Introduction

Vitiligo

Last Updated: April 14, 2007

Synonyms and related keywords: white spot disease, acquired leukoderma, nonpigmented skin, depigmented skin, depigmentation, hypopigmentation, loss of melanin, hypomelanosis, HLA-DR4, HLA-B13, HLA-B35, leukotrichia, trichrome vitiligo, blue vitiligo

Definition of Vitiligo

Vitiligo is an autoimmune disease in which pigment cells (melanocytes) are destroyed, resulting in irregularly shaped white patches on the skin. Any part of the body may be affected. Common sites are exposed areas (face, neck, eyes, nostrils, nipples, navel, genitalia), body folds (armpits, groin), sites of injury (cuts, scrapes, burns) and around pigmented moles (halo naevi). The hair may also go grey early on the scalp, eyebrows, eyelashes and body. White hair is called poliosis. The retina may also be affected.

Mucosal vitiligo

Trichrome vitiligo

Poliosis

Halo moles

A halo mole (or halo naevus) is a mole with a white ring, or halo, around it. It is sometimes known as Sutton naevus or leukoderma acquisitum centrifugum.

Halo moles are not uncommon and are usually seen in children or young adults of either sex.

Halo naevi

More images of halo naevi ...

Why do they arise?

For reasons which are unknown, the body selects a particular mole or moles for destruction. This is presumably because the mole is recognised as being abnormal in some way. It is considered an autoimmune process.

The mole in the centre of a halo is rarely malignant (cancerous) although all halo moles need to be examined carefully by an appropriate medical practitioner. A malignant mole is called a melanoma, and these may sometimes develop white halos around them as well.

Sometimes halo moles are triggered by sunburn which damages the mole and causes it to be recognised by the body as foreign.

A circulating antibody and special white cells (T cells) attack the pigment cells in the mole. This causes the central mole to fade from dark brown to light brown to pink, eventually disappearing completely. Some of the reaction affects the normal skin around the mole, which also has pigment cells in it, causing the white halo. This is usually about 0.5 to 1.0 cm wide, usually on the trunk. They are less common on the head, and are rare on the limbs. They develop at intervals round one or several moles but not all.

Once the the mole in the centre of the halo disappears, repigmentation can occur. This can sometimes take several years.

Pathophysiologyof vitiligo

: Mechanisms by which the melanocytes are lost may be multiple but are not yet identified unequivocally.

Some observations seem to support autosomal dominant inheritance with variable expression and incomplete penetrance. The disease itself is not inherited, but the disposition to have vitiligo is inherited.

Human leukocyte antigens (HLAs) may be associated but not in a consistent manner: HLA-DR4 is increased in blacks, HLA-B13 is increased in Moroccan Jews, and HLA-B35 is increased in Yemenite Jews. An association with HLA-B13 is described in the presence of antithyroid antibodies.

Frequency:

Internationally: Vitiligo is relatively frequent, with a rate of 1-2%. About 30% of cases occur with a familial clustering of cases.

Sex: No sex-related difference in prevalence is reported. The age of onset is unlikely to vary between the sexes.

Age: Vitiligo may appear at any time from birth to senescence, though the onset is most commonly observed in persons aged 10-30 years.

It rarely is seen in infancy or old age. Nearly all cases of vitiligo are acquired relatively early in life.

The average age of onset is around 20 years. The age of onset is unlikely to vary between the sexes.

Heightened concern about the appearance of the skin may contribute to an early awareness of the condition among women.

clinic

History:

In early vitiligo, white areas are not distinct and may be pruritic.

Vitiligo primarily progresses without any symptoms.

In late vitiligo, the tendency of the disease to spread can be stopped.

Physical:

Vitiligo appears as sharply circumscribed, cosmetically disturbing, white spots that stand out. The appearance is particularly noticeable when the

unaffected skin is tanned.

o At first, only a few, small, and sharply circumscribed foci are present. The borders of these foci are often hyperpigmented.

o Lesions increase in number and become confluent, taking on bizarre shapes.

o Vitiligo lesions may be localized or generalized, with the latter being more common than the former.

Localized vitiligo is restricted to 1 general area with a segmental or quasidermatomal distribution.

Generalized vitiligo implies more than 1 general area of involvement. In this situation, the macules are usually found on both sides of the trunk, either symmetrically or asymmetrically arrayed.

o Most common sites of involvement are the face, neck, and scalp.

o Many of the most common sites of occurrence are areas subjected to repeated trauma, including the following:

Bony prominences Extensor forearm Ventral wrists Dorsal hands Digital phalanges

o Involvement of the mucus membrane is frequently observed in the setting of generalized vitiligo.

o Vitiligo often occurs around body orifices such as the lips, genitals, gingiva, areolas, and nipples.

o Depigmentation of body hair in vitiliginous macules may be present. Vitiligo of the scalp usually appears as a localized patch of

white or gray hair, but total depigmentation of all scalp hair may occur.

Scalp involvement is the most frequent, followed by involvement of the eyebrow, pubic, and axillary hair, respectively.

Leukotrichia may indicate a poor prognosis in regard to repigmentation.

o Clinical variants Trichrome vitiligo has an intermediate zone of hypochromia

located between the achromic center and the peripheral unaffected skin. This results in three shades of color-brown, tan, and white-in the same patient (see Image 1).

Marginal inflammatory vitiligo results in a red, raised border, which are present from the onset of vitiligo (in rare cases) or which may appear several months or year after the initial onset. A mild pruritus may be present (see Image 2).

Blue vitiligo results in blue coloration of vitiligo macules. This

type has been observed in a patient with postinflammatory hyperpigmentation who then developed vitiligo.

Clinical classification of vitiligo: The classification system is important because of the special significance assigned by some authorities to each type of vitiligo. The widely used classification of vitiligo as localized, generalized, and universal types is based on the distribution, as follows:

o Localized Focal - One or more macules in 1 area but not clearly in a

segmental or zosteriform distribution Segmental - One or more macules in a quasidermatomal

pattern Mucosal - Mucus membrane alone

o Generalized Acrofacial - Distal extremities and face Vulgaris - Scattered macules Mixed - Acrofacial and vulgaris involvement, or segmental

and acrofacial and/or vulgaris involvement Universal - Complete or nearly complete depigmentation

o When progression, prognosis, and treatment are considered, vitiligo can be classified into 2 major clinical types: segmental and nonsegmental.

Segmental vitiligo usually has an onset early in life and rapidly spreads in the affected area.

The course of segmental vitiligo can arrest and depigmented patches can persist unchanged for the life of the patient (see Image 3).

The nonsegmental type includes all types of vitiligo except segmental vitiligo (see Image 4).

Causes:

Four pathogenic theories have been discussed, as follows:

Immune hypothesis: Aberration of immune surveillance results in melanocyte dysfunction or destruction.

Neural hypothesis: A neurochemical mediator destroys melanocytes or inhibits melanin production.

Self-destruction hypothesis: An intermediate or metabolic product of melanin synthesis causes melanocyte destruction.

Genetic hypothesis: Melanocytes have an inherent abnormality that impedes their growth and differentiation in conditions that support normal melanocytes.

Because none of these theories alone is entirely satisfactory, some have suggested a composite hypothesis.

oxidative stress \ This is one theory about what may cause or contribute to the onset or exacerbation of vitiligo. Oxidative stress is an over-accumulation of hydrogen peroxide in the skin. Every person develops hydrogen peroxide in the skin, as a result of natural biological processes. An enzyme called "catalase" normally breaks down the hydrogen peroxide in the skin into water and oxygen. However, some people with vitiligo may have a problem manufacturing, using or delivering catalase to the skin.

differentials

Leprosy Piebaldism Tinea Versicolor Tuberous Sclerosis

Other Problems to be Considered:

Idiopathic guttate-form hypomelanosis Nevus anemicus Nevus depigmentosus

workup

Lab Studies:

Although the diagnosis of vitiligo generally is made clinically, biopsy is occasionally helpful in differentiating vitiligo from other hypopigmentary disorders.

Vitiligo may be associated with other autoimmune diseases, especially thyroid disease and diabetes mellitus. Other associated autoimmune diseases include pernicious anemia, Addison disease, and alopecia areata.

Patients should be made aware of signs and symptoms that suggest onset of hypothyroidism, diabetes, or other autoimmune disease. If signs or symptoms occur, appropriate tests should be performed.

o Thyroid-stimulating hormone (TSH) test is the most cost-effective screening test for thyroid disease.

o Screening for diabetes can be accomplished with a fasting blood sugar or glycosylated hemoglobin.

Other Tests:

- Vitiligo is diagnosed by means of inspection with a Wood lamp.

Treatment

are good candidates for repigmentation?

All the patients are not good candidates. The ideal person for this treatment

must have the following requirements:

- Loss of pigment less than 5 years. It is possible to treat a vitiligo appeared

more than 5 years ago, but results are not so good.

- Patients should be at least 10 years old. Younger children can follow this

treatment, but it is long and better results are achieved when the child is

interested in the treatment. The process is long and requires much patience.

