Abstract
Objective: To estimate efficacy of narrowband UVB phototherapy (311 nm) in non-segmental vitiligo and its effect on subpopulations of T-cells and dendritic cells in vitiligo lesions. Methods: 56 patients with progressive non-segmental vitiligo underwent narrowband UVB phototherapy (311 nm). 11 patients had biopsies before and after therapy from lesional (depigmentation area), marginal, and perilesional skin for immunohistochemical studies of CD4+, CD8+, CD1a+ and CD83+ cells in epidermis and derma. Results: Median number of UVB procedures per course was 71, median total radiation dose-91.8 J/cm2, median percent of repigmentation-49%. Repigmentation of >25% of the affected area was reached in 67.9% of patients and repigmentation of 76-100% in 19.6% . VIDA index decreased from 2 to 1 post-treatment (P<0.035). In a subgroup who underwent immunohistochemical studies median number of UVB procedures per course was 88, median total dose of radiation-140.2 J/cm2, and median percent of repigmentation-50%. Significant activation of T-cellular immune reactions was found in lesions before treatment. There was a statistically significant increase in CD8+ lymphocytes and CD1a+ dendritic cells in marginal and perilesional normally pigmented skin in epidermis. There was an increase in CD4+ and CD8+ lymphocytes and CD83+ dendritic cells in all three zones in derma. Normalization of CD8+ and CD1+ cells in epidermis of the affected skin was observed post-treatment. There was only partial reduction of CD4+, CD8+ and CD1+ cells in dermis. Conclusions: Narrowband UVB phototherapy (311 nm) is an effective method of treatment of nonsegmental vitiligo. T-lymphocytes and Langerhans cells play a critical immunoregulatory role in narrowband UVB phototherapy (311 nm)-induced immune suppression. Lack of full normalization of immunological parameters in the skin after treatment indicates a need for optimization of narrowband UVB phototherapy (311 nm): conduction of longer courses including 150-200 procedures, or combinations of this treatment with immunosuppressive drugs.
Highlights
Vitiligo is an acquired disease characterized by the formation of areas of depigmentation of the skin due to reduction in the number of melanocytes
Immune responses in areas of vitiligo involve a complex interaction of melanocytes, keratinocytes, and lymphocytes
After a course of phototherapy there was a significant decrease in the VIDA index that indicates a decrease in the disease activity due to treatment
Summary
Vitiligo is an acquired disease characterized by the formation of areas of depigmentation of the skin due to reduction in the number of melanocytes. The prevalence of vitiligo in the general population is ranging from 0.5 to 2% [1]. According to many experts the leading role in the damage of melanocytes and the disturbance of melanogenesis in vitiligo skin is played by autoimmune mechanisms, including the disturbance of T-cell immunity [2,3,4,5,6,7]. Immune responses in areas of vitiligo involve a complex interaction of melanocytes, keratinocytes, and lymphocytes. Skin dendritic cells which are responsible for recognizing and binding a foreign antigen and initiation of immune responses have significant importance in vitiligo pathogenesis as well [8,9]
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