今日の臨床サポート

尋常性白斑

著者: 谷岡未樹 谷岡皮フ科クリニック

監修: 戸倉新樹 掛川市・袋井市病院企業団立 中東遠総合医療センター 参与/浜松医科大学 名誉教授

著者校正/監修レビュー済:2019/03/22
参考ガイドライン:
尋常性白斑診療ガイドライン 日本皮膚科学会 2012
患者向け説明資料

概要・推奨   

  1. 尋常性白斑の治療にステロイド外用を勧められる(推奨度1)。
  1. 尋常性白斑に対して活性型ビタミンD3外用薬単独では効果が弱い(推奨度3)。紫外線療法と併用することは考慮してもよい(推奨度2)。
  1. タクロリムス軟膏は治療効果が高い可能性はある。しかし、長期安全性は不明であり、3~4カ月をめどに効果判定を行う(推奨度2)。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
谷岡未樹 : 特に申告事項無し[2021年]
監修:戸倉新樹 : 講演料(田辺三菱,サノフィ,マルホ,協和キリン),研究費・助成金など(ノバルティス,レオファーマ)[2021年]

改訂のポイント:
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 尋常性白斑は生命を脅かす疾患ではないが、視覚的に患者が認識できるため、特に露出部に生じた場合、そのQOLに与える影響は大きい。
  1. 尋常性白斑は後天的にメラノサイトが減少して発症する。
  1. メラノサイトに対する自己免疫反応が原因と考えられている。
  1. 尋常性白斑は全身型(汎発型)と、神経分節に沿って片側性である分節型に分類される。
  1. 頭痛、めまい、眼症状(眼痛、視力低下)、難聴があればVogt-小柳—原田病に伴う白斑を疑う。
  1. 自己免疫性甲状腺疾患を伴う場合があるので、脈拍、発汗、頚部の診察を行う。
  1. 初診時には甲状腺ホルモン検査を行ってもよい。
  1. 治療はステロイド外用や紫外線療法を行う。症状の固定した難治性病変には手術療法も検討される。
問診・診察のポイント  
  1. 患者自身が皮膚色の変化に気がついて受診する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: S Radakovic, J Breier-Maly, R Konschitzky, H Kittler, P Sator, H Hoenigsmann, A Tanew
雑誌名: J Eur Acad Dermatol Venereol. 2009 Aug;23(8):951-3. doi: 10.1111/j.1468-3083.2009.03138.x. Epub 2009 Jun 2.
Abstract/Text BACKGROUND: A few studies on the treatment of vitiligo with topical tacrolimus have been published and showed promising results. However, most of these trials were uncontrolled.
OBJECTIVE: This study aims to assess the response of vitiligo to once- or twice-daily treatment with 0.1% tacrolimus in a controlled, randomized, observer-blinded study.
METHODS: Seventeen patients with generalized vitiligo were enrolled in this study. In each patient, two lesions were selected and randomized to treatment with either once- or twice-daily application of 0.1% tacrolimus for a total period of 6 months. In 10 patients, a third patch was left untreated to serve as a control.
RESULTS: Fifteen patients with 40 target lesions completed the study. Twice-daily treatment induced excellent (> 75%) repigmentation in two lesions, moderate (> 25-50%) and poor (1-25%) repigmentation in four lesions each, and no response in five lesions. Once-daily treatment resulted in moderate repigmentation in two lesions and poor repigmentation in five lesions, whereas no effect was observed in the remaining eight lesions. One out of 10 control lesions developed moderate spontaneous repigmentation, the other nine remained unchanged. Besides the frequency of tacrolimus application, the treatment outcome was determined by the localization of the affected areas with the facial region showing the best response.
CONCLUSIONS: Tacrolimus ointment appears to be an effective treatment option for facial vitiligo. A guarded prognosis is advisable for vitiliginous lesions on other localizations. Treatment must be applied twice daily for optimum response.

