PUVA therapy specifics of vitiligo in

childhood1Čárska N, 2Bernadičová K, 1,2Hegyi V, 1,2Danilla T.

1Department of Pediatric Dermatovenereology

Comenius University Bratislava, Slovak Republic2Children Hospital in Bratislava

Ethiologic hypotheses for vitiligo Genetic Biochemical Neural Immunologic

Autoimmune melanocyte destruction

UV induced repigmentation Stabilization of the abnormal immune responses +

depigmentation Stimulation of the melanocytic reserves in the outer root

sheath of the hair follicle

Tamesi M.E.B, Morelii J.G. Vitiligo Treatment in Childhood: A State of the Art Review. Pediatric Dermatology. 2010;27 (5):437-445.

Systemic PUVA therapy Oral intake capsule (2 hours before UVA) of 8-MOP Psoralens oral intake - metabolized after 24 hours Excretion after 12-24 hours Dose: J/cm2

Usually 2x per week (25x)

Side effects Acute

Conjunctivitis Keratitis Sunburn Nauzea Vomitus Headache Dizziness

Chronic Lentiginosis Aging of the skin Actinic keratosis Hypertrichosis Skin cancer PUVA itch

Local PUVA therapy Balneo-PUVA

“Sheet bath PUVA” Psoralens in:

cream ointment Solution

application 30 min - 1 hr before UVA exposure

Plastic sheet bath PUVA Polypropylen sheet (4x4m) 150 litres water in the

bathtube On the sheet (4-5 l of 8-

MOP) solution Pacient is immersed in the

solution for 15 minutes Followed by UVA exposure

within 15 minutes Benefit – costs savings

Case no.1 - history Age: 15 Family history: grandfather –vitiligo, grandmother psoriasis,

aunt - thyreopathy Personal history: normal birth, mother had muscle-

convulsions of unknown etiology after birth, frequent infections of airways, dispensarized for struma eufunct., vitiligo

Medicaments: none

Case no.1

patient seen by dermatologist since 2000 with findings of hypopigmentated areas around eyes, elbows and knees

Local therapy: Vitix cream, no effect.

Patient 3 times hospitalized in our department 2008 – balneoPUVA, after 30 doses therapy terminated with good

effect – solitary isles of pigment in vitiligo areas

Case no.1 – clinical findings Bilateral symetrical elbows, ankles, knees, face, chin and

fingers of upper limbs – sharply bordered hypopigmented areas of different sizes and shapes, smooth surface, no erytema and desquamation

Case no.1 – laboratory findings Inflammatory parameters slightly elevated ANA: ++ Thyroid hormones: TSH, anti-thyroid antibodies

negat. USG thyroid gland: normal echogenity and texture, no

nodes/cystic structures

Therapy Balneo PUVA fotochemotherapy 1. cycle - total body initial dose 0,7J/cm2, cumulative dose

90,8J/cm2, average dose 2,67J/cm2

2. cycle - local initial dose 0,8J/cm2, cumulative dose 93,9J/cm2, average dose 2,93J/cm2

Very good effect achieved with appearance of pigment isles in vitiligo areas

No complications and/or side effects were observed

Before After

Case no.2 - history Age: 8 Family history: father –vitiligo, treated for thyreopathy Personal history: normal birth, normal adaptation after birth,

followed for short-sightness, pedes plani Medicaments: none

Case no.2

Patient seen by dermatologist since 2007 – vitiligo Hypopigmented areas were observed after intensive sun-

tanning No therapy was recieved, reffered to our department

because of treatment

Case no.2 – clinical findings

Both lower limbs, medial areas of thighs, knees – non symetrical multiple sharply bordered maculae of different shapes and sizes are present, no erythema or desquamation observed

Case no.2 – laboratory findings FW: 6/17, CRP: 1,1mg/l, ASLO: normal values, other

laboratory tests – normal values Thyroid hormones: TSH, fT4, cortisol – normal values,

antibodies negat.

Therapy Balneo PUVA fotochemotherapy initial dose 0,5J/cm2, cumulative dose 78,9J/cm2, average

dose 2,63J/cm2

Very good effect achieved with appearance of pigment isles in vitiligo areas

We used standard scheme of diagnostic and terapeutic approaches with good results

No complications and/or side effects were observed

Before After

“Special technique”

Thank you for your attention