Vitiligo (eBook)

Medical and Surgical Management

Somesh Gupta, Mats J. Olsson, Davinder Parsad, Henry W. Lim, Nanja van Geel, Amit G. Pandya (Herausgeber)

eBook Download: PDF

2018
John Wiley & Sons (Verlag)
9781118937389 (ISBN)

Infos

Practical guidance based on expert experience and evidence for developing management strategies for vitiligo 

This complete guide to vitiligo provides a full appraisal of strategy for the treatment of this autoimmune disease that affects 1-2% of the world's population. It addresses all aspects of vitiligo, covering the science, medical and surgical therapies, and the psychological evaluations and approaches based on the proper understanding of the causes and classification of a particular case.

Management of vitiligo is challenging and requires a multipronged approach. Vitiligo: Medical and Surgical Management is a comprehensive, timely, state-of-the-art resource that will help those involved with affected patients better understand and treat this disease, which takes its toll on the mental wellness of those afflicted by it. It takes an evidenced-based approach to the disease's treatment; provides an overview of the surgical management; covers tissue and cellular grafting; and more. 

• Thoroughly guides those involved in the clinical aspects of vitiligo
• Aids diagnosis and classification of severity
• Balances evidence and experience
• Compiled by world-leading expert editors

Comprehensive in nature, Vitiligo: Medical and Surgical Management contains a strong practical element, and is a welcome go-to source for practicing dermatologists and those training to become a dermatologist.

About the Editors

Somesh Gupta, MD, DNB, MNAMS, Professor, Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi, India

Mats J. Olsson, MD, PhD, CEO, ParkCell AB and President, International Vitiligo Center, Uppsala, Sweden

Davinder Parsad, MD, Professor, Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Henry W. Lim, MD, Chair Emeritus, Department of Dermatology and Senior Vice President for Academic Affairs, Henry Ford Health System. Past President, American Academy of Dermatology, Detroit, USA

Nanja van Geel, MD, PhD, Professor, Department of Dermatology, Ghent University Hospital, Ghent, Belgium

Amit G. Pandya, MD, Professor, Department of Dermatology, University of Texas, Southwestern Medical Center, Dallas, USA

