Vitiligo as a Reaction to Topical Treatment with Diphencyprone

Hatzis, J.; Gourgiotou, K; Tosca, Androniki; Varelzidis, A.; Stratigos, J.

doi:10.1159/000248532

Cited by 53 publications

(26 citation statements)

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“…However, based on our clinical experience, this agent seems to be quite dangerous and unreliable. There are reports of vitiligo occurring after treatment with DPCP for alopecia areata (Hatzis et al, 1988;Pires et al, 2010). The authors have also experienced some cases of deterioration of vitiligo in patients treated with DPCP for their alopecia totalis or molluscum contagiosum.…”

Section: Commercial Therapeutics For Vitiligomentioning

confidence: 99%

Complementary and Alternative Medicine for Vitiligo

Yoon¹,

Sun²,

Kim³

2011

Vitiligo - Management and Therapy

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Section: Commercial Therapeutics For Vitiligomentioning

confidence: 99%

Complementary and Alternative Medicine for Vitiligo

Yoon¹,

Sun²,

Kim³

2011

Vitiligo - Management and Therapy

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“…Some authors believe that it may represent a Koebner phenomenon in predisposed individuals (4). Correlations between vitiligo and AA have been reported, ranging from 4% to 9% (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors believe that it may represent a Koebner phenomenon in predisposed individuals (4). Correlations between vitiligo and AA have been reported, ranging from 4% to 9% (4,5). Latent vitiligo may be unmasked as a result of the Koebner phenomenon fi-om repeated incidences of contact dermatitis (6).…”

Section: Discussionmentioning

confidence: 99%

Narrow-band Ultraviolet B Treatment for Diphenylcyclopropenone-induced Vitiliginous Lesions

Oh¹,

Shin²,

Lee³

2012

Acta Derm Venerol

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Topical immunotherapy, defined as the induction and periodic elicitation of an allergic contact dermatitis by topical application of potent contact allergens, has been used to treat conditions such as alopecia areata (AA) and recalcitrant warts since the 1970s (1). Topical immunotherapy with diphenylcyclopropenone (DPCP) is a safe and sometimes effective treatment for chronic extensive AA and viral warts (2).Pan et al. (3) have reported four patients with AA who developed vitiligo as a side-effect of DPCP immunotherapy. Pires et al. (1) also reported a case of vitiligo following DPCP therapy.We report here two cases, one patient with viral warts and one with AA, who developed vitiliginous lesions secondary to topical therapy with DPCP. The vitiliginous lesions were subsequently treated with narrow-band ultraviolet B (NB-UVB), and both patients showed excellent responses. CASE REPORT Patient 1A 13-year-old girl presented with a 1-year history of multiple verruca plana on both cheeks. DPCP was applied topically to the upper arm every week for 2 months. However, the treatment had to be discontinued due to a severe hypersensitivity reaction. Four months later, a vitiliginous lesion appeared on her upper arm, corresponding to the area of previous DPCP application (Fig. la). The patient had no personal or family history of vitiligo, atopy, or other autoimmune disorders. The results of laboratory studies, which included thyroid auto-antibodies, antinuclear antibody (ANA), complete blood count (CBC), and biochemical panel, were all normal. The vitiliginous lesion was treated with NB-UVB twice a week on non-consecutive days. The initial irradiation dose was 0.25 J/cm^ and this was halted after 21 exposures with a total cumulative dose of 12.15 J/cm^. After 3 months of treatment, the lesion showed 80% improvement (Fig. lb). Patient 2A 42-year-old man presented with a hairless patch that had been present for 7 months on the scalp. The scalp revealed scattered, rounded patches of alopecia varying from 1 to 4 cm. After 2 weeks of sensitization with 2% DPCP on scalp, the patient started on a regimen of 0.0001% DPCP, and the concentration was gradually increased to 0.001% by his final weekly session. Gradual hair re-growth was observed. Five months posttreatment, vitiliginous lesions appeared where DPCP had been applied (Fig. 2a). There was no personal or family history of vitiligo, and laboratory studies, which included thyroid auto-antibodies, ANA, CBC, and biochemical panel, were all normal. The vitiliginous lesions were accentuated on Wood's lamp examination (Fig. 2b). These patches were subsequently treated with NB-UVB twice a week. The initial irradiation dose was 0.25 J/cm^ and this was halted after 29 exposures with a total cumulative dose of 18.29 J/cm^ The vitiliginous lesions disappeared almost completely after 4 months of treatment (Fig. 2c). DISCUSSIONTopical DPCP immunotherapy is currently considered to be the most effective treatment for conditions that involve immunomodulation. It is usually safe and well- fig. ...

