Hartmann Anke, Bröcker Eva-B, Becker Jürgen C
Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany.
Drugs. 2004;64(1):89-107. doi: 10.2165/00003495-200464010-00006.
Alterations of skin and hair pigmentation are important features that have warranted treatment from ancient history on up to modern time. In some cultures, even today patients with vitiligo are regarded as social outcasts and are affected considerably both emotionally and physically. This article presents current options and future directions for the treatment of hypopigmentary disorders. Whereas with congenital disorders, such as albinism and phenylketonuria, no causal therapy has been established up to now, several treatment options for acquired hypopigmentary disorders have been investigated. In particular, in vitiligo, one of the most prevalent hypopigmentary disorders, a number of treatment modalities have been employed in the past 30 years. However, most of them are only able to palliate, not cure, the disease. Depending on the distribution of the hypopigmented lesions (localised or generalised) and the state of the disease (active or stable), several therapeutic options, for example phototherapy, surgical skin grafts, autologous melanocyte transplantation and immunomodulators, can be applied alone or in combination. For phototherapy, because of unfavourable results and adverse effects, ultraviolet (UV) A has been largely replaced by narrow-band UVB for repigmentation of generalised vitiligo. Although immunomodulators, such as corticosteroids, have been used both topically and systemically over the past 3 decades for the treatment of disseminated vitiligo, they are only suitable for the treatment of acrofacial and localised forms because of adverse effects. Hence, new immunomodulatory agents, such as calcineurin antagonists, have recently been introduced as new promising tools to treat acquired hypopigmentary disorders. However, all therapeutic approaches are hampered by the fact that the pathophysiology of hypopigmentary disorders is still poorly understood.
皮肤和毛发色素沉着的改变是从古至今都值得治疗的重要特征。在一些文化中，即使在今天，白癜风患者仍被视为社会弃儿，在情感和身体上都受到极大影响。本文介绍了色素减退性疾病的当前治疗选择和未来方向。对于先天性疾病，如白化病和苯丙酮尿症，目前尚未确立因果治疗方法，而对于后天性色素减退性疾病，已经研究了几种治疗选择。特别是，白癜风作为最常见的色素减退性疾病之一，在过去30年中采用了多种治疗方式。然而，其中大多数只能缓解疾病，而不能治愈。根据色素减退性皮损的分布（局限性或泛发性）和疾病状态（活动期或稳定期），可以单独或联合应用几种治疗选择，例如光疗、手术皮肤移植、自体黑素细胞移植和免疫调节剂。对于光疗，由于效果不佳和不良反应，紫外线A（UVA）在很大程度上已被窄带紫外线B（NB-UVB）所取代，用于泛发性白癜风的复色。尽管免疫调节剂，如皮质类固醇，在过去30年中已局部和全身用于治疗播散性白癜风，但由于不良反应，它们仅适用于肢端面部和局限性白癜风的治疗。因此，新型免疫调节剂，如钙调神经磷酸酶拮抗剂，最近已作为治疗后天性色素减退性疾病的新的有前景的工具被引入。然而，所有治疗方法都受到色素减退性疾病的病理生理学仍知之甚少这一事实的阻碍。
