Childhood vitiligo: Treatment paradigms

Kanwar, Amrinder J.; Kumaran, Muthu Sendhil

doi:10.4103/0019-5154.103067

Cited by 24 publications

(20 citation statements)

References 38 publications

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“…However, vitiligoʼs impact goes beyond skin discoloration, as this condition can affect patientsʼ emotional health, leading to lower self-esteem and a psychosocial impact on children [3]. Studies using quality of life psychiatric morbidity questionnaires have shown a prevalence of psychiatric morbidity, including depressive episodes, adjustment disorders, and anxiety in 25 % of patients with vitiligo [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics, Pharmacodynamics and Dermal Distribution of 5-Methoxypsoralen Based on a Physiologically Based Pharmacokinetic Model to Support Phytotherapy Using Brosimum gaudichaudii

Martins¹,

Fonseca³

et al. 2020

Planta Med

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The treatment of vitiligo includes the combination of psoralens and ultraviolet type A exposure. Psoralens belong to a group of natural furanocoumarins that cause the skin to become sensitive temporarily to ultraviolet type A. The aim of this study was to develop a physiologically based pharmacokinetic model of 5-MOP from Brosimum gaudichaudii to support psoralen and ultraviolet type A therapy. A study of rats was used to establish and validate rat tissue distribution. The same chemical-specific parameters used in the rat model were also employed in the human model to project human pharmacokinetics. The highest exposures in the rats were in the brain and skin. Following a single dose of 1.2 mg/kg 5-MOP in humans, the model predicted a maximum concentration of 20 ng/mL and an area under the curve of 125 ng.h/mL, matching clinical results. The half-maximum melanogenesis concentrations in B16F10 cells were 29.5, 18.5, 11.5, and 6.5 ng/mL for synthetic 5-MOP, synthetic 5-MOP with ultraviolet type A, B. gaudichaudii alone, and B. gaudichaudii plus ultraviolet type A, respectively. Physiologically based pharmacokinetic model prediction in humans supported a once-every-two-day regimen for optimal melanin production. This type of framework can be applied to support strategies for dose selection and to investigate the impact of drugs on melanocyte recovery.

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Section: Introductionmentioning

confidence: 99%

Pharmacokinetics, Pharmacodynamics and Dermal Distribution of 5-Methoxypsoralen Based on a Physiologically Based Pharmacokinetic Model to Support Phytotherapy Using Brosimum gaudichaudii

Martins¹,

Fonseca³

et al. 2020

Planta Med

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“…NBUVB therapy is now a more or less established and recommended phototherapy for generalized vitiligo, pregnant women, and children because of the high safety profile. [3][4][5] Determination of MEDs is essential for rational treatment with UV light. Serish and Srinivas reported that the mean MED for NBUVB was 300 mJ/cm 2 for the Indian adults skin.…”

Section: Discussionmentioning

confidence: 99%

“…NBUVB also has been increasingly tested in the pediatric population as a therapy for diseases, including vitiligo and atopic dermatitis. [1][2][3][4][5] In 1997, Westerhof and Nieuweboer-Krobotova [6] were the first to study the effect of NBUVB in vitiligo. In 2000, Njoo et al [7] and 2005, Kanwar and Dogra [8] ABSTRACT Background: Management of vitiligo in children is difficult as therapeutic options are restricted when compared to that in adult patients.…”

mentioning

confidence: 99%

Narrow-band ultraviolet B in childhood vitiligo: An open prospective uncontrolled study in 28 children of South India

Kumar

Rao

2015

Indian J Paediatr Dermatol

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is a safe and efficacious treatment option for several photoresponsive conditions in adults. NBUVB represents a notable advance in phototherapy and is considered more efficacious than broadband ultraviolet B in the treatment of psoriasis, mycosis fungoides, and vitiligo. NBUVB also has been increasingly tested in the pediatric population as a therapy for diseases, including vitiligo and atopic dermatitis. [1][2][3][4][5] In 1997, Westerhof and Nieuweboer-Krobotova [6] were the first to study the effect of NBUVB in vitiligo. In 2000, Njoo et al. [7] and 2005, Kanwar and Dogra [8] ABSTRACT Background: Management of vitiligo in children is difficult as therapeutic options are restricted when compared to that in adult patients. Selection of treatment should be careful in these patients with the aim to achieve best results with minimal side effects. Only few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in children with vitiligo. Aims:The purpose of this study was to know the efficacy and safety of NBUVB in children with vitiligo of age group ranging from 3 to 16 years.Methods: Twenty-eight patients (12 males, 16 females), aged 3-16 years with vitiligo were included in the study between years 2011 and 2013 and were treated twice weekly with NBUVB. The starting dose was 150 mJ/cm 2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1-year and were followed-up for another 12 months for stability of repigmentation.Results: Analysis of our study showed that a majority of our cases, 22 (78.6%) had > 75% to complete repigmentation, about 4 (14.2%) achieved 26-75% moderate repigmentation and 2 (7.2%) had < 25% mild repigmentation. Adverse effects were transient and minimal. Only one child developed depigmentation of repigmented sites during 1-year follow-up. Conclusion:Our study proves that NBUVB therapy is safe and effective tool in the management of childhood vitiligo, with good stability of repigmentation.

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“…tachyphylaxis, suppression of hypothalamic-pituitary-adrenal axis, Cushing’s syndrome and growth retardation). In detail, the use of TCs on vitiligo patches of the face should be avoided or limited in time because of the higher risk of topical side effects, including glaucoma [ 6 ][ 7 ].…”

Section: Topical Treatmentsmentioning

confidence: 99%