Inhalt

Title Page 5
Copyright Page 6
Contents 9
List of Contributors 15
Foreword 21
Preface 23
About the Companion Website 25
Section 1 Basic Science 27
Chapter 1 Introduction 29
Vitiligo is Clinically Visible as Cutaneous Depigmentations 29
Vitiligo is a Disease with an Important Psychosocial Impact 29
The Search for New Vitiligo Therapies is on 31
Surgical Management of Vitiligo 31
The Hair Follicle is Considered an Immunologically Privileged Site 33
Stability of the Disease and Repigmentation Achieved by Treatment 33
References 33
Chapter 2 Melanocyte and Melanogenesis: Applied Anatomy and Physiology 35
The Pigmentary System 35
Embryological Development 36
Melanogenesis 36
Melanocortin 1 Receptor (MC1R) Signaling 37
KIT Signaling Pathway 37
The Melanosome 37
References 38
Chapter 3 Epidemiology of Vitiligo 41
Introduction 41
International Prevalence of Vitiligo 41
Gender Equivalency of Vitiligo 42
Age of Presentation of Vitiligo 42
Vitiligo and Associated Comorbidities 42
Inheritance Patterns 43
Conclusions 43
References 43
Chapter 4 Pathogenesis of Vitiligo 45
Introduction 45
Vitiligo Pathogenesis 45
Relevance to Treatment Approach 48
Medical Treatment 48
Surgical Treatment 50
Summary 50
References 50
Chapter 5 Understanding the Mechanisms of Repigmentation in Vitiligo 53
Introduction 53
Mechanisms of Repigmentation: Medically Induced 54
Mechanisms of Repigmentation: Surgically Induced 56
References 57
Section 2 Clinical Science 59
Chapter 6 Classification and Clinical Features of Vitiligo 61
Introduction 61
Classification of Vitiligo 61
Clinical Characteristics of Vitiligo/Non?segmental Vitiligo 63
Clinical Features of Segmental Vitiligo 65
Undetermined/Unclassified Vitiligo 69
Other Types or Rare Variants 69
Acknowledgments 71
References 71
Chapter 7 Outcome Measures for Vitiligo 75
Introduction 75
Repigmentation 76
3-D Image Analysis 79
Disease Activity 80
Quality of Life Measures 81
Conclusions 83
References 84
Chapter 8 Evaluation and Treatment of the Psychosocial Burden of Vitiligo 87
Introduction 87
Why Assess the Psychological Impact of Vitiligo in Patients? 87
Psychosocial Impact of Vitiligo 87
Patient Evaluation and Expectation Assessment 88
Management of the Psychosocial Burden of Vitiligo 89
Other Interventions 90
Support Groups 91
References 91
Chapter 9 Patient Support, Education, and Compliance 95
Introduction 95
Psychosocial Morbidity in Vitiligo 95
Psychosocial Interventions in Vitiligo 96
Educational Resources for Patients with Vitiligo 97
Psychological Effects of Vitiligo 98
Communication – Vital for Better Perception, Commitment, and Outcomes 99
Strategies to Improve Compliance 99
Role of Realistic Expectations 99
Conclusions 100
References 100
Chapter 10 Goals of Vitiligo Treatment, and Evidence-Based Practice Guidelines for Medical and Surgical Management 103
Introduction 103
Example – Psoriasis Treatment Goals 103
Goals of Vitiligo Treatment from the Patient’s Perspective 104
Goals of Vitiligo Treatment from the Physician’s Perspective 104
Conclusions 105
References 105
Chapter 11 The Concept of Stability of Vitiligo and Stabilization Therapies 107
Introduction 107
Monitoring Stability 107
Clinical Features and Stability 108
Reflectance Confocal Microscopy and Stability 109
Biochemical Features and Stability 109
Oxidative Stress and Stability 109
Ultrastructural and Microscopic Features and Stability 110
Immunity and Activity of Vitiligo 110
Stabilization Therapies 112
References 114
Section 3 Phototherapy 117
Chapter 12 Narrow-Band Ultraviolet B Phototherapy in Vitiligo 119
Introduction 119
Light Sources and Lamps 119
Home NB-UVB Phototherapy 119
NB-UVB Administration 120
Contraindications 120
Mechanism of Action of NB-UVB in Vitiligo 121
Efficacy and Prognostic Factors for NB-UVB Monotherapy 121
Persistence of Repigmentation after NB-UVB Treatment 123
Combination Therapy 123
Safety Profile 126
Summary 126
References 126
Chapter 13 UVA-Based Phototherapy: PUVA, PUVA-Sol, and UVA1 Phototherapy 131
Introduction 131
Psoralen Photochemotherapy (PUVA) 131
