The original article can be found at http://archderm.ama-assn.org/cgi/content/short/146/8/836

Perhaps similar studies could be done on people with Vitiligo and the results could help those people who are Vitamin D deficient.

I realize that this is off topic but comments and ideas are welcomed.

For many people with Vitiligo patience is a necessity.

There are not enough dermatologists here in the USA. The  AAD (American Academy of Dermatology) does influence our universities and from what I’m told recommends maximums for number of med students in dermatology in each school, thereby limiting the number of derms and maximizing the salaries/incomes for the ones lucky enough to graduate.

A side effect of this is patients need patience while they are waiting for their first and possibly subsequent appointments. Over the years, I have spoken with hundreds and hundreds of folks who are waiting sometimes up to three or more months before they can get into see a dermatologist. Many times, once they get there they are often told that it’s only a cosmetic condition and not much can be done. Why a derm would say such a thing is beyond me. This is a disease that can play with the mind and can cause a loss of self esteem with many people. Not everyone with Vitiligo is comfortable in public with Vitiligo.

I also believe that many dermatologists shy away from treating Vitiligo because the treatments typically take months before the white areas begin to re-pigment and they and their patients become discouraged. Diseases, such as Psoriasis, Eczema and some others respond within a few days of the initiation of treatment giving immediate hope to the patient. With Protopic, Elidel and UVB Narrowband (UVB311) It’s unlikely that re-pigmentation will begin in less than 3 months and the progress of re-pigmentation can be slow. The only ‘instant’ remedy is the use of make-up or skin dyes to mask the white areas. On hot summer days, perspiration can be an issue causing the makeup to transfer to the nice white shirt or blouse you put on a few minutes ago.

The treatment of Vitiligo takes time and I’m afraid that the patient does need to be patient.

What have been your experiences?

Here in the USA, a team at Northwestern University (Chicago)  reverse engineered drug created by Dr. Schallreuter and it is now available here in the USA from some compounding pharmacies. There is one on line at www.pseudocatalase.com and you may find others in your city or town.

Generally PC-KUS (PseudoCatalase ‘Karin U Schallteuter) is prescribed and applied to the skin and is immediately treated with UVB Narrowband UVB311) light. This cream is the only one that I am aware of that’s applied before UVB NB Treatment, See http://www.vithappens.com/index.php/2010/07/protopic-and-elidel-and-uvb-nb-for-vitiligo/ for a discussion about UVB NB and Elidel or Protopic.

Taken from www.HomePhotoTherapy.com

From:

Skin & Allergy News

Patented Cream Can Hold Vitiligo at Bay

Author: Mike Bykowski, Staff Writer

Skin & Allergy News 29(5):32, 1998. © 1998 International Medical News Group.

SHORT HILLS, N.J. — A new cream can clear almost all traces of vitiligo from the hands and faces of over half of the patients with the disorder, Dr. Karin U. Schallreuter said at a conference on cosmeceuticals sponsored by International Business Communications.

Dr. Schallreuter, professor of clinical and experimental dermatology at the University of Bradford in West Yorkshire, England, and her colleagues have developed a patented cream, pseudocatalase, which in combination with calcium has achieved very high success rates in treating vitiligo.

The pseudocatalase cream only works in about 60% of Vitiligo patients, but in these patients, a treatment regimen combining pseudocatalase and calcium is up to 95% effective in clearing affected hands and faces, Dr. Schallreuter said.

She has treated 220 patients with this regimen. Pseudocatalase is not yet available. (webmaster’s note: at this time, Pseudocatalase IS available in Europe and the United States, and more patients have been treated with it.)

It remains unclear which patients are candidates for pseudocatalase, Dr. Schallreuter added. Current vitiligo treatments, including psoralens plus ultraviolet A radiation and steroids, very infrequently reach a significant efficacy rate, she noted.

Previous studies have indicated high levels of oxidative stress and low levels of epidermal catalase in the skin of patients with vitiligo. Pseudocatalase prevents oxidative stress in vitiliginous skin, she explained.

Dr. Schallreuter and her colleagues obtained punch biopsies from the involved and uninvolved skin of 18 vitiligo patients who were randomly selected before treatment with pseudocatalase; biopsies also were taken 6 and 12 months after treatment.

Patients applied pseudocatalase cream twice daily and were exposed to the sun or to a narrow band of ultraviolet B radiation twice a week.

Pseudocatalase reduced epidermal hydrogen peroxide in vitiliginous skin within 2 minutes at a rate 15 times faster than natural catalase. It also prevented vacuolation in melanocytes and keratinocytes and increased the number of functioning melanocytes in the involved epidermis, she said.

Hailed by some as the cure for vitiligo, Dr. Schallreuter takes a more realistic view. “Pseudocatalase will be a substitutional therapy, not a cure.”

