Vitiligo is an autoimmune disorder of melanocyte characterized by macular and depigmented patches. There are several treatment modalities for this disease, including the use of corticosteroids, ...calcineurin inhibitors, vitamin D analogous and topical phenytoin. Combination therapy utilizing fractional CO2 laser with different topical agents has been used to enhance treatment response with promising results. In this study, we aimed to evaluate the effect of fractional CO2 laser in combination with topical phenytoin. In this study, 25 patients (11 females and 14 males) with age of 18–59 (mean age of 31.12) with nonsegmental stable vitiligo were recruited with insufficient response to at least 1‐year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB‐UVB phototherapy. Patients were treated with a combination of fractional CO2 laser (10,600 nm, pulse energy 30–50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60 Hz) with monthly intervals for six sessions and application of phenytoin 1% cream twice daily. Photography was done before and after treatment with Wood's lamp. The severity of disease using VASI score was calculated and compared before and after treatment. The mean VASI score before treatment was 0.55, and sixth month after treatment increased to 1.97 (p‐value < 0.001). Patients were divided into three groups based on the vitiligo subtype: acral, upper extremities, and trunk. VASI score was measured in each group: VASI score before and after treatment was 0.50 and 1.48 in acral areas, 0.45 and 2.04 in upper extremities and 0.79 and 3.39 in trunk, respectively. This study revealed that combination therapy with phenytoin and fractional CO2 laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas.
Although understandings of scientific inquiry (as opposed to conducting inquiry) are included in science education reform documents around the world, little is known about what students have learned ...about inquiry during their elementary school years. This is partially due to the lack of any assessment instrument to measure understandings about scientific inquiry. However, a valid and reliable assessment has recently been developed and published, Views About Scientific Inquiry (VASI; Lederman et al. 2014, Journal of Research in Science Teaching, 51, 65- 83). The purpose of this large-scale international project was to collect the first baseline data on what beginning middle school students have learned about scientific inquiry during their elementary school years. Eighteen countries/regions spanning six continents including 2,634 students participated in the study. The participating countries/regions were: Australia, Brazil, Chile, Egypt, England, Finland, France, Germany, Israel, Mainland China, New Zealand, Nigeria, South Africa, Spain, Sweden, Taiwan, Turkey, and the United States. In many countries, science is not formally taught until middle school, which is the rationale for choosing seventh grade students for this investigation. This baseline data will simultaneously provide information on what, if anything, students learn about inquiry in elementary school, as well as their beginning knowledge as they enter secondary school. It is important to note that collecting data from all of the approximately 200 countries globally was not humanly possible, and it was also not possible to collect data from every region of each country. The results overwhelmingly show that students around the world at the beginning of grade seven have very little understandings about scientific inquiry. Some countries do show reasonable understandings in certain aspects but the overall picture of understandings of scientific inquiry is not what is hoped for after completing 6 years of elementary education in any country. Author abstract
There are diverse assessment tools for vitiligo, with no standardized approach that helps unify treatment outcome measures. Thus, comparing different treatment modalities and developing ...evidence-based recommendations for vitiligo management has been quite challenging.
We compared the most commonly used tools assessing both vitiligo activity and extent, namely, Vitiligo Disease Activity Score (VIDA) and Vitiligo Area and Severity Index (VASI) score to their newly developed counterparts, namely, Vitiligo Extent Score Plus (VES plus) and Vitiligo Signs of Activity score (VSAS), to provide insights that would help set recommendations for a unified outcome assessment protocol for vitiligo patients.
Thirty-six active non-segmental vitiligo cases were recruited, 30 of whom completed 48 sessions of narrow band ultraviolet B (NB-UVB). Patients were assessed for both extent and activity both before and after treatment with NB-UVB. Scores were correlated. Additionally, VES plus was assessed for its reliability in comparison to VASI score.
Both extent (VASI and VES plus) and activity scores (VIDA and VSAS) showed significant improvement following treatment. Additionally, VES plus and VASI were positively correlating both before and after treatment as well as their percent change. Furthermore, VES plus proved as reliable as VASI. Regarding activity scores, total, hypochromic and Koebner VSAS only correlated with VIDA following treatment. Confetti VSAS neither correlated with VIDA before nor after treatment.