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“…Nine months later, depigmentation was recovered by topical corticosteroid ointment. To date, several cases of vitiligo induction during topical immunotherapy have been reported [4][5][6][7][8]. The mechanisms are speculated as a direct cytotoxic effect of SADBE on the melanocytes, or as a result of Köbner phenomenon.…”

Section: Sirmentioning

confidence: 99%

Vitiliginous lesions during contact immunotherapy for alopecia in a patient with autoimmune thyroiditis

Kato¹,

Yamamoto²

2014

Our Dermatol Online

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Letter to the Editor Sir,Squaric acid dibutylester (SADBE) is frequently used for the treatment of alopecia, but sometimes unwanted side effects occur. Herein we report a case which developed vitiliginous lesions induced by topical SADBE application in a patient with autoimmune thyroiditis. A 60-year-old female visited our department, complaining of diffuse alopecia of the scalp. She was suffering from chronic autoimmune thyroiditis over several years, and taking thyradin (90mg per day). After obtaining written informed consent, topical application of SADBE solution was started. Two months later, a sufficient effect was obtained for hair regrowth; however, when she was treated with 0.05% SADBE, depigmentation appeared and rapidly spread on the scalp. On physical examination, diffuse depigmentation along with gray hairs was found on the scalp, forehead, and nape ( Fig. 1). Laboratory examination showed normal liver and renal function, anti-nuclear antibody (1:160, speckled), anti-thyroid antibody (1:100), anti-microsome antibody (1:6400), anti-thyroid peroxidase antibody (139.6 IU/ ml, normal <16), but anti-thyroid stimulating hormone receptor antibody, free T3 and T4 levels were normal. A skin biopsy showed decrease of melanocytes and melanin deposition in the epidermis (Fig. 2A). Results of immunohistochemistry revealed a predominant CD8-positive T-cell infiltration (Fig. 2B). SADBE therapy was stopped, and betamethasone butyrate propionate and carpronium chrolide lotion were applied, which showed a dramatical effect within 9 months (Fig. 3). Adverse effects of topical immunomodulatory therapy include local irritation, blister formation, persistent dermatitis, lymphadenopathy, generalized eczema, and urticarial reaction. Mechanism of contact immunotherapy is suggested to modulate cytokine gene expression balance, and interferon-γ expression was reduced while interleukin-2 (IL-2), IL-8, IL-10 and tumor necrosis factor-α levels were increased in the lesional skin [1].Further, recent studies demonstrate that Th17 cells are involved in the pathogenesis of contact hypersensitivity. Skin biopsies of hypersensitivity reactions to contact sensitizers demonstrate the presence of CD8+ T-cells, Th1 CD4+ effector cells and regulatory T-cells [2]. T-cells play an important role in the pathogenesis of vitiligo, and IL-10 is supposed to play a role by inhibiting T-cells. Also, active Th17 cells are increased in vitiligo skin [3], and thus those mediators may play a role in the autoimmune mechanisms of vitiligo. Our case developed vitiliginous lesions not only on the scalp, but the forehead and nape were also involved beyond the application areas. Three months later from the start of immunotherapy, depigmentation was suddenly

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Vitiligo as a Reaction to Topical Treatment with Diphencyprone

Cited by 53 publications

References 6 publications

Complementary and Alternative Medicine for Vitiligo

Complementary and Alternative Medicine for Vitiligo

Narrow-band Ultraviolet B Treatment for Diphenylcyclopropenone-induced Vitiliginous Lesions

Vitiliginous lesions during contact immunotherapy for alopecia in a patient with autoimmune thyroiditis

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