Plain Language Summaries
Hypochromic vitiligo: delineation of a new entity
K. Ezzedine, A. Mahé, N. van Geel, N. Cardot-Leccia, Y. Gauthier, V. Descamps, A. Al Issa, F. Ly, O. Chosidow, A. TaÏeb and T. Passeron
This summary relates to DOI 10.1111/bjd.13423
British Journal of Dermatology, 172, 716–721, March 2015
Summary
Vitiligo is the most common depigmenting disorder, meaning a disease that causes loss of colour or ‘pigment’ from the skin. There are two major forms: nonsegmental vitiligo (NSV) and segmental vitiligo. In NSV, the most common form of the disease, patches occur symmetrically on both sides of the body. Isolated cases of a different type of NSV, which the authors call hypochromic vitiligo, have been reported, however no study on a series of patients with the disorder had previously defined the condition adequately. Therefore, the researchers looked through patient records from eight dermatology departments in France, Belgium, Senegal and Saudi Arabia, to identify cases and better define the disorder. Twenty-four cases of hypochromic vitiligo were identified. Fourteen were men and 10 women. The mean age at diagnosis was 35·4 years, although the patients’ ages ranged from eight to 66. Strikingly, all patients were dark skinned. The distribution pattern of the lesions was highly similar in 18 of the 24 patients, with lesions on the face and neck area, mainly on oil-producing (seborrheic) areas of the face where lots of individual macules (patches) occurred. Macules tended to have reduced pigment rather than total loss of pigment. The researchers conclude that this is a rare form of NSV that has been very sparsely reported, and the disease seems to be limited to dark-skinned individuals. Clinicians should be aware of this unusual form of vitiligo as it may easily be confused with other skin disorders causing loss of pigment.
Stretch marks during pregnancy: a review of topical prevention
K. Korgavkar and F. Wang
This summary relates to DOI 10.1111/bjd.13426
British Journal of Dermatology, 172, 606–616, March 2015
Summary
Striae gravidarum (SG) is the medical term for stretch marks occurring during pregnancy, which affect up to 90% of pregnant women. While not medically dangerous, SG can be disfiguring, causing emotional and psychological distress. However, studies specifically addressing the prevention of SG are sparse. The authors of this study, from the US, therefore carried out a review of existing studies that examine treatments applied to the skin (called topical modalities) used specifically for SG. The authors looked at the treatments’ effectiveness at either preventing the development of new SG during pregnancy, or reducing the severity of SG that have recently developed. They found that creams containing centella, a medicinal herb, may be effective for preventing SG and reducing their severity. However, as centella is often combined with other ingredients, its specific role in SG prevention requires further investigation. There is weak evidence that massage with bitter almond oil may be effective for preventing SG and reducing their severity, however, it is unclear if the benefits are mainly due to massage alone or in combination with bitter almond oil. Products containing almond oil in combination with certain other ingredients have not shown similar benefit. There is weak evidence that creams containing hyaluronic acid can prevent SG. Tretinoin shows promise for decreasing the severity of newly developed SG, however tretinoin is not recommended for use during pregnancy and lactation, so women should wait until after this period to apply it. Studies suggest that cocoa butter, which is often combined with vitamin E, is not effective for preventing SG or reducing their severity, and neither is olive oil. The authors conclude that reliable methods for preventing SG during pregnancy are lacking, and that more investigation in this area is needed.