Furthermore, younger children still have not completed the development of the

crystalline, and therefore there is an increased cataracts risk for oral psoralens.

In these cases, treatment will have to be topical or with drugs that do not

produce phototoxic eye damage.

- Normally, children and young adults have better response than older persons

do. Patients should be healthy. Pregnant woman should not be treated because

treatment is dangerous for the fetus.

- The patient must have time to follow the treatment 3 times a week from 2 to 5

years. 85% of patients treated with PUVA will respond the treatment in greater or

minor degree, and just in a few cases total repigmentation will be achieved. We

have to indicate that, after the first 3 treatment weeks, patients can present a

worse aesthetic appearance. This is due to the contrast produced between the

tanned normal skin and the white areas with vitiligo. Soon after, small round

brownish spots begin to appear and tend to confluent, covering the white areas.

In some cases psoralen lotions may be applied on the spots, and 2 hours later the

skin is exposed to the sunlight. This treatment turns the skin very sensitive to the

sun, and also very susceptible to develop sunburns if sun exposure is excessive.

- It is accepted, as a rule, that for a vitiligo affecting less than 20% of the skin

surface, the treatment must be topical. In cases affecting 50% of the surface or

more, only the visible zones must be treated. Depigmenting the skin or

therapeutic abstention are other choices.

- Segmental and acrofacial vitiligo respond poorly to the treatment, as well as

vitiligo on areas such as palms and soles, folds, wrists, ankles, feet and eyelids.

- It is possible that associating several of the oral treatment modalities and/or

topical agents, the response could be better in percentage and/ or rapidity of

repigmentation.

medical treatment

The goal in treating vitiligo is to attempt to restore color (pigment) to your skin and improve your appearance. Depending on the type of therapy, treatment for vitiligo may take from six to 18 months. Treatment choices are based on the number of white patches you have and how widespread they are. Each person responds differently to treatment, and a particular therapy may not work for you.

Medical Therapies

Topical corticosteroid therapy.

Corticosteroids may help return color to your skin (repigmenting), particularly if they're started early in the disease. These drugs, which include cortisone, are similar to the hormones produced by your adrenal glands. Your doctor may prescribe a mild topical corticosteroid cream or ointment for children younger than 10 years old or a stronger form for adults. You may need to apply the cream or ointment to the white patches on your skin for at least three months before you see any results. This treatment is simple and safe, but your doctor will monitor you closely for side effects, such as skin shrinkage and streaks or lines on your skin (skin striae). Calcipotriene (Dovonex), a vitamin D derivative, also may be used topically and is sometimes used with corticosteroids or ultraviolet light

Topical steroids

Topical steroids have revolutionized the practice of dermatology since they were introduced in the late 1950s.

Like all medications, topical (cortico)steroids are associated with potential adverse effects (side effects) especially if they are used incorrectly.

The topical steroids can be divided up into four groups according to their strength. As a general rule, use the weakest possible steroid that will do the job. However, sometimes it is appropriate to use a potent preparation for a short time to make sure the skin condition clears completely.

Topical steroids available in New Zealand

Note:

Topical steroids are prescription medicines regulated by Health Authorities. The products listed here are the generic (and trade) names of those available in New Zealand currently (July 2007). The products available in other countries may be different. For example, in the USA, the classification of topical steroids places them in seven potency classes. Seek the advice of a pharmacist or your own medical practitioner if you require more information.

Class 1

Very potent (up to 600 times as potent as hydrocortisone)

Clobetasol propionate (Dermol Cream/Ointment Betamethasone dipropionate (Diprosone OV Cream/Ointment)

Class 2

Potent (I50-100 times as potent as hydrocortisone)

Betamethasone valerate (Beta Cream/Ointment/Scalp Application, Betnovate Lotion/C Cream/C Ointment, Daivobet 50/500 Ointment, Fucicort)

Betamethasone dipropionate (Diprosone Cream/Ointment) Diflucortolone valerate (Nerisone C/Cream/Fatty Ointment/Ointment)

Hydrocortisone 17-butyrate (Locoid C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion)

Mometasone furoate (Elocon Cream/Lotion/Ointment) Methylprednisolone aceponate (Advantan Cream/Ointment)

Class 3

Moderate (2-25 times as potent as hydrocortisone)

Clobetasone butyrate (Eumovate Cream) Triamcinolone acetonide (Aristocort Cream/Ointment, Viaderm KC

Cream/Ointment, Kenacomb Ointment)

Class 4

Mild

Hydrocortisone 0.5-2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

Topical steroids are also available in combination with salicylic acid to enhance penetration, and with antibacterial and antifungal agents.

Skin absorption of topical steroids

Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. But a potent steroid may cause side effects on the face. For example:

Forearm absorbs 1% Armpit absorbs 4% Face absorbs 7% Eyelids and genitals absorb 30% Palm absorbs 0.1% Sole absorbs 0.05%

Side effects of topical steroids

Internal side effects

If more than 50g of clobetasol propionate, or 500g of hydrocortisone is used per week, sufficient steroid may be absorbed through the skin to result in adrenal gland suppression and/or eventually Cushing's syndrome.

Adrenal Gland Suppression. Topical steroids can suppress the production of natural steroids, which are essential for healthy living. Stopping the steroids suddenly may then result in illness.

Cushing's Syndrome If large amounts of steroid are absorbed through the skin, fluid retention, raised blood pressure, diabetes etc. may result.

Skin side effects

Local side effects of topical steroids include:

Skin thinning (atrophy) and stretch marks (striae). Easy bruising and tearing of the skin. Perioral dermatitis (rash around the mouth). Enlarged blood vessels (telangiectasia). Susceptibility to skin infections. Disguising infection e.g. tinea incognito. Allergy to the steroid cream.

The risk of these side effects depends on the strength of the steroid, the length of application, the site treated, and the nature of the skin problem. If you use a potent steroid cream on your face as a moisturiser, you will develop the side effects within a few weeks. If you use 1% hydrocortisone cream on your hands for 25 years, you will have done no harm at all (except for having wasted a lot of money!)

Adverse effects of topical steroids

Bruising

Skin thinning

Prominent capillaries

Stretch marks

How to use topical steroids

Ask for specific instructions how to use your topical steroid(s). See DermNet's information about fingertip units. Which one, where, when, how often and for how long? Cream, ointment or lotion? This is particularly important if:

You are using strong steroids over large areas of your body. You have been asked to use plastic to cover treated areas (occlusion). Your skin condition persists for more than two or three weeks. You are a child.

Topical steroids are very effective medications. They work by reducing inflammation, and when used correctly are very safe.

Apply topical steroids only to the areas affected by the skin disease, and generally only once or twice daily. If your skin is dry, apply an emollient frequently.

Topical psoralen plus ultraviolet A (PUVA).

Topical PUVA may be a treatment option if you have a small number of depigmented patches (affecting less than 20 percent of your body). PUVA, also called photochemotherapy, is performed under artificial UVA light once or twice a week in your doctor's office. Your doctor or a nurse will apply a thin coating of psoralen to the depigmented patches of your skin about 30 minutes before UVA light exposure. You're then exposed to an amount of UVA light that turns the affected area of your skin pink. Your doctor may slowly increase the dose of UVA light over many weeks. Eventually, the pink areas of your skin fade and a more normal skin color appears.

Potential short-term side effects of topical PUVA therapy include severe sunburn and blistering and too much repigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). You can minimize your chances of sunburn by avoiding exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment stops.

Oral psoralen photochemotherapy (PUVA).

Oral PUVA therapy may be used if you have extensive vitiligo (affecting more than 20 percent of your body) or if you haven't responded to topical PUVA therapy. Oral PUVA isn't recommended for children younger than 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, you take a prescribed dose of psoralen by mouth about two hours before exposure to artificial UVA light or sunlight. Your doctor adjusts the dose of light until the skin areas being treated become pink. Treatments are usually given two or three times a week, with at least one day in between.

If you don't have access to a PUVA facility, your doctor may prescribe psoralen to be used with natural sunlight exposure. Your doctor will give you careful instructions on carrying out treatment at home and monitor your progress with frequent office visits.

Short-term side effects of oral PUVA may include sunburn, nausea and vomiting, itching, abnormal hair growth, and too much repigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). If received for longer periods of time, this type of treatment may increase your risk of skin cancer. To avoid sunburn and reduce your risk of skin cancer, you'll need to apply sunscreen

and avoid direct sunlight for 24 to 48 hours after each treatment. Wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.

Depigmentation. Depigmentation involves fading the rest of the skin on your body to match the already-white areas. If you have vitiligo on more than 50 percent of your body, depigmentation may be the best treatment option. In this procedure, the drug monobenzone (Benoquin) is applied twice a day to the pigmented areas of your skin until they match the already-depigmented areas. Avoid direct skin-to-skin contact with others for at least two hours after applying the drug.

The major side effect of depigmentation therapy is redness and swelling (inflammation) of the skin. You may experience itching, dry skin or abnormal darkening of the membrane that covers the white of your eyes. Depigmentation is permanent and cannot be reversed. In addition, if you undergo depigmentation you will always be extremely sensitive to sunlight.

