Clinical Observation And Laboratory Study Of Targeted High-Intensity UVB In The Treatment Of Vitiligo

objective:To evaluate the efficacy and safety of targeted high-intensity UVB (TH-UVB) and narrow band UVB(NB-UVB) in the treatment of vitiligo.Methods:Thirty-three patients with vitiligo was enrolled in the study. Symmetrical or near lesions were selected as reference lesions. Then one side was treated with TH-UVB and the other side with NB-UVB in each patient, twice per week,24 times in all. MED was examinated in the test group. The first dose is 2MED, and the subsequent dose is determined as follows:10% increment if no erythema developed from the prior irradiation,5% increment if erythema lasting for less than 24h, and no increment if erythema lasted more than 24h. If pain or blistering developed, treatment was withheld until resolution, and then the dose was decreased by 10%. The first dose is 70% MED in the control group, and the subsequent dose is determined as follows:10% increment if there is no erythema or erythema lasting for less than 24h, and no increment if there is erythema lasting 24-72h. If pain or blistering developed or erythema lasting more than 72h, treatment was withheld until resolution, and then the dose was decreased by 10%. Patients were examined weekly intervals and recorded their response to the treatment. All data were analysed by SPSS.Results:Thirty patients were evaluated. The effective rate was 56.7% in the test group, and 20.0% in the control group. The difference was statistically (P<0.05).The mean number of radiation for initial repigmentation was (7.95±3.43) in the test group, and (15.36±3.43) in the control group. The difference was statistically (P<0.05) There is no correlation between clinical feature and the efficacy(P>0.05). Adverse effects were light in both groups.Conclusion:TH-UVB is more effective than NB-UVB in the treatment of vitiligo, and both of them are safe. Objective:To study the effects of various dosages of TH-UVB and NB-UVB on hyperpigmentation and expression of a-melanocyte-stimulating hormone(a-MSH) and endothelin-1(ET-1) in the skin of guinea pigs.Methods:Five isolated areas were selected on the skin of brownish guinea pigs, and were treated with different dosages of TH-UVB and NB-UVB. In the TH-UVB groups, the first dose was 270 or 90mJ/cm2 (the high dosage group and the low dosage group, respectively), and the subsequent dose was determined as follows:10% increment if no erythema developed from the prior irradiation,5% increment if erythema lasting for less than 24h, and no increment if erythema lasted more than 24h. If pain or blistering developed, treatment was withheld until resolution, and then the dose was decreased by 10%. The first dose was 200 or 100mJ/cm2 in the NB-UVB groups (the high dosage group and the low dosage group, respectively).The subsequent dose was determined as follows:20% increment if there was no erythema, 10% increment if there was minor erythema, and treatment was withheld for one time if there was obvious erythema. If pain or blistering developed, treatment was withheld until resolution, and then the dose was decreased by 10%. Nothing was treated on control group. Efficacy was evaluated by visual assessment, Fontana-Masson staining. The mRNA and protein expression of a-MSH and ET-1 was detected by RT-PCR and immunohistochemistry, respectively.Results:The differences of hyperpigmentation scores and melanin contents among the 5 groups were statistically significant (P<0.01). There was no statistically difference between the high dosage TH-UVB group and the low dosage TH-UVB group (P>0.05). However, the TH-UVB groups were significantly higher than the NB-UVB groups (P<0.05), and the high dosage NB-UVB group was significantly higher than the low dosage NB-UVB group (P<0.05). The differences of immunohistochemical scores of a-MSH among the 5 groups were statistically significant (P<0.05), and the TH-UVB groups were significantly higher than the NB-UVB groups (P<0.01). However, there was no statistically difference between the high dosage group and the low dosage group of each wavelength (P>0.05). The differences ofα-MSH mRNA expression among the 5 groups were statistically significant (P<0.05). There was no statistically diference between the high dosage group and the low dosage