{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:20:57Z","timestamp":1787509257447,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:00:00Z","timestamp":1708819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Reflectance confocal microscopy (RCM) has a defined in vivo morphology of vitiligo and re-pigmentation. Combination therapies seem more effective than monotherapies. Objective: We aim to describe the clinical and RCM features of re-pigmentation with combined narrowband ultraviolet B (NB-UVB) and piperine-based topical treatment in localized vitiligo. Methods: Eight patients enrolled at a single center received combined treatment: topical treatment was applied twice daily + NB-UVB twice weekly for 2 \u00d7 2-month periods. Clinical changes were analyzed by the Vitiligo Noticeability Scale (VNS) and percentage of re-pigmentation. The evaluator agreement was assessed. Predefined RCM features had the presence\/absence of (i) blood vessels, (ii) dendritic cells, and the quantity of (i) an irregular honeycombed pattern and (ii) non-pigmented papillae. Clinical and RCM monitoring was performed at the baseline, 2, 3, 5, and 7 months. Results: Macules were \u201cslightly less noticeable\u201d with 25\u201350% re-pigmentation. Irregular honeycomb patterns and non-pigmented papillae were significantly less frequently observed, and in less extended areas (T1 vs. T2, p = 0.039; T0 vs. T1, p = 0.005 and T2 vs. T4, p = 0.033). Dendritic cells and blood vessels improved, with significant changes in blood vessels (T1 vs. T2, p = 0.005 and T3 vs. T4, p = 0.008). Conclusions: RCM confirms the morphological changes induced by combined treatment for localized vitiligo.<\/jats:p>","DOI":"10.3390\/diagnostics14050494","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T08:59:01Z","timestamp":1708937941000},"page":"494","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Vitiligo Treated with Combined Piperine-Based Topical Treatment and Narrowband Ultraviolet B Therapy: Follow-Up with Reflectance Confocal Microscopy"],"prefix":"10.3390","volume":"14","author":[{"given":"Cristina","family":"Bertoli","sequence":"first","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2866-0783","authenticated-orcid":false,"given":"Johanna","family":"Chester","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Cortelazzi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"},{"name":"Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Ciardo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3601-655X","authenticated-orcid":false,"given":"Marco","family":"Manfredini","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Di Nuzzo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaniko","family":"Kaleci","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pellacani","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00196 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Farnetani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41123 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15011","DOI":"10.1038\/nrdp.2015.11","article-title":"Vitiligo","volume":"1","author":"Picardo","year":"2015","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1159\/000506103","article-title":"Vitiligo: A Review","volume":"236","author":"Bergqvist","year":"2020","journal-title":"Dermatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1111\/j.1755-148X.2012.00997.x","article-title":"Revised classification\/nomenclature of vitiligo and related issues: The Vitiligo Global Issues Consensus Conference","volume":"25","author":"Ezzedine","year":"2012","journal-title":"Pigment. Cell Melanoma Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/bjd.13839","article-title":"Living with vitiligo: Results from a national survey indicate differences between skin phototypes","volume":"173","author":"Ezzedine","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/exd.13677","article-title":"The convergence theory for vitiligo: A reappraisal","volume":"28","author":"Kundu","year":"2019","journal-title":"Exp. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1034\/j.1600-0749.2003.00023.x","article-title":"Evidence for an Autoimmune Pathogenesis of Vitiligo","volume":"16","author":"Ongenae","year":"2003","journal-title":"Pigment. Cell Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.bbrc.2004.10.185","article-title":"Regulation of tyrosinase by tetrahydropteridines and H2O2","volume":"325","author":"Wood","year":"2004","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Telegina, T.A., Vechtomova, Y.L., Borzova, V.A., and Buglak, A.A. (2023). Tetrahydrobiopterin as a Trigger for Vitiligo: Phototransformation during UV Irradiation. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241713586"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1111\/jdv.19162","article-title":"Topical ruxolitinib: A new treatment for vitiligo","volume":"37","author":"Tavoletti","year":"2023","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/bjd.20596","article-title":"British Association of Dermatologists guidelines for the management of people with vitiligo 2021","volume":"186","author":"Eleftheriadou","year":"2022","journal-title":"Br. