Depigmentation Therapy Research Articles

Vitiligo Causes and Treatment: A Review

Vitiligo is a chronic autoimmune disorder characterized by patches of skin losing pigment due to the destruction of melanocytes, the cells responsible for producing pigment. The condition can affect people of all ages and ethnicities, with symptoms including milky-white patches on the skin, premature graying of hair, and color loss in mucous membranes like the mouth or nose. Among the main causes of vitiligo are; Autoimmune Response: Vitiligo is primarily an autoimmune disease where the immune system mistakenly attacks melanocytes, leading to depigmentation. Factors like family history, genetic predisposition, and immune system disorders contribute to its development, Triggers: Events such as sunburn, emotional distress, or exposure to certain chemicals can trigger or exacerbate vitiligo. The treatment options are; Medications: Treatments include light therapy (phototherapy), oral medications like psoralen combined with UVA light (PUVA), and depigmentation therapy using monobenzone to match skin tones Surgery: Surgical options are available for some cases of vitiligo and Psychological Support: Counseling and mental health services can help individuals cope with the emotional impact of vitiligo, in conclusion, v is a multifaceted skin condition lacking a conclusive remedy, many types of vitiligo, but the most common one is Non-segmental Vitiligo (NSV), honmental and genetic are the most important causes of vitiligo. Important symptoms of vitiligo are; depigmented patches, hair discoloration, sensitivity to sunlight, treatment of vitiligo have many approach, among them are; topical Corticosteroids, phototherapy and Cosmetic Camouflage.

Structural elucidation and development of azelaic acid loaded mesoporous silica nanoparticles infused gel: Revolutionizing nanodrug delivery for cosmetics and pharmaceuticals

This research aimed to enhance dermal delivery and optimize depigmentation therapy by designing mesoporous silica nanoparticles (MSNs) encapsulating azelaic acid (AZA) within a gel matrix. The MSNs were prepared using the sol-gel method. After subsequent processes, including acid extraction and drug loading, were then elucidated through PDI, size, zeta-potential, entrapment efficiency, nitrogen adsorption assay, FE-SEM, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, X-ray diffraction, and tyrosinase inhibition assay, were employed to assess the formulation. In-vitro stability tests for both AZA-MSN gel (AZCG) and AZA-loaded mesoporous silica gel (AZMG) were conducted at 8 °C, 25 °C, 40 °C, and 40 °C + 75 % RH, encompassing assessments of color, liquefaction, pH, and conductivity. Our findings showed a notable entrapment efficiency of 93.46 % for AZA-MSNs, with FE-SEM illustrating porous spherical MSNs. The particle size of AZA-MSNs was determined to be 211.9 nm, with a pore size of 2.47 nm and XRD analysis confirmed the amorphous state of AZA within the MSN carriers. Rheology examination indicated a non-Newtonian flow, while ex-vivo rat skin permeation studies conducted in a phosphate buffer (pH = 5.5) demonstrated a biphasic release pattern with 85.53 % cumulative drug permeation for AZA-MSNs. Overall, the study endorse the potential of AZA-MSNs as an efficacious and stable formulation for AZA delivery, highlighting their promise in addressing pigmentation concerns compared to conventional approaches.

A focused review of visible light therapies for vitiligo.

Vitiligo can be challenging to treat and exhibit an unpredictable clinical course. Phototherapy in the form of visible light can achieve both repigmentation and depigmentation outcomes in vitiligo, with minimal associated adverse events. This review focuses on the mechanistic understandings and clinical outcomes of visible light-based treatments for vitiligo. Articles were retrieved from PubMed starting from May 1965 until August 2023, yielding 496 unique articles. We conducted title, abstract, and full-text screening to identify articles describing the use of visible light (380-750 nm), either as part of combination therapy or as monotherapy, for repigmentation or depigmentation treatment in vitiligo. Twenty-seven articles met inclusion criteria, offering preclinical and clinical data regarding the utilization of helium-neon laser (red light) and blue light-emitting diodes (LEDs) as methods of repigmentation therapy in vitiligo. Preclinical and clinical data on the utilization of Q-switched ruby laser (694 nm) and frequency-doubled (FD) Nd:YAG laser (532 nm) for vitiligo depigmentation therapy were also identified. While limited by small studies and a lack of standardized administration of phototherapy, the evidence for visible light's effectiveness in managing vitiligo is encouraging. Red light therapy using He-Ne lasers and blue light therapy via LEDs can stimulate repigmentation in patients with vitiligo with minimal adverse events. Q-switched ruby and FD Nd:YAG lasers provide viable, visible light depigmentation options, either alone or with topical agents. With limited clinical data, larger studies are needed to validate the efficacy of visible light therapy in treating vitiligo and to better understand its long-term outcomes.

