Vitiligo & Pigmentary Disorders Masterclass Tel Aviv, November 25 – 26, 2015
It was a great pleasure to be invited by Dr. Ines Verner to take part in the above mentioned Masterclass in Tel Aviv. On behalf of the Israel Society of Dermatology and Venerology and the Vitiligo Research Foundation, the Organizing Committee, together with the Scientific Committee led by Prof. Reuven Bergman, a comprehensive scientific program, which covered all aspects of pigmentary disorders, was presented. For lack of space, I picked out those lectures, I find most interessting, although all 29 lectureres gave great insights into the field of pigmetary disorders.
UV exposure and skin pigmentation
Dr. Carmit Levy (Tel Aviv University) lectured on UV exposure and skin pigmentation. Skin pigmentation is a natural adaption to UV exposure as it provides protection against UV-induced DNA damage. However, the regulation of the pigmentation machinery is still not fully understud. Surprisingly in Dr. Levy’s working group, they found out, that exposure to UVB every other-day compared to every day, results in higher pigmentation levels and thus in better DNA damage protection. Sun-tanning response depends on a crosstalk between keratinocytes and melanocytes within the epidermis. Following UV exposure, keratinocytes release the melanocyte stimulating hormone (MSH) which elevates cAMP levels in the melanocytes, leading to up regulation of the microphtalmia associated transcription factor (MITF), which is the key regulator of the pigmentation process. Double negative regulatory loops affecting the machinery in a 48 hour time frame, were revealed. This data contributes to a comprehensive understanding of skin pigmentation regulation and will hopefully aid to the prevention of UV-induced DANN damage and Skin cancer.
Vitiligo: What’s new and what is true
Prof. Torello Lotti (Dept. of Dermatology and Venerology G. Marconi University, Rome), gave an overview of the developement of new treatment methods of vitiligo. Recent discoveries about the pathogenesis of vitiligo have led to the developement of new therapies as well as the use of new medical devices. In particular, develeopments in phototherapy, one of the cornerstones in the treatment of vitiligo, has made available new treatments such as microphototherapy with a UVB narrow band excimer laser and monochromatic excimer light. These therapies achieve good results in both patients with generalized vitiligo and those with focal and segmental vitiligo.
In addition to steroids, topical medical treatments include derivatives of vitamin D, calcineurin inhibitors up tot he promising use of products based on prostaglandin E or antoxodants. The actions of some topical treatments is furtherly enhanced, when combined with light therapy, thus increasing the therapeutic outcome. Surgical therapy is still an alternative to be reserved for young patients with stable forms of vitiligo, says Lotti.
For vitiligo, narrow band UVB (NB-UVB) phototherapy is an effective option, demonstrating greater efficacy and safety compared to broadband UVB or psoralen plus UVA treatments. While the treatment efficacy of NB-UVB artificial light sources is well documented, the long term time and cost commitment remains a barrier to treatment adherence.
Cytokine profiling in Vitiligo
Dr. Maja Kovacevic (University Clinical Hospital Center „Sestre Milosrdnice, Zagreb) gave insight into cytokines and vitiligo. The autoimmune origin of vitiligo is highly supported due to it’s frequent association with other autoimmune diseases such as psoriasis, diabetes and thyroid diseases. Recent identification of susceptibility genes, particularly those encoding certain major histocompatibility complex antigen specificities, and those involved in regulating the immune response , emphasize the importance of autoimmunity in vitiligo. According to recent studies, keratinocytes have a substantial role in the process of melanocyte inactivation and ist apoptosis by producing various numebers of cytokines and growth factors. Therefore, the role of cytokines in etiopathogenesis oft he disease appears inevitable. The low dose cytokines therapy, a new therapeutic strategy based on disease etiology is a brakethrough in the treatment of vitiligo, because it, in the same time modulates inflammatory micro-environment and stimulates melanocytes, thus resulting in stopping diseases progression and induction of repigmentation.
Social events did not come to short
After the Masterclass, we had a tour through the center of wonderful Tel Aviv. The actual city center is comprised of buildings of a German settlement of the mid 1800’s, which have been turned into shops and restaurants, after being restored into their original condition. They are surrounded by new highrises, that are partially still under construction. After the tour, weh ad Dinner a Winery, where we tasted various wines of israel and were served tasty snacks.
The next day we took a tour by bus to the Jordan River, the fortress of Masada and then to the Dead Sea. During the tour we were able to delve into the lectures of the two days before.
Here, I want to express my thanks to Ines Verner, Dr. Felix Pavlotsky and the rest of the organizing team, for a very interessting scientific program and the great hospitality.