1.Selection of parameters of narrowband ultraviolet B phototherapy for vitiligo
Ai'e XU ; Jiehao LEI ; Qimin FAN
Chinese Journal of Dermatology 2020;53(2):89-92
Narrowband ultraviolet B has been applied to the treatment of vitiligo for more than 10 years in China.Currently,there are no consistent standards for clinical treatment parameters,and patients cannot benefit from non-standard treatment,which is liable to cause erythema,blisters,photoaging and other adverse reactions.Based on the Vitiligo Working Group recommendations for narrowband ultraviolet B phototherapy for vitiligo,relevant literature and clinical experiences,the authors discuss parameters of narrowband ultraviolet B phototherapy for vitiligo from the aspects of treatment frequency,initial dosing,dose adjustment during consecutive treatment or after missed treatment,response plateau,treatment course and maximum acceptable number of phototherapy,so as to improve the efficacy of narrowband ultraviolet B phototherapy for vitiligo.
2.Clinicopathological analysis of nine cases of hypopigmented mycosis fungoides
Gang QIAO ; Jiehao LEI ; Ai′e XU
Chinese Journal of Dermatology 2020;53(4):292-295
Objective:To analyze clinical and pathological characteristics of 9 cases of hypopigmented mycosis fungoides (HMF) .Methods:Nine patients with clinically and histopathologically confirmed HMF were collected at Department of Dermatology, Hangzhou Third People's Hospital from 2014 to 2018, and their clinical and pathological manifestations and follow-up findings were retrospectively analyzed.Results:Among the 9 patients, there were 7 males and 2 females; the age ranged from 6 to 29 years (average, 12.4 years) ; the duration of disease varied from 6 months to 3 years (average, 20.7 months) . All skin lesions manifested as poorly demarcated, irregular, hypopigmented patches, some hypopigmented patches were confluent, and hypopigmented patches were covered with scales in 2 cases. Wood′s lamp examination of hypopigmented patches showed a grayish-white color with weak fluorescence. Dermoscopic images showed white scales on the lesions and blood vessels distributed in spermatozoa-like, punctiform or short linear patterns. Reflectance confocal microscopy showed mild hypopigmentation in the basal layer without obvious depigmentation, and highly-refractive atypical cells at the dermo-epidermal junction. Histopathological examination of the 9 cases showed epidermotropic phenomenon of atypical lymphocytes, and some cells clustered and formed Pautrier′s microabscess, immunohistochemical staining revealed that all the cells expressed T cell phenotypes, and were mainly infiltrating CD8 + T cells. The 9 patients were treated with narrow-band ultraviolet B (NB-UVB) , and all of them achieved clinical complete response. During a follow-up of 23.8 months on average, 2 patients experienced recurrence, and they achieved clinical complete response again after NB-UVB treatment. Conclusions:HMF progresses slowly, and NB-UVB treatment is effective. There is the possibility of recurrence after clinical recovery in patients with HMF, and a long-term follow-up is needed.
3.Association between efficacy of and response to narrow-band ultraviolet B phototherapy as well as factors related to phototherapy response in patients with vitiligo
Jiehao LEI ; Qimin FAN ; Rong CHEN ; Ai'e XU
Chinese Journal of Dermatology 2019;52(4):259-262
Objective To evaluate the association between clinical efficacy of and response to narrow-band ultraviolet B (NB-UVB) phototherapy in patients with confirmed vitiligo,and to identify factors influencing phototherapy response.Methods From January 2017 to March 2018,a total of 104 patients with vitiligo,who received NB-UVB phototherapy at the Department of Dermatology,Hangzhou Third Hospital,Zhejiang University of Traditional Chinese Medicine,were enrolled into this study.Among them,there were 55 males and 49 females,with an average age of 32.06 years (range:4-64 years).Their course of disease ranged from 2 months to 27 years,and the average course of disease was 8.15 years.The phototherapy sessions required to achieve initial repigmentation and to enter the plateau phase during which repigmentation ceased to increase with treatment sessions (plateau photothereapy sessions),as well as effective phototherapy sessions (the difference between the phototherapy sessions required to achieve initial repigmentation and those to enter the plateau phase) were recorded.Rank sum test was used to analyze the difference in the above phototherapy sessions between patients with different response,and multiple linear regression analysis to identify factors influencing plateau photothereapy sessions and effective phototherapy sessions.Results All the 104 patients were followed up.Among them,2 patients achieved complete repigmentation,1 showed no response to the phototherapy,and the remaining 101 patients were enrolled into the analysis.Among the 101 patients,52 achieved ≥ 50% repigmentation (high efficacy group),and 49 achieved < 50% repigmentation (low efficacy group).Compared with the low efficacy group,the high efficacy group showed significantly less phototherapy sessions required to achieve initial repigmentation (M [P25,P75],8 [7,10] vs.10[8,13],Z =3.125,P =0.002),but significantly more plateau phototherapy sessions (41 [29,60] vs.35 [26,44],Z =-3.375,P < 0.001) and effective phototherapy sessions (32 [18,51] vs.24 [8,36],Z =-4.407,P < 0.001).Multiple linear regression analysis showed that the total number of plateau phototherapy sessions was positively correlated with vitiligo area (β =0.360,t =2.698,P =0.008) and duration of disease (β =0.215,t =2.325,P =0.022),but negatively correlated with vitiligo disease activity score (VIDA) (β =-2.665,t =3.969,P < 0.001).Moreover,the number of effective phototherapy sessions was positively correlated with vitiligo area (β =0.358,t =2.582,P =0.011) and duration of disease (β =0.216,t =2.276,P =0.025),but negatively correlated with VIDA (β =-2.669,t =-3.935,P < 0.001) and phototherapy sessions required to achieve initial repigmentation (β =-1.011,t =-4.508,P < 0.001).Conclusions During the treatment with NB-UVB,the less the number of phototherapy sessions required to achieve initial repigmentation is,the more the number of effective phototherapy sessions is,and the better the efficacy of NB-UVB phototherapy is.Vitiligo area,duration of disease and clinical staging may provide the basis for predicting phototherapy sessions required to enter the plateau phase.
