Day 2 :
Keynote Forum
Agustin Alomar Muntañola
University of Barcelona, Spain
Keynote: How to face vitiligo treatment
Biography:
Agustin Alomar Muntanola is a Dermatologist of University of Barcelona, Barcelona Vice-president and Treasurer in the Organizing Committee of the Congress of EADV, Barcelona, 2003. He is the member of Member of Spanish Academy of Dermatology and Venereology, Ibero-Latino-Americano College of Dermatology, European Society of Dermatological Research, American Academy of Dermatology, European Academy of Dermatology and Venereology, European Society of Contact Dermatitis, American Contact Dermatitis Society. He is Founding member of the Vitiligo European Task Force VETF. He is the President Organizing Committee of the XXIX National Congress of the Spanish Academy of Dermatology and Venereology, 20-24 June 2001, Barcelona.
Abstract:
When evaluating vitiligo, the dermatologist must bear in mind that although not a serious health risk, it does have a great psychological impact, which is why he must be proactive and be motivated to convince the patient to carry out the treatment. As with any dermatological process which does not guarantee a total cure and with a long-term yet simple treatment perspective which despite being uncomfortable has very rare side effects, the vitiligo-dedicated dermatologist must know how to transmit to the patient the three following virtues: Faith, Hope and Charity: Faith in the doctor, Hope that the treatment can work and Charity with himself to accept the compliance of a hard and prolonged treatment. Personally this is the focus that I use with my patients that usually come to me looking for an expert. My treatment can be prescribed by any dermatologist but it could be difficult to obtain nice results without following the recommendations mentioned previously. What is the basic treatment for me? Taking as a starting point that treatments must suit the patient and not only the illness, I personally manage the following: Topical Tacrolimus: Its use has become fashionable without many dermatologists knowing exactly why. It is not merely an anti-inflammatory, there are studies which explain scientifically that Tacrolimus is able to increase tyrosine activity of the melanocyte and increase its migratory ability. Ultraviolet Light: Mainly in UVB-NB band or even sunlight controlled exposition in sunny countries like Spain. Without light it is impossible to stimulate melanocytes from any reservoir, such as the peri-folicular niche or peri-lesional skin. Topical Khellin: 30 years of experience have convinced me completely about the use of topically applied khellin plus sunlight exposure. Although its capacity to stimulate melanocyte mitosis is inferior to psoralens, its long-term safety is important. Topical application of khellin achieves a notable level of penetration of the active substance to the basal layer in just an hour (recent unpublished research), but also daily application achieves an effective epidermic depot effect. The combination of a minimum daily sunlight exposure of 5, 10 or 15 minutes if possible usually produces excellent results in responsive body areas. Oral Antioxidants: Given that the function of light is essential yet knowing that it stimulates free radical production, using Prof. Schallreuter’s theory of melanocyte defect that they are unable to clean these toxic products, it seems useful to provide oral antioxidants to manage free radicals in vitiligo. Those with proven efficacy such as Polypodium Leucotomos and Vitamin E protect against possible photo-induced damage and create a better environment for new melanocyte migration. It is clear that these options are not the only possible therapies for all vitiligo cases but they are very effective especially in countries where controlled sunlight exposure is cheap and easy for 7 or 8 months a year. Over 30 years dedicated to treating vitiligo patients allow me to share this experience with which I have obtained excellent results.
- Vitiligo treatment and therapy l Skin pigmentation disease l Vitiligo and associated auto immune disease l Diagnostic and clinical analysis l Tissues grafting of vitiligo l Skin Diseases and Vitiligo
Session Introduction
Pranab Kumar Das
University of Amsterdam, Netherlands
Title: An enigmatic disease by the name of vitiligo: Autoimmune manifestation
Biography:
Pranab Kumar Das has received his PhD degree in Biochemistry from London University in 1969 and gained extensive research and teaching experiences in different countries globally and finally settled down in Immunological Research in Netherlands covering diverse field with a focus on the inflammation and immunity. One of his main interests had been skin diseases such as leprosy and idiopathic diseases like vitiligo and psoriasis and skin cancer. He has developed a strong interest in correlating tissue reactivity and systemic immunity of hosts. He has published more than 230 articles in peer viewed journals and book chapters in diverse field of life/medical sciences. He is retired in 2006 but still active in Honorary capacity.
Abstract:
Vitiligo is characterized by complete loss of UV protective pigment producing cells melanocytes. Due to the appearance of white depigmented patches causing ugly look, the disease, though not life threatening, could be psychologically debilitating despite the demonstration of the presence of mild inflammatory infiltrate in the skin paralleling the loss of melanocytes, vitiligo is not an inflammatory dermatoses. Interestingly, however, the disease is often associated with the presence of classical autoimmune diseases in the same patient. Various theories on the etiology of vitiligo are discussed among the experts. Since last decade the autoimmune mechanism is being subscribed by the investigators. Indeed, our own work demonstrated that the loss of melanocytes in some vitiligo patients is caused most likely by melanocyte specific autoreactive T cells and in addition, in some patients auto-antibodies against melanocytes can also be demonstrated. Nevertheless, vitiligo as such is not always perceived as one of the classical autoimmune diseases. However, studying vitiligo as a model autoimmune disease has opened up to develop novel therapeutics for melanoma. Various investigators had been investing much effort during last decade in designing targeted therapeutics with debatable success. This presentation would attempt to summarize and discuss some of the results in literature, including our own and those of the collaborators to have fresher look in this respect.
