Treatment of vitiligo nabytego / 2 / - photochemotherapy
WHAT IS THE CAUSE OF BIELACTIVE?
The cause of the disappearance of the dark pigment of the skin and the appearance of white spots of leukemia
there are genetic factors. The effect of a faulty system reaction was also documented
for the destruction of skin pigment producing cells.
FOTOCHEMIOTHERAPY BY PUVA
Photochemotherapy using the PUVA method - UVA and solarena radiation
The PUVA method stimulates inactive melanocytes to produce dark pigment. PUVA - we decipher as the action of two components of therapy. P - psoralens (specifically 8-methoxypsoralen); UVA - is skin exposure to UVA radiation. It is believed that psoralens induce a sequence of local biogenetic changes - resulting in a beneficial decomposition of the double helix of the skin's DNA. In turn, UV radiation inhibits unfavorable DNA replication of the skin, thanks to which the immunological regulation of repigmentation (skin pigmentation blackening) is improved and the activity of antibodies destroying skin pigment cells is inhibited. In summary - thanks to this method, skin cells (melanocytes) are no longer destroyed, and ultraviolet stimulates them to produce dark pigment.
Application of the PUVA method
In people with vitiligo occupying not more than 20% of body surface area - psolaren can be used not only orally but also locally (currently the best is so-called 8-methoxypsoralen). After taking (or applying to the skin) psilarenum discolored skin irradiates two or three times a week, and the dose of UVA increases gradually until erythema. The disadvantage of this method is the risk of local irritation and discoloration at the perimeter of the leukemia spots. An advantage - less frequent systemic side effects. The condition for the safe use of the local PUVA method is high discipline (punctuality of treatments and rigors of skin care) and high motivation. Warning! Immediately after the procedure, patients should wash psoralens from the skin and use sunglasses and creams with sunscreen and avoid the sun for the rest of the day.
Oral use of psoralens in combination with UVA radiation
The PUVA method with oral (systemic) use of psilarenum is indicated in very extensive skin lesions - covering over 20% of the skin surface. In addition, people who do not respond to local treatment. This method should not be used in children under 12 years of age.
The effectiveness of PUVA treatment
In 7 of 10 patients, skin pigmentation is stimulated. However, only about 2 in 10 complete repigmentation occurs, while in others - partial lesions disappear. Therefore, patients should be carefully selected for treatment with PUVA.
Selection of patients for PUVA treatment
PUVA patients with dark complexion respond well to PUVA treatment, with lesions localized on the parts of the limbs and the proximal faces of the body and children. The unsatisfactory results of PUVA-therapy were obtained with changes located on the distal parts of the limbs and around natural openings as well as in vitiligo with a segmental system.
Adverse symptoms of PUVA
When using the PUVA method, side effects such as nausea, fatigue, erythema, itching, discoloration, hyperkeratosis, cataracts, formation of tumors (including melanoma) and accelerated skin aging may occur. Contraindications to the PUVA method are: pregnancy, breast-feeding, cataracts, positive skin cancer, arsenic, radiotherapy, photodermatosis.
The PUVA sol method
The PUVA sol method is cheaper to the classical PUVA method, because as psolaren - instead of 8-methoxypsoralen, relatively cheap - trioxylalene (trimethylopsoralene) is used. In this method - just as in the previous time of skin irradiation increases gradually. Initially, it can not exceed 5-10 (depending on the type of skin to gradually increase to 2 hours depending on the assessment of redness of the skin). It is advisable to wear glasses with sunscreen during treatment with PUVA sol, and an ophthalmologic examination should be performed before starting treatment.
OTHER METHODS OF PHOTOCHEMOTHERAPY IN THE TREATMENT OF ACQUISITION BINDING
KUVA method (kellina + UVA)
The PUVA modification is oral (or topical) use of the extract of the fruit of the Egyptian amine and after that irradiation of skin lesions with UVA radiation. The medicinal substance from the extract is so-called Kellin. It is a chemical compound currently obtained not only from the fruit of an Egyptian amine, but also synthetically. Topically, kelline is given as a 2% solution with the addition of acetone and propyl alcohol. UVA doses are addicted to the type of skin, exposure is carried out 3 times a week.
Extract from St. John's Wort + UV radiation
St. John's wort is a natural substance that is competitive against the fruit of an Egyptian amine, initiating the regeneration of pigment cells. In children, it is recommended to use it orally and / or externally with possible skin irradiation with UV radiation. But be careful. despite the fact that the St. John's wort can be bought without a prescription in a pharmacy, and UV radiation supplies the sun - treatment can only be carried out under the supervision of a doctor. Incorrect therapy can cause skin burns and other unwanted symptoms!
Therapy with the help of vitamin D3 derivatives and UV irradiation
Vitamin D3 derivatives are sometimes used in the treatment of vitiligo - for example, externally used calcipotriol. It can be used alone, but the effectiveness of treatment increases when local treatment with ultraviolet (UV) radiation is combined. Calcipotriol can also be added to PUVA therapy.
The method of UVB irradiation
In the treatment of vitiligo, this method shows faster repigmentation compared to the local PUVA method and the absence of phototoxic symptoms.
ed. Edward Ozga Michalski, MA
dermatological consultation drug. med Dorota Bystrzanowska
I invite residents of Warsaw and the surrounding area
to use the services of my Dermatology office
Doctor dermatologist - Private Medical Cabinet Ul. Klaudyny 18 Warsaw / Żoliborz
Contact for appointment (22) 676-69-86 0-603-753-493 [email protected]
Literature
1 / Advances in the treatment of acne vulgaris - Dr med. Maria Barancewicz-Łosek, lek. med. Wojciech Baran Chair and Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw; Head: prof. dr hab. med. Eugeniusz Baran WYd. THERAPY- DERMATOLOGY - MARCH 2005
2 / Błaszczyk-Kostanecka M., Chodynicka B., Gliński W. et al .: Acne vulgaris: pathogenesis and principles of treatment. Overview. Dermatol. 1998, 85 (1), 3-19.
3 / Practical Dermatology; dermatologists: Małgorzata Opalińska, Katarzyna Prystupa, Wadim Stąpór, Wyd. Lek. PZWL 1997.