Carska, bernadicova puva specifics of vitiligo in childhood
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Carska, bernadicova puva specifics of vitiligo in childhood

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PUVA therapy specifics of vitiligo in childhood...

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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  • 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. Ethiologic hypotheses forvitiligo Genetic Biochemical Autoimmune melanocyte destruction Neural Immunologic
  • 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. 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. Side effects Acute  Chronic  Conjunctivitis  Lentiginosis  Keratitis  Aging of the skin  Sunburn  Actinic keratosis  Nauzea  Hypertrichosis  Vomitus  Skin cancer  Headache  PUVA itch  Dizziness
  • 6. Local PUVA therapy Balneo-PUVA  “Sheet bath PUVA” Psoralens in:  cream  ointment  Solution application 30 min - 1 hr before UVA exposure
  • 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. 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. 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. 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. 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. 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. Before After
  • 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. 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. 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. 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. 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. Before After
  • 20. “Special technique”
  • 21. Thank you foryour attention