الفهرس 
Viittiilliigo
Cell-mediated immunityOnly 14 pages are availabe for public view
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Abstract
Vitiligo is an acquired pigmentary disorder of unknown etiology. it affects approximately 1% of the world population of all skin types. It is a multifactorial disorder including genetic theory, auto-immune theory, neurogenic factors, intrinsic defect of melanocytes (self destructive theory), oxidative stress theory, reduced melanocyte survival theory, trans-epidermal melanocytorrhagy theory and convergence theory is also suggested. The treatment of vitiligo is a challenge to dermatologists. A variety of therapeutic agents have been tried on vitiligo but none is uniformly effective. Narrow band ultraviolet B(NB-UVB) is considered to be the most effective and safe initial treatment of choice for the treatment of moderate-to-severe vitiligo affecting more than 10-20% of the skin surface, however the response is usually delayed and slow. Microneedling has recently attain’s popularity as it is effective and can be used safely, the basic principal is formation of microchannels with resultant healing response, introducing and pushing the active melanocytes, which are in the pigmented border of the lesions, towards the central vitiliginous area, also stimulating the melanocytes from the periphery and the black hair follicles to proliferate, migrate and repigment. Various proinflammatory cytokines are released which have an effect on melanogenesis and pigment cell migration. Actually, in chronic disease like vitiligo, finding a short course treatment protocol has a great effect on increasing patients’ adherence to therapy, which is also cost benefit. The aim of this work was to study the clinical and histological efficacy of combined NB-UVB phototherapy and Microneedling versus NB-UVB phototherapy in the treatment of vitiligo. The present study included 20 patients with vitiligo; 12 females (60%) and 8 males (40%) with stable vitiligo that was clinically diagnosed. The selected patients were divided into two groups (A&B), each group enrolled 10 patients. Both groups were matched regarding age, sex, skin type and have at least one depigmented patch at the same corresponding site. group A was subjected to microneedling with dermapen at one depigmented patch followed by NB-UVB phototherapy sessions for the whole body twice weekly for three months. group B was subjected to NB-UVB phototherapy sessions twice weekly for three months. Patients were clinically examined two times/ week during the session period, Photographs were taken at baseline and before each session, the effectiveness of the treatment was assessed based on the recorded images using Investigator’s global assessment (IGA) scoring by an independent dermatologist. Two Skin biopsies one before and one after the therapy (3months later) were taken for histopathological examination by hematoxylin and eosin (H&E) & immunohistochemistry by HMB 45. The results of this study are summarized as following; group A showed improvement ranged from 5% to 85% with a mean of 48.50% ± 26.46 and a median 55%. 20% showed mild improvement (G1), 20% showed moderate improvement (G2), (40%) showed good improvement (G3) and 20% showed excellent improvement (G4). group B showed improvement ranged from 0% – 60% with a mean 20.0 %± 19.58 and a median 20%. 30% showed no improvement, 50% showed mild improvement (G1), 10% showed moderate improvement (G2) and 10% showed good improvement (G3). There was statistically significant difference between both groups (p=0.027*) In group A; the start of response ranged from 3-10 weeks with a mean of 5.90 weeks ± 2.33 while in group B; the start of response ranged from 5-12 weeks with a mean of 9.10 weeks ± 2.73. Starting of the repigmentation was statistically significant earlier on group A than group B (p=0.017*). No statistically significant relation between the percentage of improvement and the age of the patients, site of the lesions, duration of the disease, age of onset, sex of the patients, family history, precipitating factors, graying of hair in the lesion, type of vitiligo and history of previous disease on both groups. Side effects were temporary and tolerable; in group A; 60% were complaining of pain during the sessions,40% had pin point bleeding during the sessions, new lesion formation was noticed in 20% and 10%was complaining of burning. In group B new lesion formation was noticed in10% and one patient was complaining of burning (10%). Histopathological evaluation by H&E stain regarding the histopathological changes revealed no statistically significant difference between both groups regarding the reappearance of melanocytes and melanosomes, hyperkeratosis and inflammatory infiltrate, while the immunohistochemical changes revealed marked expression of HMB45 in group A more than group B. group A showed color intensity ranged from 0.01– 0.12 with a mean of 0.05 ± 0.04 and a median of 0.03 while group B showed color intensity ranged from 0.01 – 0.03 with a mean 0.01 ± 0.01 and a median of 0.01. group A was statistically significant better than group B (p=0.002*).