Identification of a new disease cluster of pemphigus vulgaris with autoimmune thyroid disease, rheumatoid arthritis and type I diabetes
A. Parameswaran, K. Attwood, R. Sato, K. Seiffert-Sinha and A.A. Sinha
This summary relates to DOI 10.1111/bjd.13433
British Journal of Dermatology, 172, 729–738, March 2015
Summary
Pemphigus vulgaris (PV) is a potentially fatal blistering skin disease. It is an autoimmune disease, meaning that the body's immune system, which normally fights off disease, in this case attacks healthy cells. It is known that people suffering from autoimmune diseases, such as PV, as well as family members, are at increased risk of developing another autoimmune disease. However, it is unknown whether there are specific autoimmune diseases that ‘cluster’ with PV, meaning that they are more likely to occur with PV. This study from the US therefore analysed data from 230 PV patients on the researchers’ patient database, 171 responses from an anonymous online survey conducted by their laboratory, and 393 patients on the International Pemphigus and Pemphigoid Foundation registry. The aim was to find out how many PV patients and their relatives also suffer from other autoimmune diseases and whether any of these occur as ‘clusters’ linked to PV, and to determine the prevalence of specific autoimmune diseases in PV patients versus the general population. They found that the prevalence of autoimmune thyroid disease (AITD), rheumatoid arthritis, and type 1 diabetes was significantly increased in PV patients as compared to the general population. These diseases were also among the most frequent in family members of PV patients, in addition to systemic lupus erythematosus (SLE). Further analysis showed that PV forms a distinct cluster with AITD, rheumatoid arthritis, and type 1 diabetes, and another cluster with SLE, AITD, and rheumatoid arthritis.
Digital ultraviolet therapy: a novel therapeutic approach for the targeted treatment of psoriasis vulgaris
T. Werfel, F. Holiangu, K.-H. Niemann, O. Schmerling, F. Lüllau, A. Zedler, H.-D. Sträter and M. Niebuhr
This summary relates to DOI 10.1111/bjd.13464
British Journal of Dermatology, 172, 746–753, March 2015
Summary
Ultraviolet light is used to reduce inflammation of the skin, particularly in psoriasis, and this is known as phototherapy. There are different types of phototherapy. Patients can be treated with the full UVB spectrum (called broadband UVB) or just a small part (narrowband UVB). UVA treatment usually consists of UVA light, combined with a ‘sensitiser’ called a psoralen (a chemical that increases the effect of UVA on the skin), which is either taken as tablets or by the application of a solution, cream or gel directly onto your skin, sometimes in a bath. This type of treatment is called PUVA, which is short for Psoralen + UVA. Phototherapy can have a number of side effects, including premature skin ageing and increased risk of a type of skin cancer called squamous cell carcinoma (SCC). The purpose of this study, from Germany, was to evaluate a device called Digital Phototherapy Device skintrek® which targets the UV light to the lesions (patches) of psoriasis, while protecting the healthy surrounding skin, to reduce the risk of premature skin ageing and SCC. Twenty-eight patients had certain lesions called ‘target lesions’ treated with skintrek® in the following formats: eight target lesions were treated first with psoralen cream and then skintrek® (group ‘skintrek® cream PUVA’), 11 skin lesions with psoralen in a bath and then skintrek® (group ‘skintrek® bath PUVA’) and 10 skin lesions with skintrek® followed by UVB (group ‘skintrek® UVB’). The patients’ remaining lesions not treated by skintrek® were treated with conventional therapies, such a topical treatments, UVA or UVB. The researchers found that the PASI score, which assesses the severity and extent of patients’ psoriasis and which is higher the greater the level of severity/extent, was reduced by 54% in the skintrek® cream PUVA group, 51% in the skintrek® bath PUVA group and 63% in the skintrek® UVB group. The authors conclude that targeted UV-therapy of psoriatic plaques with the Digital Phototherapy Device skintrek® is as effective as conventional cream and bath PUVA and narrowband UVB, while also avoiding damage to the healthy adjacent skin.
