Biomedical subjects

M D Njoo

Publications and source records attributed to M D Njoo.

12 recordsLinked to original sources

PubMed2000

Treatment of generalized vitiligo in children with narrow-band (TL-01) UVB radiation therapy.

BACKGROUND: Only a few clinical trials have been performed on the treatment of generalized vitiligo in children. Recently, narrow-band UVB therapy has been reported to be an effective and safe therapeutic option in adult patients with vitiligo. OBJECTIVE: We studied the efficacy and safety of UVB (311 nm) therapy in children with generalized vitiligo and evaluated the effect of the therapy on the quality of life in these children. METHODS: In an open trial, 51 children (20 males, 31 females) with generalized vitiligo were treated twice weekly with narrow-band UVB radiation therapy for the maximum period of 1 year. The Children's Dermatology Life Quality Index (CDLQI) was used to evaluate the psychosocial impact of disease and treatment and was scored before and after therapy. RESULTS: The treatment resulted in more than 75% overall repigmentation in 53% of patients and in stabilization of the disease in 80%. Responsiveness to therapy was positively correlated with localization of the lesions and the patients' compliance. Adverse events were limited and transient. The better the repigmentation grade, the better the CDLQI scores had improved. CONCLUSION: Narrow-band UVB therapy is effective and safe in childhood vitiligo; it also may significantly improve the quality of life.

Child↗

PubMed2000

Depigmentation therapy in vitiligo universalis with topical 4-methoxyphenol and the Q-switched ruby laser.

BACKGROUND: Monobenzylether of hydroquinone is used worldwide to remove residual pigment in patients with vitiligo universalis. Because of the side effects reported with this drug, the use of monobenzylether of hydroquinone has been restricted in The Netherlands. OBJECTIVE: Our purpose was to evaluate the long-term effectiveness and safety of a combination therapy consisting of topical 4-methoxyphenol (4-MP) cream and Q-switched ruby (QSR) laser in 16 patients with vitiligo universalis. METHODS: In a retrospective study, patient record forms were evaluated. Data were collected regarding history as well as physical and histologic examination. The patients came to the institute for a follow-up visit after a treatment-free period of 2 to 36 months. RESULTS: Thirteen patients received both therapies. Three patients only used the cream. None of the areas was treated by the cream and QSR laser at the same time. In 11 of the 16 patients (69%; 95% confidence interval [CI], 41%-89%) total depigmentation was achieved using the 4-MP cream. Onset of depigmentation was between 4 and 12 months. Four of the 5 patients who did not respond to the 4-MP cream had successful depigmentation with the QSR laser. Mild burning or itching was reported with the cream in 4 cases (25%). Of the 11 patients who responded to the 4-MP cream, 4 had recurrence of pigmentation (relapse rate of 36%; 95% CI, 11%-69%) after a treatment-free period of 2 to 36 months. In 9 of the 13 patients (69%; 95% CI, 39%-91%) total depigmentation was achieved after QSR laser therapy. Onset of depigmentation was between 7 and 14 days after the treatment. Three of the 4 unresponsive patients showed total depigmentation after application of the 4-MP cream. No side effects were observed. Of the 9 patients who responded to QSR laser therapy, 4 had recurrence of pigmentation (relapse rate of 44%; 95% CI, 14%-79%) after a treatment-free period of 2 to 18 months. These patients had a negative Koebner phenomenon. CONCLUSION: Depigmentation therapy using a 4-MP cream and/or QSR laser therapy is an effective and safe method to remove disfiguring residual pigment in patients with vitiligo universalis. Patients should be warned that repigmentation may occur, even after total depigmentation has been achieved.

Administration, Topical↗

PubMed1999

The development of guidelines for the treatment of vitiligo. Clinical Epidemiology Unit of the Istituto Dermopatico dell'Immacolata-Istituto di Recovero e Cura a Carattere Scientifico (IDI-IRCCS) and the Archives of Dermatology.

