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VitiligoPRPNCT04320160

Evaluation of Human Melanocytes After the Use of PRP Versus Fractional CO2 Laser in Vitiligo

A study testing Platelet rich plasma and Fractional CO2 laser in people with Vitiligo, run by Assiut University.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Vitiligo is considered the most common chronic depigmentation disorder that affects around 0.5 -2% of the world population . In Africa , its prevelance is around 0.4% and 1.22 % in Assiut . Read more about this study

Who is it for?
Ages 20 to 60 years
Conditions the study is for
Vitiligo
What is being tested?
Platelet rich plasma and Fractional CO2 laser
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
No sites listed yet
Study dates
1 Aug 2020to 24 Oct 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Age from 20-60 years old
  • Avoid using any other treatment modalities for vitiligo during the course of the study

Who cannot join

  • Pregnant and lactating women
  • local medications or laser therapy one month prior to the study
  • bleeding disorders
  • history of keloid formation
  • photosensitivity
  • seizure disorders

Trial locations and contacts

No sites are listed yet.

Reham I. ElGibaly, researcher contact

01003639560 ext. +2

dr.reham.elgibaly@hotmail.com

Dalia A. El-Gamal, Professor contact

01003343040 ext. +2

delgamal197462@gmail.com

About this study

Official title: Structural Evaluation of Human Melanocytes After the Use of Autologous Platelet-rich Plasma (PRP) Versus Fractional Carbon Dioxide Laser (Fr:CO2 Laser) in Treatment of Vitiligo: (A Histological, Immunohistochemical and Molecular Study )

Vitiligo is considered the most common chronic depigmentation disorder that affects around 0.5 -2% of the world population . In Africa , its prevelance is around 0.4% and 1.22 % in Assiut .

Treatment of vitiligo includes medical topical and systemic immune -suppressants ,phototherapy and surgical modalities .Despite the numerous treatment options , the treatment of choice is still controversial as the response is variable , unsatisfactory ,and requires a prolonged course. Therefore, new therapeutic approaches are required .

Read more

Platelet -rich plasma (PRP) is a treatment modality which has been used over the last several years in various medical and surgical fields . It is composed of high concentration of platelets , several growth factors and plasma proteins such as fibrin, fironectin ,vitronectin .This is hypothesized to stimulate keratinocytes and fibroblasts proliferation .

Another treatment modality is the fractional CO2 (Fr: CO2) laser .There are theories that fractional CO2 laser causes release of various types of cytokines and growth factors that can stimulate migration of melanocytes and act as mitogens for melanogenesis .

Melanogenesis is a complex process with involvement of multiple signaling pathways. Therefore, there have been extensive efforts to reveal the molecular mechanisms that control melanogenesis as the main step for treating hypopigmentary skin disorders .

There is yet very limited histopathological and molecular information about how the signaling networks are involved in the initiation , progression and also treatment of vitiligo disease.

Read the detailed description

Vitiligo is considered the most common chronic depigmentation disorder that affects around 0.5 -2% of the world population .In Africa , its prevelance is around 0.4% and 1.22 % in Assiut .

Vitiligo may appear at any age and affect both sexes. It is a cosmetically disfiguring disorder characterized by formation of depigmented patches of skin and /or mucosa.It has a psychological devastating effect which could lead to low self-steam and poor body image .

Vitiligo disease has three types according to the distribution of lesions ; segmental, non-segmental and mixed vitiligo .It could be classified as progressing or stable according to the activity of the disease .

Vitiligo pathogenesis includes many theories (the combination theory). The important theories include: autoimmune destruction of melanocytes, genetic predisposition , altered redox status and free radical mediated melanocyte damage , impaired melanocyte adhesion or melanocytorrhagy and heightened sympathetic response and catecholamines/ neurotransmitter mediated melanocyte damage .

The treatment of vitiligo depends upon the clinical diagnosis and usually includes two strategies.

The first strategy aims to provide stability by arresting the progression of the active disease and therefore limiting the depigmented areas. The second strategy is repigmentation of the depigmented areas Treatment of vitiligo includes medical topical and systemic immune -suppressants ,phototherapy and surgical modalities .

First line of treatment includes topical corticosteroids ,calcineurin inhibitors and phototherapy . While the second line of treatment includes systemic corticosteroids , topical calcipotriol and excimer laser .Surgical methods include skin /single-hair grafting , autologous cultured melanocyte or epidermal suspension transplantations and immunomodulators .