T helper cell 2 immune skewing in pregnancy/early life: chemical exposure and the development of atopic disease and allergy
J.P. McFadden, J.P. Thyssen, D.A. Basketter, P. Puangpet and I. Kimber
This summary relates to DOI 10.1111/bjd.13497
British Journal of Dermatology, 172, 584–591, March 2015
Summary
Atopic disorders are a group of conditions which include asthma, eczema and hay-fever and which are associated with the immune system being overly sensitive to some potential ‘allergens’ (substances triggering allergy). Studies have shown that in westernised countries there has been a 300–500% increase in the prevalence of atopic disease during the last 50 years. One popular explanation is the ‘hygiene hypothesis’, in which it is suggested that modern hygiene standards have reduced our exposure during early childhood to microorganisms (such as germs) which can help strengthen the immune system, the body's defence system that keeps us healthy. This review explores the role of exposure during pregnancy to certain chemicals that are known to stimulate the immune system, to see if this may also have an impact. There are two groups of white blood cells called T Helper lymphocytes, Th1 and Th2. During pregnancy, it is normal for there to be a higher level of Th2 cell activity, which helps to protect the foetus, and this imbalance continues in the baby for a few months after birth before returning to normal. Higher levels of Th2 cells can also be found in atopic diseases, and these cells are linked to allergy, whereas Th1 cells help to prevent development of allergic disease. By reviewing a range of research, the authors of this study, from the U.K., Denmark and Thailand, suggest that the Th2 bias in the baby may be increased and/or prolonged by the mother's exposure during pregnancy, and the baby's exposure to chemicals that can have an effect on the immune system and on the balance between Th1 and Th2. They argue that this may make the child more likely to develop atopic allergy, contributing to the increase in atopic diseases seen in recent decades.
Disease recurrence in localized scleroderma: a retrospective analysis of 344 patients with pediatric- or adult-onset disease
J.S. Mertens, M.M.B. Seyger, W. Kievit, E.P.A.H. Hoppenreijs, T.L.Th.A. Jansen, P.C.M. van de Kerkhof, T.R.D. Radstake and E.M.G.J. de Jong
This summary relates to DOI 10.1111/bjd.13514
British Journal of Dermatology, 172, 722–728, March 2015
Summary
Localised scleroderma (LoS), also known as morphoea, is an uncommon disorder in which areas of skin become thicker and firmer than the rest of the skin. It is not one disease with one prognosis as there are different types, including plaque, linear and the generalised type. It can affect anyone, including children. While it cannot be cured, it often improves on its own, known as being in remission, but can then come back, known as disease recurrence. This study, from the Netherlands, examined the frequency and characteristics of disease recurrences in pediatric LoS (occurring during childhood) and adult-onset LoS (first occurring during adulthood), and looked at whether any variables among patients are associated with a higher risk of disease recurrence. By analysing data from 344 patients, of which 35% had pediatric-onset LoS and 65% had adult-onset LoS, they discovered that disease recurrence occurred in 27% of the pediatric-onset group and 17% of the adult-onset group. The researchers also found an association between disease recurrence and one subtype of the disease called linear LoS of the limbs, regardless of the patient's age when the disease started. Disease recurrences can occur even after many years of remission. The authors conclude that awareness of the high recurrence rates may help doctors to recognize recurrence of the disease, which may in turn help to reduce any delay in restarting treatments.
Limited exposure to ambient ultraviolet radiation and 25-hydroxyvitamin D levels: a systematic review
S.A. Rice, M. Carpenter, A. Fityan, L.M. Vearncombe, M. Ardern-Jones, A.A. Jackson, C. Cooper, J. Baird and E. Healy
This summary relates to DOI 10.1111/bjd.13575
British Journal of Dermatology, 172, 652–661, March 2015
Summary
Ultraviolet radiation (UVR) from the sun helps the body to produce vitamin D, which is important for bone health and may have other health benefits. Humans also get vitamin D through the diet and dietary supplements. It is widely reported that humans obtain most of their vitamin D from sunshine, and many authorities therefore advise people that UVR exposure is essential to maintain adequate vitamin D levels in the body. However, UVR causes skin cancers, which are among the most common cancers in many Western countries. This systematic review from the U.K. examined 42 698 published articles to see if there is evidence to show that vitamin D levels can be maintained during extended periods of little or no exposure to sunlight. Forty-one studies, which provided evidence on this subject, were identified. The authors conclude that, while UVR is an important source of vitamin D in various populations, many healthy adults in different populations across the world can maintain adequate serum vitamin D levels despite low UVR exposure for several months of the year. They advise that although there remains a need for further research on whether UVR exposure is required for longer-term maintenance of adequate vitamin D levels, public health campaigns promoting a high vitamin D diet or supplements to healthy adults could help to ensure people receive enough vitamin D while avoiding the damaging effects of UVR exposure.