PMID 19496898  J Eur Acad Dermatol Venereol. 2009 Aug;23(8):951-3. doi・・・
著者: L A Drake, S M Dinehart, E R Farmer, R W Goltz, G F Graham, M K Hordinsky, C W Lewis, D M Pariser, J W Skouge, M L Turner, S B Webster, D C Whitaker, B J Lowery, J J Nordlund, P E Grimes, R M Halder, H R Minus
雑誌名: J Am Acad Dermatol. 1996 Oct;35(4):620-6.
Abstract/Text
PMID 8859294  J Am Acad Dermatol. 1996 Oct;35(4):620-6.
著者: Y K C Kwok, A V Anstey, J L M Hawk
雑誌名: Clin Exp Dermatol. 2002 Mar;27(2):104-10.
Abstract/Text A 10-year retrospective analysis of the use of psoralen photochemotherapy (PUVA) in the treatment of vitiligo was undertaken at the St John's Institute of Dermatology, London, UK. Of 97 patients included in this study, eight had complete or almost complete repigmentation, 59 moderate to extensive repigmentation, and 30 showed little or no response. However, 24 of those who had responded to PUVA with extensive repigmentation did not consider their response satisfactory because of persistence of vitiligo at cosmetically sensitive sites, and poorly matching, speckled repigmentation. Fifty-seven patients who initially improved with PUVA therapy subsequently relapsed, in most cases within a year of stopping treatment. Relapses in 22 patients were on the same cutaneous sites as previously affected, while vitiligo at new sites developed in 20 patients and both new and old sites were affected in a further 15 patients. Patients who retained their pigmentation after 2 years appeared to have a better chance of permanent remission. The only statistically significant prognostic indicator of relapse was patient age at the start of treatment, younger patients tending to retain their pigmentation longer than older patients. This study emphasizes the need for careful patient counselling before PUVA therapy as this treatment seldom achieves extensive repigmentation that is cosmetically acceptable, and treatment response is often followed by relapse.

PMID 11952699  Clin Exp Dermatol. 2002 Mar;27(2):104-10.
著者: W Westerhof, L Nieuweboer-Krobotova
雑誌名: Arch Dermatol. 1997 Dec;133(12):1525-8.
Abstract/Text OBJECTIVE: To compare the efficacy and safety of 2 treatment modalities, topical psoralen plus UV-A (PUVA) with unsubstituted psoralen and 311-nm UV-B radiation, in patients with vitiligo.
DESIGN: This intervention study was designed as a before-and-after trial with 2 arms, in which patients were consecutively included.
PATIENTS: Male (n = 99) and female (n = 182) patients, who predominantly had skin type III, with extensive, generalized vitiligo of more than 3 months' duration.
INTERVENTIONS: Two patient groups were investigated. The first group of patients was treated for 4 months with either topical PUVA (n = 28) or 311-nm UV-B radiation (n = 78). The second group of patients, treated twice weekly with 311-nm UV-B radiation, was followed up for 3 (n = 60), 6 (n = 27), 9 (n = 37), or 12 months (n = 51).
RESULTS: Thirteen (46%) patients in the first group treated with topical PUVA showed repigmentation after 4 months. Fifty-two patients (67%) in the 311-nm UV-B treatment group showed repigmentation after 4 months. After 3 months, 5 patients (8%) in the second group showed more than 75% repigmentation of lesional skin compared with 32 patients (63%) after 12 months. As in other treatment modalities, the face showed good repigmentation, whereas hands and feet responded poorly. No adverse effects were encountered with treatment with narrowband UV-B radiation, contrary to those seen with topical PUVA treatment. The cumulative UV-B dose was very small compared with that of the topical PUVA treatment.
CONCLUSIONS: According to our results, the treatment of patients with vitiligo with 311-nm UV-B radiation is as efficient as with topical PUVA and has fewer adverse effects.

PMID 9420536  Arch Dermatol. 1997 Dec;133(12):1525-8.
著者: M D Njoo, J D Bos, W Westerhof
雑誌名: J Am Acad Dermatol. 2000 Feb;42(2 Pt 1):245-53. doi: 10.1016/S0190-9622(00)90133-6.
Abstract/Text BACKGROUND: Only a few clinical trials have been performed on the treatment of generalized vitiligo in children. Recently, narrow-band UVB therapy has been reported to be an effective and safe therapeutic option in adult patients with vitiligo.
OBJECTIVE: We studied the efficacy and safety of UVB (311 nm) therapy in children with generalized vitiligo and evaluated the effect of the therapy on the quality of life in these children.
METHODS: In an open trial, 51 children (20 males, 31 females) with generalized vitiligo were treated twice weekly with narrow-band UVB radiation therapy for the maximum period of 1 year. The Children's Dermatology Life Quality Index (CDLQI) was used to evaluate the psychosocial impact of disease and treatment and was scored before and after therapy.
RESULTS: The treatment resulted in more than 75% overall repigmentation in 53% of patients and in stabilization of the disease in 80%. Responsiveness to therapy was positively correlated with localization of the lesions and the patients' compliance. Adverse events were limited and transient. The better the repigmentation grade, the better the CDLQI scores had improved.
CONCLUSION: Narrow-band UVB therapy is effective and safe in childhood vitiligo; it also may significantly improve the quality of life.