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- homeopathy

What is homeopathy? Homeopathy is a branch of medicine originated in Germany in 1794, which is based on the principle of The

Law of Similars. In a way, it is an advanced form of vaccination; whereby a substance which is capable of

producing a disease like state is administered to the patient, but in a very minute dose, to cure the similar

disease.

Homeopathy works much beyond vaccination. Here, the dose administered is unbelievably miniscule, which

renders if absolutely harmless yet very powerful.

Contrary to the conventional medicine, the action of homeopathy is much safer, deeper acting, somewhat

slower, and results much longer lasting by energizing the body's curative powers.

Homeopathy is amongst the youngest and latest medicines calling for more research and promotion.

How does it work? There are theories on how exactly homeopathic medicine works. As supported in major clinical trials and in

practice, it is believed to be working by stimulating body's own healing mechanisms.

For example, in case of diseases which are caused by infection, it seems to be working by stimulating the

production of antibodies, defense blood cells, etc.

In cases of immune diseases, it seems to be working by correcting the immune mechanism.

In case of painful conditions, by activating body's anti-pain mechanisms.

Similarly, its action must be on the lines of being antispasmodic, anti-allergic, immuno-modulatory, anti-

inflammatory, hormone stimulatory, anti-carcinogenic, etc.

Large scale studies alone will allow full exploration of this young science.

What can it do? Homeopathy boasts of tremendous powers as a system of medicine.

Especially in case of chronic, long standing and recurring diseases like allergies, bronchitis, Chron's diseases, ..Psoriasis,

Rheumatism, Sinusitis, Trigeminal Neuralgia, Ulcerative Colitis, Vitiligo, etc, homeopathy offers results which can change

the life of patients.

In the cases of allergic diseases like Asthma, urticaria, and the like, it can enhance body's immune mechanism is such as

way that the body no more reacts in abnormal way by producing constricted bronchial tubes, abnormal release of

histamine, spasm, inflammation, etc.

In cases of ulcerative diseases (like Ulcerative colitis), it leads the immune mechanism to enhance ulcer healing

mechanism.

In cases of chronic infections (e.g. Hepatitis C ) it reduces the count and activities of viral.

This goes true for most chronic diseases.

Phototherapy Treatment can effectively treat Vitiligo

UV light, or phototherapy vitiligo treatment can help create repigmentation. This process is slow, working from the outer edges of

each patch inward, so regular phototherapy vitiligo treatment is prescribed. Phototherapy vitiligo treatment may continue twice a week

for a year or more. Phototherapy equipment has been well-studied and has been proven to be an effective treatment for vitiligo.

Home Phototherapy Equipment to treat vitiligo

Vitiligo treatments at home or at your doctor's office is a decision between you and your doctor. Home phototherapy units are usually reimbursed by

insurance. The right phototherapy equipment is based on the size of the area affected by vitiligo. The most often used phototherapy units for vitiligo are:

Foldalite III - full-sized folding home phototherapy booth Extra-large treatment area, yet folds to only 9 deep

Panosol II - 2-foot & 6-foot phototherapy light panels; optional foldable wings

Dermalight-80 handheld model is ideal for smaller areas of vitilig

PHOTOTHERAPY SYSTEMS

Houva II Houva III - NEW!

Foldalite 32 - NEW!

Clinical Starter Kit - NEW! Compare Phototherapy Booths

Hand/Foot II Foot Phototherapy- NEW! Dermawand - wound care

Excilite - Rapid Spot Treatment REQUEST A BROCHURE

Phototherapy Booths for Clinical Settings

Houva II

full body phototherapy booth

Houva III

low maintenance phototherapy booth

with removable

sensors

Foldalite 32

"The Space-Saver" folding phototherapy

booth

32 narrowband UVB lamps

Full-Body Phototherapy for Patients at Home

Foldalite-III similar to clinical

version (Foldalite-32, above)

now available for

home use with 16 narrowband lamps

Panosol-II home light panels

now available with optional wings

Houva II

High output phototherapy device with PhotoSense Exposure Controlthe ultimate in

phototherapy technology.

Features

Utilizes watchdog circuitry which automatically shuts off the device if it

senses a potential malfunction Designed to never fail in the ON

position ON/OFF safety key switches Non-UV-transmitting viewing window to

monitor patient Exclusive perimeter flow ventilation for patient comfort Full reflector panels to maximize lamp output Lamp hour clocks(s) to monitor lamp life Raised floor for proper treatment of lower leg Hand rails and non-skid floor mat for patient safety Sturdy screen protection for lamps

PhotoSense Exposure Control

For precise treatment management Preset a maximum exposure time Minimize the chance for overexposure

Treatments are covered by most insurers.

Six Configuration Options

Option Description UVA Lamps

Broad Band

UVB Lamps

Narrow Band

UVB Lamps

Measuring Devices

Included

1 Combination

Unit 36 12 UVA & UVB

2 UVA-Only 48 UVA

3 Broad Band UVB-Only

18 UVB

4 Combination

Unit 12 36 UVB

5 Narrow Band

UVB-Only 48 UVB

6 Combination

Unit 24 24 UVA & UVB

UVA phototherapy lamps: # F72T12 BL/HO BB UVB phototherapy lamps: # FSX72T12/HO

NB UVB phototherapy lamps: # TL100W/01

Houva II Specifications:

Electrical Rating: 120/240 volt, 3 wire, single phase, solid neutral, 50/60 hertz. A fourth wire (green) is required to be

attached to an isolated ground. 30 amperes per leg for NB UVB units 10-foot, 4 conductor #10 AWG power

cable supplied

Dimensions: 46W x 49D x 87H

International Product

Specifications:

For countries with electrical current other than U.S. standard, the device will be delivered with an international

base.

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

Houva II 5-Year/3-Year Total Support Warranty

All parts (excluding lamps) carry a 5-year free replacement warranty.

All labor carries a 3-year no charge warranty from date of installation

Lamps carry a 90 day warranty

Houva III Specifications:

Electrical Rating: 120/240 volt, 3 wire, single phase, solid neutral, 50/60 hertz

30 amperes per leg all units 10-foot, 4 conductor #10 AWG power

cable included

Optional international base 220-240 volts, 50/60 hertz

Electrical Certification:

Listed with ETL laboratories, Inc. Certified to Canadian Standards

Association and CMDCAS

Pending certifications CE

System

Dimensions:

46W x 49D x 82H

CAUTION: Federal law restricts this device to sale by or on the

order of a physician.

Houva III Warranty

All parts (excluding lamps) carry a 5-year, free replacement warranty.

All labor carries a 5-year, NO CHARGE warranty from date of installation.

Extended warranties available Lamps warranted for 90 days.

We are the only company certified to ship phototherapy units to Canada.

HOUVA III

clinical phototherapy system is most effective way to treat a large number of patients with psoriasis or vitiligo covering much of their

body. With 48 lamps and numerous features for more effective, safer, and faster treatment of patients, HOUVA III clinical

phototherapy system will improve your practice. Houva III is available in Narrowband UVB or UVA/UVA options. Choose Houva III as your clinical phototherapy system. Phototherapy system

treatments are generally covered by insurers. With

all Houva III units built on premises, your satisfaction is assured.

Contact National

Biological about Houva III clinical phototherapy system today!

Foldalite 32 - THE SPACE_SAVER Full-Body UVB Clinical Phototherapy Booth PART OF THE

Roomy, compact, and economical booth

Foldalite-32 is Fast and easy

Rapid treatments with 32 narrowband UVB lamps

Simple push button operation

Foldalite-32 has Large interior treatment area

At 5.4 sq ft, its roomy enough for most patients

Easily treat entire body with single session Adjustable doors can expand treatment area

further

Foldalite-32 is Economical

Less expensive option with fewer lamps and features than our Houva III phototherapy

system Less expensive than competitive models Treatments usually covered by insurers

Foldalite-32 has Space-saving design

Ultrathin Foldalite-32 UVB clinical phototherapy unit is only 9 deep when closed

Easy open doors and adjustable wheels designed for any floor surface

Foldalite-32 is Safe for any clinical setting

Calculating timer to ensure exact dosage

Specifications:

Folding UV Clinical

Phototherapy Unit Dimensions:

CLOSED footprint: 76H x 56W x 9D OPEN footprint: 76 x 38W x 38D OPEN treatment area: 5.4 square feet

Lamps: 32 TL 100W UVB narrowband lamps

Electrical Rating: 120-240V AC hardwired 50/60 Hz 15 Amps per leg - Risk class 1

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

Warranty

3 year limited (excluding lamps) Lamps carry a 90 day warranty

Safety Features

Safety key lock switch prevents unauthorized use Internal switch allows patient to stop treatment in

emergency Calculating timer to ensure exact dosage

Support Comes Standard

Unlimited Customer Service Most insurance carriers reimburse phototherapy treatment in

offices

Financing options available All major credit cards accepted

Foldalite is Foldalite-32. Foldalite-32 is 50% larger than any

folding UV clinical phototherapy unit available today. Yet, Foldalite-32 easily folds to only 9 of wall space. Attractive and durable

powder coated aluminum finish will look as good today as in years to come. Foldalite-32 UV clinical phototherapy unit has our exclusive

watch dog circuitry. Foldalite-32 is the most safe, convenient and economical UVB clinical phototherapy unit available. A compact and economical UVB clinical phototherapy unit!

