PUVA therapy specifics of vitiligo in      childhood1Čárska       N, 2Bernadičová K, 1,2Hegyi V, 1,2Danilla T.1Department ...
Ethiologic hypotheses forvitiligo Genetic Biochemical   Autoimmune melanocyte                destruction Neural Immuno...
UV induced repigmentation Stabilization of the abnormal immune responses +  depigmentation Stimulation of the melanocyti...
Systemic PUVA therapy Oral intake capsule (2 hours before UVA) of 8-MOP Psoralens oral intake - metabolized after 24 hou...
Side effects Acute                 Chronic     Conjunctivitis        Lentiginosis     Keratitis             Aging of...
Local PUVA therapy Balneo-PUVA   “Sheet bath PUVA” Psoralens in:   cream   ointment   Solution application 30 min -...
Plastic sheet bath PUVA Polypropylen sheet (4x4m) 150 litres water in the  bathtube On the sheet (4-5 l of 8-  MOP) sol...
Case no.1 - history Age: 15 Family history: grandfather –vitiligo, grandmother psoriasis,  aunt - thyreopathy Personal ...
Case no.1 patient seen by dermatologist since 2000 with findings of  hypopigmentated areas around eyes, elbows and knees...
Case no.1 – clinical findings Bilateral symetrical elbows, ankles, knees, face, chin and  fingers of upper limbs – sharpl...
Case no.1 – laboratory findings Inflammatory parameters slightly elevated ANA: ++ Thyroid hormones:       TSH, anti-thy...
Therapy Balneo PUVA fotochemotherapy 1. cycle - total body initial dose 0,7J/cm2, cumulative dose  90,8J/cm2, average do...
Before   After
Case no.2 - history Age: 8 Family history: father –vitiligo, treated for thyreopathy Personal history: normal birth, no...
Case no.2 Patient seen by dermatologist since 2007 – vitiligo Hypopigmented areas were observed after intensive sun-  ta...
Case no.2 – clinical findings Both lower limbs, medial areas of thighs, knees – non  symetrical multiple sharply bordered...
Case no.2 – laboratory findings FW: 6/17, CRP: 1,1mg/l, ASLO: normal values, other  laboratory tests – normal values Thy...
Therapy Balneo PUVA fotochemotherapy initial dose 0,5J/cm2, cumulative dose 78,9J/cm2, average  dose 2,63J/cm2 Very goo...
Before   After
“Special technique”
Thank you foryour attention
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Carska, bernadicova puva specifics of vitiligo in childhood

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PUVA therapy specifics of vitiligo in childhood
Stabilization of the abnormal immune responses + depigmentation
Stimulation of the melanocytic reserves in the outer root sheath of the hair follicle

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This PPT is loaded as student material "as is", from the VRF Vitiligo Master Class Barcelona November 2011; VRF does not endorse or otherwise approve it.

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Carska, bernadicova puva specifics of vitiligo in childhood

  1. 1. PUVA therapy specifics of vitiligo in childhood1Čárska N, 2Bernadičová K, 1,2Hegyi V, 1,2Danilla T.1Department of Pediatric DermatovenereologyComenius University Bratislava, Slovak Republic2Children Hospital in Bratislava
  2. 2. Ethiologic hypotheses forvitiligo Genetic Biochemical Autoimmune melanocyte destruction Neural Immunologic
  3. 3. UV induced repigmentation Stabilization of the abnormal immune responses + depigmentation Stimulation of the melanocytic reserves in the outer root sheath of the hair follicle Tamesi M.E.B, Morelii J.G. Vitiligo Treatment in Childhood: A State of the Art Review. Pediatric Dermatology. 2010;27 (5):437-445.
  4. 4. Systemic PUVA therapy Oral intake capsule (2 hours before UVA) of 8-MOP Psoralens oral intake - metabolized after 24 hours Excretion after 12-24 hours Dose: J/cm2 Usually 2x per week (25x)
  5. 5. Side effects Acute  Chronic  Conjunctivitis  Lentiginosis  Keratitis  Aging of the skin  Sunburn  Actinic keratosis  Nauzea  Hypertrichosis  Vomitus  Skin cancer  Headache  PUVA itch  Dizziness
  6. 6. Local PUVA therapy Balneo-PUVA  “Sheet bath PUVA” Psoralens in:  cream  ointment  Solution application 30 min - 1 hr before UVA exposure
  7. 7. Plastic sheet bath PUVA Polypropylen sheet (4x4m) 150 litres water in the bathtube On the sheet (4-5 l of 8- MOP) solution Pacient is immersed in the solution for 15 minutes Followed by UVA exposure within 15 minutes Benefit – costs savings
  8. 8. Case no.1 - history Age: 15 Family history: grandfather –vitiligo, grandmother psoriasis, aunt - thyreopathy Personal history: normal birth, mother had muscle- convulsions of unknown etiology after birth, frequent infections of airways, dispensarized for struma eufunct., vitiligo Medicaments: none
  9. 9. Case no.1 patient seen by dermatologist since 2000 with findings of hypopigmentated areas around eyes, elbows and knees Local therapy: Vitix cream, no effect. Patient 3 times hospitalized in our department  2008 – balneoPUVA, after 30 doses therapy terminated with good effect – solitary isles of pigment in vitiligo areas
  10. 10. Case no.1 – clinical findings Bilateral symetrical elbows, ankles, knees, face, chin and fingers of upper limbs – sharply bordered hypopigmented areas of different sizes and shapes, smooth surface, no erytema and desquamation
  11. 11. Case no.1 – laboratory findings Inflammatory parameters slightly elevated ANA: ++ Thyroid hormones: TSH, anti-thyroid antibodies negat. USG thyroid gland: normal echogenity and texture, no nodes/cystic structures
  12. 12. Therapy Balneo PUVA fotochemotherapy 1. cycle - total body initial dose 0,7J/cm2, cumulative dose 90,8J/cm2, average dose 2,67J/cm2 2. cycle - local initial dose 0,8J/cm2, cumulative dose 93,9J/cm2, average dose 2,93J/cm2 Very good effect achieved with appearance of pigment isles in vitiligo areas No complications and/or side effects were observed
  13. 13. Before After
  14. 14. Case no.2 - history Age: 8 Family history: father –vitiligo, treated for thyreopathy Personal history: normal birth, normal adaptation after birth, followed for short-sightness, pedes plani Medicaments: none
  15. 15. Case no.2 Patient seen by dermatologist since 2007 – vitiligo Hypopigmented areas were observed after intensive sun- tanning No therapy was recieved, reffered to our department because of treatment
  16. 16. Case no.2 – clinical findings Both lower limbs, medial areas of thighs, knees – non symetrical multiple sharply bordered maculae of different shapes and sizes are present, no erythema or desquamation observed
  17. 17. Case no.2 – laboratory findings FW: 6/17, CRP: 1,1mg/l, ASLO: normal values, other laboratory tests – normal values Thyroid hormones: TSH, fT4, cortisol – normal values, antibodies negat.
  18. 18. Therapy Balneo PUVA fotochemotherapy initial dose 0,5J/cm2, cumulative dose 78,9J/cm2, average dose 2,63J/cm2 Very good effect achieved with appearance of pigment isles in vitiligo areas We used standard scheme of diagnostic and terapeutic approaches with good results No complications and/or side effects were observed
  19. 19. Before After
  20. 20. “Special technique”
  21. 21. Thank you foryour attention
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