VES plus and VASI scores have proven of comparable reliability. While examination-based VSAS score comes as an additive tool to the history-based VIDA score.
Background: Vitiligo is an amelanotic disorder affecting 0.5% to 2% of the world’s population. Several treatment modalities have been tried and it has been reported that combination therapies augment ...the repigmentation in vitiligo. Objective: To compare the efficacy of microneedling with 5% 5-FU and microneedling with 0.1% tacrolimus in treatment of vitiligo. Methods: Twenty-five patients with localized stable vitiligo were subjected to microneedling of two patches with dermaroller of size 2 mm, then application of 5-fluorouracil to one patch and tacrolimus on the other patch. This procedure was repeated every month for maximum 6 months (six sessions). The patients were followed up for 3 to 4 months after the last session. Results: The overall repigmentation was slightly higher in 5-FU treated patches than tacrolimus treated patches. Very much improved to much improvement in VASI score was seen in 14 patches (64%) in 5% 5FU treated patches and 11 patches (44%) in 0.1% tacrolimus treated patches. Improved and minimally improved lesions, that is, eight patches (32%) and 11 patches (44%) respectively treated with 5% 5FU and 0.1% tacrolimus. Three patients (12%) showed no improvement. However, there was significant difference between the two drugs, regarding inflammation, ulceration, and hyperpigmentation which occurred with 5-FU. Conclusion: Microneedling combined with 5% 5-fluorouracil or tacrolimus is effective though 5-FU achieved better repigmentation.
Background Persistence of pigmentation after a melanocyte-keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy. Objective We sought to determine long-term ...repigmentation of MKTP in vitiligo and other leukodermas. Methods A retrospective review of electronic medical records was conducted for all MKTPs performed at Henry Ford Hospital between January 2009 and April 2014. Repigmentation was assessed by a 5-point grading scale (poor to excellent) and Vitiligo Area Scoring Index (VASI). Results One hundred patients had MKTP performed at 236 anatomically-based lesions (ABLs); 63 patients with 157 ABLs had long-term data available (12-72 months; median, 24 months). Segmental vitiligo, nonsegmental vitiligo, and physical leukoderma demonstrated improvement in VASI scores: −75.6 ± 24.6%, −59.2 ± 36.6%, and −32.4 ± 33.5%, respectively. In vitiligo, at 24, 48, and 72 months after MKTP, 53%, 64%, and 53% of ABLs, respectively, maintained >75% repigmentation. Skin phototype, age, and anatomic location of ABLs had no significant effect on the outcome of treatment. Limitations Limitations of the study include the retrospective design with uncontrolled, postoperative adjuvant treatments and inconsistent compliance to scheduled follow-up evaluations. Conclusions MKTP provides satisfactory long-term repigmentation in the majority of appropriately selected patients with leukoderma. MKTP can maintain repigmentation for at least 72 months.
There are conflicting reports not only on the effect of scientific inquiry on academic achievement but also insufficient evidence on the relationship between understanding the nature of scientific ...inquiry and academic achievement; more generalizable studies are needed. The purpose of this large sampled study was to investigate the middle school graduates’ understandings of scientific inquiry (SI) and the relationship between students’ understandings of SI and academic achievement. The sample of the study (
X
= 3067) was selected by purposeful and layered-sampling techniques among ninth grade students studying at high schools with different orientations in Istanbul. Descriptive and inferential statistical approaches were used in the data analysis procedure. The students’ academic achievement was operationally defined as the scores they received in the High School Entrance Exam (HEE). Views about scientific inquiry scale was applied to determine the participants’ understandings about scientific inquiry. The data were collected in the first 2 weeks of the first semester of high school in accordance with the purpose of the study. The results of the study revealed that middle school graduates generally do not have adequate understandings of SI. Furthermore, according to the findings except for the “conclusion data conformity” aspect, there are statistically significant correlations between students’ academic achievement and understandings in all aspects of SI.