Contact us to learn how a Foldalite-32 phototherapy system can improve your practice

Pricing and availability information available.

Foot Phototherapy High output lights for quick, effective treatment

Foot Phototherapy Features:

UVA, UVB, or narrowband UVB lights Targeted phototherapy is effortless

and safe

Ideal for office use. Key Lock to prevent unauthorized use Electronic Timer ensures accurate

treatment times Sturdy protective lamp shield Full reflector backing to maximize

output

Goggles and operating manual included Ventilating Fan (100 c.f.m.) Weight 68 lb (74 lb shipping weight) Device shipped fully assembled, ready for immediate use.

Optional Stand

Heavy duty casters for easy movement. Positions unit at ideal treatment height Size: 29" W x 32" H x 17" D (Upper) and 21.5" D (Lower)

Treatments are covered by most insurers.

Specifications:

Electrical Rating: 110-120 Volt AC 60H 3.0 Amps with grounded plug

Dimensions: 24W x 12 H x 20D

Optional Cart: 29W x 32H x17D (upper) / 21.5D (lower)

Lamps: UVA - 8 high output UVA lamps UVB - 8 high output UVB lamps NB UVB - 8 narrowband UVB lamps

International

Product Specification:

For countries with electrical current other than U.S standard, the device will require a step down transformer.

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

We are the only company certified to ship phototherapy units to Canada.

National Biological makes all of our phototherapy units on premises in our production facility.

Warranty

All parts (excluding lamps) and labor carry a 3-year full replacement warranty.

Lamps carry a 90 day warranty.

Dermalight 80

Handheld Narrow Band UVB Phototherapy Device for spot treatment or scalp psoriasis treatment

Scalp psoriasis treatment UVB narrowband light!

Dermalight 80 Features Dermalight 80 Features

No need for drugs! Dermalight 80 is effective spot or scalp psoriasis treatment

Effective! Dermalight 80 works for psoriasis spot treatment, psoriasis scalp treatment, vitiligo spot treatment and treatment of other localized skin conditions

Convenient! Portable and lightweight, Dermalight 80 is ideal for localized treatment of spots or scalp psoriasis treatment

Precise scalp psoriasis treatment! Comb attachment (included with Dermalight 80) separates hairs to allow precise scalp psoriasis treatment

Safe for skin! Dermalight 80 comb attachment may be used as a distance guard to treat areas other than the scalp. Uses NB UVB light.

Arrives ready for use! Dermalight 80 is shipped fully assembled

We are the exclusive U.S. Distributor of Dermalight-80

Covered by most insurance carriers. Let us help.

Specifications:

Electrical: 110-120V plug-in 60 Hz AC .5 Amps

Lamps: Narrowband UVB (NB UVB) PL-F 9W/01 lamp

International

Product Specifications:

For countries with electrical current other than U.S. standard, the Dermalight 80 device will require a

step down transformer.

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

Warranty

Dermalight 80 wand carries a 1 year on parts (excluding lamps) and labor.

Lamps carry a 90 day warranty

Comb attachment, goggles and timer included.

Dermalight 80, also known as Dermalight, is a

handheld phototherapy tool for spot treatment of psoriasis and vitiligo. Dermalight 80 is portable and convenient for local areas or as scalp psoriasis treatment.

Dermalight-80 is a highly effective scalp psoriasis treatment. Dermalight 80 and Dermalight are the same product.

Dermalight 80 uses NB-311 narrowband UVB (NB UVB) lamps. Narrow

band UVB (NB UVB) lamps are highly effective for scalp psoriasis treatment without need for drugs. A separate timer is included to monitor spot or scalp psoriasis treatment with Dermalight 80. Now

there's a safe, effective, and economical scalp psoriasis treatment. While spot and scalp psoriasis treatment is the most common use of

Dermalight-80, UV phototherapy effectively treats vitiligo, eczema and many other conditions. Dermalight-80 is generally covered by insurance.

Excilite- Non-laser excimer psoriasis light source

NEW Shared Revenue Model --

Excilite- has TEN TIMES the coverage area vs psoriasis excimer

laser

Universally reimbursed by health insurers Small footprint for tight spaces High output 308nm narrowband UVB Very simple to use. Just fit aperture and settings for excimer

treatment. Fast! Treat in seconds and adjust settings for next patient just as

fast. Safer than laser! No dangerous gasses to fill Portable psoriasis excimer laser targetted light

Main Applications:

Psoriasis Alopecia Areata Vitiligo Atopic Dermatitis

The Excilite- 308nm excimer technology offers the physician or phototherapy technician all the advantages of a psoriasis excimer

laser source, while eliminating many of the negative aspects of an

excimer laser psoriasis system. The Excilite- offers high energy

excimer output with a 308nm narrowband wavelength, without requiring long treatment times or the use of dangerous bottles of chlorine acid of a laser. The wide coverage area enables the

operator to treat the targeted area very quickly. The excilite- non-

laser psoriasis excimer light does not involve costly maintenance like the frequent replacement of filters, aligning, cleaning and tuning of

other psoriasis excimer laser treatments

Excilite- is portable, compact and lightweight. The non-laser

psoriasis excimer system is fitted with additional apertures and screens to allow for different treatment areas that can range from one centimeter in diameter to 30 square centimeters. This serves to

protect the surrounding uninvolved regions.

Excilite- Advantages:

Short treatment times, both in duration (ten to twenty seconds), and number of sessions.

Completely sealed excimer light source which eliminates the need for bottles containing chlorine.

Ergonomic, user-friendly, and safe. Large treatment surfaces (5 x 6 cm ) with high intensity

non-laser output, narrowband wavelength (308 nm).

Spot The Difference?

308 Excimer Excilite

Feature

Psoriasis Excimer

Laser

Extensive Insurance Coverage

Limited

Limited Maintenance Frequent

Water Consumable XeCl Gas

30 cm Treatment Area 4 cm

9" x 15" x 19" 42 lbs.

Size 34" x 39" x 18" 220 lbs.

Technical Data:

Type of Source: Monochromatic Excimer Light

Wavelength: 308 nm

Power Density: 50 mW/cm

Treatment Surfaces

Rectangular:

30 cm (5x6) Max

Electrical Requirements:

110 V

Dimensions: 9 in. (H), 15 in (D), 19 in (W)

Weight: 42 lbs.

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

Excilite- 308nm non-laser psoriasis excimer light will change the

way you treat psoriasis. Its safe, targeted, high output light is more

effective than psoriasis excimer laser. Excilite- 308nm allows more

targeted treatment than psoriasis excimer laser. Excilite- is safer

for both patient and clinician than psoriasis excimer laser psoriasis

treatment. And, unlike psoriasis excimer laser, Excilite- is universally reimbursed, making it a solid source of income for your

practice. Excilte non-laser Psoriasis excimer light beats beats lasers and beats psoriasis.

Contact us about Excilite- non-laser psoriasis excimer treatment

today.

Lamps

Regular re-lamping saves valuable treatment

time.

Always in stock!

We carry replacement UVA phototherapy bulbs and UVB phototherapy bulbs for all your phototherapy needs.

PUVA and UVB High Output Broad Band (BB) Lamps Slimline and Bi-Pin Lamps UVA-1 High Output Lamp UVB Narrow Band (NB) TL-01 311nm Lamps

UVB narrow band bulb UVB narrowband lamps -

TL01 - TL-01

TL01 lamps (TL-01 lamps) - narrowband lamp for Panosol and Foldalite phototherapy units!! - TL-01 lamp

TL01 100W UVB 311 Narrow Band 6 ft. (Panosol II, Foldalite III, Foldalite 32)

TL01 20W UVB 311 Narrow Band 2 ft. (Panosol II) PL S9W101 Narrow Band (Dermalight)

UVB broad band bulb UVB broadband lamps

FSX72T12/UVB/HO 6 ft.

FX72T2/UVB/HO 6 ft.

FS72T12/UVB/SL 6 ft.

FS40T12/UVB 4 ft.

FSX24T12/UVB/HO 2 ft. FS20T12/UVB 2 ft. F6T5/UVB (Handisol)

UVA bulb - UVA Lamps

FR72T12/BL/HO (UVA) 6 ft.

F72T12/BL/HO (UVA) 6 ft.

F40/350 BL (UVA) 4 ft.

F36T12/BL/HO (UVA) 3 ft.