PUVA?sol 135
UVA1 Phototherapy 136
Other UVA Applications 136
UVA-based Phototherapy in Vitiligo: Conclusions and Future 137
Acknowledgments 137
References 137
Chapter 14 Targeted Phototherapy in Vitiligo 139
Introduction 139
Targeted Phototherapies in the Treatment of Vitiligo 139
Conclusions 145
References 146
Section 4 Medical Management 149
Chapter 15 Immunomodulators and Immunosuppressives in Vitiligo Treatment 151
Introduction 151
Oral Corticosteroids 151
Narrow-band Ultraviolet B (NB-UVB) 152
Ginkgo Biloba 153
Zinc 153
Methotrexate 153
Levamisole 154
Minocycline 154
Statins 154
Tofacitinib Citrate 154
Azathioprine 154
Cyclophosphamide 154
Anti-interferon-gamma Therapeutic Strategy 155
Anti-tumor Necrosis Factor-alpha Treatment (anti-TNF-?) 155
References 155
Chapter 16 Topical Glucocorticoids, Topical Calcineurin Inhibitors, and Topical Vitamin D3 Analogs 159
Introduction 159
Topical Glucocorticoids 159
Topical Calcineurin Inhibitors 160
Topical Vitamin D3 Analogs 163
Conclusions 164
References 164
Chapter 17 Other Therapies in Vitiligo 167
Introduction 167
Khellin 167
5-Fluorouracil 170
Alpha-lipoic Acid 170
Ginkgo Biloba 170
Pseudocatalase 171
Melagenine 171
Minoxidil 171
Tar 172
Afamelanotide 172
Rituximab 172
Selectively Permeable for NB-UVB Sunscreen 173
Minocycline 173
Bimatoprost 173
Basic Fibroblast Growth Factor (bFGF)-Derived Peptide 173
Piperine 174
References 174
Chapter 18 Biologic Therapies for Vitiligo 177
Introduction 177
IFN-?-CXCL10-CXCR3 Axis as a Therapeutic Target 177
CXCL10 and CXCL3 Blockers 178
JAK Inhibitors 179
Afamelanotide 181
Conclusions 182
References 182
Chapter 19 Evidence Toward Integrated Management of Vitiligo, Combining Ayurveda and Homeopathy with Modern Dermatology 185
Introduction 185
Disease Information in Ayurveda 185
Patient Selection in Ayurveda 186
Therapeutics in Ayurveda 187
Dietary Recommendations of IM for Vitiligo 189
Homoeopathic Approach to Treatment 192
References 194
Section 5 Surgical Therapies: History, Patient Selection, and Classification 197
Chapter 20 History and Chronology of Development of Surgical Therapies for Vitiligo 199
Introduction 199
Evolution of Vitiligo as a Physical and Social Disease 200
First Attempts at Vitiligo Grafting: Exchange Grafts 200
The Concept of Stability in Vitiligo 201
The Development of Surgical Methods for Repigmentation of Vitiligo 201
Repigmentation of Leukotrichia 205
Conclusions 205
References 205
Chapter 21 Patient Selection, Pre- and Postoperative Information in Surgical Therapies for Vitiligo 211
Introduction 211
Patient Selection for Autologous Melanocyte Transplantation 213
Age 215
Contraindications 215
Preoperative Information 215
The Day of Surgery 215
Postoperative Information (Cellular Grafting) 216
References 217
Chapter 22 Classification of Surgical Therapies in Vitiligo 219
Introduction 219
Transplantation of Autologous Melanocytes 219
Tissue Grafts 220
Cellular Grafts 225
Conclusions 230
References 231
Section 6 Surgical Therapies: Tissue Grafting 235
Chapter 23 Minigrafting for Vitiligo 237
Historical perspective 237
The Punch Instrument 237
Evolution of Mini?punch Grafting 238
Test grafting 238
Procedure of minigrafting [32,42–44] 239
Follow-up and Course of Events 240
Complications 242
Discussion and Analytical Perspective 242
Conclusions 247
Acknowledgments 247
References 247
Chapter 24 Suction Blister Epidermal Grafting 251
Introduction 251
Suction blistering 251
Preparation of the Recipient Site 256
Chemical Epilation Before Epidermal Grafting on hair?bearing skin 258
Transfer of grafts and dressing 258
Efficacy and Safety of Epidermal Grafting 259
Advantages and limitations 260
Conclusions 263
References 263
Chapter 25 Thin and Ultra-Thin Skin Grafts for Vitiligo 267
Introduction 267
History 267
Basic principles and biology of Skin Grafting 267
Selection of patient 268
Methods 268
Conclusions 273
References 273
Chapter 26 Treatment of Leukoderma by Transplantation of Ultra-Thin Epidermal Sheets Using a Motorized Dermatome 275
Introduction 275
