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TVCA Newsletter - Summer 2019
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Vitiligo Surgery Update
Dr Phillip Artemi recently attended the Vitiligo International Symposium held in Detroit Michigan from November 8-11th 2018. During the meeting he was invited to join 13 other Vitiligo Specialist Dermatologists from around the world in a Vitiligo Surgery Workshop held at the Henry Ford Hospital.
The current treatment of choice around the world remains non-cultured autologous epidermal suspension transplantation and in the presence of stable vitiligo (no extension of existing vitiligo, no development of new lesions of vitiligo and no history of trauma induced vitiligo over a 12-month period), success rates on average are greater than 75% repigmentation in greater than 75% of patients. In non-segmental stable facial vitiligo and segmental vitiligo regimentation rates are much higher reaching more than 90-95%
The meeting also discussed the latest advances in melanocyte stem cell transplantation using intact hair follicles from the scalp of patients. This procedure, termed non-cultured extracted hair follicle outer root sheath cell suspension
* No scaring at the donor site (scalp) compared with the current split skin graft required (thigh)
* Greater population of “donor” pigment cells from the hair follicle compared to the skin
* Larger and more active pigment cells from the hair follicle compared to the skin
* The additional presence of melanocyte stem cells in hair follicles
Dr Artemi has been performing all types of vitiligo surgery since 2015 and has trained in Europe, India, Singapore and the United States. At the Vitiligo Centre Dr Artemi and staff believe all patients should be able to access vitiligo surgery if suitable for their condition. The cost of vitiligo surgery to patients ranges from $500-$1000.00. This is comparably cheaper than overseas centres and has allowed all suitable patients to benefit from the treatment
Excimer Pulse Light Treatment Now Available
After a successful trial earlier this year, The Vitiligo Centre Australia has purchased the German Engineered ExSys 308nm light system, a hand-held device that has the same emission spectrum and power output as excimer laser (monochromatic 308nm UVB light). Compared to traditional UVB therapy, doses available are higher, treatment times faster (seconds rather than minutes) and response times much quicker (weeks rather than months)
During the trial, we assessed the treatment on 12 patients (children and adults) with vitiligo affecting areas such as the face, neck, scalp, trunk, limbs hand and feet. The crystal glass cylinders unique to the ExSys 308nm system, allowed superior visibility of the treatment areas, precise delivery of the required dose to the vitiligo lesion, and enabled us to treat difficult areas such as the ears, around the eye and in the groin.
We found that the face. neck, genitals and trunk responded best, particularly in darker skin types. In these areas, with three treatments per week we found 50% of vitiligo patches showed some repigmentation after just 5-6 treatments, and in up to 95% of patches some repigmentation was detected after just 18 treatments. Unfortunately, vitiligo on the hands and fingers did not respond as well.
At your first Excimer light treatment appointment, your skin type will be assessed, and a number of test doses administered to determine the best starting dose for your skin and area of vitiligo. Topical treatment will also be commenced to maximise the response to Excimer light therapy. The dose of UV light delivered and the exposure time is carefully monitored. The dosage will be adjusted according to the skin type reaction. If no adverse reactions are noted, the dosage of UV-light delivered will be increased in small increments at each visit as your treatment progresses.
If you would like to find out more about excimer pulsed light click here go to video, speak to one of our Vitiligo Nurse on 9602-0286, or make an appointment to see Dr Phillip Artemi to discuss a comprehensive vitiligo management plan that may include Excimer pulsed light.
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
Vitiligo International Symposium 2018
Dr Artemi from The Vitiligo Centre Australia is excited to be attending the 2018 Vitiligo International Symposium in Detroit, Michigan from November 9-10th. The Vitiligo International Symposium (VIS) will gather world experts to present the latest scientific studies, and medical and surgical treatment information on vitiligo. In addition, the symposium provides a forum for exchange of research ideas and clinical care of Vitiligo as well as the gathering of information from patients on advocacy efforts, and quality of life, and perception of the disease. All the latest information will be available on our website soon after the Symposium.
Gingko Biloba for Vitiligo
One of the most frequent questions asked by my patients, is whether a “natural” product found on the internet or a dietary supplement, could be used to treat or perhaps even cure their vitiligo. Despite my explanations about the lack of science, the ever-present danger of charlatans and a warning that “if it sounds too good to be true it usually is” patients and their families all too easily part with their hard-earned money. Gluten free diets, vitamin B12 supplements, antioxidant and vitamin C infusions have all been recommended and tried in the hope that it just might work? Unfortunately, disappointment invariably follows.
That said, Dermatologists and scientists are continuing to investigate the potential for herbal supplements to benefit vitiligo sufferers.
Gingko Biloba, from the leaves of the Ginkgo biloba tree, is one such herb which is showing some interesting results in small studies.
Gingko biloba has been shown to possess quite potent anti-inflammatory and antioxidant therapies and in medical studies has been tested using an extract of ginkgo, standardised to 24% flavone glycosides and 6% terpene lactones (60mg dosage form)
In one such trial, therapy with Ginkgo Biloba without any other treatment at 120mg daily for 2 months, arrested disease activity in all patients and led to an average re-pigmentation of 15%. Other studies have shown greater benefit when Ginkgo Biloba is combined with traditional vitiligo therapies particularly medically delivered phototherapy. This combination is best discussed and undertaken under the supervision of a vitiligo patient’s dermatologist