4.Efficacy of home versus hospital narrow-band ultraviolet B phototherapy for vitiligo
Jiehao LEI ; Qimin FAN ; Ai'e XU
Chinese Journal of Dermatology 2018;51(10):749-751
Objective To compare the efficacy and acceptance of home versus hospital narrowband ultraviolet B (NB-UVB) phototherapy for vitiligo.Methods Eighty patients with vitiligo were collected at the Department of Dermatology of Hangzhou Third Hospital from August 2016 to September 2017,and randomly and equally divided into two groups to be treated with home (home NB-UVB group) or hospital NB-UVB phototherapy (hospital NB-UVB group) twice a week for 36 sessions.After the treatment,the efficacy,adverse reactions and patient acceptance were evaluated.Results Finally,39 patients in the home NB-UVB group and 37 in the hospital NB-UVB group completed the treatment.The response rates in the face and neck,trunk and extremities were 62.5%,48.6% and 42.3% respectively in the home NB-UVB group,and were 66.7%,55.9% and 48.6% respectively in the hospital NB-UVB group.There were no significant differences in the response rate,cumulative dosage required for initial repigmentation and cumulative dosage at the end of treatment at the same body site between the 2 groups.The incidence of adverse reactions was significantly higher in the home NB-UVB group than in the hospital NB-UVB group (61.5% vs.24.3%,P < 0.05),and the duration of a single treatment was significantly shorter in the home NB-UVB group than in the hospital NB-UVB group (27.95 min vs.129.73 min,P < 0.05).Multiple linear regression analysis showed that the patient acceptance in the home NB-UVB group significantly increased along with the improvement of efficacy (β =0.483,t =4.573,P < 0.001),but decreased along with the increase of treatment duration (β =-0.569,t =-5.831,P < 0.001).However,the patient acceptance in the hospital NB-UVB group significantly increased along with the improvement of efficacy (β =0.758,t =7.547,P < 0.001),but was not correlated with the treatment duration (β =-0.204,t =-2.030,P =0.05).Conclusions The home and hospital NB-UVB phototherapy can complement each other for the treatment of vitiligo.Appropriate therapy should be chosen for different patients,so as to enhance patient compliance,which is an essential condition for the improvement of efficacy.
5.In vitro culture of melanocytes from segmental vitiligo-like nevus depigmentosus lesions and its clinical significance
Jiehao LEI ; Weisong HONG ; Fuquan LIN ; Wenting HU ; Ai′e XU
Chinese Journal of Dermatology 2022;55(9):798-802
Objective:To assess the value of culture of epidermal melanocytes from negative-pressure suction blisters in the auxiliary diagnosis of segmental vitiligo-like nevus depigmentosus.Methods:Between June 2019 and March 2020, 8 patients with segmental vitiligo-like nevus depigmentosus, who met the Coupe′s clinical diagnostic criteria, were enrolled from Department of Dermatology, Hangzhou Third People′s Hospital. All patients were evaluated by the Wood′s lamp, reflectance confocal microscopy (RCM) , 308-nm excimer laser radiation, and in vitro culture of epidermal melanocytes from negative-pressure suction blisters. Results:Among the 8 patients, fluorescence was observed in 6 under the Wood′s lamp, dermal papillary rings were incomplete or absent in 4 as shown by RCM, and 5 experienced no repigmentation after 308-nm excimer laser radiation. Among the 8 patients, in vitro cultured lesional melanocytes were all positive for ferrous sulfate staining, yellowish-white precipitates were obtained after digestion and centrifugation of the melanocytes, and stage Ⅰ-Ⅲ melanosomes were observed in the cytoplasm of melanocytes under the electron microscope; however, the precipitates were black in color after digestion and centrifugation of the melanocytes collected from the normal skin tissues at the contralateral anatomical site, and stageⅠ-Ⅳ melanosomes were seen in the cytoplasm of the melanocytes under the electron microscope. Conclusion:Culture of epidermal melanocytes from negative-pressure suction blisters may facilitate the diagnosis of segmental vitiligo-like nevus depigmentosus.
6. Efficacy of Q-switched Nd:YAG laser in the treatment of melasma in female patients and analysis of factors influencing the efficacy
Rong CHEN ; Jiehao LEI ; Ai′e XU
Chinese Journal of Dermatology 2019;52(11):826-829
Objective:
To evaluate the clinical efficacy of Q-switched Nd:YAG laser in the treatment of melasma, and to explore factors influencing the efficacy.
Methods:
Forty-four female patients with melasma were enrolled into this study, who received treatment with Q-switched Nd:YAG laser once every 2-3 weeks for a total of 10 sessions in Department of Dermatology, Hangzhou Third Hospital between August 2017 and October 2017. Skin lesions were classified into epidermal type and mixed type by reflectance confocal microscopy, and a VISIA skin imaging detector was used to evaluate if subclinical melasma existed in patients. According to the modified melasma area and severity index (mMASI) , the severity of skin lesions before and after the treatment, as well as the efficacy, was evaluated by dermatologists. Statistical analysis was carried out by using paired