PMID 10642680  J Am Acad Dermatol. 2000 Feb;42(2 Pt 1):245-53. doi: 10・・・
著者: L Scherschun, J J Kim, H W Lim
雑誌名: J Am Acad Dermatol. 2001 Jun;44(6):999-1003. doi: 10.1067/mjd.2001.114752.
Abstract/Text BACKGROUND: The treatment of vitiligo remains a challenge.
OBJECTIVE: The purpose of this article is to review our results and experience with narrow-band ultraviolet (UV) B phototherapy for vitiligo.
METHODS: This is a retrospective analysis of our experience and results with patients with vitiligo who were treated with narrow-band UVB between November 1998 and November 1999. Narrow-band UVB phototherapy was given as monotherapy 3 times a week. The starting dose was 280 mJ/cm(2), with 15% dose increments at each subsequent treatment.
RESULTS: Seven patients were able to be evaluated for the purposes of this analysis. Their ages ranged from 19 to 59 years (mean, 37.6 years). Three patients had Fitzpatrick skin phototype IV and V, and 4 had phototypes II and III. Five of the 7 patients achieved more than 75% repigmentation with a mean of 19 treatments; the mean duration of disease was 13 months. The remaining two patients had 50% and 40% repigmentation after 46 and 48 treatments, respectively. Their mean duration of disease was 132 months. Adverse effects were mild erythema and pruritus.
CONCLUSION: This treatment protocol resulted in rapid repigmentation in many patients, including those with skin phototypes IV and V. In accordance with previous studies, this report indicates that narrow-band UVB is a useful and well-tolerated therapy for vitiligo.

PMID 11369913  J Am Acad Dermatol. 2001 Jun;44(6):999-1003. doi: 10.10・・・
著者: Sami Sasi Yones, Roy A Palmer, Trish M Garibaldinos, John L M Hawk
雑誌名: Arch Dermatol. 2007 May;143(5):578-84. doi: 10.1001/archderm.143.5.578.
Abstract/Text OBJECTIVE: To compare the efficacy of oral psoralen-UV-A (PUVA) with that of narrowband-UV-B (NB-UVB) phototherapy in patients with nonsegmental vitiligo.
DESIGN: Double-blind randomized study.
SETTING: Phototherapy unit in a university hospital.
PATIENTS: Fifty-six patients with nonsegmental vitiligo. Interventions Twice-weekly therapy with PUVA or NB-UVB.
MAIN OUTCOME MEASURES: The change in body surface area affected by vitiligo and the color match of repigmented skin compared with unaffected skin were assessed after 48 sessions of therapy, at the end of the therapy course, and 12 months after the end of therapy.
RESULTS: The results in the 25 patients each in the PUVA and NB-UVB groups who began therapy were analyzed. The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB-treated group (P = .03); we suspect this difference was because of the differences in efficacy and adverse effects between the 2 modalities, such that patients in the NB-UVB group wanted a longer course of treatment. At the end of therapy, 16 (64%) of 25 patients in the NB-UVB group showed greater than 50% improvement in body surface area affected compared with 9 (36%) of 25 patients in the PUVA group. The color match of the repigmented skin was excellent in all patients in the NB-UVB group but in only 11 (44%) of those in the PUVA group (P<.001). In patients who completed 48 sessions, the improvement in body surface area affected by vitiligo was greater with NB-UVB therapy than with PUVA therapy (P = .007). Twelve months after the cessation of therapy, the superiority of NB-UVB tended to be maintained.
CONCLUSION: In the treatment of nonsegmental vitiligo, NB-UVB therapy is superior to oral PUVA therapy.

