Case Report
Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation
Melpone Komnitskia,
, Angelo Komnitskib, Amilton Komnitski Juniorc, Caio César Silva de Castrod
Autor para correspondência
a School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
b School of Medicine, Universidade do Vale do Itajaí, Itajaí, SC, Brazil
c Private Rheumatology Clinic, Curitiba, PR, Brazil
d Department of Dermatology, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
Lido
7207
Vezesque se leu este artigo
3131
Total PDF
4076
Total HTML
Compartilhar estatÃsticas
array:24 [ "pii" => "S036505962030115X" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.08.032" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "188" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:19 [ "pii" => "S2666275220301867" "issn" => "26662752" "doi" => "10.1016/j.abdp.2019.08.011" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "188" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "pt" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Repigmentação parcial de vitiligo com tofacitinibe sem exposição à radiação ultravioleta" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "473" "paginaFinal" => "476" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 763 "Ancho" => 1675 "Tamanyo" => 120142 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">(A)</span>, antes do tratamento, inúmeras máculas hipocrômicas. <span class="elsevierStyleBold">(B)</span>, Após dois anos de tratamento, a repigmentação está quase completa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Melpone Komnitski, Angelo Komnitski, Amilton Komnitski Junior, Caio César Silva de Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Melpone" "apellidos" => "Komnitski" ] 1 => array:2 [ "nombre" => "Angelo" "apellidos" => "Komnitski" ] 2 => array:2 [ "nombre" => "Amilton Komnitski" "apellidos" => "Junior" ] 3 => array:2 [ "nombre" => "Caio César Silva de" "apellidos" => "Castro" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962030115X" "doi" => "10.1016/j.abd.2019.08.032" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962030115X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301867?idApp=UINPBA00008Z" "url" => "/26662752/0000009500000004/v2_202008070652/S2666275220301867/v2_202008070652/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059620301197" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.11.008" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "191" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "477" "paginaFinal" => "479" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 1007 "Tamanyo" => 148207 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple, grouped lesions of irregular size with purulent discharge.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristian Morán-Mariños, Wendy Nieto-Gutierrez, Josmel Pacheco-Mendoza" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cristian" "apellidos" => "Morán-Mariños" ] 1 => array:2 [ "nombre" => "Wendy" "apellidos" => "Nieto-Gutierrez" ] 2 => array:2 [ "nombre" => "Josmel" "apellidos" => "Pacheco-Mendoza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301892" "doi" => "10.1016/j.abdp.2020.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301892?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301197?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301197/v3_202008041755/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059619301515" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.02.007" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "98" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 12 "formatos" => array:2 [ "EPUB" => 2 "PDF" => 10 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Successful therapeutic approach in a patient with elephantiasic pretibial myxedema" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "469" "paginaFinal" => "472" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2132 "Ancho" => 905 "Tamanyo" => 162960 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance of the right foot and ankle after 11 months of intralesional corticosteroid therapy. Almost total reduction of nodules and edema, making the appearance resemble the contralateral foot.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina Ferreira, Luciana Helena Zacaron, Annair Freitas do Valle, Aloisio Carlos Couri Gamonal" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marina" "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "Luciana Helena" "apellidos" => "Zacaron" ] 2 => array:2 [ "nombre" => "Annair Freitas do" "apellidos" => "Valle" ] 3 => array:2 [ "nombre" => "Aloisio Carlos Couri" "apellidos" => "Gamonal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275219300864" "doi" => "10.1016/j.abdp.2019.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275219300864?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059619301515?