Background: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) wer...Background: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. Aim and objective: This study was undertaken to validate Hanifin and Rajka’s criteria and to assess the comparative efficacy of their criteria and the UK working party’s diagnostic criteria in the diagnosis of AD in a hospital setting in North India. Subjects and methods: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. Results: Hanifin and Rajka’s criteria [sensitivity 96%, specificity 93.75%, positive predictive value 97%(PPV) and negative predictive value (NPV) 91.84%] had a statistical advantage over the UK working party’s diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75%and NPV 76.67%), with a P-value < 0.005.展开更多
Background. Vitiligo is an acquired depigmentation disorder of great cosmetic importance, affecting 1% of the general population. Photochemotherapy is the most commonly used treatment modalityinextensivevitiligo,butis...Background. Vitiligo is an acquired depigmentation disorder of great cosmetic importance, affecting 1% of the general population. Photochemotherapy is the most commonly used treatment modalityinextensivevitiligo,butisassociatedwithmanyshortand long-term side-effects. Recently, narrow-band ultraviolet B (NBUVB) therapy has been reported to be an effective and safe therapeutic option in patients with vitiligo. We studied the efficacy and safety of NBUVB (311 nm) therapy in Indian patients with generalized vitiligo. Methods. Fourteen patients (six males and eight females), aged 12- 56 years, with generalized vitiligo, were treated thrice weekly with NBUVB radiation therapy for a maximum period of 1 year. Results. At the end of 1 year, 10 patients (71.4% ) had marked to complete repigmentation and two each (14.3% ) had moderate or mild repigmentation. Repigmentation sites showed an excellent color match. The response to therapy was correlated with the sites of involvement, duration of disease, and compliance to therapy. Adverse events were limited and transient. Conclusion. NBUVB therapy is effective and safe in Indian patients with vitiligo. Long- term follow up is required, however, to establish the stability of repigmentation.展开更多
Vitiligo usually begins in childhood with approximately half of the patients manifesting onset of disease prior to the age of 20 years. Treatment options in this age group are few and have disappointing response rates...Vitiligo usually begins in childhood with approximately half of the patients manifesting onset of disease prior to the age of 20 years. Treatment options in this age group are few and have disappointing response rates. This study was designed to evaluate the role of narrow-band UVB in the treatment of generalized vitiligo in children. Twenty-six children (aged 5-14 years) with generalized vitiligo (minimal extent of depigmentation of 5%oftheskin)were treated three times per week with narrow-band UVB therapy for a maximum period of 1 year. Of 26 patients, 6 were lost to follow up and 20 (7 males, 13 females) completed the study. At the end of 1 year of therapy, 15 (75%) patients developed marked to complete repigmentation. Moderate and mild repigmentation was noted in four (20%) and one (5%) patients, respectively. An average number of 34 (±2) treatment visits was required to achieve 50%repigmentation. Adverse events were mild and transient. Narrow-band UVB is an effective and well-tolerated treatment option for childhood vitiligo.展开更多
The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiologi...The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiological profile of vitiligo in the elderly, we retrospectively analyzed the data of patients with vitiligo having onset of disease after 50 years of age attending the pigmentary clinic of our center. Of the 182 patients, 87 (47.8% ) were males and 95 (52.2% ) were females. The mean age of onset of disease was 55± 2.3 years. Vitiligo vulgaris was the most common (83.5% ) followed by focal (5.5% ), segmental (4.4% ), acrofacial (3.8% ), mucosal (2.2% ), and universal (0.5% ). The most common site of onset was the head and neck (24.2% ) followed by the upper limbs (23% ), trunk (22% ), lower limbs (17.6% ), oral/genital mucosae (7.1% ), and flexures (6% ). Koebner’ s phenomenon was observed in 14.8% while leukotrichia was present in 47.3% of the patients. Halo nevi were observed in 3.8% of patients, and vitiligo was stable in 64.8% . Twenty- nine (15.9% ) patients had family history of vitiligo. Associated autoimmune autoimmune/endocrine disorders were present in 39 (21.4% ) of the patients. Differences in disease characteristics compared with vitiligo in children and young adults are discussed.展开更多