PMID 17519217  Arch Dermatol. 2007 May;143(5):578-84. doi: 10.1001/arc・・・
著者: Iltefat Hamzavi, Hem Jain, David McLean, Jerry Shapiro, Haishan Zeng, Harvey Lui
雑誌名: Arch Dermatol. 2004 Jun;140(6):677-83. doi: 10.1001/archderm.140.6.677.
Abstract/Text BACKGROUND: There is currently no quantitative tool for evaluating vitiligo treatment response using parametric methods.
OBJECTIVE: To develop and apply a simple clinical tool, the Vitiligo Area Scoring Index (VASI), to model the response of vitiligo to narrowband UV-B (NB-UV-B) phototherapy using parametric tests.
DESIGN: Prospective, randomized, controlled, bilateral left-right comparison trial.
SETTING: North American tertiary care, university-affiliated phototherapy center.
PATIENTS: Patients older than 18 years with stable vitiligo involving at least 5% of their total body surface in a symmetric distribution.
INTERVENTION: Treatment with NB-UV-B was given 3 times a week to half of the body on all patients for either 60 treatments or 6 months. The contralateral side served as a no-treatment control.
MAIN OUTCOME MEASURE: Repigmentation was assessed using the VASI, which was based on a composite estimate of the overall area of vitiligo patches at baseline and the degree of macular repigmentation within these patches over time. The VASI was validated separately against physician and patient global assessments. The overall reductions in VASI for NB-UV-B and control groups were modeled by multilevel regression with random effects and compared parametrically.
RESULTS: The VASI scoring correlated well with both patient and physician global assessments (P =.05 and P<.001, respectively, using ordinal logistic regression). The extent of repigmentation after 6 months on the treated side was 42.9% (95% confidence interval, 26.7%-59.0%) vs 3.3% (95% confidence interval -19.3% to 30.0%) on the untreated side (P<.001). A significant difference between control and NB-UV-B groups was apparent within the first 2 months of therapy. The legs, trunk, and arms were much more likely to repigment than the feet and hands.
CONCLUSIONS: The VASI is a quantitative clinical tool that can be used to evaluate vitiligo parametrically. Patients treated with NB-UV-B can be expected to achieve approximately 42.9% repigmentation of their vitiligo after 6 months of treatment, with the greatest response being achieved over the trunk and nonacral portions of the extremities.

PMID 15210457  Arch Dermatol. 2004 Jun;140(6):677-83. doi: 10.1001/arc・・・
著者: D J Gawkrodger, A D Ormerod, L Shaw, I Mauri-Sole, M E Whitton, M J Watts, A V Anstey, J Ingham, K Young, Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists, Clinical Standards Department, Royal College of Physicians of London, Cochrane Skin Group, Vitiligo Society
雑誌名: Br J Dermatol. 2008 Nov;159(5):1051-76. doi: 10.1111/j.1365-2133.2008.08881.x.
Abstract/Text This detailed and user-friendly guideline for the diagnosis and management of vitiligo in children and adults aims to give high quality clinical advice, based on the best available evidence and expert consensus, taking into account patient choice and clinical expertise. The guideline was devised by a structured process and is intended for use by dermatologists and as a resource for interested parties including patients. Recommendations and levels of evidence have been graded according to the method developed by the Scottish Inter-Collegiate Guidelines Network. Where evidence was lacking, research recommendations were made. The types of vitiligo, process of diagnosis in primary and secondary care, and investigation of vitiligo were assessed. Treatments considered include offering no treatment other than camouflage cosmetics and sunscreens, the use of topical potent or highly potent corticosteroids, of vitamin D analogues, and of topical calcineurin inhibitors, and depigmentation with p-(benzyloxy)phenol. The use of systemic treatment, e.g. corticosteroids, ciclosporin and other immunosuppressive agents was analyzed. Phototherapy was considered, including narrowband ultraviolet B (UVB), psoralen with ultraviolet A (UVA), and khellin with UVA or UVB, along with combinations of topical preparations and various forms of UV. Surgical treatments that were assessed include full-thickness and split skin grafting, mini (punch) grafts, autologous epidermal cell suspensions, and autologous skin equivalents. The effectiveness of cognitive therapy and psychological treatments was considered. Therapeutic algorithms using grades of recommendation and levels of evidence have been produced for children and for adults with vitiligo.

