P7616Occurrence of nonsegmental vitiligo after combination therapy of pegy-lated interferon-a 2a, ribavirin, and vitamin D in a patient with chronichepatitis C

Naoki Oiso, MD, PhD, Department of Dermatology, Kinki University Faculty ofMedicine, Osaka-Sayama, Japan; Akira Kawada, MD, PhD, Department ofDermatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan;Hiromasa Matsuda, MD, Department of Dermatology, Kinki University Facultyof Medicine, Osaka-Sayama, Japan; Masako Sato, MD, Department of InternalMedicine, Osaka Rosai Hospital, Sakai, Japan

Vitiligo is an acquired disorder in which the loss of melanocytes results indepigmented macules. We reported nonsegmental vitiligo after combinationtherapy of pegylated interferon-alfa 2a (PEG-IFN-? 2a), ribavirin, and vitamin D in apatient with chronic hepatitis C. A 56-year-old Japanese womanwas referred to us inNovember 2012 with depigmented macules on the face. The depigmented maculeshad begun to develop in September 2012. The patient had received bloodtransfusion during childbirth. Hepatitis C virus infection had been detected in2002, because she had undergone a total hysterectomy for severe atypical epitheliain the uterocervical lesion. Her hepatitis C workup had shown genotype 1. Thepatient had been started on combination therapy of PEG-IFN-? 2a and ribavirin fromJuly 2005 to June 2006. However, hepatitis C virus had recurrently becomeseropositive and chronic hepatitis C had gradually progressed. The patient hadbeen started on another combination therapy of PEG-IFN-? 2a 180 �g once weekly,ribavirin 600 mg daily, and 1-hydroxycholecalciferol 1 �g daily from April 2011. Thetherapy ended in August 2012. Her HCV RNA (PCR) was undetectable after 16weeks from the start of therapy in August 2011, but was detectable after 8 weekslater from the end of therapy in October 2012. A physical examination in November2012 revealed completely depigmented macules on the lateral ocular angles and thejaw. The leukodermas were diagnosed as vitiligo. Tacrolimus ointment 0.1% wasapplied to the affected lesions once daily. Four months later, we detected moderaterepigmentation. Persons with genotype 1 chronic hepatitis C are shown to have low25-hydroxyvitamin D serum levels. A noticeable relationship is present betweenvitamin D deficiency and higher risk for autoimmune diseases, including vitiligo. Wesurmised that vitamin D deficiency- or insufficiency-associated vitiligo occurred afterstopping administration of 1-hydroxycholecalciferol and during recurrent seropos-itive of genotype 1 hepatitis C virus.

MAY 201

cial support: None identified.

Commer

P8341Patient assessment of the depigmenting effect of a new oral formulation inmelasma

Antonio Gomes-Neto, MD, ISDIN, Barcelona, Spain; Carles Trull�as, PhD, ISDIN,Barcelona, Spain; Leonor Gir~ao, MD, EVIC Hispania (Centro Experimental deEvaluaci�on Cut�anea S.L.), Barcelona, Spain; Maria Teresa Sanz, MD, ISDIN,Barcelona, Spain; Sonia Aladr�en, PharmD, ISDIN, Barcelona, Spain

Background: Skin pigmentation disorders are important contributors to the signs ofaging and to person’s lack of psychological well-being. Melasma is a commonhypermelanosis characterized by symmetric irregular brown to gray-brown mac-ules. We investigated the depigmenting effect and tolerability of a new oral productwith DP2-Unify complex.

Methods: Thirty women with mild to moderate melasma, skin type II-IV, aged 23 to63 years, were included in order to assess the efficacy of the new oral formulationadministered once daily over 12 weeks. Assessments were performed at baseline(D0), and after 28, 56, and 84 days; including Patient’s Global Assessment (PGA)with a 7-point ordinal scale (from 6 ¼ worsening to 0 ¼ eliminated), and patientquestionnaire evaluating the depigmenting and antiaging effects with a 5-pointqualitative scale (ranging from strongly disagreement to strongly agreement), suchas skin uniformity, whitening effect, reduction of the size of the spots, elimination ofspots and reduction of the appearance of new spots, general improvement of theskin, skin brightness, younger aspect of the skin, skin firmness, skin smoothness,skin moisture, and reduction of signs of age.