Psychosocial and quality-of-life factors associated with depigmentation therapy for vitiligo.

There is a paucity of data examining the psychosocial factors relevant to depigmentation therapy, an irreversible treatment for vitiligo. This study explores patients' perspective and experience while undergoing depigmentation therapy and quality-of-life effects of such therapy. An online instrument assessing the impact of depigmentation therapy on various psychosocial variables and including the validated Dermatology Life Quality Index (DLQI) were administered to two groups of participants with vitiligo: (1) those who are currently undergoing or have completed depigmentation therapy and (2) those with vitiligo who have not undergone depigmentation therapy but had considered it. Data were collected on psychosocial factors such as length of time until depigmentation therapy was offered, duration, financial burden, level of satisfaction, impact on life activities, and challenges faced during and after depigmentation therapy. DLQI scores were also measured. Thirty-five vitiligo patients who did not undergo depigmentation and 42 patients who did undergo depigmentation therapy were included in the study. Baseline characteristics were comparable between groups. Mean DLQI was higher for patients who did not undergo depigmentation than for those who underwent depigmentation (10.2 versus 5.3, p = 0.002), indicating worse quality-of-life in those not depigmenting. Patients who underwent depigmentation reported significantly less discomfort in various social situations after undergoing depigmentation therapy compared to how they felt before undergoing therapy and reported significantly less discomfort in these situations than patients who did not undergo depigmentation therapy. Despite potential challenges, depigmentation therapy appears to augment quality-of-life across various domains in individuals with vitiligo.

Aesthetic Reconstruction with Gingival Depigmentation

Currently, there is an increase in the demand for aesthetics, which includes the need for a beautiful appearance. Gingival hyperpigmentation is an extremely disturbing aesthetic problem caused by melanin deposition of melanocytes in the basal and suprabasal layers of the epithelium. The color of the pigment can range from pale to dark brown or black, depending on the amount and distribution in the tissue. Gingival depigmentation therapy is a periodontal plastic surgery method that can provide patients with good outcomes. A 21-year-old female complained of having brown front gums and an unsettling appearance. The patient does not smoke, has allergies to drugs and food, or suffers from systemic disease. The depigmentation process was conducted using number15 scalpels, and the gingival contour was created before irrigation utilizing Kirkland. Furthermore, a periodontal pack was used to cover the surgical site, and there were no complaints during the postoperative follow-up visit.

The use of Janus kinase inhibitors and narrowband ultraviolet Bcombination therapy in non-segmental vitiligo.

Vitiligo is a depigmentation disorder of the skin that occurs secondary to the destruction of melanocytes by an immune-mediated process. Vitiligo clinically presents with depigmented macules and patches, most commonly on the face, acral sites, and genitalia. It can be characterized as generalized or localized based on distribution. The localized form can be further divided into segmental (linear, band-like, or Blaschkoid) and non-segmental vitiligo. The classical treatment of vitiligo includes topical steroids, pulsed oral steroids in unstable vitiligo, phototherapy, a combination of steroid therapy and phototherapy, surgical grafting, as well as intentional depigmentation therapy in severe cases. However, recent advances in understanding the immune mechanisms implicated in the pathogenesis of vitiligo have led to the use of an FDA-approved topical Janus kinase (JAK) inhibitors for vitiligo. Despite this novel therapy advancement, we recommend the addition of narrowband ultraviolet B (NB-UVB) to JAK inhibitors in patients with extensive and progressive lesions, or those not fully responsive to JAK inhibitor monotherapy.