Ultra-thin Epithelial Sheet Grafting Principles 276
Discussion 280
Conclusions 282
References 282
Chapter 27 Mesh Grafts for Vitiligo 283
Historical background 283
Introduction 283
Technique 284
Conclusions 286
References 286
Chapter 28 Smash Grafting 287
Introduction 287
Method of Smash Grafting 287
Complications of Smash Grafting 289
Advantages of Smash Grafting 291
Disadvantages 291
References 291
Chapter 29 Therapeutic Needling and Needling Micrografting 293
Introduction 293
Melanocyte Transplantation in Vitiligo Patients Using Needling Micrografting 293
Results 294
Discussion 296
References 297
Chapter 30 Complications and Limitations of Melanocyte Transplantation 299
Introduction 299
Complications of Melanocyte Transplantation 299
Limitations of Melanocyte Transplantation 301
Conclusions 302
References 302
Section 7 Surgical Therapies: Cellular Grafting 305
Chapter 31 Treatment of Leukoderma by Transplantation of Basal Cell Layer Suspension 307
Introduction 307
Methods 308
Discussion 314
Conclusions 316
References 316
Chapter 32 Non-Cultured Extracted Follicle Outer Root Sheath Cell Suspension Transplantation 319
Introduction 319
The role of Hair Follicle Melanocytes and Stem Cells in repigmentation 319
Hair Follicle Transplantation for Vitiligo 320
Transplantation of Hair Follicle Outer Root Sheath Cell Suspension 320
Technique 320
Results reported in Various Studies 322
Advantages 323
Disadvantages 323
Conclusions 323
References 324
Chapter 33 Long-Term Results of Non-Cultured Epidermal Cellular Grafting in Vitiligo 325
Introduction 325
Long-term results of the non-cultured Epidermal Suspension Technique 325
Conclusions 327
References 327
Chapter 34 Simplified Non-Cultured Cellular Grafting 329
Introduction 329
Methods 329
Conclusions 334
References 334
Chapter 35 Novel Methods of Preparing Epidermal Cell Suspension for Transplantation in Vitiligo 335
Introduction 335
Harvesting the Donor Tissue for non-cultured Epidermal Cell Suspension by Dermabrasion 335
Preparation of In?vivo Non?cultured Epidermal Cell Suspension from Suction Blister Graft 338
References 341
Chapter 36 Management of Vitiligo: Setting Up a Tissue Culture Laboratory 343
Introduction 343
Standards and regulations 343
Laboratory design 343
Equipment 344
Summary 347
Chapter 37 Treatment of Leukoderma by Transplantation of Cultured Autologous Melanocytes 349
Introduction 349
Methods 351
Discussion 358
Conclusions 359
References 360
Chapter 38 Transplantation of In-Vitro-Cultured Epithelial Grafts for Vitiligo and Piebaldism 363
Introduction 363
The in-vitro-reconstituted Epidermis-bearing Melanocytes in the Treatment of Pigmentary Disorders 364
The In-vitro-reconstituted Epidermis-bearing Melanocytes: Culture Conditions for Optimal M/K Ratio 364
Clinical Applications of Cultured Epidermis in Pigmentary Disorders 366
Quality Controls of Cell Cultures 366
Selection of Patients 368
Preparation of the Receiving Bed 368
The Importance of Postoperative Management 370
Histologic Examination of the Regenerated Epidermis 370
Overall Success Rate in the Literature 371
Conclusions 371
References 374
Chapter 39 Application of Lasers for Abrasion in Transplantation Procedures for Vitiligo 377
Introduction 377
Carbon Dioxide Laser 377
Erbium:YAG laser 378
Fractionated CO2 laser 378
Conclusions 379
References 380
Chapter 40 Cell Delivery on Recipient Skin 383
Introduction 383
Methods and Results 383
Discussion 384
References 386
Chapter 41 Safety Concerns in Transplantation of In-Vitro-Cultured Cellular Grafts 389
Introduction 389
Regulatory environment 389
Good Manufacturing Practice 390
Cell?culture procedures 391
Quality Assurance System 391
Good Clinical Practice 392
Indian Regulatory Agency 392
References 392
Section 8 Special Issues in Medical and Surgical Therapies 395
Chapter 42 Surgical Management of Vitiligo of Lips, Eyelids, and Genitals 397
Introduction 397
Lips 397
Eyelids 406
Genitals 409
References 411
Chapter 43 Surgical Management of Acral Vitiligo 415
Introduction 415
When is the Term Acral Vitiligo Used? 415