PMID 19036036  Br J Dermatol. 2008 Nov;159(5):1051-76. doi: 10.1111/j.・・・
著者: Makoto Kunisada, Hiroshi Kumimoto, Kanji Ishizaki, Kunihiko Sakumi, Yusaku Nakabeppu, Chikako Nishigori
雑誌名: J Invest Dermatol. 2007 Dec;127(12):2865-71. doi: 10.1038/sj.jid.5701001. Epub 2007 Aug 9.
Abstract/Text Phototherapy with narrow-band UVB (NB-UVB), with a peak exclusively at 311 nm wavelength, has been found to be more effective in treating a variety of skin diseases than conventional broad-band UVB (BB-UVB). To assess the difference in carcinogenic activity between NB-UVB and BB-UVB, we investigated skin tumor formation by irradiating albino hairless, Ogg1 knockout mice and C57BL/6J wild counterparts with these two UV sources. We found that the ratio of malignant skin tumors induced by NB-UVB was significantly higher than that induced by BB-UVB. There was no significant difference in carcinogenicity of skin tumor induced by NB-UVB between Ogg1 knockout and wild-type mice. To investigate the possible cause of different carcinogenic activity by the different UV sources, we examined three types of DNA damage: cyclobutane pyrimidine dimer (CPD), (6-4) photoproduct, and 8-oxoguanine (8-oxoG) induced by each UV source. We found that CPD formation following a minimum erythema dose (MED) by NB-UVB was significantly higher than that following 1 MED by BB-UVB, whereas the formation of (6-4) photoproducts and 8-oxoG following BB-UVB was significantly higher than those following NB-UVB exposure. These results suggest that CPD formation is closely related to the higher carcinogenic characteristics of NB-UVB. JID JOURNAL CLUB ARTICLE: For questions, answers and open discussion about this article please go to http://network.nature.com/.

PMID 17687389  J Invest Dermatol. 2007 Dec;127(12):2865-71. doi: 10.10・・・
著者: Electra Nicolaidou, Christina Antoniou, Alexander Stratigos, Andreas D Katsambas
雑誌名: J Am Acad Dermatol. 2009 Mar;60(3):470-7. doi: 10.1016/j.jaad.2008.07.053. Epub 2009 Jan 20.
Abstract/Text Vitiligo is a common and chronic disease with a great impact on patients' quality of life. Phototherapy with narrowband ultraviolet B radiation and excimer laser are two treatment modalities that are used increasingly for the management of the disease with variable results. In this article, we review the efficacy, adverse effects, and possible mechanisms of action of narrowband ultraviolet B and excimer laser in the management of vitiligo. Available data concerning the follow-up of treated patients and some criteria for the selection of patients with a greater chance to respond satisfactorily to treatment are also presented.

PMID 19157641  J Am Acad Dermatol. 2009 Mar;60(3):470-7. doi: 10.1016/・・・
著者: Zhu Shen, Tian-Wen Gao, Ling Chen, Li Yang, Yan-Chun Wang, Lin-Chao Sun, Chun-Ying Li, Yan Xiao, Yu-Feng Liu
雑誌名: Photomed Laser Surg. 2007 Oct;25(5):418-27. doi: 10.1089/pho.2007.2086.
Abstract/Text OBJECTIVES: This study was designed to determine the optimal treatment frequency with the 308-nm excimer laser for vitiligo and identify key clinical variable(s) associated with treatment efficacy at the optimal frequency.
BACKGROUND DATA: Optimal clinical parameters for excimer laser treatment of vitiligo have not been fully determined. Data about the influence on treatment frequency of different clinical variables of vitiligo are needed to facilitate effective treatment regimens.
METHODS: A total of 187 patients were treated with the 308-nm excimer laser for 20 sessions at different frequencies (0.5, 1.0, 2.0, and 3.0 per week). The repigmentation rate was graded on a six-point scale and was blindly evaluated by independent physicians.
RESULTS: The final percentage of repigmentation for group 0.5 was statistically lower than those for group 1.0, 2.0, and 3.0, and percentages of final levels of repigmentation among these three groups were not statistically different. The clinical variables showed no statistical differences in the final repigmentation effect. Repigmentation occurred fastest with treatment frequencies of 2.0 and 3.0 and there was no statistically significant difference between them. The onset of repigmentation correlated with the area of vitiliginous patches treated, not with the other clinical variables.
CONCLUSIONS: The 308-nm excimer laser is effective for therapy to treat vitiligo on the face and neck. The ultimate laser-induced repigmentation effect does not correlate with treatment frequency and repigmentation occurs faster with treatment frequencies of 2.0 and 3.0 than that of 1.0. It appears that the onset of repigmentation correlates with the total area of vitiliginous patches and the optimal treatment frequency. Monitored studies on a larger population with long-term follow-up would be needed to confirm and extend our findings.