Pieter Spee
FibroTx LLC, Estonia
Title: Development of a non-invasive skin diagnostic test for guiding vitiligo treatment
Biography:
Pieter Spee has completed his PhD at the Graduate School of Oncology, at the Netherlands Cancer Institute and the University of Leiden in the Netherlands. He has worked eleven years at Novo Nordisk as the Director and Scientific Director of Translational Immunology, and where he made significant contributions to Lirilumab and Monalizumab, currently in clinical development for various cancers. Currently, he serves as a Chief Technology Officer of FibroTx where he brought the non-invasive biomarker test FibroTx TAP to the market and where he oversees the clinical development of FibroTx SELF, a non-invasive skin diagnostic test intended as point-of-care device for catering personalized skin treatment.
Abstract:
Vitiligo is a chronic and as yet incurable disease characterized by depigmentation of skin. Disease progression often follows the typical pattern of disease-active periods that are alternated by periods of relative stability. There are no specific treatments for vitiligo, with the exception of skin transplantation, which success critically depends on stable disease to avoid depigmentation of transplanted skin. Treatments for active disease typically suppress inflammation, a critical component of vitiligo pathology, with the aim to inhibit the expansion of skin lesions. Treatment options include steroids, calcineurin inhibitors, as well as phototherapy, which only have effect on active disease, but not on stable disease. Although the status of disease activity is an important parameter for treatment decision-making, assessment of disease activity remains difficult. Either, dermatologists monitor the expansion of lesions, a rather lengthy process or dermatologists rely on patient testimonies. Both methods have proven unsatisfactory and thus there is an unmet medical need for diagnostic tools that can monitor disease activity to guide disease management. FibroTx TAP and SELF are novel molecular diagnostic platform technologies that can measure protein biomarkers directly from skin. These non-invasive platform technologies are currently being tested in clinical studies for the development of a skin diagnostic tool that can assess the activity status of skin lesions of vitiligo patients. The aim of the studies is to develop the first point-of-care device that can markedly improve vitiligo treatment, which is cost-efficient and does not require the need for clinical laboratory expertise.
Seyed Mohhamed Radmanesh
Ahvaz Jundishapur University of Medical Sciences, Iran
Title: The melanocytes of different body areas have different susceptibility for vitiligo involvement
Biography:
Seyed Mohammad Radmanesh has completed his Medicine and Dermatologic Residency in Shiraz University of Medical Sciences, Shiraz Iran previously known as Pahlavi University and received the National Board of Dermatology in 1993. From 1993, he is an Academic Member of Ahvaz University of Medical Sciences, Iran. He is currently the Associate Professor of Dermatology. One of the fields of his interest is vitiligo. He has published several papers in the literature, some are the reference papers.
Abstract:
Monobenzyl ether of hydroquinone is a melanocytotoxic drug which is used for depigmentation of normally pigmented patches in extensive and generalized vitiligo. Cases have been reported that following application of MBEH depigmention has developed in remote areas not directly in contact with MBEH. The term chemical vitiligo has been applied to this situation. I visited four patients who developed generalized vitiligo after using MBEH for the treatment of intractable melasma. The lesions were started first as mottled depigmented patches on the face, where the MBEH was applied for a long time followed by development of vitiligo patches on the fingers, dorsum of the hands and forearm and then extended to other areas. The MBEH was reported to induce some immunological changes through which it may exert its melanocytotoxic activities. These melanocytotoxic activities may be used as an alternative therapy for melanomas. This finding supports the theory that not all vitiligos are inherited immune-genetic in nature, some may develop as a result of exposure to toxic chemicals such as MBEH or other unknown chemicals. These melanocytotoxic chemicals may exert their effects through changing the immunological profile of the tissue and subsequent death of melanocytes and vitiligo development.
- Immune mediators and thier role in vitiligo l Theories for Vitiligo pathogenesis l New insights in segmental vitiligo l Surgical management of vitiligo
Location: Sylt 3
Session Introduction
Seyed Mohhamed Radmanesh
Ahvaz Jundishapur University of Medical Sciences, Iran
Title: Generalized vitiligo development in the patients who has used monobenzone for the treatment of melasma
Biography:
Seyed Mohammad Radmanesh has completed his Medicine and Dermatologic Residency in Shiraz University of Medical Sciences, Shiraz Iran previously known as Pahlavi University and received the National Board of Dermatology in 1993. From 1993, he is an Academic Member of Ahvaz University of Medical Sciences, Iran. He is currently the Associate Professor of Dermatology. One of the fields of his interest is vitiligo. He has published several papers in the literature, some are the reference papers.
Abstract:
The melanocytes of different body areas have different susceptibility for vitiligo involvement. In the case of non-segmental vitiligo, many areas are more prone to develop vitiligo earlier than other sites. The areas that develop vitiligo earlier and are more prone to vitiligo are periorbital, perioral, mucosal genitalia in men and distal extremities and the areas that usually involved by vitiligo later are more resistant to vitiligo are thighs, trunk, particularly the lower trunk and arms. For these reasons the areas that are more resistant to vitiligo are chosen to harvest melanocytes or tissue autograft. Any cell or tissue autograft including the suction blister autograft is performed when the vitiligo is in a stable state. The stable vitiligo is defined as a condition in which there is no extension of the previous lesions and development of no new lesions within the past 6-12 months. For many cases of stable vitiligo we have done suction blister autograft. Years later the disease became flared up in some of those who received suction blister autograft. The vitiligo started to develop from different areas as well as the areas surrounding the grafted areas but surprisingly spared the grafted areas. This finding supports the hypothesis that melanocytes from different areas have different susceptibility to vitiligo.