Despite the numerous treatment options , the treatment of choice is still controversial as the response is variable , unsatisfactory ,and requires a prolonged course . High proportion of vitiligo patients are resistant to the treatment. Therefore, new therapeutic approaches are required .

Platelet -rich plasma (PRP) is a treatment modality which has been used over the last several years in various medical and surgical fields .It is a simple and cheap new break thorough in soft tissue healing which has attracted the attention of dermatologists in the skin rejuvenation field .

PRP is composed of high concentration of platelets (seven times the normal blood level ), several growth factors and plasma proteins such as fibrin, fironectin ,vitronectin . Growth factors are known to regulate many processes such as cell migration , proliferation and differentiation .This is hypothesized to stimulate keratinocytes and fibroblasts proliferation .

Another treatment modality is the fractional CO2 (Fr: CO2) laser which represents a new modality for skin rejuvenation based on the theory of fractional photothermolysis . It has been used in treating facial photo-aging and scars . There are theories that fractional CO2 laser causes release of various types of cytokines and growth factors that can stimulate migration of melanocytes and act as mitogens for melanogenesis .

Melanogenesis is a complex process with involvement of multiple signaling pathways. Therefore, there have been extensive efforts to reveal the molecular mechanisms that control melanogenesis as the main step for treating hyperpigmentary skin disorders .

Molecular signaling pathways include p38 Mitogen-activated protein kinase (MAPK) , c-Jun N-terminal kinase /stress -activated protein kinase (JNK/SAPK) and extracellular signal-regulated kinase (ERK). These pathways are important in regulating cell proliferation ,differentiation and apoptosis of melanocytes .

Another important signaling pathway is protein kinase B ( Akt )which is involved in the differentiation of the keratinocytes. Activation of the Akt pathway triggers the differentiation process and is sustained until reaching the last stage of keratinocytes differentiation.

There is yet very limited histopathological and molecular information about how these signaling networks are involved in the initiation , progression and also treatment of vitiligo disease.

Conditions
Vitiligo
Being tested
Platelet rich plasma, Fractional CO2 laser
Medical subject headings
Vitiligo

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Platelet rich plasmaProcedure or surgery

    Also called PRP

    Eight milliliters of blood sample will be aspirated from the patient's peripheral vein, and the sample will be centrifuged at 1,500 rpm for 5 minutes.

    A 30-G needle will be used for superficial intradermal (ID) microinjections (0.1 mL per injection and space about 1 cm apart)

  • Fractional CO2 laserProcedure or surgery

    Also called Fr: CO2 laser

    Fifteen lesions will be treated by Fr: CO2 laser (10,600 nm; KES Corporation, Beijing, China).

    Scanner spot size will be adjusted based on the lesion size. Density selected will be 0.6 in the static mode.

    Two passes with minimal overlap will be delivered. The laser will be applied to the vitiligo lesion and over a thin rim of healthy skin

Study groups in NCT04320160
Study groupRoleWhat they receive
Positive control groupNo interventionInclude the thirty patients before any treatment
PRP groupActive comparatorInclude fifteen patients that will recieve PRP sessions .Patients will receive six treatment sessions with one month interval for 6 months and will be followed up after 6 months.
Receives: Procedure: Platelet rich plasma
Fractional CO2 groupActive comparatorInclude fifteen patients that will recieve FR: CO2 laser sessions.Patients will receive six treatment sessions with one month interval for 6 months and will be followed up after 6 months.
Receives: Procedure: Fractional CO2 laser

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. melanocyte cell quantification by light microscope

    Punch biopsy specimens will be stained by special immunohistochemical stain of Melan A antibody marker then counting melanocyte cells per field in five non overlapping fields using NIKON camera attached to a light microscope

    Measured: 1 year

Secondary outcomes (1)
  1. Mean improvement score by physician (MISP)

    MISP will be calculated by comparing the photographs. Physicians' clinical assessments will be done by two blinded dermatologists using a quartile grading scale (grade 1: <25%, no or minimal improvement; grade 2: 25%-49%, moderate; grade 3: 50%-74%, marked; grade 4: >75%-99%, excellent; and grade 5: 100%, complete)

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Mar 2020
  2. Study start1 Aug 2020 (estimated)
  3. Primary completion28 Feb 2021 (estimated)
  4. Study completion24 Oct 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
30 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04320160
Sponsor's protocol ID
70265
Acronym
PRP
Status last verified
Mar 2020
First submitted
19 Mar 2020
Last updated
24 Mar 2020
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Kadry M, Tawfik A, Abdallah N, Badawi A, Shokeir H. Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study. Clin Cosmet Investig Dermatol. 2018 Nov 8;11:551-559. doi: 10.2147/CCID.S178817. eCollection 2018.

