Although vitiligo is a common pigmentary disorder, inflammatory vitiligo is an unusual occurrence. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. Among them, 3 reports were of inflammatory vitiligo with erythematous, scaly plaques, as in our patient .
A 56-year-old male resented with a 1-year history of hypopigmented lesions on the trunk and extremities. On physical examination, there were variable sized hypopigmented patches on the buttocks and trunk, both under natural light and by Wood lamp examination (Fig. la). On the thigh, there were several centrally-hypopigmented patches with a discrete, elevated, scaly, erythematous rim (Fig. lb). The patient described that at first, the lesions on the abdomen and buttocks also showed an elevated, scaly, erythematous rim but the lesions had then subsequently turned into completely depigmented patches. There was no significant past medical or family history. Intermittent mild itching was noted. A KOH preparation of scales from the thigh and ankle showed negative findings. Laboratory evaluation including a complete blood count, ANA, and VDRL were within normal limits. Given the loss of pigment on the buttocks and trunk, inflammatory vitiligo was the leading diagnosis. However, the differential diagnosis included hypopigmented mycosis fungoides.
INTRODUCTION
The classic description of inflammatory vitiligo is an erythematous rim at the periphery of a patch of hypopigmented skin. Although vitiligo is a common pigmentary disorder, there are few published reports of inflammatory vitiligo. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. Moreover, there have been no reports of this condition in Korea.
Beginning with Kennedy’s pioneering studies, topical ALA has been studied in skin because it is a nontoxic, naturally occurring substance that targets cells involved in porphyrin synthesis. This new photosensitizing drug has the ability to penetrate the stratum corneum in a variety of skin tumors, basal cell carcinomas, solar keratoses, and squamous cell carcinoma as well as sebaceous glands. Topically applied ALA to photo-aged and photo- damaged skin leads to the accumulation of the photosensitizer, which is activated by exposure to light, and decrease sun-induced, uneven skin pigme- ntion changes and disorders of the pilosebaceous unit.
All 10 subjects completed the study. There was a statistically significant reduction in the inflammatory acne lesion count at eight weeks after two sessions of treatment (Table 1) compared to the baseline. Three dermatologists, unaware of the status of treatment, globally assessed clinical improvement; they graded the acne changes without knowledge of the clinical factors. The treated area was noted to have improved at visit one (week 1) and this improvement continued throughout the follow-up period (up to 12 week at least). The effects were determined based on comparisons of the assessed grades at baseline (Fig. 1) compared to the eight- week follow-up visit (Fig. 2) after the second treatment. Using the Wilcoxon signed rank test the differences were significant (p< 0.002). There was also a reduction in the noninflammatory lesion counts at the ALA-PDT site; but these changes did not reach statistical significance. The study subjects scored their overall satisfaction with the treatment, and 76.2% of the patients rated the treatment as either good or excellent.
Materials
We studied 10 healthy subjects of both genders (6 women, 4 men) with an age range of 20 to 29 years (mean age 24.7 years) with acne vulgaris on the face (KAGS; Korean acne grading system grade 3-5). They were enrolled from March 2005 to April 2005. All patients were Fitzpatrick photo skin type II-III and their degree of pigmentation varied from light to medium. Exclusion criteria included serious intercurrent illness, infections, pregnancy or lactation, women of childbearing age not using effective contraception, systemic antibiotics taken in the past two weeks, or systemic retinoids used in the past one year. Any patient with a photosensitivity disorder and those planning excessive sun light exposure were also excluded. All patients gave informed consent for the procedure and alternative treatments were discussed.
INTRODUCTION
Photodynamic therapy (PDT) using aminolevulinic acid (ALA) is a new technique. PDT is being extensively studied in a variety of dermatology settings. These applications include FDA approved treatment of premalignant and malignant skin conditions, as well as off-label uses for photoreiuvination and the treatment of acne vulgaris, sebaceous gland hyoerolasia, telangiectasia, rosacea, and hirsutism. There are three possible modes of action suggested for ALA-PDT use in acne: photodynamic destruction of Propionibacterium acne by sterilizing the sebaceous follicle, direct photodynamic injury of the sebaceous glands inhibiting sebum production and reduction of follicular obstruction bv effects on keratinocyte shedding and hyperkeratosis.