Pseudocatalase also may have applications in other skin disorders, she said. For example, in one patient with xeroderma pigmentosum, it significantly reduced de novo actinic keratoses, basal cell carcinomas, and squamous cell carcinomas when applied topically over the entire body over a period of a year.

The reader should review Dr. Schallreuter’s comments at her website
See http://www.vitiligo.eu.com/copies.htm

She is quite adamant and writes “ Copies of pseudocatalase are advertised worldwide. One ineffective copy of pseudocatalase cream plus calcium (P-CAT) has been advertised by Northwestern University in Chicago, Illinois, USA. Much confusion has taken place since the same name has been used from the original publication by Schallreuter et al 1995. The publications from Schallreuter et al on the subject of pseudocatalase formed the basis to support the efficacy of this product. More recently, Community Drug, Pittsburgh, USA, and McDonald’s Pharmacy, Vancouver, BC, Canada, are offering the same formulation for sale via the internet. There are no published results in the peer-reviewed journals on P-CAT.

TITLE: Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo

AUTHORS: Y Hari Kishan Kumar¹, G Raghu Rama Rao¹, K.V.T Gopal, G Shanti, K Veerabhadra Rao

Background: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size.

Aims: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups.

Methods: One hundred fifty patients (69 males, 81 females), aged 3-70 years, with vitiligo were treated twice weekly with NBUVB. The starting dose was 250 mJ/cm 2 in adults and 150 mJ/cm 2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1 year and were followed-up for 6 months for stability of repigmentation. Statistical methods were employed to establish the relation between the response and the number of exposures, duration of treatment, cumulative dose and the compliance.

Results: Analysis of our study showed that a majority of our cases, about 73, achieved 25-75% repigmentation, with an average of 51 ± 19 exposures, 51 had <25% repigmentation, with an average of 19 ± 11 exposures and 26 had >75% repigmentation, with an average of 74 ± 24 exposures. Good response to therapy was directly associated with good compliance, more number of exposures and increasing cumulative dose, which was statistically significant (P < 0.01). Adverse effects were minimal. Only three patients developed depigmentation of repigmented sites during follow-up.

Conclusion: Our study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.

Link to full article <Click Here>
PDF of Article <Click Here>

With Vitiligo, we typically see re-pigmentation begin after forty to sixty treatments, remember with treatments usually ocurring three times a week we’re looking at 12 to 20 weeks before re-pigmentation begins.

With Vitiligo it usually begins with freckling in the white areas and then over time the freckles expand to cover the area. Treatment will most likely continue for a year or more to fill in all/most areas that will re-pigment.

Folks with Psoriasis and Eczema usually respond quickly to treatment and begin to see results with in the first week or so and treatments then continue for a month or two with most people clearing within a few months.

Here’s a page at National Psoriasis Foundation on UVB Phototherapy
Excerpt from page “Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. Narrow-band UVB may be effective with fewer treatments per week than broad-band UVB. Narrow-band UVB is also emerging as an alternative to PUVA, the light-sensitizing medication psoralen plus exposure to ultraviolet light A. Although not as effective as PUVA, narrow-band UVB is easier for people to undergo and may be safer over the long term. The use of narrow-band UVB may increase as doctors and patients learn more about its effectiveness and safety…” See http://www.psoriasis.org/treatment/psoriasis/phototherapy/uvb.php

With Eczema and Psoriasis, what do you do when clearing has happened?

1. Wait for a re-occurence and start treatments again or
2. Perform a weekly maintenance dose at perhaps 75% of the last treatment time.

In either case, check with your dermatologist or medical professional. As a reminder, please read our disclaimer.

A question that comes up quite often is “Should I use Protopic?” or perhaps “Should I use Elidel?” and then the question continues “… while using UVB Narrow Band?”.

Generally speaking, any drug or cream should be avoided and not be applied immediately before or during UVB Narrow Band treatment. Elidel and Protopic and most other things you apply to your skin, change the skin’s sensitivity to UV light. Some drugs increase your sensitivity (Psoralens & others) while others reduce your skin’s sensitivity (sun blocks and the like). All of these should be avoided UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist.

I do recommend that if Protopic, Elidel or other Corticosteroid has been prescribed that you use it following UV treatment or on the alternate days. Do not apply these creams before treatment UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist. It is not safe to apply these creams before treatment as they can increase your skin’s sensitivity to UV light and increase the risk of severe erythema (sunburn).

Do no assume that you know more than your dermatologist!

Avoid sunlight, sun lamps, tanning beds, and phototherapy treatments with UVA or UVB light. If you must be outdoors, wear loose clothing over the skin areas treated with Protopic. Do not use sunscreen on treated skin unless your doctor has told you to.