PMID 17975956  Photomed Laser Surg. 2007 Oct;25(5):418-27. doi: 10.108・・・
著者: M Casacci, P Thomas, A Pacifico, A Bonnevalle, A Paro Vidolin, G Leone
雑誌名: J Eur Acad Dermatol Venereol. 2007 Aug;21(7):956-63. doi: 10.1111/j.1468-3083.2007.02151.x.
Abstract/Text BACKGROUND: Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients.
METHODS: The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side.
RESULTS: At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3).
CONCLUSIONS: It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly.

PMID 17659006  J Eur Acad Dermatol Venereol. 2007 Aug;21(7):956-63. do・・・
著者: F Sassi, S Cazzaniga, G Tessari, L Chatenoud, A Reseghetti, L Marchesi, G Girolomoni, L Naldi
雑誌名: Br J Dermatol. 2008 Nov;159(5):1186-91. doi: 10.1111/j.1365-2133.2008.08793.x. Epub 2008 Aug 19.
Abstract/Text BACKGROUND: Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge.
OBJECTIVES: We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy.
METHODS: Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75% of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores.
RESULTS: A total of 76 (90%) patients completed the study. In an intention-to-treat analysis, seven [16.6%; 95% confidence interval (CI) 5.3-27.8%] patients in the excimer monotherapy arm and 18 (42.8%; 95% CI 27.8-57.8%) in the combination arm showed > or = 75% reduction of vitiligo lesions at 12 weeks (chi(2) test 6.89, P = 0.0087). Clearance was observed in two (4.7%; 95% CI 1.6-11.2%) and nine (21.4%; 95% CI 9.0-33.8%) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29.
CONCLUSIONS: Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.

PMID 18717675  Br J Dermatol. 2008 Nov;159(5):1186-91. doi: 10.1111/j.・・・
著者: M D Njoo, W Westerhof, J D Bos, P M Bossuyt
雑誌名: Arch Dermatol. 1998 Dec;134(12):1543-9.
Abstract/Text OBJECTIVE: A systematic review of the effectiveness, safety, and applicability of autologous transplantation methods in vitiligo.
DATA SOURCES: Computerized searches of bibliographical databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms.
STUDY SELECTION: Predefined selection criteria were applied to all studies found.
DATA EXTRACTION: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted.
DATA SYNTHESIS: Sixty-three studies were found, of which 16 reported on minigrafting, 13 on split-thickness grafting, 15 on grafting of epidermal blisters, 17 on grafting of cultured melanocytes, and 2 on grafting of noncultured epidermal suspension. Of these, 39 patient series were included. The highest mean success rates (87%) were achieved with split-skin grafting (95% confidence interval, 82%-91%), and epidermal blister grafting (87%) (95% confidence interval, 83%-90%). The mean success rate of 5 culturing techniques varied from 13% to 53%. However, in 4 of the 5 culturing methods, fewer than 20 patients were studied. Minigrafting had the highest rates of adverse effects but was the easiest, fastest, and least expensive method.
CONCLUSIONS: Because no controlled trials were included, treatment recommendations should be formulated with caution. Split-thickness and epidermal blister grafting can be recommended as the most effective and safest techniques. No definite conclusions can be drawn about the effectiveness of culturing techniques because only a small number of patients have been studied. The choice of method also depends on certain disease characteristics and the availability of specialized personnel and equipment.

PMID 9875191  Arch Dermatol. 1998 Dec;134(12):1543-9.
著者: Rafael Falabella, Maria I Barona
雑誌名: Pigment Cell Melanoma Res. 2009 Feb;22(1):42-65. doi: 10.1111/j.1755-148X.2008.00528.x. Epub 2008 Nov 27.
Abstract/Text Treatment for vitiligo is difficult and prolonged. Nevertheless, at present considerable knowledge accumulated during several decades on the pathogenic mechanisms, revealed important clues for designing new strategies to improve vitiligo depigmentation. With available medical therapies, high repigmentation percentages mostly on facial and neck lesions are achieved, although they are less effective on trunk and limbs and poor on the acral parts of the extremities. Narrow band UVB and psoralens and UVA are the two most important treatments for generalized vitiligo affecting more than 10-20% of the cutaneous surface, and topical corticosteroids, or calcineurin inhibitors are the most valuable treatments for localized vitiligo. Persistence of achieved regimentation is variable and an undefined percentage of patients may have variable recurrence. When vitiligo becomes refractory, surgical methods may improve depigmentation as effectively as with medical therapy; in segmental (unilateral) or long standing, non-segmental (bilateral) stable vitiligo, repigmentation with surgical methods is usually permanent.