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/ced.14435","article-title":"Vitiligo: An update on systemic treatments","volume":"46","author":"Searle","year":"2020","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jaad.2016.12.041","article-title":"The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo","volume":"76","author":"Mohammad","year":"2017","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"685116","DOI":"10.3389\/fphar.2021.685116","article-title":"Plant-Derived Compounds as Promising Therapeutics for Vitiligo","volume":"12","author":"Pang","year":"2021","journal-title":"Front. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/j.1365-2230.2007.02514.x","article-title":"Antioxidants and narrow band-UVB in the treatment of vitiligo: A double-blind placebo controlled trial","volume":"32","author":"Mastrofrancesco","year":"2007","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1080\/10408390601062054","article-title":"Black Pepper and its Pungent Principle-Piperine: A Review of Diverse Physiological Effects","volume":"47","author":"Srinivasan","year":"2007","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/j.1365-2133.2008.08464.x","article-title":"In vivo evaluation of piperine and synthetic analogues as potential treatments for vitiligo using a sparsely pigmented mouse model","volume":"158","author":"Faas","year":"2008","journal-title":"Br. J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1111\/bjd.19592","article-title":"Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: Results of the HI-Light Vitiligo Trial","volume":"184","author":"Thomas","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1002\/ptr.6116","article-title":"The effect of topical piperine combined with narrowband UVB on vitiligo treatment: A clinical trial study","volume":"32","author":"Shafiee","year":"2018","journal-title":"Phytotherapy Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/bjd.21671","article-title":"Using the Vitiligo Noticeability Scale in clinical trials: Construct validity, interpretability, reliability and acceptability","volume":"187","author":"Batchelor","year":"2022","journal-title":"Br. J. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1111\/jdv.16248","article-title":"Reflectance confocal microscopy diagnostic accuracy for malignant melanoma in different clinical settings: Systematic review and meta-analysis","volume":"34","author":"Pezzini","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/CMR.0b013e32835d90b8","article-title":"Can noninvasive imaging tools potentially predict the risk of ulceration in invasive melanomas showing blue and black colors?","volume":"23","author":"Longo","year":"2013","journal-title":"Melanoma Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1111\/j.1468-3083.2007.02275.x","article-title":"Preliminary evaluation of vitiligo using in vivo reflectance confocal microscopy","volume":"21","author":"Ardigo","year":"2007","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"709","DOI":"10.5114\/ada.2021.110077","article-title":"Progress in the application of reflectance confocal microscopy in dermatology","volume":"38","author":"Lu","year":"2021","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/j.1600-0846.2011.00521.x","article-title":"In vivo reflectance confocal microscopy imaging of vitiligo, nevus depigmentosus and nevus anemicus","volume":"17","author":"Lai","year":"2011","journal-title":"Skin Res. Technol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1111\/exd.14359","article-title":"A plea for standardization of confocal microscopy and optical coherence tomography parameters to evaluate physiological and para-physiological skin conditions in cosmetic science","volume":"30","author":"Ciardo","year":"2021","journal-title":"Exp. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/001316446002000104","article-title":"A Coefficient of Agreement for Nominal Scales","volume":"20","author":"Cohen","year":"1960","journal-title":"Educ. Psychol. Meas."},{"key":"ref_27","unstructured":"Sprent, P., and Smeeton, N.C. (2001). Applied Nonparametric Statistical Methods, Chapman & Hall\/CRC. [3rd ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1177\/014662168100500115","article-title":"Balanced Incomplete Block Designs for Inter-Rater Reliability Studies","volume":"5","author":"Fleiss","year":"1981","journal-title":"Appl. Psychol. Meas."},{"key":"ref_29","first-page":"1309175","article-title":"Piperine Enhances the Antioxidant and Anti-Inflammatory Activities of Thymoquinone against Microcystin-LR-Induced Hepatotoxicity and Neurotoxicity in Mice","volume":"2019","author":"Sayed","year":"2019","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta24640","article-title":"Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT","volume":"24","author":"Batchelor","year":"2020","journal-title":"Health Technol. Assess."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/494\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:04:37Z","timestamp":1760105077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,25]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["diagnostics14050494"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14050494","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,25]]}}}