Melanocytes are not completely absent in the depigmented epidermis Comment: A subpopulation of “resistant” epidermal melanocytes can persist independent of disease duration Repigmentation can always occur independent of disease duration and with non-perifollicular pattern

1. Vitiligo Physical Treatments Torello Lotti University Unit of Dermatology University of Florence Florence, Italy

9. Monochromatic treatment of vitiligo XTRAC Xenon-Chloride Gas Excimer Laser (308 nm) EXCILITE Xenon-Chloride Monochromatic Excimer Light (308 ± 1 nm) BIOSKIN Narrowband UVB (311nm)

13. BEFORE AFTER 20 TREATMENTS J Korean Med Sci 2005; 20: 273-8

15. BIOSKIN ® device simplified scheme 1) UVB generator 2) Visible and UV 4) Interference Filter 3) Time controlled Leaf Shutter 7) Specific Optical Fiber 5) N.B. UVB 8) Vitiligo patch 6) Iris Diaphragm

16. BIOSKIN ® Microphototherapy

17. BIOSKIN ® emission spectrum Intensity 10-100 mW/cm 2 DEM=40 mW × 10 sec=400mJ/cm2

20. Results of a study on 734 patients after 2 years of BIOSKIN ® treatment

23. CONCLUSION? VITILIGO Both Narrow Band UVB Excimer Laser and Narrow Band UVB Light show similar results in similar time of treatment even if they can be used only in limited skin surfaces.

27. Vitiligo combination therapy: our experience

28. Group 1 BIOSKIN ® alone Group 2 0.1%Tacrolimus+ BIOSKIN ® Group 3 1% Pimecrolimus+BIOSKIN ® Group 4 Betamethasone dipropionate 0.05%+BIOSKIN ® Group 5 Calcipotriol ointment 50mcg/g+BIOSKIN ® Group 6 10% L-phenylalanine+BIOSKIN ® Group 7 0.1% Tacrolimus alone Group 8 Group 1 Group 9 Betamethasone dipropionate 0.05% Group 10 Calcipotriol ointment 50mcg/g alone Group 11 10% L-Phenylalanine alone

30. Percentage of repigmentation in patients treated with BIOSKIN ® alone or in combination, or with active topicals alone. Treatment (n° of patients) Excellent (>75%) Marked (50-75%) Moderate (25-50%) Minimal (<25%) Group 1: BIOSKIN ® alone (100) 72% 19.8% 4.6% 3.6% Group 2: 0.1% Tacrolimus + BIOSKIN ® (59) 76.5% 18.2% 3.3% 2% Group 3: 1% Pimecrolimus + BIOSKIN ® (63) 76.1% 20.1% 2.7% 1.1% Group 4: Betamethasone dipropionate 0.05% + BIOSKIN ® (28) 90.2% 6.7% 2.2% 0.9% Group 5: Calcipotriol ointment 50 mcg/g + BIOSKIN ® (60) 75.6% 14.1% 7.4% 2.9% Group 6: 10% L-Phenylalanine + BIOSKIN ® (60) 74.8% 11.3% 10.1% 3.8% Group 7: 0.1% Tacrolimus alone (22) 61% 16.1% 18.4% 4.5% Group 8: 1% Pimecrolimus alone (19) 54.6% 18.4% 21.7% 5.3% Group 9: Betamethasone dipropionate 0.05% alone (23) 71.2% 25% 2.1% 1.7% Group 10: Calcipotriol ointment 50 mcg/g (18) 59.1% 10.6% 27.1% 3.2% Group 11: 10% L-Phenylalanine alone (18) 29.3% 8.1% 55% 7.6%

31. Repigmentation rates: beginning of repigmentation (weeks) as assessed by clinical evaluation

32. Repigmentation rates and final repigmentation results: visual comparison of different treatment groups as assessed by clinical evaluation

36. Thank you for your attention professor @ torellolotti.it Future combination treatments are in the pipeline