vitiligo

白癜风
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  • 文章类型: Journal Article
    白癜风的治疗在皮肤病学中仍然是一个挑战。关于碱性成纤维细胞生长因子(bFGF)在白癜风患者中的明确临床作用的文献很少。
    我们决定达成共识,试图回答与白癜风的管理和bFGF的作用有关的一些关键问题。
    在印度的21位专家中进行了德尔菲法。就患病率的27项声明达成共识(同意率为75%或更高),流行病学,白癜风的治疗及bFGF在白癜风治疗中的作用。经过两轮谈判,协商一致进程完成。
    外用皮质类固醇治疗是白癜风的一线治疗,它的副作用是众所周知的,特别是在敏感地区。在稳定的面部白癜风中,首选局部钙调磷酸酶抑制剂,脖子,生殖器,或中间区域作为局部皮质类固醇的替代品。局部bFGF是一种相对较新的疗法,在稳定的白癜风中具有有希望的作用。bFGF可安全有效地诱导白癜风病变的色素沉着。bFGF与其他局部治疗的联合治疗,光疗,和外科手术可以对白癜风患者有益。
    这一共识将补充目前关于bFGF的文献,并帮助医生认识到白癜风治疗中未满足的需求。
    UNASSIGNED: Treatment of vitiligo is still a challenge in dermatology. Literature is sparse on the definitive clinical role of basic fibroblast growth factor (bFGF) in vitiligo patients.
    UNASSIGNED: We decided to generate a consensus in an attempt to answer some critical questions related to the management of vitiligo and the role of bFGF.
    UNASSIGNED: A Delphi method among 21 experts across India was conducted. A consensus (agreement was 75% or greater) was taken on 27 statements on the prevalence, epidemiology, and treatment of vitiligo and the role of bFGF in the management of vitiligo. The consensus process was completed after two rounds.
    UNASSIGNED: Topical corticosteroid therapy is the first-line therapy for vitiligo; however, its adverse effects are widely known, especially in sensitive areas. Topical calcineurin inhibitors are preferred in stable vitiligo of the face, neck, genitals, or intertriginous regions as an alternative to topical corticosteroids. Topical bFGF is a relatively newer therapy with a promising role in stable vitiligo. bFGF is safe and effective in inducing repigmentation of vitiligo lesions. Combination therapy of bFGF with other topical therapies, phototherapy, and surgical procedures can be beneficial in patients of vitiligo.
    UNASSIGNED: This consensus would complement the currently available literature on bFGF and help the practitioner to recognize the unmet need in the treatment of vitiligo.
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  • 文章类型: Journal Article
    白癜风表现为皮肤上的色素斑和斑块,并且可以显着影响患者的生活质量。尽管有几种治疗方式,在个体和疾病亚型之间,色素沉着的发生率差异很大.对于药物治疗效果不佳的稳定型白癜风患者,黑素细胞-角质形成细胞移植程序(MKTP)是可行的选择。虽然这种自体非培养细胞移植程序的变化是由世界各地的皮肤科外科医生进行的,并显示出良好的耐受性和有效性,它在美国仍未得到充分利用。我们对MKTP进行了全面的概述,强调循证和实用技术,以提高患者的治疗效果。作为一种宝贵的资源,这项审查旨在支持寻求将MKTP纳入其实践并提高对其益处的认识的皮肤科外科医生,最终培养更全面的白癜风护理方法。
    Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient\'s quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.
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  • 文章类型: Journal Article
    白癜风是一种常见的皮肤病,其特征是免疫介导的黑素细胞破坏。非节段白癜风,最常见的临床亚型,通常具有慢性病程,并且通常会对受影响的患者造成重大的社会心理后果。早期识别,对合并症的认识,对疾病程度和活动的精确评估,评估生活质量的损害以及基于现有循证疗法的快速开始治疗是白癜风管理的重要基石.这个S1指南帮助德国皮肤科医生更好地诊断和治疗白癜风。
    Vitiligo is a common skin disorder characterized by immune-mediated destruction of melanocytes. Non-segmental vitiligo, the most common clinical subtype, has usually a chronic course and often results in significant psychosocial consequences for the affected patient. Early recognition, awareness of comorbidity, precise assessment of disease extent and activity, evaluation of impairment of quality of life as well as rapid initiation of treatment based on currently available evidence-based therapies are crucial cornerstones in the management of vitiligo. This S1 guideline helps German dermatologists to better diagnose and treat vitiligo.
