|Year : 1990 | Volume
| Issue : 2 | Page : 121-122
Treatment of vitiligo with psoralen
PK Kar, PS Snehi, PK Jha
P K Kar
Source of Support: None, Conflict of Interest: None
The outcome of treatment in 120 cases of vitiligo receiving psoralen was analyzed. Forty patients were treated with topical psoralen, another 40 patients were given oral psoralen and the remaining 40 patients used, both oral and topical psoralens. Treatment was given once daily followed by sun exposure for 6 months. Fourteen cases using topical psoralen, 22 patients receiving oral psoralen lvmg and 24 patients receiving combined treatment showed partial repigmentation. Only 15% cases using oral psoralen alone showed complete repigmentation. Combined treatment was the most effective, leading to complete repigmrntation in 30% patients.
Keywords: Psoralen, Vitiligo
|How to cite this article:|
Kar P K, Snehi P S, Jha P K. Treatment of vitiligo with psoralen. Indian J Dermatol Venereol Leprol 1990;56:121-2
The reported incidence of vitiligo in various dermatological clinics in India varies from 3.5% to 4.3%. 12 Oral and topical psoralens have both been used with varying results for the treatment of vitiligo. 3 This trial was undertaken to compare the results of various modes of psoralen therapy on the repigmentation process in vitiligo.
| Materials and Methods|| |
A total of 120 patients with vitiligo at quiescent stage were studied. Each patient was examined in detail. Routine laboratory investigations on urine, stools, hemoglobin and liver function tests were` undertaken in all the cases prior to starting the treatment.
Forty patients (Group 1) having less than 10 sq cm lesions were treated topically with 1 : 16 psoralen solution diluted with spirit. The dilution was progressively decreased to a pure solution (0.25% psoralen) depending upon the reaction produced by the previous dilution. Another 40 patients (Group II) were given a single oral dose of psoralen, 0.6 mg/kg body wt (maximum 40 mg) daily. The remaining 40 patients (Group III) were given combined treatment consisting of topical application of psoralen lotion along with oral psoralen.
Fifteen minutes after the topical application and two hours after the oral intake of psoralen, the lesions were exposed to sun rays between 11.00 am to 2.00 pm for 1/2 minute per patch duting the first week and increased subsequently upto 2 minutes per patch. They were advised to wear optical dark glasses during the sun exposure and for 4 to 5 hours thereafter.
The patients were examined once in 15 days for 6 months to record the degree of repigmentation. The patients who did not come regularly were excluded from this study.
| Results|| |
The youngest patient was a 2-year-old girl and the oldest patient was 65 years. In 52 (43.2%) patients, the disease had started before the age of 20. Only 6 cases had a family history of vitiligo. All routine laboratory investigations were within normal limits except for the presence of intestinal worms in 14 (12%) cases. Exposed areas of the body were involved in 80 (66.6%) patients, front of legs in 60 (50%) patients, hands in 44 (36.6%), and face in 36 (30%) cases. Genitals were the least affected area, in 4 (3.3%) patients only. Circumscript type of vitiligo was seen in 96 (80%) cases, and segmental type in 12 (10%) cases. Symmetrical lesions were found in 8 (6.6%) patients. Four (3.3%) patients had universal vitiligo. Twenty four (20%) had a single lesion, 28 (23.3%) had less than 10 lesions and 68 (56.6%) patients had more than 10 lesions.
In group I, 14 patients showed partial response to treatment, but none of them had complete repigmentation [Table - 1]. In group II, 22 patients showed partial response to the treatment and 6 patients showed complete repigmentation. In group III, 24 patients showed more than 50% repigmentation of the patches. In 12 patients repigmentation was complete. The remaining patients did not improve at all.
| Comments|| |
In the aurvedic system of medicine Bavachee (Psoralea corylifolia) seeds are used for the treatment of vitiligo. In Egypt, another plant Ammi majus Linn was employed. Psoralen has been used systemically for vitiligo for over two decades.
In 45% of our cases, the initial response to treatment was erythema of the lesion and blisters in 25% cases. Majority (90%) of the patients in group I developed erythema and irritation on topical application of psoralen lotion even in 1:8 dilution. Eight patients developed blisters repeatedly and could not use even 1:16 dilution. The blisters were common (20%) in patients using topical psoralen lotion, and were not seen in any patient receiving systemic psoralen. If the blisters appeared, further applications of psoralen lotion were stopped and a soothing lotion or cream was prescribed. Later, the psoralen lotion was used in a more diluted form.
After 4-6 weeks of therapy, erythema would be followed by repigmentation. In 35% cases, the repigmentation was perifollicular in nature. A cream containing 10% paraminobenzoic acid was applied to the normal skin surrounding the vitiligo patches particularly on the face before psoralen lotion was used. This helped to avoid disfiguring hyperpigmentation of the border areas.
Best results were obtained where psoralen was administered orally as well as applied topically followed by exposure to sun rays. In 60% of the patients with this modality of treatment repigmentation developed within 6 to 12 weeks. Only twelve (30%) patients showed complete repigmentation of the patches.
| References|| |
|1.||Dutt AK and Mandal SS : A clinical study of 650 vitiiigo cases and their classification, Ind J Dermatol, 1969; 14 : 103-107. |
|2.||Gopinathan T : A study of the lesion of vitiligo, Arch Dermatol, 1965; 91 : 397-404. |
|3.||Lerner AB, Denton CR and Fitzpatrick TB : Clinical experimental studies with 8-methoxy psoralen in vitiligo, J Invest Dermatol, 1959; 20 : 299-314. |
|4.||Whitney WD : In Atherva veda sarnhita (Translation and notes) Harvard oriental series, Vol 7, Lannman, Harvard University Press, Cambridge, 1905. |
|5.||Fahmy IR and Abu-Shady H : Ammi maius Linn; Pharmacological study and isolation of crystalline constituent, ammoidin, Quart J Pharm, 1947; 20 : 281-291. |
|6.||Behl PN, Agarwal RS and Singh G : Aetiological studies in vitiiigo and therapeutic response to standard treatment, Ind J Dermatol, 1961; 6 101-104. |
[Table - 1]
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