JOURNAL READING

Pembimbing:

Dr. wiwin mulianingsih, Sp. KK, M. Kes

Disusun Oleh:

I Wayan Suparthanaya

08.06.0028

REPIGMENTATION OF EXTENSIVE INFLAMMATORY

VITILIGO WITH RAISED BORDERS USING EARLY ANDAGGRESSIVE TREATMENT

ABSTRACInflammatory vitiligo with raised borders (IVRB)

Sign

Target

rare subtype of vitiligo

raised erythema at the periphery of the depigmented patches

early and aggressive treatment can lead to significant and rapid improvement

CASE patient is a 38-year-old previously healthy South Asian male presented with progressive skin lesions that

had started 1 year prior to the initial presentation and were increasing in number.

Some lesions on his lower extremities were pruritc, but all others were generally asymptomatic.

The lesions covered a significant body surface area, including the bilateral forehead, vermilion lips, neck, axillae, arms, hands, chest, back, groin, legs and dorsal feet.

CONT. diagnose with vitiligo and had been

treating the lesions at home with a hand held narrow-band UVB (NB-UVB)

EXAM ON CASE On physical examination, he was skin

phototype V with numerous guttate macules coalescing into patches in some areas.

On Wood’s lamp examination, the lesions appeared depigmented in all areas described above. There was some poliosis of chest hair. Many lesions had raised rims of blue-gray coloration.

Sensation of skin still normal

BIOPSI 2 punch biopsies were performed on the

right posterior axilla one of affected and the other of nearby

unaffected skin

satellitosis

positive dermal dendritic cells

positive regulatory T cells

DEVELOPMENT With a diagnosis of active inflammatory

vitiligo, the goals of therapy were to stabilize the disease and stimulate repigmentation.

started on 30 mg (0.5 mg/kg) oral prednisone taken daily for 1 month and then discontinued

with in-office whole-body NB-UVB phototherapy (311–313 nm) 3 times weekly given the wide spread nature of his lesions

CONT. NB-UVB starting dose was 200 mJ/cm 2

The maximum facial dose of irradiation was 1,500 mJ/cm2

and the maximum body dose (including inguinal areas) 3,000 mJ/cm2

BASE LINE IMAGE

IVRB

Raised border

FOLLOW UP 1 MOUNTH was noted to have numerous islands of

repigmentation on his forehead, neck, arms, back and abdomen

His treatment regimen with NB-UVB was continued. Clobetasol cream applied twice daily on weekdays only, sparing the face, was also added

2 MOUNTS patient had significant islands of

repigmentation on his arms, neck, lower back and abdomen, with some areas showing near complete resolution

Patient was recommended to use his home handheld UV unit on the groin area for better exposure.

oral prednid sone at the same dose of 0.5 mg/kg (30 mg)

4 MONTH

7 MONTH patient has had complete

repigmentation of his forehead, neck, upper back, chest and abdominal lesions, and more than 75% repigmentation of his extremities and lower back

LITERATUR OF VITILIGO DEVELOPMENT

NB-UVB

PUVA

DISSCUSION In conclusion, the patient describe here

achieved not only disease stability but also substantial repigmentation of many of his skin lesions following treatment with NB-UVB and 2 courses of oral corticosteroid

Two reports of psoralen plus ultraviolet A (PUVA) were found. Treatment of one case with PUVA and oral prednisolone led to improvement of erythema and depigmentation after 2 months of therapy

DISSCUSION In this case, NB-UVB therapy produced

resolution of the raised borders and islands of repigmentation

These findings add further support to our observation that aggressive and early treatment of inflammatory vitiligo with raised borders can produce drastic improvement and alter the course of the disease

THANK YOU FOR

ATTENTION