and British guidelines for the treatment of vitiligo. There is no presumptive evidence or indication that the combination of these therapies may result in a higher risk of side effects. All together the burden due to the study is low and the risk for systemic or local side effects is low.
Punchgrafting Techniques for Vitiligo
Non-segmental VitiligoSegmental Vitiligo1 moreRationale: Punch grafting is a safe, simple and widely used technique for in vitiligo. However, no reliable data are available on the effect of punch depth and punch size. Objectives: Primary: to compare the efficacy and safety of different punchdepths and punchsizes in punch grafting in patients with segmental and non-segmental vitiligo. Secondary: to assess the practical aspects and patients preference of different punch grafting techniques. Study design: Prospective observer blinded randomised controlled study. Study population: 35 patients ≥ 18 years with segmental or stable non-segmental vitiligo who will receive regular treatment by punch grafting at the Netherlands Institute for Pigment Disorders (SNIP) at the Academic Medical Centre University of Amsterdam. Methods: Four depigmented regions on the trunk or upper extremities will be randomly allocated to either epidermal 1,5 mm punch grafting, epidermal 1mm punch grafting, dermal 1,5 mm punch grafting and dermal 1 mm punch grafting. After grafting, all regions will receive UV-therapy twice a week for 3 months. Three and six months after grafting, the repigmentation of the lesions will be assessed by measuring the outgrowth. Main study parameter/endpoint: Outgrowth of pigment after six months. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The study involves 16 additional punch grafts but no additional visits to our institute. Patients will not miss any regular treatment. The extra time due to participation in the study will be about 40 minutes. No increase of the risk of side effects is expected by placing 16 additional punch grafts. 1.
Comparative Study Using Dermabrasion vs CO2 Laser & Collagen Dressing vs Vaseline Gauze in MKTP...
VitiligoDepigmented Scars1 moreThe purpose of this study is to: Compare two different techniques in the melanocyte keratinocyte transplant procedure: Use of carbon dioxide laser versus use of dermabrasion Compare two different dressings in the melanocyte keratinocyte transplant procedure: vaseline impregnated gauze versus collagen dressing
Open-label Pilot Study of Abatacept for the Treatment of Vitiligo
VitiligoVitiligo is a chronic autoimmune disease with evidence of CTLA-4 involvement. We are performing a pilot study for the treatment of new onset or actively progressing vitiligo with abatacept to determine if weekly self-injections of medication lead to clinical improvement in vitiligo lesions.
Comparative Study of Surgical Treatment of Vitiligo
VitiligoA comparative study for the surgical treatment of vitiligo in which the same patient will receive in acromic and symmetric lesions of vitiligo dermabrasion with micro needling and on the other side dermabrasion with micro needling followed by the application of cell suspension (melanocytes and uncultured keratinocytes). These cells will be removed from the own patient through the skin of the scalp. After the surgical procedure, patients will be submitted to UVB-NB phototherapy sessions (twice a week) and evaluated for repigmentation of vitiligo lesions at 14 and 24 weeks of treatment.
Prostaglandin F2-alpha (PGF2α) in Vitiligo
Vitiligostudy the cutaneous expression of PGF2α in vitiligo patients and compare it with normal control subjects.
Metabolic Syndrome in Early Onset Versus Late Onset Vitiligo
Metabolic SyndromeVitiligoThis study aims at detection of possible associated metabolic syndrome with vitiligo and assessment of possible contribution of the age of onset of vitiligo.
Human Beta-defensin 1 in Vitiligo
VitiligoThere is a need to know the role of human beta defensin-1 in vitiligo pathogenesis and the probability of finding newer and effective therapy for vitiligo in the future.
The Investigation on the Expression of High Mobility Group Protein Box-1 (HMGB1) in Peripheral Blood...
VitiligoVitiligo is an acquired depigmented disorder that causes white spots on the skin due to the loss of melanocytes. It is a common disease which accounts for 0.5-1% of the whole population. It is a refractory skin disease with 25-50 thousand patients in Korea. And it is often caused in the exposed areas of the patient, causing a great deal of mental and social dysfunction in the patient's life, and may lead to suicide attempts.
Effect of Early Systemic Stabilization Therapy on Recent Onset Vitiligo
VitiligoVitiligo is a distressing disorder of depigmentation. In spite of multiple successful therapeutic regimens, disease relapse remains a challenge to patients and physicians. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T cell population predisposing to future disease relapses. The aim of this study was to assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6 months) vitiligo to control disease activity and minimize the possibility of recurrence.