OBJECTIVE: To develop and introduce evidence-based guidelines for the treatment of vitiligo in children and in adults. PATIENTS AND SETTING: Patients, residents, and dermatologists from the Department of Dermatology, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Pigmentary Disorders in Amsterdam. DESIGN: Scientific evidence obtained from 3 systematic reviews of the literature was combined with the results of 2 questionnaires and interviews of potential users of the guidelines, 3 internal expert meetings, and 1 local expert meeting, during which preliminary guidelines were presented and commented on. A final version of the guidelines was synthesized and disseminated among potential users. Six months after the introduction of these guidelines, their use was evaluated. RESULTS: Before the development of the guidelines, there was no uniformity in treatment selection, and there was a variability in estimates of treatment outcome. The metaanalysis showed class 3 corticosteroids and narrowband UV-B to be the most effective and safest therapies for localized and for generalized vitiligo, respectively. From another systematic review, it could be concluded that patients with segmental, stable, or lip-tip vitiligo could be successfully treated with most autologous transplantation methods. For vitiligo universalis, results of the systematic review showed that depigmentation using monobenzone or a Q-switched ruby laser was equally effective. The final version of the guidelines consisted of a treatment scheme together with detailed treatment protocols. Implementation of the guidelines was evaluated in 5 physicians. After the introduction of these guidelines, they were followed in most adult cases with vitiligo (71% of patients with localized vitiligo, 82% with generalized vitiligo, 100% with stable or segmental vitiligo, and 80% with universal vitiligo). In children with vitiligo, the physicians adhered to the guidelines for 52% of the cases. CONCLUSIONS: Guidelines for the treatment of vitiligo can be successfully developed and disseminated for daily clinical practice. The results of the implementation of these guidelines should be confirmed in other centers involving more clinicians.

Adrenal Cortex Hormones↗

PubMed1999

Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris.

OBJECTIVE: To investigate the association between the experimentally induced Kobner phenomenon (KP-e) and the Kobner phenomenon by history (KP-h), disease activity, and therapeutic responsiveness in vitiligo vulgaris. DESIGN: Cohort study. SETTING: An outpatient clinic. PATIENTS: Sixty-one consecutive patients with vitiligo vulgaris. INTERVENTION: Three months after a standardized epidermodermal injury was induced, the KP-e was evaluated. For 1 year, UV-B (311 nm) therapy or topical fluticasone propionate plus UV-A therapy was given, depending on the severity of depigmentation. MAIN OUTCOME MEASURES: The presence or absence of the KP-e and the KP-h disease activity as scored on a 6-point scale from -1 to +4 (vitiligo disease activity [VIDA] score) and therapy-induced repigmentation grade. RESULTS: Nineteen (31%) of the patients had a positive KP-h, whereas 37 (61%) showed a positive KP-e (P<.001). The VIDA score did not always predict a positive KP-e, although patients with a positive KP-e had a higher mean VIDA score (VIDA score of 1.6) than did patients with a negative KP-e (VIDA score of 0.5) (P<.001). The responsiveness to UV-B (311 nm) therapy among KP-e-positive or KP-e-negative patients was not significantly different (P=.66). However, KP-e-positive patients who were treated with fluticasone propionate plus UV-A showed a better response than did KP-e-negative patients (P=.01). Among patients responding to both therapies, VIDA scores were significantly decreased (P<.001) compared with VIDA scores before therapy. CONCLUSION: The KP-e may function well as a clinical factor to assess present disease activity and may also predict the responsiveness to fluticasone propionate plus UV-A therapy but not to UV-B (311 nm) therapy.

Administration, Topical↗

PubMed1999

Management of vitiligo. Results of a questionnaire among dermatologists in The Netherlands.

BACKGROUND: Several therapeutic options are available for the treatment of vitiligo. Concern exists that there is no uniform approach towards the management of vitiligo among Dutch dermatologists. METHODS: A written survey concerning the management of vitiligo was sent to 332 dermatologists in The Netherlands. RESULTS: The response rate was 86%. "Giving information and reassurance concerning the nature of disease" was regarded by most dermatologists (68%) as being the most important goal in the management of vitiligo. Only 16% of the dermatologists aimed for active treatment in vitiligo. The reported therapy choices in children resembled those of adults, except that slightly more dermatologists did not prescribe active therapy in children. Nine different therapeutic modalities were mentioned as first choice therapies. Topical corticosteroids were indicated by most dermatologists as first choice therapy (241 out of 266, i.e. 91%); however, only 2% indicated that 50% or more of the patients achieved a successful treatment; 66% found that less than 25% of the patients were successfully treated with topical corticosteroids. Only 15% of the respondents reported that 50% or more of the patients were treated successfully with narrow-band UVB. The observed response profile to broad-band UVB therapy was found to be comparable with that of narrow-band UVB. The classical therapy with oral psoralen plus UVA (PUVA) was prescribed as first choice therapy by only 12% (32 out of 266) of the dermatologists. Only 6% of these respondents observed that 50% or more of the patients achieved successful therapy using oral PUVA. The recommended maximum treatment duration for topical corticosteroids, oral PUVA, and UVB therapy was found to vary from 3 to 12 months. CONCLUSIONS: Most dermatologists in The Netherlands do not offer active treatment in vitiligo, probably because the estimated effectiveness of (nonsurgical) repigmentation therapy is low. In cases where treatment is prescribed, there appears to be no consensus on the choice of therapies and treatment strategies. The development of practice guidelines may be helpful in reducing inappropriate care and improving treatment outcome.

