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PUVA therapy specifics of vitiligo in childhoodStabilization of the abnormal immune responses + depigmentationStimulation of the melanocytic reserves in the outer root sheath of the hair follicle- Disclaimer- This PPT is loaded as student material "as is", from the VRF Vitiligo Master Class Barcelona November 2011; VRF does not endorse or otherwise approve it.
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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