Background:Vitiligo of the lips is a common concern of great psychologic consequence.Medical therapies are often ineffective due mainly to the absence of hair follicles.The transfer of melanocytes or melanocyte-bearin...Background:Vitiligo of the lips is a common concern of great psychologic consequence.Medical therapies are often ineffective due mainly to the absence of hair follicles.The transfer of melanocytes or melanocyte-bearing skin by a surgical procedure may repigment this condition.Only a few surgical modalities have been successful in this “difficult to treat”site.Objective:To assess the effectiveness of autologous melanocy tetransfer by epidermal grafts for lip vitiligo and to review the literature on the surgical correction of lip vitiligo.Methods:Twenty-six vitiligo patients(20 women and six men;age range,13-43 years;mean,26.8 years)having 31 affected lips with stable disease were included in the study.The suction blisters were raised using our own modified device on the lateral aspectof the thigh.The roofs of the blisters were transferred to the dermabraded recipient area.The dressing,together with the grafts,was removed on day 8.Patients were given photochemotherapy for 6 weeks.In addition,meta-analysis of the published literature on the surgical management of lip vitiligo was also performed.Results:Complete repigmentation was observed in 27 of the 31 lip areas(87%)in 23 of 25 patients(92%)in whom a follow-up for 6 months or more was available.Complications observed were persistent hyperpigmentation in12 lips and reactivation of herpes in one patient.Minimal Hyperpigmentation was seen in most of the remaining lips.The results of the meta-analysis revealed that the success rate varies from 32.5%to 100%with various surgical procedures.Conclusion:Autologous melanocyte transfer is an effective and safe therapeutic option for stable vitiligo of the lips.It is cosmetically more acceptable,as there is no abnormal keratinization,which is a problem associated with dermo-epidermal grafts.展开更多
Dowling-Degos disease is a rare autosomal dominant inherited pigmentary disorder characterized by reticulate pigmentation of the flexures, prominent comedone like lesions and pitted scars. Dyschromatosis universalis h...Dowling-Degos disease is a rare autosomal dominant inherited pigmentary disorder characterized by reticulate pigmentation of the flexures, prominent comedone like lesions and pitted scars. Dyschromatosis universalis hereditaria is characterized by the presence of hypopigmented as well as hyperpigmented macules. We report a family showing features of both these diseases.展开更多
Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. Th...Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. This study was designed to evaluate the role of topical tacrolimus in the treatment of childhood vitili go. Twenty-five children with vitiligo were treated with topical 0.03%tacrolim us ointment applied twice daily for 12 weeks. Response was noted as marked to co mplete ( > 75%repigmentation), moderate (50-75%repigmentation) and mild ( < 5 0%repigmentation). Twenty-two children (9 boys and 13 girls) of mean age 7.2 ±1.4 years completed the study. Twelve (54.5%) children had vitiligo vulgaris, nine (40.9%) had focal vitiligo and one (4.5%) had segmental vitiligo. The me an duration of disease was 8 ±3 months. Nineteen (86.4%) children showed some repigmentation at the end of 3 months and other three had no response. Of these 19 children, repigmentation was markedtocompletein11(57.9%),moderateinfive(26.3 %)and mild in three (15.7%) children. Side effects were minimal, such as the p ruritus and burning noted in only three patients. Topical tacrolimus is an effec tive and well-tolerated treatment modality in Asian children with vitiligo.展开更多
文摘Background: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. Aim and objective: This study was undertaken to validate Hanifin and Rajka’s criteria and to assess the comparative efficacy of their criteria and the UK working party’s diagnostic criteria in the diagnosis of AD in a hospital setting in North India. Subjects and methods: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. Results: Hanifin and Rajka’s criteria [sensitivity 96%, specificity 93.75%, positive predictive value 97%(PPV) and negative predictive value (NPV) 91.84%] had a statistical advantage over the UK working party’s diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75%and NPV 76.67%), with a P-value < 0.005.
文摘Background. Vitiligo is an acquired depigmentation disorder of great cosmetic importance, affecting 1% of the general population. Photochemotherapy is the most commonly used treatment modalityinextensivevitiligo,butisassociatedwithmanyshortand long-term side-effects. Recently, narrow-band ultraviolet B (NBUVB) therapy has been reported to be an effective and safe therapeutic option in patients with vitiligo. We studied the efficacy and safety of NBUVB (311 nm) therapy in Indian patients with generalized vitiligo. Methods. Fourteen patients (six males and eight females), aged 12- 56 years, with generalized vitiligo, were treated thrice weekly with NBUVB radiation therapy for a maximum period of 1 year. Results. At the end of 1 year, 10 patients (71.4% ) had marked to complete repigmentation and two each (14.3% ) had moderate or mild repigmentation. Repigmentation sites showed an excellent color match. The response to therapy was correlated with the sites of involvement, duration of disease, and compliance to therapy. Adverse events were limited and transient. Conclusion. NBUVB therapy is effective and safe in Indian patients with vitiligo. Long- term follow up is required, however, to establish the stability of repigmentation.
