Journal of Dermatology and Dermatologic Diseases

Background: Silymarin, a flavonoid with antioxidant activities and extracted from milk thistle (Silybum marianum), previously used for its liver protection activity has been recently tested for dermatologic disorders Objectives: Our purpose was to summerize all the dermatologic oriented in vitro and in vivo experiments and clinical trials on silymarin. Methods: A systematic review of the literature was conducted to investigate all the available data and summarize all the clinical trials, case reports and original articles on silymarin. Two major databases (PubMed and Google Scholar) were searched. Results: We have gone over about 26 articles. Silymarin, has been shown to have anticarcinogenic effects against ultraviolet radiation which makes it an ideal agent for supplementing sunscreens protection. Silymarin has also been effective in overcoming rosacea, melasma, vitiligo and psoriasis. Conclusions: Even though there are some promising results with silymarin in dermatologic conditions but its human efficacy is not sufficiently explored as yet.

Treatment of melasma remains challenging due to frequent relapses and the occurrence of post-inflammatory hyperpigmentation (PIH) following many interventions. Treatment goals are inhibition of melanin synthesis and transfer by sunscreens, sun avoidance and the use of bleaching agents on one hand and removal of already present pigment by peeling, lasers and light on the other hand. Triple combination creams (TCC) (also known as Kligman’s formula utilizing hydroquinone and modifications of Kligman’s formula) remain the mainstay of treatment. Newer bleaching agents derived from plants and synthetic compounds have been introduced and many of them are promising safe substitutes for hydroquinone. Peeling agents especially superficial and medium depth peels are effective treatment modalities for melasma. Newer peeling agents are less irritating and may thus lead to fewer side effects. Q-switched lasers, which target melanin, have led to PIH until the innovation of “laser toning” and fractional Qswitched ruby, which have better outcomes. Fractional non-ablative and ablative lasers are useful at lower fluencies. Pulsed dye laser, which targets the vascular component in melasma, is promising with less melasma rebound. Combinations of the above-mentioned modalities usually have a better treatment outcome than either alone. This review will focus on the more recently introduced therapies.

Melanocytes are the site of melanogenesis, a chemical reaction leading to the production of melanin. By its characteristics, melanogenesis submits the melanocytes to constant oxidative stress, which can be an essential causative factor for various pigmentary diseases such as vitiligo, melasma or melanoma. The same initial cause, oxidative stress, can lead to either hypopigmentation, or hyperpigmentation or even a carcinogenic process. Phototypes present different susceptibilities to each of these diseases, originally caused by a prooxidant/antioxidant imbalance. In any case, administration of antioxidants appears to be helpful in their treatment

Melasma is one of the most common aesthetic problems in Asians and is one of the most difficult conditions to be treated. In the past result after laser treatment was usually believe to be unpredictable. This believes was based on anecdotal reports with variable laser parameters. In order to get better and long lasting result, we need to understand biology of melanin synthesis, pathogenesis of melasma, laser / light tissue reaction, sun screen and effect of whitening agents.

Two major problems of the contemporary health services of every country are necessary to be decided are low quality of health care and unequal access to health services. One way to solve this problem is to develop such contemporary direction as telemedicine. Telemedicine is a method of providing health care services, where distance is a critical factor. Services by representative of all medical specialties using information and communications technology after receiving information required for diagnosis, treatment and prevention of disease. In teledermatology telecommunications technology are used to share medical information (for skin diseases and skin tumors) at a distance using audio, video and data transmission. Many projects of teledermatology are implemented throughout the world. One promising project is dedicated to the early detection of skin cancers in New Zealand. Experience of some countries, including Ukraine and Malta, shows that methods of telemedicine may be promising in the project “Euromelanoma.” Teledermatology is a very promising branch of medicine. Figuratively speaking, we are scratching the surface only at present. Certainly, its further development will improve the quality and accessibility of health care, especially in remote from the centers of the regions, throughout the world.

Vitiligo has long been recognized as a difficult disease to treat as most treatments throughout history have been inadequate. In addition to traditional medical practices, alternative treatments have been used for centuries to help with the disease

Vitiligo is accompanied by oxidative stress which is likely causative for disease onset. Numerous efforts were undertaken to reveal abnormalities in antioxidant system in vitiligo. Vitamin E is one of the major non-enzymatic components of antioxidant system, and several studies addressed a question of vitamin E deficiency in vitiligo, with controversial conclusions on its presence. Aiming to solve this discrepancy, we analyzed plasma vitamin E level in a cohort of non-segmental vitiligo patients. Although we failed to reveal gross plasma vitamin E level abnormalities, our data suggest that there is subgroup of vitiligo patients with low, close to lower reference value, level of plasma vitamin E, while plasma vitamin E level in remaining patients follows that in general population. While this stratification of vitiligo patients’ needs to be confirmed in large-scale studies, existence of a subgroup of vitiligo patients with “low vitamin E” status might reason inconsistency in previous reports on plasma vitamin E concentration in vitiligo patients. Observed lack of acute vitamin E deficiency in vitiligo patients is in line with reported moderate, if any, effect of oral vitamin E supplementation in complex therapy of vitiligo on extent of repigmentation. At the same time, adjuvant to phototherapy oral vitamin E has beneficial effect in terms of faster response, shorter treatment course and less frequently encountered erythema, likely due to coping with photo-oxidative stress elicited by ultraviolet. Finally, patients from “low vitamin E” group might benefit from vitamin E supplementation through maintaining proper antioxidant system balance thus precluding from oxidative stress-triggered disease recurrence due to lowered vitamin E level.