PMID 19040503  Pigment Cell Melanoma Res. 2009 Feb;22(1):42-65. doi: 1・・・
著者: Takaaki Hanafusa, Yuji Yamaguchi, Motoki Nakamura, Reiko Kojima, Rieko Shima, Yoshiko Furui, Shoichi Watanabe, Aiko Takeuchi, Natsumi Kaneko, Yoichi Shintani, Akira Maeda, Mamori Tani, Akimichi Morita, Ichiro Katayama
雑誌名: J Dermatol Sci. 2008 Jun;50(3):243-7. doi: 10.1016/j.jdermsci.2008.02.001. Epub 2008 Mar 20.
Abstract/Text
PMID 18358700  J Dermatol Sci. 2008 Jun;50(3):243-7. doi: 10.1016/j.jd・・・
著者: K Ongenae, L Dierckxsens, L Brochez, N van Geel, J M Naeyaert
雑誌名: Dermatology. 2005;210(4):279-85. doi: 10.1159/000084751.
Abstract/Text BACKGROUND: Few studies have paid attention to the effects of treatment interventions on the psychosocial consequences of vitiligo.
OBJECTIVES: To quantify and analyse the psychosocial benefit of the use of camouflage in vitiligo patients.
PATIENTS AND METHODS: 78 vitiligo patients completed the Dermatology Life Quality Index (DLQI) and an adapted stigmatization questionnaire, and 62 of them completed the DLQI after at least a 1-month use of camouflage.
RESULTS: The initial mean overall DLQI score (n = 78) is 6.9 (SD 5.6). The mean global stigmatization score is 38%. Disease extent and disease severity are strong predictors of the DLQI (p < 0.0001). Vitiligo on the face/head/neck substantially affects the DLQI, independently of degree of involvement. The mean DLQI score before and after use of camouflage (n = 62) is 7.3 (SD 5.6) and 5.9 (SD 5.2; p = 0.006). Mainly the high-scoring items 'feelings of embarrassment and self consciousness' and 'choice of clothing' improve. Predictors of improvement are higher DLQI scores (p = 0.0005) and higher total severity scores (p = 0.03).
CONCLUSIONS: Camouflage can be recommended, particularly in patients with higher DLQI scores or self-assessed disease severity. Patients with minor involvement of the face benefit from camouflage.

2005 S. Karger AG, Basel
PMID 15942213  Dermatology. 2005;210(4):279-85. doi: 10.1159/000084751・・・
著者: Miki Tanioka, Yosuke Yamamoto, Mayumi Kato, Yoshiki Miyachi
雑誌名: J Cosmet Dermatol. 2010 Mar;9(1):72-5. doi: 10.1111/j.1473-2165.2010.00479.x.
Abstract/Text BACKGROUND: Cosmetic camouflage is important for patients with vitiligo vulgaris. However, few studies have investigated its benefit for vitiligo patients.
OBJECTIVES: To analyze the psychological effects on patients with vitiligo vulgaris by camouflage lessons performed in vitiligo clinics in Kyoto University Hospital and Fukui Red Cross Hospital, Dermatological Life Quality Index (DLQI) questionnaires were collected before and 1 month after camouflage lessons.
PATIENTS: Patients with vitiligo vulgaris, who visited our clinics in 2008 and had never experienced camouflage, were enrolled in this study. They took camouflage lessons and continued subsequent self-camouflage for 1 month. Control patients took no lessons and no camouflage.
RESULTS: Camouflage improved the scores of DLQI when compared with those without camouflage (P = 0.005). Camouflage improved DLQI scores from 5.90 to 4.48. In DLQI subcategories, camouflage lessons improved a subcategory of "symptoms and feelings" (P = 0.0037).
CONCLUSIONS: These data supported the idea that camouflage for patients with vitiligo not only covers the white patches but also improves their quality of life.

PMID 20367677  J Cosmet Dermatol. 2010 Mar;9(1):72-5. doi: 10.1111/j.1・・・

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