Administration, Topical↗

PubMed1998

Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature.

OBJECTIVE: To assess the effectiveness and safety of nonsurgical repigmentation therapies in localized and generalized vitiligo by means of a meta-analysis. DATA SOURCES: Computerized searches of bibliographic databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms. STUDY SELECTION: Predefined selection criteria were applied to both randomized and nonrandomized controlled trials. DATA EXTRACTION: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted. DATA SYNTHESIS: Sixty-three studies were found on therapies for localized vitiligo. Of these, 10 of 11 randomized controlled trials and 29 of 110 patient series were included. One hundred seventeen studies on therapies for generalized vitiligo were found. Of these, 10 of 22 randomized controlled trials and 46 of 231 patient series were included. Among randomized controlled trials on localized vitiligo, the pooled odds ratio vs placebo was significant for topical class 3 corticosteroids (14.32; 95% confidence interval [CI], 2.45-83.72). In the patient series, topical class 3 and class 4 corticosteroids carried the highest mean success rates (56% [95% CI, 50%-62%] and 55% [95% CI, 49%-61%], respectively). Side effects were reported mostly with topical psoralen and intralesional and class 4 corticosteroids. In the randomized controlled trials on generalized vitiligo, the odds ratio vs placebo was significant for oral methoxsalen plus sunlight (23.37; 95% CI, 1.33-409.93), oral psoralen plus sunlight (19.87; 95% CI, 2.37-166.32), and oral trioxsalen plus sunlight (3.75; 95% CI, 1.24-11.29). In the series, the highest mean success rates were achieved with narrowband UV-B (63%; 95% CI, 50%-76%), broadband UV-B (57%; 95% CI, 29%-82%), and oral methoxsalen plus UV-A therapy (51%; 95% CI, 46%-56%). Oral methoxsalen plus UV-A was associated with the highest rates of side effects. No side effects were reported with UV-B therapy. CONCLUSIONS: Class 3 corticosteroids and UV-B therapy are the most effective and safest therapies for localized and for generalized vitiligo, respectively.

Humans↗

PubMed1998

A systematic review of autologous transplantation methods in vitiligo.

OBJECTIVE: A systematic review of the effectiveness, safety, and applicability of autologous transplantation methods in vitiligo. DATA SOURCES: Computerized searches of bibliographical databases, a complementary manual literature search, and contacts with researchers and pharmaceutical firms. STUDY SELECTION: Predefined selection criteria were applied to all studies found. DATA EXTRACTION: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulted. DATA SYNTHESIS: Sixty-three studies were found, of which 16 reported on minigrafting, 13 on split-thickness grafting, 15 on grafting of epidermal blisters, 17 on grafting of cultured melanocytes, and 2 on grafting of noncultured epidermal suspension. Of these, 39 patient series were included. The highest mean success rates (87%) were achieved with split-skin grafting (95% confidence interval, 82%-91%), and epidermal blister grafting (87%) (95% confidence interval, 83%-90%). The mean success rate of 5 culturing techniques varied from 13% to 53%. However, in 4 of the 5 culturing methods, fewer than 20 patients were studied. Minigrafting had the highest rates of adverse effects but was the easiest, fastest, and least expensive method. CONCLUSIONS: Because no controlled trials were included, treatment recommendations should be formulated with caution. Split-thickness and epidermal blister grafting can be recommended as the most effective and safest techniques. No definite conclusions can be drawn about the effectiveness of culturing techniques because only a small number of patients have been studied. The choice of method also depends on certain disease characteristics and the availability of specialized personnel and equipment.