• Read more: http://www.drugs.com/protopic.html
• Read more: http://www.drugs.com/elidel.html

REMEMBER: This is not MEDICAL ADVICE Please read my disclaimer at http://www.vithappens.com/index.php/disclaimer/

When you see insurance ads that say “total peace of mind for reasonable premiums’, you are reading total horse sh*t. Each of you should go rent Michael Moore’s movie ‘SICKO‘ and see what you’re up against. Hard to believe that some insurance companies actually pay bonuses to employees who successfully deny claims!

Let look at what happens with Empire / Blue Cross / Anthem / Blue Shield / Horizon and a host of other BCBS (Blue Cross/Blue Shield Companies). Each of these companies have different plans and different coverage depending on which state or region that you are in. Until we call call that particular patient’s Blue Cross office there is simply no way we can guess as to what a customer’s coverage is. How sad is that? There is no uniform policy and I actually believe that the agent that we call has complete latitude to give us any damned answer that they dream up for that particular phone call. If the agent is in a good mood then perhaps we’ll hear, “Yes, the patient is covered.” and if the agent got up on the wrong side of the bed then they can simply lie and say, “There is no coverage.”

In some states, BCBS cover Vitiligo in others they don’t. In some states it’s a cosmetic condition and in others it’s a disease. Sometimes UV Phototherapy is approved and the next day in the same state it’s ‘experimental’ and not covered. It’s a disaster for us and our customers. Sometimes it’s covered at the ‘billed amount’ and at others is approved for some percentage of the ‘allowed amount’. The ‘allowed amount’ is a magic number that BCBS have in some secret file that is only available after filing a claim. A typical ‘allowed amount’ is at least 30% to 50% below the billed amount but one never knows.

One thing we do not understand is the BCBS policy is that they pay their subscriber (you) and not us (the maker) when they settle a claim. They expect us to ship before we file a claim and then (1) hope they send some money to you and (2) hope that you’ll send money to us. We have adopted a policy as have many firms like us, that we only ship product after we have been paid in full. Most other insurance companies pay us and then we contact our customer and ask for payment of the balance before we ship any product.

I think you’ll detect some cynicism in my words and you should. We will do the best job we can and try as hard as we can to get some money from a client’s insurance company but we are not always successful.

Here’s some insurance company math!

• Billed amount = $2500.00
• Allowed Amount  = $1400.00
• Customer Deductible = $1000.00
• Pay 60 % of $1400.00 less $1000.00 or $240.00

Isn’t that great!

Research

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Objective To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis.

Design Pragmatic multicentre single blind randomised clinical trial (PLUTO study).

Setting Dermatology departments of 14 hospitals in the Netherlands.

Participants 196 patients with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy. The first 105 consecutive patients were also followed for one year after therapy.

Intervention Ultraviolet B phototherapy at home using a TL-01 home phototherapy unit compared with standard narrowband ultraviolet B phototherapy in an outpatient setting. Both therapies were done in a setting reflecting routine daily practice in the Netherlands.

Main outcome measures The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI) or self administered psoriasis area and severity index (SAPASI), called the PASI 50 and SAPASI 50 (relevant treatment effect). Another outcome of effectiveness was the percentage reduction in median scores on the PASI as well as SAPASI. Also the proportions of patients reaching the PASI 75 and SAPASI 75 (successful treatment effect), and the PASI 90 and SAPASI 90 (almost complete clearance) were calculated. Other secondary outcomes were quality of life (SF-36, psoriasis disability index), burden of treatment (questionnaire), patients’ preferences and satisfaction (questionnaire), and dosimetry and short term side effects (diary).

Results 82% of the patients treated at home compared with 79% of the patients treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% confidence interval -8.6% to 14.2%), and 70% compared with 73% reached the PASI 50 (-2.3%, -15.7% to 11.1%). For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), compared with 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting. Treatment effect as defined by the mean decline in PASI and SAPASI scores was significant (P<0.001) and similar across groups (P>0.3). Total cumulative doses of ultraviolet B light were similar (51.5 v 46.1 J/cm², difference 5.4, 95% confidence interval -5.2 to 16.0), and the occurrence of short term side effects did not differ. The burden of undergoing ultraviolet B phototherapy was significantly lower for patients treated at home (differences 1.23 to 3.01, all P 0.001). Quality of life increased equally regardless of treatment, but patients treated at home more often rated their experience with the therapy as “excellent” (42%, 38/90) compared with patients treated in the outpatient department (23%, 20/88; P=0.001).

Conclusion Ultraviolet B phototherapy administered at home is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients’ satisfaction.

^{<Original Article – Click Here>}

Take a look!

www.youtube.com/watch?v=CbrMS6evGFI

Cheryl and I have met April and Lori at several Vitiligo conferences over the years. Lori has written a book called “DIFFERENT -- Just Like Me”

April and Lori are remakable people in an ever changing world.

Please watch the video!

Chris