MicroRNA-183-5p regulates MITF expression in vitiligo skin depigmentation

Microphthalmia-associated transcription factor (MITF) is a master regulatory factor for melanocytes. MITF regulates multiple pigmentary genes for maintaining cellular homeostasis. MicroRNAs (miRNAs) play crucial roles in numerous biological processes however their molecular/cellular mechanisms to regulate pigmentation have not been fully explored. This study was undertaken to investigate the role of miRNAs in skin depigmentation via regulation of MITF gene. Depigmentation in C57BL/6 black mice was induced by an autoimmune response against tyrosinase. Bioinformatics approach was used to detect miRNAs conserved in 3′untraslated region (3′UTR) of MITF mRNA. The iMC23 mouse melanocytes were used for transfection experiments. The data demonstrated that the MITF mRNA/protein was markedly low in lesional skin of depigmented mice (p < 0.05). Targetscan genomic database determined that 3′UTR of mouse MITF constitutes 4819 nucleotide bases and has 23 conserved sites for different miRNAs To validate the pairing of these predicted miRNAs with MITF mRNA, five miRNAs were deregulated in lesional skin (p < 0.05). Among them, mmu-miR-181a-5p and mmu-miR-183-5p were up-regulated, whereas mmu-miR-26a-5p, mmu-miR-26b-5p and mmu-miR-32-5p were down-regulated (p < 0.05). To verify these results, the iMC23 mouse melanocytes were used. Transfection of iMC23 cells with specific miRNAs mimics or inhibitors or with 3’UTR reporter clone of MITF, showed only mmu-miR-183-5p binds to 3’UTR of MITF mRNA and regulates its expression in iMC23 melanocytes. In conclusions, this is the first study shows that miR-183-5p is a direct regulator of MITF in iMC23 melanocytes. Thus, miR-183-5p is an important regulator of melanocytes homeostasis and may be a novel target for autoimmune depigmentation therapy.

Prevalence of Gingival Pigmentation and its Association with Gingival Biotype and Skin Colour

Introduction: The facial appearance depends on several oral and extraoral factors including colour of facial skin and pigmentation of gingival epithelium. The colour of the gingiva varies among individuals and is thought to be associated with cutaneous pigmentation which ranges from light to dark brown or black colour.&#x0D; Objective: To assess the prevalence of physiological gingival pigmentation, gingival biotype and their association with skin colur in Nepalese subjects visiting Kantipur Dental College and Hospital (KDCH).&#x0D; Methods: This was an analytical cross-sectional study which was carried out from February 2020 to June 2020 in all patients of age-group 16 to 80 years visiting the Department of Periodontics at KDCH after ethical approval. Patients were recruited by convenience sampling and examined thoroughly to find out gingival biotype and extent of gingival pigmentation intraorally as well as skin colour extraorally.&#x0D; Results: In this study, 210 patients were examined among which, 105 (50%) were males and 105 (50%) were females. Out of 210, 33 (15.7%) had pink tissue without pigmentation, 84 (40%) had pigmentation only in attached gingiva, 58 (27.6%) in attached gingiva and interdental papilla, 32 (15.2%) had diffuse pigmentation involving all parts of gingiva, 2 (1%) had in marginal gingiva only, and 1 (0.5%) in marginal gingiva and interdental papilla.&#x0D; Conclusion: A strong association was found between gingival pigmentation and facial skin colour in present study (P &lt;0.001). Establishing the pattern of gingival pigmentation in Nepalese population will help to choose a specific depigmentation therapy that will harmonise with skin colour.

Surgical laser oral depigmentation procedure: an investigation on the optimum power settings using Er:YAG laser

Gingiva hyperpigmentation is often a non-pathological problem, but clinically considered unaesthetic when the gingiva appears dark and purplish. Chemical peeling, surgery, and laser ablation are the available treatment options. Er:YAG laser is one of the common laser used in soft and hard tissue management. This study compared the Er:YAG different power settings and selected the best setting for gingival depigmentation. Two phases of studies were conducted, starting with ex-vivo animal tissue experimental phase followed by prospective human experimental phase. Twenty-four different power settings were applied for the gingival depigmentation of a recently slaughtered sheep’s head. The four best power settings applied to the human studies were selected based on the following parameters: histology, carbonization, speed, and operator controllability. Two and 4 J/cm2 fluences and short pulse (SP) 0.3 ms and very long pulse (VLP) 1 ms pulse durations were chosen. Forty adult nonsmoker patients were randomly divided into four groups of 10 patients; one power setting was applied to each group followed by clinical and biological evaluation. Pain, bleeding, satisfaction, carbonization, speed of removal, and histological investigation parameters were tested. Ablated tissue specimens were sent for histological analysis. Four power settings proved safety, patient and dentist satisfaction, and efficiency in removing pigmentations. Regarding pain, satisfaction, and bleeding presented no statistical difference. Histological analysis showed a superficial damage in lamina propria. There was obvious effect of the peak power on the speed of depigmentation procedure. The higher the peak power the higher work speed and the less carbonization, but it however provided less operator controllability. The reasonable parameter for all practicing dentists is using 2 J/cm2 with very long pulse duration for laser depigmentation therapy.