F24T12/BL/HO (UVA) 2ft. F20T12/BL/HO (UVA) 2 ft. F6T5/350BL (Handisol)

UVA-01 bulb - UVA-01 Lamps F72T12/BL9/HO UVA-1

Warranty

All lamps carry a 90 day warranty TL01 lamps / TL-01 lamps are replacement UVB phototherapy bulbs

for our narrowband phototherapy units!! Replace TL01 lamps / TL-01 lamps often enough so your Panosol or Foldalite III treatment

dosage remains at its best. For effective treatment, Panosol-II, Foldalite-III, and Foldalite-32 need a full compliment of TL01 lamps/TL-01 lamps. Narrowband lamp - TL01 lamp - TL-01 lamp -

NB lamp - uvb lamps - uva lamps - tl100w Keep enough TL-01/TL01 lamps on hand. Learn about Narrow band

UVB. Contact us and restock today.

Panosol II 6'foot Light Panels and 2-foot Light Panels for Home

Phototherapy UVA, UVB, and Narrowband UVB options

OPTIONAL WINGS ARE NOW AVAILABLE FOR PANOSOL II!!

Panosol II home phototherapy light unit provides the benefits of physician-guided UVA or UVB

treatment in the comfort and privacy of your ow n home. Physician maintains control of the phototherapy treatment regimen through the use of Panosol II's exclusive CPT Timer.

Panosol II light panel features:

Home UVA/UVB phototherapy treatment for convenient, economical light therapy in the privacy of your home

2 Panosol II light panels effectively treat small area 6' Panosol II lights treats entire side of body at once OPTIONAL WINGS on 6' Panosol II extend treatment area and

close to store home phototherapy light unit discretely CPT Timer (UVB models) assures accurate dosage High-efficiency reflector design maximizes lamp output Operates on standard house current Casters for easy moving and storage Goggles and user's manual included Covered by most insurance carriers. Let us help!

Panosol II safety features:

Failsafe feature disables unit in event of emergency

Maximum 10-minute treatment setting on UVB timer

Key-locked ON/OFF switch to prevent unauthorized use

Solar Shield Glasses

Ultimate UV protection for PUVA and other light-sensitive patients

For use after UVA or UVB light treatments for patients or during treatment for medical professional

Blocks 100% UVA/UVB Meets or exceeds ANSI standards Choose from two colors (clear, smoke)

Stock Code (Smoke) - 9PE-014

Stock Code (Clear) - 9PE-015

UVB/PUVA Goggles

For use during phototherapy treatment Blocks 100% UVB/UVB Yellow lenses permit viewing of all

colored LED displays Soft rubber eye pieces and adjustable nose bridge for comfortable

fit

DEMYSTIFYING THE LIGHTS

Narrow band UVB Lights Narrowband UVB and UV lamps PUVA: Psoralen plus UVA

PUVA (photochemotherapy)

PUVA (photochemotherapy) is a type of ultraviolet radiation treatment (phototherapy) used for severe skin diseases.

PUVA is a combination treatment which consists of Psoralens (P) and then exposing the skin to long wave ultraviolet radiation (UVA). It has been available in its present form since 1976.

Psoralens are compounds found in many plants which make the skin temporarily sensitive to UVA. The ancient Egyptians were the first to use psoralens for the treatment of skin diseases thousands of years ago.

Methoxsalen capsules are taken two hours before exposure to UVA. Bulbs emitting different wavelengths are used for UVB (short wavelength radiation).

Those patients requiring treatment to small areas only may be treated using the smaller hand and foot unit. 'Bathwater' PUVA may be suitable. In this case the hands and/or feet are soaked in a dilute solution of methoxsalen

for 30 minutes, then immediately exposed to UVA.

A few patients may be treated with topical Tripsor PUVA - a lotion is painted on the affected areas 10 minutes before UVA exposure.

PUVA is useful for patients with various skin disorders, including psoriasis, dermatitis, polymorphic light eruption and mycosis fungoides. The number and the frequency of PUVA treatments will depend on the condition being treated and individual factors.

Side Effects

Burning An overdose of PUVA results in a sunburn-like reaction called phototoxic erythema. It is more likely in fair skinned patients who sunburn easily. A burn is most likely 48 to 72 hours after the first two or three treatments. Sensitive areas such as breasts and buttocks may need to be covered for all or part of the treatment. Avoid photosensitizers such as certain medications, perfumed cosmetics and coal coal tar. If the treated skin becomes pink the dose of UVA will not be increased. One or more treatments may be missed. Unfortunately phototoxic erythema can persist for longer than sunburn from natural sunlight. Moisturizers and painkillers can reduce the discomfort.

Itching Temporary mild pricking or itching of the skin is common after treatment. The skin is often rather dry. Apply moisturizing cream or lotion frequently. Antihistamine tablets may help.

Nausea Nausea occurs in a quarter of those treated with psoralens. If it occurs, tell your phototherapy nurse or doctor. Nausea is less if the methoxsalen capsules are taken with food, or the dose is reduced. Antiemetic tablets can be prescribed.

Tanning PUVA usually leads to tanning which lasts several months. Although the skin appears brown it may still burn easily on sun exposure.

Eye damage If the eyes are not protected from UV radiation, keratitis may occur. This results in red sore gritty eyes. Damage to the lens in the eye leading to cacoal taracts is another possible risk.

Skin aging and skin cancer Extensive PUVA treatment results in premature aging changes in the skin (i.e. increased dryness, freckling and wrinkling) and can increase the chance of skin cancer. Fair skinned individuals or those with previous sun or radiation damage are most at risk. This is not a concern for most patients, who receive PUVA therapy for two or three months only. Patients on long term maintenance therapy should have their skin checked by the specialist at least every 6 months. Bring any new moles or freckles, sores which are slow to heal, or growing lumps to the doctor's attention. It should be remembered that usually, but not always, skin cancers are readily curable. When ageing changes are evident or skin cancers occur, it becomes unwise to continue this form of treatment.

Pregnancy There is no evidence to suggest that PUVA will damage a developing baby. However, should a patient become pregnant, or suspect she is pregnant, during a course of treatment, we advise our patients to stop PUVA treatment immediately.

Treatment of different skin conditions

Psoriasis Psoriasis is a common inherited skin disorder, which may vary considerably in extent and severity. Neither phototherapy nor any other available treatment effects a permanent cure. PUVA is usually reserved for patients in older age groups, or for those whose psoriasis is either severe or not responding adequately to more conventional forms of treatment. In most cases (approximately 90%) PUVA is effective in clearing psoriasis, and can often control it as long as treatments are continued. Psoriasis in body areas shielded from light (e.g. scalp and body flexures) may not clear satisfactorily with PUVA. Initially most patients have their treatment two or three times a week. The first few exposures will be short (less than 5 minutes). The length of exposure is gradually increased, according to the patient's response, up to a maximum of 30 minutes per session. Few patients require such long exposures, most being controlled with shorter times. Most psoriasis patients will have their psoriasis cleared or much improved after 12 to 24 treatments. At this stage treatments may be reduced to once a week or less. Even without treatment, the skin may remain clear for some months. However, the psoriasis may later flare up again, and further PUVA treatments may be necessary. Those few cases of psoriasis which appear to be resistant to PUVA may still be helped by combining PUVA with other treatments (e.g. ointments or tablets).

Eczema or dermatitis PUVA is occasionally used for severe cases of dermatitis. Frequency and dosage of treatment is similar to that used for psoriasis. However, a course of phototherapy may need to be more prolonged than that generally required for psoriasis.

Mycosis fungoides For this rare skin form of cutaneous T-cell lymphoma, PUVA is usually given twice a week at first, using shorter exposures than for psoriasis. When the skin is clear, treatment is given less frequently. If PUVA is stopped, the condition sometimes relapses.

PMLE Polymorphic light eruption (PMLE) is a common light sensitivity disorder. A six week course of PUVA in the spring or early summer usually gives patients good protection for the remainder of the summer. UVB may be recommended for those in whom PUVA is unsuitable. A further course of treatment will be necessary if protection is required in subsequent years.

Vitiligo Patients with vitiligo have areas of completely white skin. PUVA can bring about some repigmentation, particularly for vitiligo of the face, and in dark-skinned patients. Results for other body sites and white-skinned patients are less encouraging. Treatment is usually twice a week for two years. Even then, complete repigmentation cannot be guaranteed and relapse is possible.

Instructions

If you are receiving PUVA therapy, follow the advice of the phototherapy nurse and that of your dermatologist. Some general advice:

Keep all scheduled appointments. Allow time for changing. Tell the staff about your health problems, including medications and eye disease. Do not apply any ointments or cosmetics (especially perfumes and coal coal tar

products) except as directed by your doctor or phototherapist. Schedule treatments at the same time of day whenever possible. Always take the capsules at exactly the same interval before the UVA exposure. Ideally, take the capsules two hours after a meal. Alcohol consumption should be minimal. Avoid sun exposure on treatment and non-treatment days. Apply broad spectrum sunblock to face and hands before treatment. Cover male genitalia - this area must not be exposed to UVA. You must protect your skin and eyes from natural sunlight for twelve hours after

taking methoxsalen tablets. During treatment, you must wear the special goggles provided. Wear wrap-around ultraviolet-protective sunglasses both indoors and outdoors, from

the moment you take the methoxsalen tablets until nightfall on the treatment day. After dark the glasses must still be worn under fluorescent lighting, but are not

necessary outside or with incandescent lamps. Wear fully covering clothing outdoors and if near a window indoors, i.e. hats, long

sleeves and skirts or trousers. Apply sunscreen to all uncovered skin after treatment. In some circumstances polarized or prescription glasses may be suitable; they must

cut out all UV radiation however. You can use clear perspex glasses indoors. Arrange to be seen regularly by your dermatologist

Narrow-band ultraviolet B (NBUVB) therapy.