group of TH-UVB, also between the low dosage NB-UVB group and the control group (P>0.05). The difference between other two groups were statistically significant (P<0.05). The differences of the expression of ET-1 protein among the 5 groups were statistically significant (P<0.05), There was no statistically difference between the high dosage group and the low dosage group of NB-UVB (P>0.05), and The difference between other two groups were statistically significant (P<0.05). The differences of ET-1 mRNA expression among the 5 groups were statistically significant (P<0.05).Conclusions:TH-UVB is more effective than NB-UVB to induce experimental hyperpigmentation. Each kind of ultraviolet can up-regulate the protein and mRNA expression of a-MSH and ET-1 in the epidermis, and the efficacy of TH-UVB is better than that of NB-UVB. Objectives:1. To investigate the effect of various dosages of TH-UVB and NB-UVB on a-MSH and ET-1 mRNA expression and protein secretion of human keratinocytes.2. To investigate the a-MSH and ET-1 mRNA expression and protein secretion at various time after 300mJ/cm2 TH-UVB radiation in human keratinocytes.Methods:Cultured HaCaT was treated with various dosage of TH-UVB and NB-UVB. ELISA and RT-PCR were applied to evaluate the protein secretion and mRNA expression of a-MSH and ET-1 in HaCaT. Cultured HaCaT was treated with 300mJ/cm2 TH-UVB. ELISA and RT-PCR were applied to evaluate the protein secretion and mRNA expression of a-MSH and ET-1 at 0,6,12,24,48,72h after radiation, respectively.Results:In both TH-UVB and NB-UVB groups, the protein secretion and mRNA expression of a-MSH and ET-1 were significantly higher than the control group and increasing in a dose dependent manner at several range. After radiated of 300-400mJ/cm2 TH-UVB, the protein secretion of a-MSH was highest (P<0.05) So was the mRNA expression of a-MSH. The level of a-MSH protein and mRNA was increased in a dose dependent manner in the range of 0-300mJ/cm2. After radiated of 500mJ/cm2 NB-UVB, the protein secretion of a-MSH was highest, and so was the mRNA expression of a-MSH. The TH-UVB groups had higher a-MSH protein secretion levels than the NB-UVB groups which exposed to 100-400mJ/cm2 (P<0.05). There was no difference in 500mJ/cm2 radiation of two kinds of light source (P>0.05). The TH-UVB groups had higher a-MSH mRNA expression levels than the NB-UVB groups which exposed to 100-400mJ/cm2 (P<0.05), but there was no difference in 100 and 500mJ/cm2 radiation of two kinds of light source (P> 0.05)After radiated of 200-500mJ/cm2 TH-UVB, the protein secretion of ET-1 was higher than that of the control group (P<0.05), but there was no difference within this dosage range (P>0.05). The mRNA expression of ET-1 was highest after 300mJ /cm2 radiation, and there was no difference between 500mJ/cm2 group and the control group (P>0.05). After radiated of 100-500mJ/cm2 NB-UVB, the ET-1 protein was higher than that of the control group, but there was no difference within this dosage range(P>0.05). The expression of ET-1 mRNA were significantly higher than the control group and increasing in a dose dependent manner in the range of 200-500mJ/cm2 (P<0.05)After radiated of 500mJ/cm2 NB-UVB, the expression of ET-1 mRNA was highest. The TH-UVB group had higher ET-1 protein secretion level than the NB-UVB group which exposed to 500mJ/cm2 (P< 0.05), but there was no difference in 100-400mJ/cm2 radiation of two kinds of light source (P>0.05). The TH-UVB groups had higher ET-1 mRNA expression levels than the NB-UVB groups which exposed to 200-500mJ/cm2 (P<0.05), but there was no difference in 100mJ /cm2 radiation of two kinds of light source (P>0.05)After radiated of 300mJ/cm2 TH-UVB, the protein secretion ofα-MSH increased at 6h, reaching peak level at 24h, lasting to 72h. The expression of a-MSH mRNA increased at 6h, reaching peak level at 24h, lasting to 48h, and decreased at 72h. The protein secretion and mRNA expression of ET-1 increased at 6h, reaching peak level at 48h, and decreased at 72h.Conclusions:1. Both TH-UVB and NB-UVB can promote keratinocytes to express a-MSH and ET-1 mRNA and secrete a-MSH and ET-1 protein. The efficacy of TH-UVB is better than that of NB-UVB.2. The level of a-MSH and ET-1 mRNA expression and protein secretion is highest at 48-72h after radiated of 300mJ/cm2 TH-UVB.