皮肤病学和皮肤病杂志

Pigmentation disorders are a group of diseases caused by changes in the levels of the pigment melanin produced by melanocytes, the cells that manufacture pigment in the skin, or due to the accumulation of other pigments in the skin. These can be examined under the headings hypo-, hyper- and depigmentation. This review describes pigment disorders in the light of the current literature.

Abstract Background: Halo Nevi (HN), are defined as benign melanocytic nevi that are surrounded by a rim of depigmentation, resembling a halo. The halo phenomenon indicates the involution and subsequent regression of the melanocytic nevus. Material and Methods: A random series of 137 nevi, including 75 HN were examined. Serial paraffin and frozen sections were subjected to: routine histochemistry; (HE, Reticulin, Auro, PAS), enzyme histochemistry: dopa oxidase, counterstained with Nuclear Fast Red (NFR) to highlight the endothelium and dopamine oxidase; immunohistochemistry to assess presence of lymphocytic infiltrates; electron microscopy: after enbloc dopa stain. Results and Discussion: Junctional nevi show proliferation of highly dendritic melanocytes within the epidermis. Intradermal nevi are composed of dermal nevus cells separated from the epidermis by a clear Grenz zone. Compound nevi show a combination of junctional activity and sheets of dermal nevus cells. Some nevi show a depigmented halo and can regress completely to be replaced by a depigmented patch, the halo nevus. The nevus cells and marginal melanocytes are replaced by endothelial cells, lining vascular spaces, with involution of the nevus. Intriguingly there is a complete absence of inflammatory and immune related lympho-histiocytic cells in the cases studied. These observations, suggest that nevus cells are replaced by vascular endothelial cell types which results in dissolution of the lesion.

Vitiligo is one of the disease which is yet to understand its pathogenesis, however many studies associate this disease as an autoimmune. Detection of autoimmune cells in the serum, lesional and perilesional area of vitiligo patients gives more insight on the disease mechanism. Presence of autoantibodies against melanocytes antigens in vitiligo patients indicates an autoimmune involvement in the aetiology of the disease. Identification and characterization of vitiligo autoantibodies would pave the way for developing new laboratory test for diagnosis. Studying the autoantibodies profile can give an impression on the disease condition of vitiligo patients. We realized the need of research emphasis in this area as more is yet to be discovered. In this review we give an account on different autoantibodies and their associated autoantigens in vitiligo as another effort of providing an updated data for detail analysis.

The atypical Spitz nevus is a lesion of frequent occurrence in children, which is classified within the spectrum of “Spitzoid” injuries, which is characterized by a significant deviation on the findings of conventional Spitz nevus but without meeting the diagnostic criteria malignant melanoma. The prognosis is uncertain and only after the study and monitoring of a sufficient number of patients, may obtain truly objective information for management. We report the case of a teenager with a gluteal injury diagnosed with atypical Spitz nevus.

Morphea, also known as Localized scleroderma, is an idiopathic often self-limited, inflammatory disorder that causes fibrotic changes in the skin. Fibrotic, asymmetric plaques, usually 2-15 cm wide, characterize the disease. The active lesions may have erythematous or violaceous borders, whereas the inactive ones may result to hyperpigmentation. The thickening may expand to the subcutaneous tissue or may be to the lower layers of the skin, causing dysfunction at certain levels. There is no relevance to any systematic disease. Morphea usually evolves for several years and then degrades.

Background: Vitiligo is an acquired skin disease characterized by loss of melanin pigment due to disappearance of functional melanocytes. Several treatments are recommended worldwide, but none is really effective. Topical use of materials having high catalase activity is suggested to be effective to regain melanin pigment in the vitiligo skin. Objective: To investigate the efficacy and safety of topical use of PAPLAL which has extremely high activity of catalase in the treatment of vitiligo vulgaris subjects. Methods and Patients: 58 patients with vitiligo vulgaris who suffered more than 10% skin area and were refractory to the conventional therapies during the last one year or more. PAPLAL cream containing platinum (Pt, 139 μM) and palladium (Pd, 40 μM) nanoparticles, or PAPLAL lotion (Pt:5 μM, Pd:7 μM) was topically applied two times a day at the depigmented skin, mainly face and the back side of the hands and fingers which are well recognized as the sites resistant to the common therapies, or PAPLAL water (PT:1.03 mM, Pd:2.82 mM) was orally administered once a day. Therapeutic efficacy was evaluated by a dermatologist when the patients visited to the clinic mostly at every two weeks or every one month. Repigmentation effect was evaluated using photographs taken before and after the treatments of the selected vitiligo areas, face, the back of the hands or trunk by a single dermatologist. The treatment response was evaluated as follows; excellent: more than 50%, good: >10%, <50%, moderate: >5%, <10%, poor to none: less than 5%. We regarded the cases responded more than 10% repigmentaton after PAPLAL treatment as effective. The time points of evaluation were not fixed, but carried out at 2, 4, 8 weeks, and 3, 6 and 12 months after the initiation of the treatment. Results: PAPLAL cream was the most effective, as 58% patients had more than 10% repigmentation, compared to 35.2% and 11.1% of PAPLAL lotion and water, respectively. Two patients treated with PAPLAL cream exhibited erythema around 8 weeks after the intiation of the treatment. Conclusions: Our results have shown that PAPLAL cream and lotion may be the effective topical agents to treat vitiligo patients, since it showed a high efficacy of repigmentation of vitiligo cases who had not responded to the conventional modalities including excimer radiation therapy.