Background: Narrow-band ultraviolet B (NB-UVB) phototherapy is a mainstay treatment in vitiligo. However, data relative to repigmentation outcome, prognostic factors, and duration of repigmentation ...are limited.
Objectives: To investigate the quantitative repigmentation outcome of NB-UVB phototherapy in vitiligo, the factors associated with favorable prognosis after NB-UVB, and the duration of repigmentation after NB-UVB discontinuation.
Materials and methods: Medical records of vitiligo patients who underwent NB-UVB phototherapy at Department of Dermatology, Siriraj Hospital during 2012 to 2016 were retrospectively reviewed. Repigmentation was assessed using Vitiligo Area Scoring Index (VASI) score.
Results: Fifty-eight patients were included. All patients received NB-UVB phototherapy twice to three times weekly for a median duration of 12 months. Forty-two patients had nonsegmental vitiligo (NSV), and 16 had segmental vitiligo (SV). NSV and SV demonstrated overall improvement in VASI score of -50.0%±31.0% and −40.0%±28.3%, respectively. Factors predictive of good outcome included type of vitiligo, lesion location, disease duration before NB-UVB, and duration and total number of NB-UVB treatments. Persistence of repigmentation was observed in approximately 80% of cases at one year after discontinuation of NB-UVB.
Conclusion: NB-UVB phototherapy is an effective treatment for vitiligo, especially NSV. Repigmentation persisted in 80% of patients at 1 year after cessation of phototherapy.
Background
Vitiligo is a chronic depigmentary skin disorder, characterised clinically by the development of white macules and or patches caused by loss of epidermal melanocytes. S100B is a dual ...function protein released from epidermal melanocytes in response to injury. It considered a possible marker of disease activity in both malignant melanoma and vitiligo.
Aim of the study
To estimate the serum level of S100B level in vitiligo patients and correlate its level with disease activity and various disease parameters.
Patients and methods
Sixty vitiligo patients and 60 healthy volunteers as controls were included in the study. Vitiligo Area Severity Index (VASI) and Vitiligo Disease Activity (VIDA) scores were estimated for each patient. Quantitative assessment of S100B level using ELISA technique was done for all participants.
Results
S100B level was significantly correlated with the presence of vitiligo (P = 0.01), while it showed no correlation with the disease activity using VASI or VIDA scores. As regards the receiver operating characteristic (ROC) curve analysis of S100B for diagnosis and discrimination of vitiligo, serum S100B showed area under the curve (AUC) of 0.781 with 73.3% sensitivity and 80% specificity.
Conclusion
The serum level of S100B was related to the presence of vitiligo, but its level did not show any relation to the disease activity using either VASI and VIDA scores or various disease parameters.
Greco-Arab medicine is an ancient system of medicine with greater treasure on therapeutics of vitiligo. The trial Unani formulations have not been scientifically explored for their safety and ...efficacy, but have been repeatedly prescribed by the great Unani physicians in the management of
(vitiligo). Hence, these interventions were selected for the trial.
In this randomized, controlled, open-label clinical trial, 82 participants with non-segmental vitiligo aged 18-40 years were block randomized to either receive Unani interventions or control for 16 weeks. Out of 82 participants, 42 were randomized to the Unani group and 40 were randomized to the control group. The primary outcome measure was change in vitiligo area scoring index (VASI), which was assessed on weeks 4, 8, 12 and 16. The secondary outcome measures included the patient's global assessment on VAS and investigator's global assessment based on photographic evaluation at baseline and after the treatment. Safety parameters included hemogram, LFTs, RFTs, CXR, ECG, urine, and stool examinations, which were evaluated at baseline and after the treatment.
The per-protocol analysis was done on 30 participants in each group and the response in Unani group was not inferior to those receiving control group. The mean ± SD of vitiligo area scoring index (VASI) decreased from 4.09 ± 2.87 and 5.50 ± 5.73 at baseline to 3.13 ± 2.20 and 4.29 ± 4.95 at the end of the trial in both the Unani and control groups respectively.
The study inferred that both the interventions are equally effective and well-tolerated in patients with non-segmental vitiligo.
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