How is a Surgical Modality Chosen? 417
Preoperative counseling and Informed Consent 418
Preparation of Autologous Melanocyte Cell Suspensions 418
Harvesting of the Skin Graft 419
Modifications of the Procedure For Specific Acral Areas 420
Discussion 424
References 424
Chapter 44 Surgical Management of Leukotrichia 427
Introduction 427
Treatment of leukotrichia 427
Dermabrasion and ultra?thin split?thickness Skin Grafting 428
Suction Blister Grafting and Systemic PUVA 428
Non-cultured Epidermal Cell Suspension Transplantation 428
Minigrafting 428
Follicular Unit Extraction (FUE) and transplantation 428
Hair transplantation 429
Acknowledgments 430
References 431
Chapter 45 Surgical Treatments of Leukodermas Other Than Vitiligo Vulgaris 433
Introduction 433
Types of leukoderma and Surgical Methods 433
References 439
Chapter 46 Ethnic Issues in Management of Vitiligo and Sun Protection 443
Introduction 443
History of vitiligo in Select Cultures 443
Current Social Stigmas About Vitiligo 445
Impact of Cultural Beliefs on treatment and Patient Perceptions of prognosis in vitiligo 447
Sun Protection in Vitiligo Patients: Additional Considerations 448
Conclusions 449
References 449
Chapter 47 Management Issues for Vitiligo in Children and Pregnant Women 453
Introduction 453
Overview of Issues Pertinent to Pediatric Vitiligo 453
Overview of Issues Pertinent to the Pregnant Vitiligo Patient (see Table 47.2) 454
Preventive strategies for vitiligo 455
Issues with General Health in patients with vitiligo 456
Issues with drugs and Other Treatments Used for Vitiligo 456
Conclusions 462
References 462
Chapter 49 Combination Treatments for Vitiligo 465
Introduction 465
Phototherapy and Medical Treatment 465
Surgery and phototherapy 468
Surgery and Medical Treatment 469
Various combinations of Medical Treatments 470
Conclusions 471
References 473
Chapter 49 Micropigmentation 477
Introduction 477
Basic principles 477
Pigments and preparations 478
Equipments and procedure 478
Micropigmentation in vitiligo 479
Factors Affecting Cosmetic Results 480
Adverse Effects and Limitations 481
Conclusions 482
References 482
Chapter 50 Camouflage in Vitiligo 485
Introduction 485
History 485
Basic principles of camouflage 485
Role of camouflage in vitiligo 486
Classification of camouflage 487
Formulations of Cosmetic Camouflage 488
Practical pearls for the application of camouflage 489
Acknowledgments 493
References 493
Chapter 51 Depigmentation Treatment for Vitiligo: Bleaching Cream, Laser, and Cryotherapy 495
Introduction 495
Depigmentation: The Moment of the decision and indications 495
Depigmentation techniques 496
Comparison Between Laser- and cryotherapy as depigmentation treatment for vitiligo 497
References 498
Chapter 52 Future Directions in the Treatment of Vitiligo 501
Introduction 501
Stem cells and vitiligo 501
Combating Melanocyte Oxidative Stress 502
Tackling autoimmunity 502
Stimulating melanocytes 505
Advances in Surgical Treatment 507
Maintaining repigmentation in Vitiligo Patches 507
Biomarkers to Predict Disease Activity and stability in vitiligo 508
Conclusions 510
References 510
Chapter 53 Informed Consent 517
Introduction/background 517
Clinical studies 517
Layout of the form 519
References 519
Index 521
EULA 536

Produkt-Details

• Erscheint lt. Verlag: 14.2.2018
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie
• Schlagworte: Autoimmune diseases • Cosmetic / Esthetic Dermatology • depigmented skin • dermatologic surgery • Dermatologie • Dermatologische Chirurgie • Dermatology • dermatology conditions • epidermal disease • guide to vitiligo • Kosmetische u. Ästhetische Dermatologie • Medical Science • Medizin • Melanocytes • pigment forming cells • plastic surgery for skin disease • rare skin disorders • Skin • skin conditions • skin diseases • skin pigment • surgical depigmentation • the psychological effects of vitiligo • Venereology • Vitiligo • vitiligo and suicide • Vitiligo: Medical and Surgical Management
• ISBN-13: 9781118937389 / 9781118937389