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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
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Ethiologic hypotheses for vitiligo Genetic Biochemical Neural Immunologic
Autoimmune melanocyte destruction
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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.
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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)
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Side effects Acute
Conjunctivitis Keratitis Sunburn Nauzea Vomitus Headache Dizziness
Chronic Lentiginosis Aging of the skin Actinic keratosis Hypertrichosis Skin cancer PUVA itch
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Local PUVA therapy Balneo-PUVA
“Sheet bath PUVA” Psoralens in:
cream ointment Solution
application 30 min - 1 hr before UVA exposure
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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
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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
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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
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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
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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
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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
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Before After
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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
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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
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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
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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.
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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
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Before After
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“Special technique”
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Thank you for your attention