    PubMed 30510437
  • Abdel-Hafez K, Abdel-Aty MA, Hofny ER. Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt. Int J Dermatol. 2003 Nov;42(11):887-92. doi: 10.1046/j.1365-4362.2003.01936.x.

    PubMed 14636205
  • Kim HJ, Hong ES, Cho SH, Lee JD, Kim HS. Fractional Carbon Dioxide Laser as an "Add-on" Treatment for Vitiligo: A Meta-analysis with Systematic Review. Acta Derm Venereol. 2018 Feb 7;98(2):180-184. doi: 10.2340/00015555-2836.

    PubMed 29110015
  • Abuaf OK, Yildiz H, Baloglu H, Bilgili ME, Simsek HA, Dogan B. Histologic Evidence of New Collagen Formulation Using Platelet Rich Plasma in Skin Rejuvenation: A Prospective Controlled Clinical Study. Ann Dermatol. 2016 Dec;28(6):718-724. doi: 10.5021/ad.2016.28.6.718. Epub 2016 Nov 23.

    PubMed 27904271
  • Calautti E, Li J, Saoncella S, Brissette JL, Goetinck PF. Phosphoinositide 3-kinase signaling to Akt promotes keratinocyte differentiation versus death. J Biol Chem. 2005 Sep 23;280(38):32856-65. doi: 10.1074/jbc.M506119200. Epub 2005 Jul 21.

    PubMed 16036919
  • Bishnoi A, Parsad D. Clinical and Molecular Aspects of Vitiligo Treatments. Int J Mol Sci. 2018 May 18;19(5):1509. doi: 10.3390/ijms19051509.

    PubMed 29783663
  • Kumar R, Parsad D, Kanwar AJ, Kaul D. Altered levels of Ets-1 transcription factor and matrix metalloproteinases in melanocytes from patients with vitiligo. Br J Dermatol. 2011 Aug;165(2):285-91. doi: 10.1111/j.1365-2133.2011.10324.x.

    PubMed 21428970
  • Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, Chen HD. Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective, randomized half-body, comparative study. Dermatol Ther. 2015 May-Jun;28(3):131-4. doi: 10.1111/dth.12202. Epub 2015 Mar 5.

    PubMed 25753514
  • Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-38. doi: 10.1002/lsm.20048.

    PubMed 15216537
  • Picardo M, Dell'Anna ML, Ezzedine K, Hamzavi I, Harris JE, Parsad D, Taieb A. Vitiligo. Nat Rev Dis Primers. 2015 Jun 4;1:15011. doi: 10.1038/nrdp.2015.11.

    PubMed 27189851
  • Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE; Vitiligo Working Group. Current and emerging treatments for vitiligo. J Am Acad Dermatol. 2017 Jul;77(1):17-29. doi: 10.1016/j.jaad.2016.11.010.

    PubMed 28619557
  • Wrotniak M, Bielecki T, Gazdzik TS. Current opinion about using the platelet-rich gel in orthopaedics and trauma surgery. Ortop Traumatol Rehabil. 2007 May-Jun;9(3):227-38. English, Polish.

    PubMed 17721419
  • Zhang Y, Cai Y, Shi M, Jiang S, Cui S, Wu Y, Gao XH, Chen HD. The Prevalence of Vitiligo: A Meta-Analysis. PLoS One. 2016 Sep 27;11(9):e0163806. doi: 10.1371/journal.pone.0163806. eCollection 2016.

    PubMed 27673680

Questions about this trial

What is this clinical trial studying?

A study testing Platelet rich plasma and Fractional CO2 laser in people with Vitiligo, run by Assiut University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 24 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Reham I. ElGibaly, researcher (01003639560 ext. +2, dr.reham.elgibaly@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

melanocyte cell quantification by light microscope (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04320160, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Mar 2020.

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