Efficacy of PUVA Therapy in various types of Vitiligo

Meenakshi, K (2007) Efficacy of PUVA Therapy in various types of Vitiligo. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Vitiligo is an acquired common pigmentary disorder clinically characterized by the development of depigmented macules which are caused by the destruction of melanocytes in the affected areas. This is described in the Hindu sacred book ATTARVA VEDA in 1400 B.C. This had been often confused with leprosy. This misconception among the people is the basis for the social stigma tagged with this disease. In certain culture, patients with vitiligo are still regarded as social outcasts. About 0.5 – 1 % of general population suffer from vitiligo. Half of all the patients develop the disease before the age of twenty. Onset at an old age occurs but is unusual and should raise concern about underlying disorders or associated diseases. AIM : 1. To evaluate the efficacy of therapeutic effect of oral psoralen followed by Ultraviolet - A irradiation (PUVA) for chronic vitiligo patients who failed to respond to other modalities of treatment for vitiligo. 2. To assess the efficacy of PUVA response at various sites involved. 3. To study the Age, Sex, Family History, Koebnerization, surface area of involvement and their influence on the PUVA response. 4. To study the association between blood group and its efficacy on PUVA therapy. 5. To assess the complication due to PUVA therapy. METHODS AND MATERIALS : Forty one patients of either sex with stable generalized type, acral, acrofacial type of vitiligo with > 20 % of body surface area involvement were enrolled for the study after obtaining the informed consent. History included the following: 1. Age of onset of depigmentation. 2. Course of the disease – stability, rate of progression. 3. Potential precipitating events including emotional stress, cutaneous trauma. 4. Any history of photosensitivity. 5. Ocular or auditory dysfunction. 6. Family history of vitiligo and early graying of hair. 7. Personal or family history of autoimmune diseases. All patients were examined under good light. Importance for the distribution, number of lesions, colour of lesions, the affected sites in the skin,approximate surface area of depigmentation, pattern of vitiligo and mucosal involvement were taken into account. Any presence of leukotrichia in the patch were noted. Any associated autoimmune disorders if present were noted . Laboratory investigations like routine blood examination (Hb, TC, DC, ESR), urine analysis, liver function tests, thyroid profile were done. Blood group, peripheral smears, blood sugar, serum creatinine were also done . INDICATIONS OF PUVA –INCLUSION CRITERIA : 1. Generalized stable vitiligo, 2. Acro facial vitiligo, 3. Acral vitiligo, 4. Patient who has given consent for clinical photo and treatment. EXCLUSION CRITERIA : 1. Patient not willing to give written consent, 2. Patient below 12 years and above 60 years, 3. History of photo sensitivity and photo sensitive skin disorders, 4. Pregnancy and lactation, 5. Concurrent immuno suppressive and premalignant skin disease, 6. Significant hepatic and renal dysfunction. Audiograms were done to rule out any sensory neural deafness. Fundoscopy was done to rule out cataract and retinal pathology .Clinical photographs were taken for all the patients before and after exposure to PUVA therapy. This study was randomized single blinded age and sex matched. CONCLUSION : In our study, the only factor to affect the overall response rate with the statistical significance (P.001) was the surface area of involvement was directly proportional to the total session to induce pigmentation (p value <0.05). • Our data showed that the following factors like the age of the patient, family History of vitiligo, Koebnerization, precipitating factors and the age at the onset of disease have no influence on repigmentaion, though the onset of repigmentation was found to be earlier in younger patients. • Hairy areas (Face, Legs, arms, trunk) were more sensitive to therapy while non hairy areas (mucosa, finger tips, toe tips, palms & soles) were less sensitive to therapy. • Generalized type was the best type to respond very well. Acral and acrofacial types were resistant to therapy. • Good response was noticed in young patients with blood group ‘O’ positive individuals. • In our study, patients with longer duration of disease showed slower response to therapy. • We conclude, that Puva is effective, safe and cosmetically acceptable therapy for vitiligo.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Psoralen and UVA.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 02:03
Last Modified: 02 Mar 2018 02:03
URI: http://repository-tnmgrmu.ac.in/id/eprint/5956

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