Depigmentation Therapies for Vitiligo.

The general goals of medical management of vitiligo are to repigment vitiliginous areas of skin and to stabilize the progression of depigmentation. However, for some patients with vitiligo affecting extensive body surface areas who are unresponsive to repigmentation therapies, depigmentation of the remaining normal skin may be a better choice. Candidates for depigmentation therapy should be carefully screened and patient education is essential. Permanent topical therapies used for depigmentation include monobenzyl ether of hydroquinone, 4-methoxyphenol, and 88% phenol. Physical modalities, such as cryotherapy and lasers, are also being used successfully.

Depigmentation with Q-switched Nd:YAG laser in universal vitiligo: a long-term follow-up study of 4years.

Q-switched (QS) lasers are used for depigmentation in universal vitiligo, but there is limited data on long-term results after laser treatment. This study was conducted to assess the safety and long-term follow-up results of QS Nd:YAG laser treatment in combination with need-based topical depigmentation therapy for universal vitiligo. A retrospective study was performed on patients with universal vitiligo who had received QS Nd:YAG laser treatment from 2010 to 2013. All patients were contacted and called for follow-up. Patients who reported were assessed clinically and information regarding adverse effects and relapse (repigmentation) in the follow-up period were obtained. Any need for topical depigmenting creams or other interventions and overall satisfaction to treatment were also documented. Records of 34 patients were retrieved, out of whom 28 cases reported for the follow-up visit. Duration of follow-up ranged from 2 to 5years (mean, 2.78). No long-term adverse effects were reported and the majority of patients were highly satisfied with treatment. Satisfactory results with >90% clearance of pigment was reported by 89.3% (25/28) of patients, out of whom 72% (18/25) had retained the therapeutic effect with the use of sunscreens with/without intermittent topical depigmentation therapies. In seven cases, partial to complete relapse was observed. QS Nd:YAG laser is an effective tool for treating residual pigmentation in universal vitiligo, and the therapeutic effect can be maintained in most cases with regular sunscreen use and need-based topical therapies.

A novel approach for the management of gingival hyperpigmentation: Diode laser

The color of normal gingiva depends on the vascular supply of the gingiva, epithelial thickness, degree of keratinization of the epithelium, and the presence of pigmented cells. Excessive gingival display and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. The foremost indication for depigmentation therapy is the demand by a patient for improved esthetics. This case report represents a correction of gingival hyperpigmentation by diode laser with satisfactory and pleasant results.

Accelerating bleaching in vitiligo: balancing benefits versus risks.

While the goal of available treatment in vitiligo is to regain pigmentation, some patients affected by extensive and treatment-resistant vitiligo, with a major social and emotional impact, may benefit from depigmentation therapy. However, results from such therapy may not always be satisfactory. So to achieve better, faster and complete bleaching, Webb etal. propose a synergistic approach that combines topical application of bleaching phenols which targets melanocytes and initiate local inflammation with immune adjuvants so as to obtain an enhanced immune response against remaining melanocytes. This strategy could be reliable, but should be evaluated cautiously in future studies, in terms of potential side effects and induction of undesired autoimmunity.

