皮肤病学和皮肤病杂志

Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relapsing nature, long-term topical maintenance therapies are often required which may be time consuming and costly for patients. As a result, light and laser therapies have become increasingly popular in the treatment of melasma. Yet, clinical studies on melasma tend to focus more on the efficacy of these treatments rather than their ability to achieve long-term results. Objective: To assess the ability of light and laser treatments to achieve long lasting results in melasma. Methods: A literature review was conducted to assess the long-term efficacy of laser and light treatments in epidermal, mixed and dermal melasma. Results: Out of 128 articles reviewed, 17 studies of laser and light therapies included patient follow-up without maintenance therapies in their study designs. According to these studies, IPL and Nd:YAG achieved long lasting results for up to 6-months. Studies also suggest that combining these therapies together as well as combining them with other topical or procedural therapies, may result in enhanced long-term efficacy. Despite this, these treatments are less commonly used than topical therapies in clinical practice due to their cost and potential side effects, such as scarring, post inflammatory hyperpigmentation and prolonged erythema. Studies also indicate that these therapies vary in efficacy depending on the melasma subtype. Limitations: There was a lack of standardized outcome assessments. Conclusions: In conclusion, light and laser treatments have a role in treating melasma. To study their efficacy in treating melasma long-term, more studies with extended duration of follow-ups and standardized outcome measures are needed.

The authors present a case of a rare pigmentation disorder, partial unilateral lentiginosis (PUL), which is characterized by multiple lentigines located in only one side of the body with histopathology of lentigine.

Background: Vitiligo is a common, multifactorial, polygenic pigmentary disorder with a complex pathogenesis. Free radical and immune mediated damage of melanocytes are the most probable pathological mechanism. There have been several conflicting reports on the blood levels of vitamin B12, folate and homocysteine in vitiligo and its severity. Because of relation between vitamin B12, RBC folate and homocysteine, we checked serum level of vitamin B12 and RBC folate as well. Methods: In this study a total of 50 patients and 53 age and sex matched healthy controls were enrolled. Serum vitamin B12, homocysteine and RBC folate are checked. Disease activity was assessed by Vitiligo Disease Activity (VIDA) score and disease severity assessed by VASI score. Results: The two groups did not differ significantly in RBC folate concentrations and serum levels of vitamin B12. Patients with vitiligo had significantly lower levels of homocysteine compared to healthy controls. Hyperhomocysteinaemia was detected in 34 (64.2%) healthy control but only in 18 (36%) patients with vitiligo. Conclusions: Our study showed that serum homocysteine level did not affect the vitiligo severity and homocysteine level was not higher in majority of vitiligo patients comparing to healthy controls. But vitamin B12 had significant association with disease severity and a negative correlation was found .

Background: Actinic Reticuloid (AR) is idiopathic photosensitivity dermatitis. AR presents with eczematous scaly plaques in a sun-exposed distribution, typically on the head and neck. AR is most commonly seen in older males with a significant history of sun exposure. Observation: A 64 year-old Hispanic male with a long-standing history of widespread vitiligo, presented with a two-week history of a pruritic, erythematous eruption of his head, neck, and hands. Sun-exposed skin which had been previously depigmented by vitiligo was involved, while normally pigmented sun-exposed areas were spared. Skin biopsy from scaly plaques on his vitiliginous skin was consistent with a diagnosis of AR. Treatment with topical and oral corticosteroids, in combination with sun protection, lead to marked improvement of symptoms. Conclusion: This case demonstrates an unusual presentation of actinic reticuloid with an unusual predilection for skin which had been previously depigmented due to vitiligo.