الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other; biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo.
Vitiligo can have a major effect on quality of life, and treatment can be considered and should preferably begin early especially when the disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photochemotherapy, surgery, combination therapies and depigmentation of normally pigmented skin.
The present study was conducted on 20 patients with non-segmental vitiligo to explore the efficacy and safety of using different concentrations of intralesional corticosteroid combined with NB-UVB phototherapy. In each patient, nearly equal 5 patches were selected and classified as follow; patch 1 (control) was injected with normal saline (placebo), patch 2 was injected with triamcinolone acetonide (Kenacort-A) diluted with normal saline at concentration of 0.625 mg per ml (1:64), patch 3 was injected with triamcinolone acetonide at concentration of 1.25 mg per ml (1:32), patch 4 was injected with triamcinolone acetonide at concentration of 2.5 mg per ml (1:16) and patch 5 was injected with triamcinolone acetonide at concentration of 5 mg per ml (1:8). In all patches, the same amount of the required concentration was used and the injection was carried out once monthly for six months. All patients were subjected to NB-UVB phototherapy twice per week for 6 months.
There was a significant difference between all groups in their
repigmentation response (p=0.017). In patch 1, 60% of cases showed no changes, while 20% showed fair response, 5% showed moderate response and 15% revealed excellent response. In patch 2, 20% showed no changes, 10% revealed fair response, 5% showed moderate response, 20% showed good response and 45% revealed excellent response. In patch 3, 20% showed no changes, 20% showed good response and 60% revealed excellent response. In patch 4, 20% showed no changes, 5% showed moderate response, 10% showed good response and 65% revealed excellent response. In patch 5, 15% showed no changes, 5% showed fair response, 10% showed good response and 70% revealed excellent response.
As regard side effects, skin atrophy was reported in 5 patients injected by the following concentrations; 1.25 mg, 2.5 mg, and 5 mg/ml of triamcinolone acetonide. While, hyperpigmentation was reported in 4 patients injected by different concentrations of triamcinolone acetonide. Meanwhile, hypopigmentation was also reported in 3 patients injected by 1.25 mg 2.5 mg
and 5 mg/ml of triamcinolone acetonide.
Histopathological evaluation of all patches with different stains (H&E,
Masson’s trichrome stain and Orcein stain) was performed before and after treatment. After treatment, the epidermal thickness was decreased (epidermal atrophy), especially with conc. of 1.25, 2.5 and 5 mg/ml of intralesional triamcinolone acetonide injection with decreased and disorganised collagen fibers.
Histometric assessment of epidermal thickness objectively confirmed the histological observation. There was no significant difference (p>0.05) when comparing the epidermal thickness before treatment in all patches. While, after
treatment there was highly significant difference (p= <0.001) when comparing the epidermal thickness in all patches.
Meanwhile, there was no significant difference between pre and post treatment epidermal thickness in patch 1, 2 and 3(p=0.256, 0.263, 0.060 respectively), while there was significant difference between pre and post treatment epidermal thickness in patch 4 and 5 (2.5 and 5 mg/ml) (p= <0.001).
To the best of our knowledge, the present study was the first to compare different concentrations of intralesional triamcinolone acetonide to determine the most effective one for management of vitiligo without increasing the possible side effects.
In conclusion, intralesional corticosteroid injections combined with NBUVB showed a good and well-tolerated therapeutic option for vitiligo. It is an
effective, simple and relatively safe treatment when used with caution. ILS
injections are considered a good alternative option especially in localized vitiligo, and better discontinued in patients showing side effects, complications
or those who did not show signs of repigmentation in about 3 months’ time. The
concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest with fewer side effects and complications. However, higher
concentrations of 2.5 and 5 mg/ml were more effective but with more side effects.