文摘Vitiligo usually begins in childhood with approximately half of the patients manifesting onset of disease prior to the age of 20 years. Treatment options in this age group are few and have disappointing response rates. This study was designed to evaluate the role of narrow-band UVB in the treatment of generalized vitiligo in children. Twenty-six children (aged 5-14 years) with generalized vitiligo (minimal extent of depigmentation of 5%oftheskin)were treated three times per week with narrow-band UVB therapy for a maximum period of 1 year. Of 26 patients, 6 were lost to follow up and 20 (7 males, 13 females) completed the study. At the end of 1 year of therapy, 15 (75%) patients developed marked to complete repigmentation. Moderate and mild repigmentation was noted in four (20%) and one (5%) patients, respectively. An average number of 34 (±2) treatment visits was required to achieve 50%repigmentation. Adverse events were mild and transient. Narrow-band UVB is an effective and well-tolerated treatment option for childhood vitiligo.
文摘The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiological profile of vitiligo in the elderly, we retrospectively analyzed the data of patients with vitiligo having onset of disease after 50 years of age attending the pigmentary clinic of our center. Of the 182 patients, 87 (47.8% ) were males and 95 (52.2% ) were females. The mean age of onset of disease was 55± 2.3 years. Vitiligo vulgaris was the most common (83.5% ) followed by focal (5.5% ), segmental (4.4% ), acrofacial (3.8% ), mucosal (2.2% ), and universal (0.5% ). The most common site of onset was the head and neck (24.2% ) followed by the upper limbs (23% ), trunk (22% ), lower limbs (17.6% ), oral/genital mucosae (7.1% ), and flexures (6% ). Koebner’ s phenomenon was observed in 14.8% while leukotrichia was present in 47.3% of the patients. Halo nevi were observed in 3.8% of patients, and vitiligo was stable in 64.8% . Twenty- nine (15.9% ) patients had family history of vitiligo. Associated autoimmune autoimmune/endocrine disorders were present in 39 (21.4% ) of the patients. Differences in disease characteristics compared with vitiligo in children and young adults are discussed.
文摘Background:Vitiligo of the lips is a common concern of great psychologic consequence.Medical therapies are often ineffective due mainly to the absence of hair follicles.The transfer of melanocytes or melanocyte-bearing skin by a surgical procedure may repigment this condition.Only a few surgical modalities have been successful in this “difficult to treat”site.Objective:To assess the effectiveness of autologous melanocy tetransfer by epidermal grafts for lip vitiligo and to review the literature on the surgical correction of lip vitiligo.Methods:Twenty-six vitiligo patients(20 women and six men;age range,13-43 years;mean,26.8 years)having 31 affected lips with stable disease were included in the study.The suction blisters were raised using our own modified device on the lateral aspectof the thigh.The roofs of the blisters were transferred to the dermabraded recipient area.The dressing,together with the grafts,was removed on day 8.Patients were given photochemotherapy for 6 weeks.In addition,meta-analysis of the published literature on the surgical management of lip vitiligo was also performed.Results:Complete repigmentation was observed in 27 of the 31 lip areas(87%)in 23 of 25 patients(92%)in whom a follow-up for 6 months or more was available.Complications observed were persistent hyperpigmentation in12 lips and reactivation of herpes in one patient.Minimal Hyperpigmentation was seen in most of the remaining lips.The results of the meta-analysis revealed that the success rate varies from 32.5%to 100%with various surgical procedures.Conclusion:Autologous melanocyte transfer is an effective and safe therapeutic option for stable vitiligo of the lips.It is cosmetically more acceptable,as there is no abnormal keratinization,which is a problem associated with dermo-epidermal grafts.
文摘Dowling-Degos disease is a rare autosomal dominant inherited pigmentary disorder characterized by reticulate pigmentation of the flexures, prominent comedone like lesions and pitted scars. Dyschromatosis universalis hereditaria is characterized by the presence of hypopigmented as well as hyperpigmented macules. We report a family showing features of both these diseases.
文摘Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. This study was designed to evaluate the role of topical tacrolimus in the treatment of childhood vitili go. Twenty-five children with vitiligo were treated with topical 0.03%tacrolim us ointment applied twice daily for 12 weeks. Response was noted as marked to co mplete ( > 75%repigmentation), moderate (50-75%repigmentation) and mild ( < 5 0%repigmentation). Twenty-two children (9 boys and 13 girls) of mean age 7.2 ±1.4 years completed the study. Twelve (54.5%) children had vitiligo vulgaris, nine (40.9%) had focal vitiligo and one (4.5%) had segmental vitiligo. The me an duration of disease was 8 ±3 months. Nineteen (86.4%) children showed some repigmentation at the end of 3 months and other three had no response. Of these 19 children, repigmentation was markedtocompletein11(57.9%),moderateinfive(26.3 %)and mild in three (15.7%) children. Side effects were minimal, such as the p ruritus and burning noted in only three patients. Topical tacrolimus is an effec tive and well-tolerated treatment modality in Asian children with vitiligo.