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  • 文章类型: Journal Article
    背景:COVID-19大流行改变了皮肤科医生的方法,关于众多条件的管理,白癜风就是其中之一。然而,关于如何处理白癜风患者缺乏共识,当我们与这场流行病作斗争时。
    目的:进行问卷调查,在皮肤科专家中;为了了解COVID-19对白癜风管理的影响。
    方法:准备了一份在线半结构化英语问卷,并在50位泛印度专家皮肤科医生中分发了该链接,通过各种平台(雪球采样)。严格保密和匿名。在研究结束时分析反应,并产生共识声明。
    结果:42.22%的受访者认为远程会诊足以诊断和治疗大多数白癜风病例。64.44%的人在开口服药物时感到舒适,即使在COVID-19大流行期间;其中62%的人更愿意开全身性类固醇;其次是17%,11%,7%,3%的人更喜欢环孢菌素,硫唑嘌呤,霉酚酸酯,和甲氨蝶呤,分别。64.44%的受访者建议在办公室进行光疗,80%的受访者更喜欢基于家庭的光疗(PUVAsol或手持式NBUVB设备)。86.67%的人更愿意停止口服免疫抑制药物,直到COVID-19RTPCR阳性患者检测为阴性。
    结论:结果是基于对一小部分皮肤科医生的调查,这些皮肤科医生根据目前可用的COVID-19信息做出了决定。根据病毒的进一步可用信息的性质及其对我们如何管理患者的影响,这种情况可能会发生变化。
    结论:初次咨询的病例可以从身体上看到,后续的可能会安排远程会诊。可以毫不犹豫地使用局部治疗。最好建议使用PUVAsol或基于家庭的光疗单元(手持式NBUVB设备)进行光疗。关于全身性免疫抑制剂,考虑到较少的监测需求,口服小脉冲治疗可能是优选的。只有在心理健康受到严重影响的情况下才应进行白癜风手术。
    BACKGROUND: COVID-19 pandemic has changed the approach of dermatologists, with respect to management of numerous conditions, vitiligo being one of them. However, there is a lack of consensus on how to deal with patients of vitiligo, as we battle this pandemic.
    OBJECTIVE: To conduct a questionnaire-based survey, amongst expert dermatologists; in order to understand the impact of COVID-19 on the management of vitiligo.
    METHODS: An online semi-structured English questionnaire was prepared and the link was circulated among 50 pan-Indian expert dermatologists, through various platforms (snowball sampling). Confidentiality and anonymity were strictly maintained. Responses were analyzed at the end of the study and a consensus statement was generated.
    RESULTS: 42.22% of the respondents believed that teleconsultation is adequate for the diagnosis and management of most cases of vitiligo. 64.44% were found to be comfortable in prescribing oral medications, even during the COVID-19 pandemic; of which 62% would prefer to prescribe systemic steroids; followed by 17%, 11%, 7%, and 3% who would prefer cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, respectively. 64.44% respondents would recommend phototherapy in their office and 80% would prefer home-based phototherapy (PUVAsol or handheld NBUVB devices). 86.67% would prefer to stop the oral immunosuppressive drugs, till the COVID-19 RTPCR positive patients are tested negative.
    CONCLUSIONS: The results are based on a survey of a small albeit selected group of dermatologists who decided on the currently available information on COVID-19. The same may change depending on the nature of further available information on the virus and its effect on how we manage the patients.
    CONCLUSIONS: Cases for initial consultation may be seen physically, and those for follow-up may be scheduled for teleconsultation. Topical therapy may be used without any hesitation. Phototherapy may be best advised with either PUVAsol or home-based phototherapy units (handheld NBUVB devices). With regards to systemic immunosuppressives, oral minipulse therapy may be preferable in view of lesser requirement of monitoring. Surgery for vitiligo should be performed only if the psychological well-being is severely affected.
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  • 文章类型: Journal Article
    背景:诊断和治疗肤色患者所需技能的不足可能会导致健康差异。小儿皮肤病学研究联盟小儿肤色特别兴趣小组(PSOCG)召集会议,为医学院学生和皮肤科居民提供基础小儿肤色(PSOC)教育所需的主题课程,以提高PSOC的教育质量。
    方法:向PSOCG成员分发了一项调查,以评估专家对纳入基本PSOC教学大纲的关键主题的意见。视频会议和两轮调查用于对纳入主题进行排名,并强调纳入的基本需求。
    结果:小组成员由学术儿科皮肤科医生组成,其教学职责包括皮肤科居民和医学生的肤色主题。为基础科学教育讲座制定了学习目标,影响PSOC的临床状况按婴儿年龄分组,儿科,和影响PSOC人群的青少年皮肤状况被确定为包括基于特定参数的排名得分,包括更高的肤色频率,肤色的细微差别,需要医疗检查。
    结论:需要增加对PSOC教育的关注,以通过增强知识来提高对有色人种儿童的护理质量。炎症,遗传,尤其是原发性色素性疾病应该成为医学受训者儿科肤色教育广泛课程的重点。目标应包括改善诊断,治疗,以及教育患者及其家人了解病情性质的能力。
    BACKGROUND: Deficiencies in the skills necessary to diagnose and manage patients with skin of color may contribute to health disparities. The Pediatric Dermatology Research Alliance Special Interest Group in Pediatric Skin of Color (PSOCG) convened to generate a curriculum of topics required for basic pediatric skin of color (PSOC) education for medical students and residents in dermatology to improve the quality of education in PSOC.