In recent years, NBUVB, a special form of ultraviolet B light, has been used as an alternative to PUVA. This type of therapy can be administered like PUVA and given up to three times a week. However, no pre-application of psoralen is required, thus simplifying the treatment process. NBUVB may be a safer long-term alternative to PUVA. However, more research is needed.

UVB Narrowband Phototherapy Lamp Technology

A UVB narrow band lamp emits light energy. Narrowband UVB phototherapy (UVB-NB) comprises a subset of the UVB wideband, or broadband, spectrum centered at roughly 311 nm. This is less than 1% of

total range of wavelengths from sunlight. Narrow band UVB has been shown to be the optimal part of the UV light spectrum which slows growth

of psoriasis lesions. Since the narrowband wavelength is shorter than braodband, exposure time to narrow band UVB phototherapy treatment lights can be increased. The result is powerful targeted phototherapy

treatment.

Another clear advantage of narrowband UVB is that skin is most sensitive to erythemic response, (sun burning) at 297 nm, so narrow band

phototherapy nearly eliminates this problem as shown in the chart below.

Narrow Band UVB lamp technology is available for nearly all home phototherapy products from National Biological, including the compact 2

and full-sized 6 Panosol II light panels, full-body folding Foldalite III booth, hand-held Dermalight 80 wand, and Hand/Foot II unit.

Psoriasis - Research shows that Narrow Band UVB lights have a therapeutic advantage over traditional Broad Band UVB lights. This is because Narrowband UVB lights provide faster clearing, less sun

burning, and more complete disease resolution. Vitiligo - Today Narrow Band UVB lights are proving to be very

useful in the treatment of Vitiligo. Narrowband UVB light treatment is replacing traditional PUVA phototherapy treatment. UVB Narrow Band for vitiligo requires no photo-sensitizing agents. Ask us or ask

your doctor.

The most recent medical methods in vitiligo treatment

AN ALL ITALIAN DISCOVERY, IT IS CALLED BIOSKIN THE LATEST COLD-LIGHT MICROPHOTOTHERAPY FOR THE CARE AND THE TREATMENT OF

THE VITILIGO.

FACE THE VITILIGO.

The latest scientific knowledge on the vitiligo consider it as a dermatosis due to multiple factors and that it can have different

aspects according to the triggering cause. In fact, this is not simply a disorder of pure cosmetic interest, but would result from little defects (probably genetic ones) that can cause thyroid unbalance and to other

organs of autoimmune nature. In order to know the indicative evaluation of the effectiveness of the BIOSKIN therapy in your specific case, it is necessary to fill out the questionnaire following

which you will have an answer by e-mail. Besides, in order to be able to understand if these problems subsist for the individual patient, it is necessary to carry out some blood tests to evaluate the possible

involvement of the above mentioned organs. Once these examinations are carried out, we will have a global vision of the

patient and would be able then to begin a specific and personalized therapy.

BIOSKIN THERAPY.

In order to understand the BIOSKIN therapy it is necessary to have some basic knowledge in dermatology. The melanocytes are some cells located in the deeper layer of the epidermis (that it is not other than the most superficial thin veil of our skin and it has an average thickness of 0,4 mm) and that during the pathological process leading to the vitiligo are "inactivated" or "killed". The melanocytes being the cells, which contain (the main colour of the skin), their absence is revealed by the lack of colour in the affected zone: this is

the vitiligo. Yet the epidermis is not the only zone of the skin provided with melanocytes. In fact, the colour of the hair and of the hairs is precisely due to the

melanocytes being situated close to the hair bulb (in the zone known as perifollicular) placed much more in depth compared to the epidermis. These deep melanocytes are very rarely interested by the process that causes the vitiligo and, if opportunely stimulated, they can multiply themselves, climb back in the epidermis and give rise to new pigmentation, and therefore to the cure of the

spots. This phenomenon, that sometimes is spontaneous or caused simply by the exposure to the sun, shows itself through the appearance of circular points of

pigmentation in the zones made achromic (that is without colour) by the vitiligo. In the illustration 1 (a and b) it may be noticed how the skin of the hands of a subject before the therapy (a) and during (b) the treatment with BIOSKIN is giving rise to these "tokens" of pigmentation that will increase of diameter and they will unite themselves, to give finally to the skin its normal pigmentation.

.

.

Copyright 1999-2008 BIOSKIN all rights reserved

The medical research and today's technologies have allowed to determine the wavelength (among all the ones of the solar spectrum) that stimulates more effectively the melanocytes to duplicate and to produce melanin (311 nm). BIOSKIN allows us to be able to convey this wavelength exclusively on the vitiligo spot and in depth towards the perifollicular melanocytes without causing the damages due to all the other solar radiation of which mainly infrared and ultraviolet rays A.

THE NEW THERAPY FOR THE CARE OF THE VITILIGO: BIOSKIN THE LATEST COLD-LIGHT GENERATION MICROPHOTOTHERAPY A new and sophisticated emitting equipment of the ultraviolet B rays to 311 [nm] can eliminate the cutaneous dyschromias caused by the vitiligo. It is about THE LATEST GENERATION MICROPHOTOTHERAPY BIOSKIN performed with an innovative equipment, which emits in a specific and selective way a bundle of ultraviolet light of type B able to stimulate the dormant melanocytes cells gradually, thus allowing to look after the disease in the least time possible and not to increase the contrast of colour between the healthy skin and the patched vitiligo. To obtain this result biomedical engineers supported by dermatologists researchers they have planned and built an electronic generator, protected by an international patent, with a very high percentage of UVB rays able to focus the light bundle exclusively on the vitiligo spots while using a particular optic fibre. The emitted UVB rays are the most effective ones in the therapy of the vitiligo because they stimulate in an optimal way the melanocytes and are active on the immune system of the skin. The bibliography in our web site lists the principal international scientific works documenting the effectiveness and lack of noteworthy negative side effects of the therapeutic UVB rays on the human skin for the dosages relating to the BIOSKIN therapy. Otherwise from all therapeutic approaches which use ultraviolet radiation on full cutaneous surfaces, the BIOSKIN therapy, because it only conveys microdoses of energy on the affected cutaneous zones, does not provoke the photo ageing of the skin. The BIOSKIN therapy is adapted to the requirements of every individual patient, as

well with regards to some characteristics of emission of the ray as for the duration of each therapeutic treatment.

We are in any event able of providing a general model of the BIOSKIN therapy. Every session, carried out exclusively by a doctor, it consists of an irradiation of the UVB rays on the spots concerned only, excluding any healthy part.

The ray, conveyed by optical fibre is applied for a maximum duration time of 10 seconds on every square centimetre of the spot. Thanks to the use of a diaphragm placed on the terminal of the optical fibre and which is modified according to the characters of the interested area, the doctor can modify the diameter of the area to be treated for any particular case.

Different to the other therapies based on the use of the UVB, this one doesn't provoke any pain, burn or other discomfort, neither during the treatment nor in the following days.

The therapy must be repeated once per month, effecting altogether 1-3 sessions in the same day in accordance with the therapeutic protocol determined by the dermatologist for each individual patient. The therapy has never highlighted any negative side effects. The treatment has a variable general duration in accordance with the extension of the affected zones and the reaction of the subject. There are conditions of relatively constant reaction for each patient. The face, the groin, the armpits, the genitals, the neck, the breast and the thighs are the areas which repigment first, while the terminal zones close to the fingernails of the hands and the feet require in general, a superior lapse of time.

Usually after 8-10 sessions it is possible to have an idea of the recovery speed of each spot of vitiligo for each individual patient.

IPL Guide

What is IPL?

IPL (Intense Pulsed Light) is a non-invasive skin treatment that emits powerful bursts of light energy to treat sun-damaged skin, wrinkles, and unwanted hair growth without damaging the surface of your skin. IPL is often marketed as a lunchtime treatment.

The idea is that after a short session you should be able to return to work, with no downtime, bruises, or special after-care. However, real experience of those who've tried IPL, including a testimonial by a RealSelf member, suggests that in some cases IPL can cause redness and scabs. Additionally, sun exposure is not a great idea after an IPL treatment.

Make sure you go to a highly reputable dermatologist or IPL operator. Poorly trained IPL device operators are more likely to make a mistake that can lead to burns or less satisfactory results.

IPL Treatment

The IPL device can generate light energy at various frequencies in order to treat these different skin problems. For this reason, many dermatologists indicate that they prefer IPL over laser therapy. Certain frequencies destroy dark skin regions, while other frequencies will increase the melanin in your skin to re-pigment skin.

