9th Asian Society for Pigment Cell Research Annual Meeting

On Friday 17th and Saturday 18th August I attended the Asian Society for Pigment Cell Research Annual Meeting in Colombo Sri Lanka. The meeting provided the opportunity to hear from world vitiligo experts and to exchange ideas on recent vitiligo research and treatments. Some of the highlights included:

Recent Advances in Pathogenesis of Vitiligo and Implications for Medical Treatment: Professor Davinder Prasad (India). Professor Prasad outlined that the ideal stage of vitiligo to commence treatment is referred to as the pre-depigmentation phase where the vitiligo areas are only just starting to show reduced pigmentation but not yet the total white colour that results when melanocyte destruction in the area is complete. Treatment at this stage includes both halting disease progression by targeting melanocyte stress (with appropriate antioxidants and herbal supplements), and autoimmunity (with an appropriate systemic medication), and inducing repigmentation (with topical and light therapy).

Optimizing Outcome of Cellular Grafting in Vitiligo: Dr Boon Kee Goh (Singapore). Dr Goh shared his thoughts, based on over 10-years’ experience, on the essentials required for optimal results when performing non-cultured autologous melanocyte transfer. OIf paramount importance is patient selection with disease stability (minimum 12 months) crucial to success. The donor skin must also be very thin such that it is translucent when held up to light whilst the recipient site must be prepared gently after laser or dermabrasion to an end point of mild pinkness and fluid release with anything more aggressive risking scarring. The epidermal keratinocyte and melanocyte suspension needs to be concentrated in a volume of not more than 0.5ml with the donor skin to vitiligo ratio no greater than 1:5

Efficacy of oral cyclosporine in treatment of progressive vitiligo: Prof Asit Kumar Mittal (Sri Lanka). Where vitiligo is unstable and spreading quickly, internal medication such as pulse steroids, methotrexate, azathioprine or minocycline is often considered. Cyclosporine is not usually considered as a first line agent, but as pointed out by Professor Mittal, Cyclosporine is known to inhibit cytotoxic T cells which are the immune cell responsible for the death of melanocytes in pigmentation and hence should be of benefit. In the study presented, 3mg per kilogram of Cyclosporine was given to 18 patients whose ages ranged from 7-28 years, over a 3-month period. In 11 out of 18 patients’ disease progression was completely halted and 9 of these 11 showed repigmentation despite no other treatment being given to them. Whilst the study was of open label, small sample size, limited duration, and there was no follow up after 3 months, the results certainly warrant cyclosporine being considered as a first line agent in unstable spreading vitiligo. The Vitiligo Centre is currently recruiting for a clinical trial comparing cyclosporine to another T cell inhibiting drug called mycophenolate in the treatment of unstable progressive vitiligo.

Oral compound glycyrrhizin promotes repigmentation of vitiligo in children: Miss Li Zhang (China). In this study, fifty children were randomly divided into two groups to receive either oral Glycyrrhizin (liquorice extract) or oral pulsed prednisone and then reviewed at 3 and 6 months. In the oral Glycyrrhizin group 55.6% children showed repigmentation at 6 months compared to the oral prednisone group that showed 47.1% showed repigmentation. There were no side effects experienced in the Glycyrrhizin group. The equivalent efficacy suggests Glycyrrhizin may be a safer option for oral treatment in children with vitiligo

Posted by Phillip Artemi, 31st August 2018