VITILIGO ADVANCES BUT
TREATMENT STILL HAS PROBLEMS:
In a journal called Dermatology (the official journal of the Swiss and
Belgian Dermatology Societies) there is a study of vitiligo written from
India. 1000 patients were treated with mini-punch skin grafts where small
pieces of normal skin are transplanted onto the vitiligo skin (i.e. the
skin where there is no pigmentation). The theory is that the pigment cells
(melanocytes) in the normal skin will spread their pigment outward into
the surrounding skin affected by vitiligo. Approximately 69% of treatments
achieved over 90% repigmentation in the affected sites. Unfortunately
there were a lot of side effects including abnormal elevation of the skin
grafts at the transplant sites (33%), an exaggerated polka dotted
appearance at the treated sites (44%), uneven pigmentation (24%), etc.
COMMENT: This incidence of side effects unfortunately very much reduces
the impact that this kind of treatment is likely to make upon vitiligo
sufferers. Perhaps with further refinement, melanocyte transplantation in
one form or another will eventually give good results but I think this
type of work still needs much more research.
Back to
Top
NEW THERAPY WITH GREAT POTENTIAL:
Archives of Dermatology 1999; 135: 574-580, edited Boston, USA.
Tacrolimus is a drug which suppresses the immune system and therefore
in theory should be helpful for a wide variety of skin diseases
(psoriasis, eczema, etc.). Tacrolimus is used in the prevention of organ
graft rejection. This is a similar history to Cyclosporin which also
started its medical life as an organ-rejection suppresser but later was
found to be very helpful in skin disease. Hopefully Tacrolimus will prove
to be equally helpful in some patients. The types of condition reviewed in
this article are psoriasis, Behcet's disease, pyoderma gangrenosum (all
three of these were treated by systemic administration). Atopic dermatitis
and alopecia areata have been treated by skin surface applications with
some suggestion of success.
COMMENT: It is early days as yet with respect to the skin development
of this drug but the future looks very promising.
Back to
Top
WHICH IS THE BEST
LASER FOR WRINKLE TREATMENTS?
Archives of Dermatology 1999; 135: 391-397
COMPARISONS OF ERBIUM AND CARBON DIOXIDE LASERS IN WRINKLE TREATMENT
Twenty-one patients were treated for wrinkles around the eyes with
Erbium laser to one side of the face and carbon dioxide laser to the other
side. Both systems were effective. The carbon dioxide laser tended to be
slightly more effective but this could be counteracted by treating more
intensively with the Erbium laser. The overall outcomes were very similar
for both systems.
COMMENT: The more established carbon dioxide laser system tends to be
slightly more powerful and therefore if it is passed over the skin less
often it should be able to achieve the same gentle results that the Erbium
laser achieves. Conversely, if the Erbium laser is passed over the skin
more often then it should be able to achieve the same results as the
carbon dioxide laser. There does not seem to be a great deal to choose
between the two systems.
Back to
Top
MORE GENETIC MANIPULATION Sunday Times, London August 8th 1999
London doctors try to produce cancer-free children.
Research at University College Hospital, London, is attempting to
screen in-vitro fertilised embryos for a variety of genetic disorders. Two
cells are removed from the embryo (which at this early stage comprises
less than 20 cells total) and the doctors predict the outcome of the
"pregnancy". The theoretical aim appears to be reduction in the likelihood
of inherited cancer syndromes. The practicalities presumably mean that
only embryos which are screen "negative" will be implanted and other
embryos will be destroyed. The article does not give statistical
information about how accurate the predictive value of these tests are.
COMMENT: This type of research should eventually be able to allow
parents to screen embryos for the likely (not definite) development of
some hereditary cancerous processes. One of the disorders mentioned in the
article - neurofibromatosis - in fact only leads to cancerous developments
in a relatively small number of sufferers. Most sufferers have much less
serious trouble and many sufferers live their entire lives unaware that
they have anything the matter with them. This type of technique moves us
still closer to the day where selectivity will be available regarding a
variety of genetic outcomes in our "children".
Back to
Top
PIG ORGANS FOR HUMAN TRANSPLANTATION?
A significant step has been taken along the line of transplantation of animal organs into humans. Cloned piglets with a specific gene inactivation for alpha-1:3 galactosyltransferase are seen as a significant step forward. This particular gene inactivation prevents pig cells producing a specific sugar group which is readily recognised by the human immune system as foreign thereby triggering a rejection response.
It is thought that about 180,000 people around the world require organ transplantation but only about 1:3 of them will ever actually receive an organ because of the wide divergence between supply and demand. Various corporations are interested in the concept of xenographs (which means transplantation from one animal species to another) to satisfy this demand. It is thought that this ability to clone piglets will prove to be a small but significant step forward along this road.