IPL can encourage new collagen growth (that causes wrinkles to diminish in appearance), remove age spots or brown spots, and decrease skin redness. Researchers at Brown University found that IPL is also highly effective at removing visible signs of birthmarks and facial lesions.

Most IPL units have a hand-held wand so the dermatologist can deliver short energy pulses to a small area of skin. During your session you'll wear protective goggles as if you were headed to a tanning bed. The area of your skin that's being treated is then covered in a gel, and the wand will be pressed against your skin. The IPL unit emits light energy pulses that get absorbed by your skin without damaging nearby healthy skin tissue. Most treatments last less than 30 minutes.

IPL Options

Common names you'll see IPL advertised as include: Intense Pulsed Light, IPL Laser, FotoFacial, EpiLight, MultiLight, Facial Light, and Photo Facial.

A popular IPL treatment is called Photoderm, which is most effective for people with light-colored skin. If you have darker skinned (even if you are normally fair-skinned but have a tan), you are poor candidates for this procedure because you will be at greater risk of your skin being burned.

ReLume Repigmentation is an IPL treatment that works to stimulate the production of melanin to restore lost pigment for stretch marks and post surgical scars and for vitiligo patients.

IPL Side Effects

Even though the IPL energy bursts do not break the skin, they can be painful. Anesthesia is not required, but you may want to request a numbing cream to minimize discomfort. Dermatologists often describe IPL treatment as feeling like a rubber band snapping against your skin. Some people who have undergone IPL treatment say it can be more uncomfortable, and can even inflict stinging pain.

Some common complications include - but may not be limited to - red, slightly puffy, or occasionally blistered skin, burns or other injuries from the heat, scarring, and skin discolorations. In some patients, reactivation of a previous herpes simplex cold sore may occur. A doctor is the best source of information for getting a complete understanding of the potential risks and complications from IPL.

IPL Hair Removal

If you have unwanted dark hair and you're sick of waxing, tweezing, and shaving, you may want to consider IPL (light colored hair does not respond to IPL treatments). IPL hair removal works by delivering energy to the dark hair follicle. The energy heats up the follicle and eventually destroys the hair-growing structure. That said, according to the UK Department of Health, IPL does not provide permanent hair removal. Laser hair removal may offer better results.

IPL Hair Removal vs. Laser Hair Removal

According to the American Academy of Dermatology, lasers can work broader areas of skin than IPL. As a result, IPL hair removal is often more time consuming and costly than laser hair removal. This may explain why you'll find dozens of laser hair removal centers in your area with constant advertised discounts and relatively few IPL hair removal providers

Beijing starlight science & technology development co., ltd

ST-B Pigmentation reduction and hair removal machine

[ST-B] [China] Posted Date: November 23, 2007 Free Member | Rate this company

Description

(1)Treatment principle The IPL skin-rejuvenating system emits varied wavelength, intense pulse, and broad spectrum light. It can permeate the cuticle to the derma and take effect on the abnormal pigment and vessel such target tissues to break the abnormal pigment cells, close the abnormal blood vessels, stimulate the proliferation of the collagen and improving the rearrangement of elastic fibers, finally achieving the purpose of pigment removal and skin rejuvenation. (2)Features of system 1. Broad-spectrum, non-invasive photodynamic therapy 2. Double handles, selectively absorption, aiming at different symptoms 3. Strong penetrating force: decomposing the deep pigment effectively 4. Effectively filtering the harmful light with triple light filter systems 5. Three cooling systems: Built-in Circle water-cooling system Air cooling system Semiconductor cooling device 6. Silver catoptric system: remarkable optical effect 7. Water-electricity separator inside: insuring the system safety 8. Double counter system: insuring the quality 9. LCD screen with low failure rate 10. Magnetic drive pump controlled water circulation: lower noise, longer lifetime 11. Smaller handle with the same spot size 12. Automobile paint appearance: showing the quality (3)Indications 1. Pathology of the pigment: chloasma, sun burn, speckles, age spot, coffee spot and pigmentation 2. Removing unexpected hair on lips, armpits, hairline, bikini, and limbs 3. Pathology of the blood vessel: red blood streak, bottlenose 4. Improve the rough skin, enhance skin elasticity, rejuvenating the skin 5. Repair various scars and acnes

Other Information

Location: China

Minimum Order: 1

Price for Minimum Order:

(This price is only for minimum order, for large quantities, please contact)

Sample Available: No

Pseudocatalase For Vitiligo

Pseudocatalase has recently become a drug of interest for patients suffering from vitiligo. Vitiligo affects 3 to 6 million people in the United States today, however, many are unaware of this rarely talked about skin condition.1 Also known as leukoderma, vitiligo is a pigmentation disorder of the skin resulting in the formation of irregular white spots or patches, despite the retention of the skins normal texture.1,2 It is a progressive condition that destroys the melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth, nose, genital and rectal areas) and the retina (inner layer of the eyeball).2 Although its cause is not greatly understood, vitiligo is non-contagious often affecting all races and both sexes equally. It may appear at any age and is believed to be hereditary.

The primary goal when treating vitiligo is to restore the skins function to as close to normal as possible and to improve the patients appearance and overall quality of life. Today, vitiligo is a treatable condition, though it can take years for patients to see results. The choice of therapy, however, ultimately depends on the degree of white patches and how widespread they are on a patients body.2 With the recent discovery of the role elevated hydrogen peroxide (H2O2) levels combined with low catalase activity play in the skin of patients afflicted by vitiligo, a new treatment involving a topical cream consisting of pseudocatalase and calcium was developed. Originally created by Dr. Karin U. Schallreuter and her colleagues, a professor of clinical and experimental dermatology at the University of Bradford in West Yorkshire, England, patients were told to apply the cream twice daily and to expose themselves to the sun or to a short-term narrow-band of ultraviolet B (UVB) phototherapy

Protopic

Protopic (Tacrolimus) is a newer medication that has is prescribed by some

dermatologists for vitiligo. Protopic, an ointment made by Fujisawa Pharmaceuticals in Japan, works to down-regulate (suppress) the immune response in an area of

vitiligo. Studies have shown repigmentation success in some (but not all) people who use it. Protopic ointment is currently indicated for the treatment of moderate to severe atopic dermatitis (eczema). Currently, the approved label has no specific mention of vitiligo, and the Food and Drug Administration (FDA) regulatory requirements do not support the clinical investigation or use of Protopic in vitiligo at this time. The product

is available in .03% strength and the stronger .1% strength . The risks and side effects of Protopic are not entirely known, and should be discussed with your doctor. A black box warning was added to Protopic in early 2005, warning that there had been several reported cases of lymphoma or skin cancer following its use. Some doctors dispute these findings, suggesting the numbers of cancer and lymphoma

cases reported are no higher than would be seen in the general population. Many experts believe that vitiligo is the result of the immune system improperly generating antibodies to one's own pigment cells, which then attack and kill or

weaken such cells. Immunomodulators may inhibit immune cells (t-cells) from attacking the pigment cells.

Surgical treatment :

Patients who have small areas of vitiligo with stable activity are candidates for surgical transplants.

Punch grafts

o Punch biopsy specimens from a pigmented donor site are transplanted into depigmented sites.

o Repigmentation and spread of color begin about 4-6 weeks after grafting.

o The major problem is a residual, pebbled, pigmentary pattern.

Minigrafts

o Small donor grafts are inserted into the incision of recipient sites and held in place by a pressure dressing.

o The graft heals readily and begins to show repigmentation within 4-6 weeks.

o Some pebbling persists but is minimal, and the cosmetic result is excellent.

Suction blister o Epidermal grafts can be obtained by vacuum suction usually with 150

mm Hg. o The recipient site can be prepared by suction, freezing, or

dermabrasion of the sites, 24 hours before grafting. o The depigmented blister roof is discarded, and the epidermal donor

graft is placed on the vitiliginous areas.

Autologous cultures and autologous melanocytes grafts:

Abstract

BACKGROUND \ Surgical treatment of vitiligo is indicated when lesions are localized in poorly responding areas.

OBJECTIVES \ The objectives were:

(1) to establish the melanocyte culture obtained from the epidermis of vitiligo patients for future treatment;

(2) to estimate the influence of selected factors on the formation of suction blisters and the results of culture;

(3) to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus psoralen

and ultraviolet A (PUVA) therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA-therapy (CP), and only PUVA therapy (OP).

METHODS \ Forty patients were qualified for the study. The roofs of the suction blisters were used as a melanocyte source for culture establishment or were directly transplanted.

RESULTS \ The CMP procedure was successfully performed on only 10 of 20 patients because of the difficulties in cell culture establishment. The SBP method was carried out on all 20 patients. A total lack of effectiveness was found in CP and OP methods.

CONCLUSIONS \ The effectiveness of culture depends on time of suction blister forming, phototype, and previous PUVA therapy. This study demonstrated the advantage of the SBP over the CMP method.