Results: All 30 patients completed the trial. This clinical study demonstrates apigmentation-reducing effect (PGA assessment) with 83.6 % of patients improving at4 weeks (D28) and 96.7% at 12 weeks (D84). The clinical improvement was judgedas ‘‘almost clear’’ in 6.7%; ‘‘significant improvement’’ in 46.7%; ‘‘moderateimprovement’’ in 23.3%; and ‘‘slight improvement’’ in 20% of patients, while 0%,20%, 23.3%, and 43.3% of patients reporting the corresponding clinical improve-ments at week 4, respectively. At the 12-week visit, the patients indicated that theproduct has ‘‘uniformity effect’’ in 96.7%, ‘‘whitening effect’’ in 96.7%,’’improves skinmoisture’’ in 96.7%, ‘‘reduces the spots size’’ in 86.7%, ‘‘improves the general aspectof skin’’ in 86.7%,’’improves the skin firmness and smoothness’’ in 86.7%, ‘‘reducesthe appearance of new spots’’ in 83.3%’’, ‘‘eliminates the spots’’ in 70%, ‘‘ improvesthe skin brightness’’ in 66.7%, ‘‘skin gets a younger aspect’’ in 66.7%, and ‘‘reducessigns of age’’ in 56.7% of cases.

Conclusion: A significant depigmenting effect of this new oral formulation wasdemonstrated, with first visible results after 28 days, increasing over time, alsoimproving the uniformity of skin tone, the whitening of dark spots, and the signs ofphotoaging according to the evaluation of patients.

d 100% by ISDIN.

Sponsore

4

P8135Skin brightening cream in Chinese females with melasma

Yan Wu, MD, Peking University First Hospital - Department of Dermatology,Beijing, China; Frank Dreher, PhD, Neocutis, Inc, San Francisco, CA, UnitedStates

Background: A hydroquinone and hydroxy acid free skin brightening cream (SBC)comprising four complementary actives inhibiting several key processes ofmelanogenesis was demonstrated effective to lighten skin of white females withmelasma and mottled hyperpigmentation.

Objective: To evaluate the safety and efficacy of SBC also in Chinese females withepidermal melasma, and to compare its efficacy to a market leader skin brighteningproduct (MLP) in China containing a combination of niacinamide with a series ofadditional skin brightening agents.

Methods: 54 Chinese females with epidermal melasma were enrolled and random-ized into 2 equal groups. Each group applied the respective test product (SBC orMLP) twice daily for 12 weeks to entire face. Melasma area and severity (MASI), skincolor measurement (N-value as being representative for melanin content) byMexameter MX18 (Courage & Khazaka Electronic GmbH, Germany), investigatorglobal assessments (IGA), and skin tolerability were evaluated before and after 4, 8,and 12 weeks of treatment.

Results: Both test products significantly reduced MASI and melanin content ofmelasma areas involving the forehead, right cheek, left cheek, and chin asdetermined by skin colorimetry after 12 weeks. As compared to baseline, SBCreduced MASI by 40% (from 16.46 6.0 to 9.96 3.4) and MLP by 30% (from 17.666.2 to 12.3 6 4.1) after 12 weeks; while SBC reduced MASI significantly (P\.05)more than MLP. Melanin content determined by colorimetry was reduced by25%/21% for forehead, 27%/23% (P\.075) for left cheek, 30%/27% (P\.05) for rightcheek, and 26%/21% (P\.05) for chin after 12 weeks of treatment with SBC or MPL,respectively. Both test products were well tolerated.

Conclusion: This study confirms the efficacy of a novel SBC for improving the signsof hyperpigmentation also in Chinese women. The cream comprised a proprietarycomplex of 4 complementary skin brightening actives and offers a clinicallydemonstrated efficient and well tolerated alternative for skin lightening.

d 100% by Neocutis, Inc.

Sponsore

P8706Terra firma-forme dermatosis: A case report

Serap Ozturkcan, Celal Bayar University, Manisa, Turkey; Baris Inan, Celal BayarUniversity, Manisa, Turkey; Cemal Bilac, Celal Bayar University, Manisa, Turkey;Mustafa Turhan Sahin, Celal Bayar University, MANISA, Turkey

Terra firma-forme dermatosis (dermatosis neglecta) is a cutaneous discoloration,which is characterized by idiopathic retention hyperkeratosis, resulting in dirty-or‘‘solid earth’’elike brown, asymptomatic plaques that can easily be removed withgentle alcohol swabbing. The pathogenesis has been attritubed to abnormal anddelayed keratinization. Terra firma-forme dermatosis is an idiopathic condition firstdescribed 20 years ago, also called Duncan’s dirty dermatosis. The 8-year-old femalepatient had been admitted to the outpatient clinic with complaints of asymptomaticbrown lesions on her legs for 5 years, and the family reported that the lesions hadspread among to the trunk and arms for 2 weeks. Dermatologic examinationrevelaed hyperpigmented plaques involving front face of trunk, arms, and legs. Thelesions disappeared after firm rubbing with 70% of alcohol. Terra firma-formedermatosis should not be confused with hyperpigmented lesions. Recognizing thiscondition avoids unnecessary aggressive diagnostic and therapeutic proceduresbecause it is more easy to diagnose and treat.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB161