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 transplantation, whilst not yet perfected, has potentially numerous benefits to traditional epidermal cell suspension therapy. These include:

* 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. Importantly, baseline and repeat photography every six weeks will be taken to monitor the progress of your treatment. Treatments are painlessly administered by our Vitiligo Registered Nurses supervised throughout the treatment period by Dr Phillip Artemi (Vitiligo Specialist Dermatologist)

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

New Treatment Could Be ‘Breakthrough’ for Vitiligo Skin Condition

By Serena GordonHealthDay Reporter (consumer.healthday.com)

MONDAY, Feb. 5, 2018 (HealthDay News) — Doctors have discovered a combination of treatments that can return colour to skin that has been lightened by vitiligo — the skin disease that turned Michael Jackson’s skin white.

he new therapy includes the oral medication Xeljanz (tofacitinib) — a drug already approved for use in rheumatoid arthritis patients that dampens the body’s immune response — and ultraviolet-B light therapy.

The combination has only been used on two vitiligo patients, but according to a study author, the results have been dramatic. Experts add, however, that the findings need to be duplicated in studies with larger groups of people.

The treatment produces “results that are impossible to achieve with common therapies,” said Dr. Brett King, an Associate Professor of dermatology at Yale University School of Medicine.  “I think this is a breakthrough in vitiligo treatment,” he added.

One of King’s vitiligo patients, Shahanaj Akter, agreed. “My skin is so much better. I can use make-up and it blends nicely. I am so excited,” she said. Akter, 34, first noticed a white patch of skin above her eyebrow on her normally brown skin while she was pregnant in her 20s. That patch grew bigger and bigger, and then white patches showed up on her hands and neck.  Akter was living in her native country of Bangladesh when her condition first began, and vitiligo carries even more of a stigma there. Some people said unkind things to her.

“I cried a lot. I wanted to be my normal colour again,” she said. To that end, Akter tried treatment after treatment in Bangladesh and then in the United States. Some therapies caused intolerable side effects, and none brought the results she was hoping for.

“It was terrible. I tried so many things,” she said.

That’s when King suggested she try the new combination therapy.  At the time of treatment, Akter had white patches on about three-quarters of her face. She also had patches on her neck, chest, forearms, hands and shins. She was given 5 milligrams of tofacitinib twice daily, and full body UV-B light therapy twice weekly. After three months, Akter’s face was almost completely free of white patches. About 75 percent of her neck, chest, forearms and shins were re-pigmented with colour. Her hands had only minimal freckling.

How does this treatment work? Dr. Seemal Desai, a clinical Assistant Professor of Dermatology at the University of Texas Southwestern Medical Center in Dallas, explained it this way: “The immune system is attacking the melanocytes, so they go into hiding. Tofacitinib tells them it’s OK to come out of hiding, and the UV light brings them out of hibernation.”

King and his colleagues also reported on a white man in his 50s who had long-standing vitiligo. He had previously received treatment to remove all pigment so he would be uniformly white. But he still had patches of whiter skin on 90 percent of his face. He also had patches on his torso and arms.  After three months of treatment on his face, he had about 50 percent re-pigmentation. After six months, he had about 75 percent re-pigmentation of his face. King was surprised at how effective the treatment was because the man had previously undergone chemical destruction of the pigment cells.

Desai said the findings “look promising, and that new treatment options are great.”

But, he added, this study needs to be replicated in a larger group of people.

And he noted that right now, people will likely have a hard time getting reimbursed for tofacitinib because it’s not approved for treating vitiligo. Both King and Desai said the drug seems to be well tolerated. King said he doesn’t know how long people would need to take the drug, but suspects some would be on it long-term, possibly for life.

Details of the cases were published online Jan. 31 in a research letter in the journal JAMA Dermatology.