WO/2006/005977) NOVEL METHOD FOR CULTURING KERATINOCYTES, MELANOCYTES AND FIBROBLASTS FOR SKIN GRAFTING

In summary, it can thus be stated that skin cell transplantations in connection with the methods and compositions according to the present invention disclosed herein not only much simpler to carry out as compared to other methods, but in addition also significantly promote the success of the transplantation or the repigmentation in question. This aspect is in particular important for example in the context of vitiligo therapy. Finally, it was also found that autologous skin cell transplants comprising cultured autologous keratinocytes and/or melanocytes and/or fibroblasts in a carrier matrix exhibiting plasticity and a gel-like consistency also exhibit very good transport and application properties. Thus, the inventive keratinocyte, melanocyte and fibroblast suspensions are useful for the in situ production of (cell) transplants, e.g. autologous (cell) transplants. The invention particularly relates to the use of transplants for treating patients with chronic ulcers of different origins, with burn wounds, post-traumatic wound defects, and for covering defects of extensive, benign, naevoid skin changes and of scars after prior dermabrasion, vitiligo, piebaldism, etc. In chronic leg ulcers and extensive two and three degree burns autologous keratinocyte transplantation is a new line of treatment instead of conventional split thickness grafts. In such cases autologous keratinocytes are prepared and cultured from the patient's own skin. Donor site for such skin samples is usually the groin, the upper leg and arm. Since hair follicles contain a higher number of undifferentiated keratinocytes, keratinocyte cultures established from hairy scalp have a better mitotic potential, making them more suitable for keratinocyte transplantation. The invention allows to produce transplants, which contain keratinocytes or melanocytes or fibroblasts, production of the keratinocyte composition or melanocyte composition or fibroblast composition, and to produce collagen-free two-constituent compositions.

Micropigmentation o Tattooing can be used to repigment depigmented skin in dark-skinned

individuals.

Therapeutic tattoos for leukoderma and vitiligo

Dr. Kalpana Sarangi fills up the patches caused by leukoderma and vitiligo with therapeutic tattoos, which are similar to the

colour of the skin of the person concerned. However the therapeutic tattoo can only be done if disease hasnt been spreading for the last six months and is therefore stable.

So, first you should be under medication to arrest the disease and receive positive results. Also, anyone who is diabetic, has any infection on the depigmented area, has a pacemaker or is HIV-

positive cannot get a tattoo.

Tattooing is a quick process. One square inch of the skin just requires 30 minutes to tattoo. Only a local anesthetic cream is used. One shouldnt wash the tattoo for seven days or wash it sparingly. Also one must take

care to avoid infections during the tattoo healing period. If there is infection there will be scab formation and the whole tattoo will come out.

Antibiotics and anti-inflammatory medication are prescribed for a week post-treatment.

Skin grafting is yet another way of treating leukoderma and vitiligo patches. The skin is taken from the buttocks or the thighs. Skin grafting is

a more effective way of treating these white patches and also more expensive than tattooing. So one can choose tattooing or grafting based on what she can afford.

LASER TATTOO REMOVAL UNITS (ALL COLORS)

BIRTHMARKS - AGE SPOTS - FRECKLE - SOLAR - NEVUS

MD-TT12

BENEFITS

Start your new business or upgrade your equipment. Why spend between $100.00 and $200.00 per session when you can own your own unit for you, your family and friends. Get a new unit at the wholesale price. Upgrading your machine? We also have the solution for you. Over the past ten years, Q-Switch YAG lasers have been shown to be very effective at

removing tattoos. Q-Switch YAG lasers deliver very high power but very short pulses of laser light, which pass through the skin and break up the particles of tattoo pigment, which are then destroyed by the body, by white blood cells and the lymphatic system. This is also the reason why tattoos usually fade over time. Q-Switch YAG laser treatments make the pigment particles small enough to be destroyed much faster. Multiple treatments, given about one month apart are necessary for best results. What is Q-Switch YAG Laser treatment? This is a laser procedure in which a beam of light at a specific wavelength is applied to the skin and is absorbed by colored pigments in the skin, including melanin and tattoo pigments. How many treatments will I need? Light pigmentation like freckles, age spots and sun marks may disappear after a single treatment. Most pigment will disappear after two treatments. Tattoo removal will require 2 to 5 treatments depending on the size of the tattoo and the different colors used. It has been observed in about 20% of cases that a dark spot appears once the scab has fallen off after treatment. Normal pigmentation of the skin should be achieved within 2 to 3 months. Get an extra discount! Dont overspend your money, we have the solution for you. Get the service you deserve! If we cannot fix your unit on time, we will simply replace it by another one. Many other distributors or suppliers are offering Q Switch Yag systems. The technology may look the same but is really not. The price seems attractive but: Does that machine have different cooling system? Does it have a dedicated water tank to cool down the Handpiece? Of course not! Same for your laser. You need to work without having to stop you machine and a fan is not enough. Some suppliers answer to that question by telling you that yes, they have a cooling system but they are only talking about fans. You absolutely need to have a dedicated water tank to cool down the handpiece or you will need to stop your unit during a treatment because your handpiece will get too hot and your unit will overheat. Are you looking at a North American unit or is it a Chinese unit? Are you on the professional market to get a reliable machine and the service you deserve? How much output power does the machine have? What is the frequency, how fast can you shoot? These are real questions you should ask and answers you should get before making your decision. A lot of supplier pretend to be in the professional market by offering units with a maximum output at 500mj and a maximum frequency at 3. The MD-TT10 goes up to 1000mj, and has a frequency from 1 to 6. The unit works at 532 namometers and 1064 nanometers. Both crystals are delivered with the unit as well as 1 pair of goggles, 1 pair of protective eyewear and a foot pedal. The TT12SC Shots and Vaccums the pigment for faster results. This is a real professional machine. The fastest you treat the better it is. Get trained like never bebore! A visit to our office for a free 2 day training, Telephone assistance, detailed user manual are just a few advantages of dealing with Medicamerica. Deal with a manufacturer and buy from Medicamerica. Get the wholesale price.

Laser Wavelength : 1064nm / 532nm

Maximum Laser output

energy : 1000mJ / 400mJ Up to 1000 volts

Laser Pulsed Width :

Indication Light : 5mW semiconductor Laser

Yag Laser : Shots and Vaccums the pigment for faster results.

Vaccum : Pressure Gauge Control

Vaccum : Switch control. ON or OFF. Unit can be operated with or without the vaccum option.

Output : Laser Gun activated by Foot Pedal

Environmental

temperature : 10 - 30 Degrees Celcius

Power supply : AC 110V-240V 50-60Hz

Frequency : 1-6 Hz

Weight : 28Kgs 60Lbs

Dimension : 102cm HX45 WX28cm D or 40 X 18 X 18 inches

o Color matching is difficult, and the color tends to fade. Skin can be dyed with dihydroxyacetone preparations, though the color match is often poor.

Dihydroxyacetone

Fake tanners, sunless tanners or preparations used to imitate a tan are becoming much more popular as people are becoming more aware of the dangers of long term sun exposure and sunburn. There are now several ways of achieving a tan without having to expose your skin to the sun, these include:

Stainers (dihydroxyacetone) Bronzers (dyes) Tan accelerators (tyrosine and psoralens) Solaria (sunbeds and sunlamps)

The sunless tanner dihydroxyacetone (DHA) is currently the most popular way of gaining a tan-like appearance without sun exposure as it carries less health risks than any of the other available methods. To date, it is the only active ingredient approved by the US Food & Drug Administration (FDA) for sunless tanning.

How does DHA work?

All effective sunless tanners contain DHA. It is a colourless 3-carbon sugar that when applied to the skin causes a chemical reaction with amino acids in the surface cells of the skin producing a darkening effect DHA does not damage skin as it only affects the outermost cells of the epidermis (stratum corneum).

What formulations of DHA are available?

There are many self-tanning preparations containing DHA on the market and many will claim to be best formulation available. Consider the following points when deciding upon the preparation most suitable for you.

Concentrations of DHA can range from 2.5 to 10% or more (mostly 3-5%). This may coincide with product ranges that list shades as light, medium, or dark. A lower concentration (lighter shade) product may be better for new users as it is more forgiving of uneven application or rough surfaces.

Some formulations will also contain moisturisers. Users with dry skin will benefit from this.

Alcohol based preparations will be more suitable for oily-skinned users. DHA provides some protection against UV rays. To increase UV protection some

products also include a sunscreen. Alpha hydroxy acids promote the sloughing off of excess dead skin cells so should

improve the evenness of colouration. Other ingredients may be added to facilitate application or to make the colour last

longer. Consult your pharmacist for advice.

Who should use DHA-containing preparations?

Anyone wanting a tanned appearance without having to expose himself or herself to UV light can use these preparations. However, the final look will depend on the formulation used, individual's application technique, and the user's complexion type.

Clinical uses may be for vitiligo, camouflage of some skin irregularities such as leg spider veins, or possibly as protection for individuals with certain photosensitivity disorders.

How do you use DHA-containing preparations?

The final result obtained from DHA self-tanning preparations is highly dependent upon the ind