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000004/v3_202008041755/S0365059619301515/v3_202008041755/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "473" "paginaFinal" => "476" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Melpone Komnitski, Angelo Komnitski, Amilton Komnitski Junior, Caio César Silva de Castro" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Melpone" "apellidos" => "Komnitski" "email" => array:1 [ 0 => "melki12@globo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Angelo" "apellidos" => "Komnitski" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Amilton" "apellidos" => "Komnitski Junior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Caio César" "apellidos" => "Silva de Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "School of Medicine, Universidade do Vale do Itajaí, Itajaí, SC, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Private Rheumatology Clinic, Curitiba, PR, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Dermatology, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 761 "Ancho" => 1674 "Tamanyo" => 126534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Prior to treatment, numerous white macules. (B) After two years of treatment, repigmentation is nearly complete.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vitiligo is a chronic autoimmune disease which affects around 0.5% of the population.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It presents with macules and achromic and/or hypochromic patches on any region of the body. It is a condition that has triggering factors, such as burns and emotional stress, in addition to genetic predisposition. Treatment is performed with topical and systemic corticosteroids, calcineurin inhibitors, and phototherapy with narrow band ultraviolet (UV) B radiation and phototherapy with UVA associated with psoralen. However, these treatments have limited efficacy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Several articles have shown that blocking the Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway with tofacitinib may produce repigmentation, provided frequent exposures to the sun or phototherapy.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 40-year-old female patient with comorbid rheumatoid arthritis and vitiligo. Her brother and mother have a positive history for vitiligo. The vitiligo condition started in 2012, with hypochromic and achromic macules in the left inguinal region.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the same year, she sought medical attention. Phototherapy with narrow band ultraviolet B radiation and systemic corticosteroid mini-pulse was performed. At that time, she reported partial improvement for a few months, but other lesions began to appear on her face, neck, elbows, hands, and feet, diagnosed as common vitiligo. She stopped phototherapy treatment in 2013 because she saw little improvement, and had no dermatological maintenance treatment. In 2014, joint pains in her hands started and she received a diagnosis of rheumatoid arthritis. Some previous treatments were reinstated, such as hydroxychloroquine, deflazacort, and loxoprofen, but they did not lead to remission of the arthritis. In 2017, a new treatment was introduced to treat the rheumatologic condition with only tofacitinib 5<span class="elsevierStyleHsp" style=""></span>mg, twice a day, which obtained a satisfactory result. Coincidentally, after eight months of medication use, the patient noted improvement of the macules and patches, with formation of several islets of repigmentation in the hands and face, without being exposed to any source of ultraviolet radiation, since the patient uses intense photoprotection with sunscreens, rarely exposes herself to the sun, and did not take any trips to the beach during this time of treatment so as not to exacerbate the vitiligo. After two years, complete repigmentation of the forehead and perilabial macules can be noted, as well as partial repigmentation in the posterior region of the neck and upper chest while the patient is still being treated with tofacitinib.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">The pathophysiology of vitiligo has still not been fully elucidated, but it is believed that the IFN-γ and the CD8<span class="elsevierStyleSup">+</span> T cells play a key role in the destruction of melanocytes.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a> Evidence shows that the CD8<span class="elsevierStyleSup">+</span> T lymphocytes produce IFN-γ, which will express CXCL9 and CXCL10 chemokines by keratinocytes, resulting in the recruitment of more CD8<span class="elsevierStyleSup">+</span> T lymphocytes, and resulting in the destruction of melanocytes by IFN-γ and perforin/granzyme.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2013, tofacitinib was approved by the National Sanitary Surveillance Agency for the treatment of rheumatoid arthritis as it acts as an inhibitor of the JAK kinase family of enzymes, mainly JAK1 and JAK3.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,5</span></a> As such, it interrupts the production of IFN-α and IFN-γ, and some interleukins such as IL-2 and IL-6, decreasing the inflammatory response.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> However, it was also seen that it was an alternative for patients with vitiligo.