Humans↗

PubMed1998

Repigmentation of leucodermic defects in piebaldism by dermabrasion and thin split-thickness skin grafting in combination with minigrafting.

The depigmented skin areas in piebaldism are unresponsive to medical or light treatment. In 12 adult patients (eight women and four men), a method using dermabrasion and thin split-skin grafts was applied initially. Residual leucodermic areas were subsequently treated using a minigrafting method. Additional irradiation with ultraviolet A (10 J/cm2) was performed to enhance melanocyte migration. This combined surgical therapy led to 95-100% repigmentation of the leucodermic defects. A perfect colour match with the surrounding non-lesional skin was achieved in all cases. Complications were minor and easy to correct. Dermabrasion and split-skin grafting followed by minigrafting should be considered as the first choice of therapy in piebaldism.

Adult↗

PubMed1997

[Vitiligo].

Vitiligo is a disorder in which, owing to disappearance of melanocytes in the skin, sharply delimited, symmetrically arranged white patches develop. The condition occurs in 1-2% of the population, mostly between the ages of 10 and 30 years, and as often in males as in females. The course is usually progressive with periods of stability. A number of autoimmune diseases and dermatoses coincide with vitiligo. The cause of vitiligo is unknown. Hereditary factors, autoimmunization, neurological disorders and autodestruction have been hypothesized. Repigmentation therapy consists of photo(chemo)therapy use of corticosteroids, and transplantation of pigment cells. For patients in whom this fails and with more than 80% cutaneous involvement, total depigmentation therapy could be considered.

Adolescent↗

PubMed1997

[Effective removal of certain skin pigment spots (lentigines) using the Q-switched ruby laser].

OBJECTIVE: To determine the results of treatment of lentigines with the so-called Q-switched ruby laser (QSRL). DESIGN: Descriptive. SETTING: Netherlands Institute for Pigment Disorders. Amsterdam, the Netherlands. METHOD: In 15 patients (nine women and six men), QSRL treatment was applied to solar lentigines (to patients), labial lentigines (2), segmental lentigines (2) and lentigo simplex (1): The light energy ranged from 3 to 10 J/sq.cm. RESULTS: In 11 of 15 patients, one treatment session sufficed to remove the lesion completely. Acute side effects were slight and transient. Six months after the treatment, none of the patients showed recurrences or scar formation. No hypo- or depigmentations were seen. CONCLUSION: In the cases described. QSRL is a successful treatment for lentigines. For lesions of this nature. QSRL is to be preferred above conventional forms of therapy, such as cryotherapy, chemical peeling and abrasion.

Adolescent↗

PubMed1997

[Vitiligo].

Explore the source record for details and available documents.

Diagnosis, Differential↗

PubMed1994

Neuromuscular and cardiovascular effects of neostigmine and methyl-atropine administered at different degrees of rocuronium-induced neuromuscular block.

The neuromuscular and cardiovascular effects of neostigmine, 40 micrograms kg-1, and methyl-atropine, 7 micrograms kg-1, administered at different degrees of rocuronium-induced (600 micrograms kg-1) neuromuscular block were evaluated. In one group of patients spontaneous recovery was awaited (Group A; n = 20). Neostigmine and methyl-atropine were administered 2 minutes after rocuronium (Group B; n = 20) or at 25% twitch recovery (Group C; n = 20). Neuromuscular transmission was monitored mechanomyographically. Data are presented as mean (SD) [95%-CI]. The initial rate of recovery (time until a TOF ratio of 0.2) in group B, i.e. 14.2 (4.5) [12.1-16.3] min, was significantly faster than in group C, i.e. 28.7 (5.3) [26.3-31.1] min. However, the time until clinically sufficient recovery (time until a TOF ratio of 0.7) was similar for groups B, i.e. 29.3 (9.5) [24.9-33.7] min and group C, i.e. 31.8 (5.6) [29.2-34.4] min, both significantly different from that of group A, i.e. 53.2 (14.5) [46.5-59.9] min. The increase in heart rate following neostigmine/methyl-atropine was more pronounced in the group reversed at 2 min after rocuronium (P < 0.01).

Adult↗