PUVA therapy specifics of vitiligo in childhood Stabilization of the abnormal immune responses + depigmentation Stimulation 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.

1. PUVA therapy
specifics of vitiligo in
childhood
1Čárska N, 2Bernadičová K, 1,2Hegyi V, 1,2Danilla T.
1Department of Pediatric Dermatovenereology
Comenius University Bratislava, Slovak Republic
2Children Hospital in Bratislava

2. Ethiologic hypotheses for
vitiligo
 Genetic
 Biochemical Autoimmune melanocyte
destruction
 Neural
 Immunologic

3. 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.

4. 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)

5. Side effects
 Acute  Chronic
 Conjunctivitis  Lentiginosis
 Keratitis  Aging of the skin
 Sunburn  Actinic keratosis
 Nauzea  Hypertrichosis
 Vomitus  Skin cancer
 Headache  PUVA itch
 Dizziness

6. Local PUVA therapy
 Balneo-PUVA
 “Sheet bath PUVA”
 Psoralens in:
 cream
 ointment
 Solution
 application 30 min - 1 hr before UVA exposure

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Before After

14. 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

15. 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

16. 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

17. 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.

18. 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

19. Before After

20. “Special technique”

21. Thank you for
your attention