Q-switched laser depigmentation in vitiligo, most effective in active disease

In widespread vitiligo, when repigmentation therapies are no longer feasible, Q-switched lasers can be used to remove the remaining disfiguring pigmentation. However, little literature is available on the long-term effects of Q-switched laser treatment in patients with vitiligo, and the variables influencing the effect of treatment are unknown. To evaluate retrospectively the effectiveness, safety and patient satisfaction of Q-switched ruby (QSR) laser-induced depigmentation in widespread vitiligo. We performed a retrospective study on well-documented patients with vitiligo with widespread lesions who received depigmentation therapy with the QSR laser between 2000 and 2012 in our institute. Eligible patients were asked to visit our institute for assessment of depigmentation and to fill in a questionnaire on patient satisfaction and disease variables. After a mean follow-up of 13 months, 48% of the 27 included patients showed > 75% depigmentation. Patients with active disease at the time of treatment had significantly better results than patients with stable disease (P < 0·05). Twenty-three (85%) patients were satisfied after treatment. Eighteen patients (67%) reported temporary side-effects after treatment. None of the patients reported adverse effects, such as scars or infections. Q-switched ruby laser therapy is effective in approximately half of patients treated; it is a safe treatment with a high patient satisfaction. Patients with active vitiligo show better results after treatment than patients with stable vitiligo. Therefore, in patients with stable vitiligo resistant to trial treatment, we advise postponing treatment until their vitiligo becomes active.

Depigmentation therapy with Q-switched Nd: YAG laser in universal vitiligo

Background:Any residual pigment left in patients of universal vitiligo is managed with topical treatments, cryotherapy, and lasers.Aim:The study aims to assess the efficacy and safety of Q-switched Nd: YAG laser in treating the residual pigmentation in patients with universal vitiligo.Materials and Methods:Fifteen patients of universal vitiligo with residual pigmentation on the face, hands, or feet, resistant to topical treatments, were treated with single or multiple sessions of Q-switched Nd: YAG laser treatment. Topical treatments were continued in between the laser sessions and the depigmentation achieved was monitored by clinical examination and repeat digital photographs. Response to the treatment was labelled as excellent if the residual pigment could be reduced by at least 90% while 50–90% resolution of pigmentation was labelled as a partial response. Adverse effects to the treatment offered were also monitored.Results:Thirteen of the 15 patients enrolled for the study showed an excellent response to the treatment offered. Two other patients showed a poor response with less than 50% resolution of pigmentation. The number of laser sessions needed at a particular site ranged from 1 to 3 and no patient was offered more than three sessions of laser treatment at any site. No significant adverse events were reported by any patient.Conclusions:Residual pigmentation in patients with universal vitiligo that does not respond to topical treatment options alone can be managed quite effectively with Q-switched Nd: YAG laser without any significant adverse effects.

Effect of monobenzyl ether of hydroquinone for advanced vitiligo patients

Background: Vitiligo is a common depigmentation disorder occurring in about 1% of the population worldwide. The disease causes the appearance of white patches on the skin. If vitiligo involves most of the body, it might be easier to depigment the normal remaining skin rather than to attempt repigmentation. For depigmentation therapy, monobenzyl ether of hydroquinone (MBEH) remains the only drug that the Food and Drug Administration approved for depigmentation therapy within the United States. The mechanism of toxicity of MBEH has remained little understood.

Is monobenzylether of hydroquinone a safe depigmentation therapy in advanced vitiligo?

Is monobenzylether of hydroquinone a safe depigmentation therapy in advanced vitiligo?

Advanced Treatment Modalities for Vitiligo

Vitiligo is an acquired multifocal and polygenic dyschromia that affects 1% to 3% of the world and presents as multiple depigmented macules and patches. Traditionally, the treatment of vitiligo has focused on pharmacologic interventions, but nearly half of all treated patients fail to respond successfully. Several advanced techniques exist that can aid dermatologists in treating vitiligo in patients who do not respond favorably to traditional pharmacologic treatments. These advanced interventions include the use of the 308-nm excimer laser, total body depigmentation therapy with monobenzyl ether of hydroquinone, microdermabrasion, micropigmentation, khellin-UVA therapy, and surgical management using miniature punch grafting, suction blister grafting, and epidermal cultures. This article reviews the current literature on these advanced treatment modalities for vitiligo and provides a practical guide for application of these techniques. Our ability to treat vitiligo may be imperfect, but through appropriate patient selection and careful application of one or more of these advanced therapies, successful treatment of vitiligo, even in patients refractory to treatment, can be achieved.

Depigmentation therapies in vitiligo

Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo.

Depigmentation therapy in vitiligo universalis with cryotherapy and 4-hydroxyanisole

Vitiligo is a disease characterized by the loss of melanocytes, resulting in progressive depigmentation of skin, and areas of normally pigmented skin can be of cosmetic concern. Several options have been tried to remove the pigment and make the skin a more even colour. We present an easy and effective therapeutic procedure based on single-session cryotherapy followed by topical 4-hydroxyanisole (4-HA).