Surgical treatment of vitiligo lesions over the fingers has poor outcome. In this intra-patient comparative study, 12 patients with stable non-segmental vitiligo (NSV) affecting the middle three fingers of one hand were included. Three variations were used in treatment of finger vitiligo lesions: minipuch grafting, melanocytes keratinocyte transplantation procedure (MKTP) preceded by cryoblebbing or full CO(2)laser resurfacing of the recipient site. Liquid nitrogen was used to create blebs in one finger 24 hours before therapy. On the following day, the second finger was treated by minipunch grafting and the third finger was resurfaced by CO(2)laser. A suspension was prepared and 0.1 mL was injected into each cryobleb. It was also applied to the resurfaced skin. All patients underwent topical PUVA therapy and were followed-up for 12 months. Ten cases with 52 lesions completed the follow-up period. About 4/18 lesions treated by cryoblebbing followed by MKTP showed >= 75% repigmentation while only 1/17 lesions treated by laser resurfacing + MKTP and 1/17 lesions treated by minipunch grafting showed 30% and 10% repigmentation, respectively. No complications occurred in MKTP treated lesions. Cryoblebbing of the recipient site seems to improve the outcome of MKTP in lesions over the fingers in stable NSV.

Addition of different growth factors to the medium used in autologous melanocyte-keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3 ' 5 ' cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB-UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point-counting technique and complications were recorded. Excellent response (90%-100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P= .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B;Pvalue: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.

Recently, multiple culprits—in addition to melanocytes—have been implicated in the pathogenesis of vitiligo. Among those factors are fibroblasts. However, their exact role has not been clearly elucidated. The aim of the study was to evaluate the possible role played by fibroblasts in vitiligo via studying the expression Tenascin C and DKK1 in acral versus non-acral vitiligo lesions. This case–control study included 19 non-segmental vitiligo patients and ten controls. All patients were subjected to thorough clinical evaluation. Both Tenascin C and DKK1 were measured in lesional and peri-lesional skin of acral and non-acral lesions using ELISA technique. The measured levels of Tenascin C and DKK1 were significantly higher in the vitiligo group when compared to controls in all assessed sites (P < 0.05). Tenascin C was found to be significantly higher in lesional areas compared to peri-lesional ones only in the acral sites. DKK1 was significantly higher in lesional areas in all assessed sites (P < 0.05). The current work suggests a malfunction of fibroblasts in vitiligo, through demonstrating significant up-regulation of two melanogenesis inhibitory products (Tenascin C and DKK1) in patients compared to controls. Larger scale studies are warranted to detect the possible implications of such findings on vitiligo treatment.

UNLABELLED Oral propranolol has become the treatment of choice of infantile hemangiomas (IH)s. However, the safety of systemic propranolol is questioned. Topical therapy with 1% propranolol has been reported to be safe and effective. Intralesional (IL) administration may possibly allow safe delivery of higher drug dosages. AIM To assess the efficacy and safety of two locally administered routes of propranolol (topical and IL), in comparison with its systemic oral use in the treatment of IHs. PATIENTS AND METHODS 45 patients with IHs were randomly divided into 3 groups, A, B and C (n = 15 in each), receiving oral propranolol, 2 mg/kg/day, topical propranolol 1% ointment twice daily, IL propranolol, 1 mg of propranolol hydrochloride in 1 ml of injection once weekly, respectively. Follow up was done for 6 months after treatment was stopped. RESULTS Excellent response was achieved in 9 patients in group A (60%), 3 in group B (20%) and 2 in group C (13.3%), (P value : 0.04). As regards safety, all 3 modalities proved safe with no major side effects apart from 1 patient in group A and 3 in group C who dropped out due to pain or inconvenience of therapy. CONCLUSIONS Further work is needed to establish clear guidelines and reach best formulations. Nevertheless, in properly selected patients with IHs, we recommend the usage of oral propranolol. Topically administered propranolol could be considered in patients at risk of potential side effects from oral administration. As IL application did not offer any more benefits, it could not be recommended.

BackgroundVitiligo is believed to result from progressive autoimmune-mediated loss of melanocytes. Although a number of studies suggest the involvement of several autoimmune influencing cytokines in the pathogenesis of vitiligo, these reports are still limited and contradictory. ObjectiveTo examine the degree of expression of transforming growth factor &bgr;1 (TGF-&bgr;1) in both the serum and the tissue of vitiligo patients and their relation to disease development, progression, and severity. Patients and methodsIn this case control study, 20 vitiligo patients and 10 age-matched and sex-matched controls were recruited. TGF-&bgr;1 levels were detected in serum and lesional as well as nonlesional specimens of cases and controls. The relations of TGF-&bgr;1 levels with disease parameters including disease extent, type, and vitiligo disease activity score were analyzed statistically. ResultsSerum and tissue levels of TGF-&bgr;1 were significantly lower in patients than the controls (P=0.001 and P<0.001, respectively). There was no significant difference between the TGF-&bgr;1 levels between the lesional and the nonlesional skin of patients (P=0.634). ConclusionDownregulation of serum and tissue TGF-&bgr;1 may result in the loss of peripheral tolerance mediated by T regulatory cells and should be further investigated as a prerequisite for disease initiation in susceptible individuals.

Journal of the Egyptian Women’s Dermatologic Society 2012, 9:151–155 Background Vitiligo is believed to result from progressive autoimmune-mediated loss of melanocytes. Although a number of studies suggest the involvement of several autoimmune influencing cytokines in the pathogenesis of vitiligo, these reports are still limited and contradictory. Objective To examine the degree of expression of transforming growth factor b1 (TGF-b1) in both the serum and the tissue of vitiligo patients and their relation to disease development, progression, and severity. Patients and methods In this case control study, 20 vitiligo patients and 10 age-matched and sex-matched controls were recruited. TGF-b1 levels were detected in serum and lesional as well as nonlesional specimens of cases and controls. The relations of TGF-b1 levels with disease parameters including disease extent, type, and vitiligo disease activity score were analyzed statistically. Results Serum and tissue levels of TGF-b1 were significantly lower in patients than the controls (P = 0.001 and Po0.001, respectively). There was no significant difference between the TGF-b1 levels between the lesional and the nonlesional skin of patients (P = 0.634). Conclusion Downregulation of serum and tissue TGF-b1 may result in the loss of peripheral tolerance mediated by T regulatory cells and should be further investigated as a prerequisite for disease initiation in susceptible individuals.

Infantile hemangiomas (IH) are the most common childhood tumors. In 2008, Labreze reported the serendipitous effect of oral propranolol on hemangioma and since then it has overshadowed the use of other therapeutic modalities in the treatment of IH. The aim of this prospective, clinical study was to assess the efficacy and safety profile of oral propranolol at a fixed dose of 2 mgkg(-1) in the treatment of 30 patients with problematic IH. Propranolol treatment continued for a duration of 2-14 months where 60% of the patients (n=18) showed a final excellent response with complete resolution of the lesion (P<0.001). 20% (n=6) showed a good response with more than 50% reduction in the size of the IH. 16.6% showed a fair response (n=5) with less than 50% reduction in the size of the IH. Only one patient (3.3%) was resistant to treatment. Five patients (17.24%) showed evidence of rebound growth after cessation of therapy and responded well to re-treatment.We did not face any side effects related to the oral propranolol. In conclusion, propranolol therapy at a fixed dose of 2 mgkg(-1), given in three equally divided doses, is a very safe and effective regimen in the treatment of IH.