    METHODS: A survey was distributed to the PSOCG members to assess expert opinion regarding critical topics for inclusion in a basic PSOC syllabus. Video conference and two rounds of survey were used to rank topics for inclusion and to highlight the underlying need for inclusion.
    RESULTS: Group members composed of academic pediatric dermatologists with teaching responsibilities including skin of color topics for dermatology residents and medical students. Learning objectives were developed for an educational lecture on basic science, and clinical conditions affecting PSOC were grouped by age-infantile, pediatric, and adolescent skin conditions affecting the PSOC population were identified for inclusion with rank score based on specific parameters including greater frequency in skin of color, nuances in skin of color, and need for medical workup.
    CONCLUSIONS: Increased focus on PSOC education is needed to improve quality of care for children of color through enhanced knowledge. Inflammatory, genetic, and particularly primary pigmentary disorders should be the focus of a broad curriculum in pediatric skin of color education for medical trainees. Objectives should include improved diagnosis, treatment, and ability to educate patients and their families regarding the nature of their conditions.
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  • 文章类型: Journal Article
    背景:白癜风是一种粘膜皮肤,自身免疫,局部化,或传播疾病,表现为低色斑或无色斑,生活质量的损失。巴西白癜风的患病率确定为0.54%。没有用于治疗的标签药物。迄今为止,巴西尚未就白癜风的治疗达成共识.
    目的:本组有治疗本病经验的巴西皮肤科医生的目的是就白癜风的临床和外科治疗达成共识,基于最好的科学证据的文章。
    方法:邀请了7位皮肤科医生,每个患者被分配两种治疗模式进行审查.每次治疗(局部,系统性,和光疗)由三位专家进行了审查。两位专家回顾了手术治疗。随后,协调员编写了不同的版本,并起草了关于每种治疗类型的文本。新版本已返回给所有专家,他们表达了他们的意见,并提出了澄清的建议。最后文本由协调员撰写,并发送给所有参与者,以准备最终共识。
    结论:专家将以下定义为白癜风的标准治疗:局部和不稳定病例使用局部皮质类固醇和钙调磷酸酶抑制剂;进行性全身白癜风的皮质类固醇小脉冲;窄带UVB光疗治疗广泛形式的疾病。对于节段性和稳定性的全身性白癜风,应采用手术方式。正在测试局部和全身抗JAK药物,有希望的结果。
    BACKGROUND: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written.
    OBJECTIVE: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence.
    METHODS: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus.
    CONCLUSIONS: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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  • 文章类型: Journal Article
    目的:白癜风仍然是皮肤病学的主要挑战。然而,大部分治疗方法仍不清楚,因为证据很少.我们试图回答一些与白癜风患者管理有关的关键问题。
    方法:对31名白癜风专家进行改良Delphi过程。通过投票收集了12个没有明确答案的临床白癜风治疗问题。为了解决每个问题,两名成员进行了系统的文献综述,并编写了陈述草案以及证据水平和建议力度.在审查了草案之后,所有人都对每个项目表示了从1(强烈分歧)到9(强烈同意)的同意程度。对草案进行了修订,以反映建议的意见。讨论继续进行,直到所有成员都同意最终决定。
    结果:五轮后完成了共识过程。我们确定了12个关键问题的最佳答案,包括长期光疗的问题,全身和局部皮质类固醇,局部钙调磷酸酶抑制剂,免疫抑制剂,准分子激光治疗,和手术干预。
    结论:这一共识将补充目前的指南,并有助于医生和患者在白癜风治疗方面的决策。
    OBJECTIVE: Vitiligo remains a major challenge in dermatology. However, much of the treatment remains unclear, because little evidence is available. We sought to answer some critical questions pertaining to management of vitiligo patients.
    METHODS: A modified Delphi process among 31 vitiligo experts was conducted. A total of 12 clinical vitiligo treatment questions without clear answers were collected via a vote. To address each question, two members performed systematic literature reviews and prepared draft statements along with the levels of evidence and strength of recommendation. After reviewing the draft, all expressed their extent of agreement from 1 (strong disagreement) to 9 (strong agreement) for each item. The drafts were revised to reflect suggested comments. Discussion continued until all members agreed with the ultimate decision.
    RESULTS: The consensus process was completed after five rounds. We identified the best answers to 12 key questions, including issues on long-term phototherapy, systemic and topical corticosteroids, topical calcineurin inhibitors, immunosuppressants, excimer laser treatment, and surgical interventions.
    CONCLUSIONS: This consensus would complement current guidelines and aid both physician and patient decision-making in the treatment of vitiligo.
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