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2015, Craiglow et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> reported the first possible mechanism of action of tofacitinib on vitiligo, which proposed that since the signal transduction of IFN-γ occurs through JAK 1/2, the use of an inhibitor of JAK 1/3 could, in fact, block IFN-γ signalling, which would reduce CXCL10 expression, interrupting the vitiligo activity. Kim et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> in a more recent case report, showed that in order to have satisfactory results, sun exposure or phototherapy would be necessary simultaneously with drug treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In a retrospective study of ten vitiligo patients on tofacitinib, Liu et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> also defended the idea that treatment with the JAK inhibitor would require exposure to light. What was proposed is that for repigmentation to occur, two events need to happen: (1) immunosuppression of inflammation of the skin, which is obtained with the use of tofacitinib and (2) stimulation of melanocytes, either by exposure to sunlight or through narrowband UVB.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the case presented, the patient only used 5<span class="elsevierStyleHsp" style=""></span>mg of tofacitinib twice a day, with improvement in hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), face (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), chest (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and mainly in the cervical region (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) where there is no sun exposure. These results are in contrast to the latest case reports, showing that tofacitinib can indeed be effective as monotherapy. It is noteworthy that, unlike the reports and studies on the subject, in which the average treatment time was 5.38 months,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,4,7,8</span></a> the present patient used the medication long-term, showing that longer treatments will probably be necessary for spontaneous repigmentation to occur after the autoimmune attack ceases, without the patient being exposed to UV radiation to aid in therapy. However, studies of larger populations using tofacitinib who are exposed (or not) to UV radiation are necessary, in order to demonstrate the actual efficacy of this medication.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Melpone Komnitski: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Angelo Komnitski: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Amilton Komnitski Junior: Conception and planning of study, drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Caio César Silva de Castro: Approval of the final version of the manuscript; conception and planning of study, drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in design of the study; participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1370005" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1259077" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-12" "fechaAceptado" => "2019-08-18" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1259077" "palabras" => array:3 [ 0 => "Janus kinases" 1 => "Phototherapy" 2 => "Vitiligo" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vitiligo is a disease that causes macules and achromic and/or hypochromic patches, which can affect from small areas to the entire tegument. Treatment options are few and are generally ineffective. Recently, some case reports have appeared which show positive results with the use of Janus kinase inhibitors associated with phototherapy. This report details the case of a patient with rheumatoid arthritis associated with vitiligo in treatment for two years, whose condition partially improved initially after eight months of oral tofacitinib at a dose of 5<span class="elsevierStyleHsp" style=""></span>mg twice a day, without exposure to ultraviolet radiation and with continuous improvement during these two years of treatment.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Komnitski M, Komnitski A, Komnitski Junior A, Castro CCS. Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation. An Bras Dermatol. 2020;95:473–6.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Private Rheumatology Clinic, Curitiba, PR, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 780 "Ancho" => 1674 "Tamanyo" => 225758 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient's hands under Wood's lamp. (A) Prior to treatment, various white macules on both hands. (B) After two years of treatment, repigmentation improvement is noted on both hands.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1310 "Ancho" => 1674 "Tamanyo" => 248431 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A and B) Prior to treatment, white macules all over the face. (C) After two years of treatment, complete repigmentation of the forehead and perilabial macules is observed, as well as an improvement of the rest of the face.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1250 "Ancho" => 1674 "Tamanyo" => 174405 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Prior to treatment, various white macules. (B) After two years of treatment, repigmentation improvement is noted.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 761 "Ancho" => 1674 "Tamanyo" => 126534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Prior to treatment, numerous white macules. (B) After two years of treatment, repigmentation is nearly complete.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of vitiligo in Brazil – a population survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Cesar Silva de Castro" 1 => "H.A. Miot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pcmr.12681" "Revista" => array:6 [ "tituloSerie" => "Pigment Cell Melanoma Res" "fecha" => "2018" "volumen" => "31" "paginaInicial" => "448" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29272074" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.Y. Liu" 1 => "J.P. Strassner" 2 => "M.A. Refat" 3 => "J.E. Harris" 4 => "B.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.05.043" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "77" "paginaInicial" => "675" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28823882" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Janus kinase inhibitors: a review of their emerging applications in dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Cinats" 1 => "E. Heck" 2 => "L. Robertson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Skin Therapy Lett" "fecha" => "2018" "volumen" => "23" "paginaInicial" => "5" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30248162" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid repigmentation of vitiligo using tofacitinib plus low-dose, narrowband UV-B phototherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Kim" 1 => "H. Heaton" 2 => "L.Y. Liu" 3 => "B.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2017.5778" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "370" "paginaFinal" => "371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29387870" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "JAK-inhibitors in dermatology: current evidence and future applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Ciechanowicz" 1 => "A. Rakowska" 2 => "M. Sikora" 3 => "L. Rudnicka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dermatol Treat" "fecha" => "2019" "volumen" => "30" "paginaInicial" => "648" "paginaFinal" => "658" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "JAK inhibitors in dermatology: the promise of a new drug class" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Damsky" 1 => "B.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.12.005" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "76" "paginaInicial" => "736" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28139263" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tofacitinib citrate for the treatment of vitiligo: a pathogenesis-directed therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.G. Craiglow" 1 => "B.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2015.1520" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2015" "volumen" => "151" "paginaInicial" => "1110" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26107994" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of light in the treatment of vitiligo with JAK-inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Joshipura" 1 => "N. Plotnikova" 2 => "A. Goldminz" 3 => "S. Deverapalli" 4 => "Y. Turkowski" 5 => "A. Gottlieb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dermatol Treat" "fecha" => "2018" "volumen" => "29" "paginaInicial" => "98" "paginaFinal" => "99" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000004/v3_202008041755/S036505962030115X/v3_202008041755/en/main.assets" "Apartado" => array:4 [ "identificador" => "80638" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000004/v3_202008041755/S036505962030115X/v3_202008041755/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962030115X?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 25 | 7 | 32 |
| 2024 Outubro | 129 | 70 | 199 |
| 2024 Setembro | 228 | 99 | 327 |
| 2024 Agosto | 213 | 125 | 338 |
| 2024 Julho | 244 | 130 | 374 |
| 2024 Junho | 204 | 96 | 300 |
| 2024 Maio | 203 | 72 | 275 |
| 2024 Abril | 164 | 79 | 243 |
| 2024 Março | 147 | 77 | 224 |
| 2024 Fevereiro | 150 | 84 | 234 |
| 2024 Janeiro | 86 | 54 | 140 |
| 2023 Dezembro | 66 | 54 | 120 |
| 2023 Novembro | 92 | 84 | 176 |
| 2023 Outubro | 76 | 102 | 178 |
| 2023 Setembro | 81 | 93 | 174 |
| 2023 Agosto | 74 | 38 | 112 |
| 2023 Julho | 76 | 31 | 107 |
| 2023 Junho | 91 | 56 | 147 |
| 2023 Maio | 55 | 20 | 75 |
| 2023 Abril | 52 | 25 | 77 |
| 2023 Março | 76 | 60 | 136 |
| 2023 Fevereiro | 49 | 32 | 81 |
| 2023 Janeiro | 60 | 51 | 111 |
| 2022 Dezembro | 68 | 40 | 108 |
| 2022 Novembro | 79 | 55 | 134 |
| 2022 Outubro | 65 | 60 | 125 |
| 2022 Setembro | 58 | 61 | 119 |
| 2022 Agosto | 42 | 45 | 87 |
| 2022 Julho | 44 | 53 | 97 |
| 2022 Junho | 53 | 57 | 110 |
| 2022 Maio | 30 | 56 | 86 |
| 2022 Abril | 34 | 45 | 79 |
| 2022 Março | 40 | 58 | 98 |
| 2022 Fevereiro | 28 | 32 | 60 |
| 2022 Janeiro | 52 | 77 | 129 |
| 2021 Dezembro | 36 | 53 | 89 |
| 2021 Novembro | 49 | 59 | 108 |
| 2021 Outubro | 50 | 76 | 126 |
| 2021 Setembro | 37 | 50 | 87 |
| 2021 Agosto | 51 | 54 | 105 |
| 2021 Julho | 42 | 48 | 90 |
| 2021 Junho | 43 | 98 | 141 |
| 2021 Maio | 70 | 96 | 166 |
| 2021 Abril | 103 | 192 | 295 |
| 2021 Março | 68 | 53 | 121 |
| 2021 Fevereiro | 21 | 24 | 45 |
| 2021 Janeiro | 38 | 13 | 51 |
| 2020 Dezembro | 26 | 20 | 46 |
| 2020 Novembro | 27 | 19 | 46 |
| 2020 Outubro | 25 | 26 | 51 |
| 2020 Setembro | 62 | 21 | 83 |
| 2020 Agosto | 22 | 10 | 32 |
| 2020 Julho | 40 | 17 | 57 |
| 2020 Junho | 19 | 12 | 31 |
| 2020 Maio | 13 | 12 | 25 |
Mostrar tudo
