Pseudocatalase Cream

Pseudocatalase has recently become a product of interest for patients suffering from vitiligo.  Vitiligo affects 3 to 6 million people in the United States today, however, many are unaware of this rarely talked about skin condition(30).  Also known as leukoderma, vitiligo is a pigmentation disorder of the skin resulting in the formation of irregular white spots or patches, despite the retention of the skin’s normal texture.(30,31)  It is a progressive condition that destroys the melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth, nose, genital and rectal areas) and the retina (inner layer of the eyeball).(31)  Although its cause is not greatly understood,  vitiligo is non-contagious often affecting all races and both sexes equally.  It may appear at any age and is believed to be hereditary.

 

            The primary goal when treating vitiligo is to restore the skin’s function to as close to normal as possible and to improve the patient’s appearance and overall quality of life.  Today, vitiligo is a treatable condition, though it can take years for patients to see results.  The choice of therapy, however, ultimately depends on the degree of white patches and how widespread they are on a patient’s body.(31)  With the recent discovery of the role elevated hydrogen peroxide (H2O2) levels combined with low catalase activity play in the skin of patients afflicted by vitiligo, studies have looked at a new option involving a topical cream consisting of pseudocatalase and calcium.  Originally created by Dr. Karin U. Schallreuter and her colleagues, a professor of clinical and experimental dermatology at the University of Bradford in West Yorkshire, England, patients were told to apply the cream twice daily and to expose themselves to the sun or to a short-term narrow-band of ultraviolet B (UVB) phototherapy twice a week.(32)

 

How is pseudocatalase proposed to work?

One of the major theories concerning the cause of vitiligo is the loss of melanocytes. There is an added theory that other cells, such as keratinocytes, Langerhans cells, and Merkel cells, are involved. Hydrogen peroxide (H2O2)-mediated oxidative stress may affect these cells, leading to vitiligo. While our body has natural defenses, called catalase, to counteract the oxidative stress, it may not be sufficient to do its job.

 

Pseudocatalase is a topical cream that studies have shown to lower levels of hydrogen peroxide (H2O2) on the skin, as well as improve defense by supplementing catalase. Catalase, through activation by UV light, will break down H2O2 to oxygen and water(17).

 

Are there any side effects of pseudocatalase?

According to experimental studies performed by Dr. Karin Schallreuter and team, there were no reported side effects or complications. There were a few instances of increased sweating and darkening of skin, which diminished over time despite continuation of use(17).

 

How is pseudocatalase used?

In studies the recommended frequency of application by Dr. Schallreuter's cream is twice daily, unless otherwise instructed by a patient's physician. It should be used in conjunction with UVB phototherapy, conveniently available for home use, or with natural sunlight(17).

 

Have there been studies done on pseudocatalase?

In 1995, Dr. Karin Schallreuter and her colleagues published case studies on 33 patients, reporting complete repigmentation of face and dorsum of the hand in 90% (fingers and feet did not repigment)(18,19). Pseudocatalase and calcium combination cream were applied twice daily, along with twice a week UVB phototherapy. The treatment period was averaged to be 15 months, but the first sign of repigmentation appeared between 2 and 4 months. Additionally, a study published in 2008 showed successful repigmentation in majority of areas on the face and neck, trunks, and extremities. It was less successful on the hands and feet(20). These results add to the prospects of considering pseudocatalase as a treatment option for vitiligo.

 

Some other clinical trials have not shown as favorable results. In 2002, an open study assessed the effectiveness of pseudocatalase applied twice daily in combination with UVB phototherapy over a period of 24 weeks. Of the 26 patients studied, ten of the patients showed improvements while the remaining patients did not show improvement or even worsening of the condition. Subsequently, in 2009, Bakis-Petsoglou and team conducted a randomized, double-blinded, placebo-controlled trial of twice daily pseudocatalase along with three times a week UVB phototherapy over a period of 24 weeks. However, results did not show that pseudocatalase added improvement to UVB phototherapy over placebo(21). According to Dr. Karin Schallreuter’s response to these two trials, both of these did not use the original formulation and certify that activated pseudocatalase has shown excellent results in patients treated(22).

 

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IMPORTANT NOTICE: The information contained on this site is general in nature and is intended for use as an educational aid. You should consult your doctor about diagnosis and treatment of any health problems. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration("FDA"), nor has the FDA approved the products to diagnose, cure or prevent disease.

 

Vitiligo Treatment References:

(1) Lebwohl MG, et al. (2006). Vitiligo. Treatment of Skin Disease: Comprehensive Therapeutic Strategies (2nd edition, pp. 683-687). Elsevier.

(2) NIH. (2010 Nov). What Is Vitiligo? Fast Facts: An Easy-to-Read Series of Publications for the Public. National Institute of Arthritis and Musculoskeletal and Skin Disease. Retrieved September 2, 2013 from http://www.niams.nih.gov/Health_Info/Vitiligo/vitiligo_ff.asp.

(3) Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011 Sep;65(3):473-91.

(4) AAD. (2013). Vitiligo: Signs and symptoms. American Academy of Dermatology. Retrieved September 2, 2013 from http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u---w/vitiligo/signs-symptoms

(5) AAD. (2013). Vitiligo: Who gets and causes. American Academy of Dermatology. Retrieved September 2, 2013 from http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u---w/vitiligo/who-gets-causes

(6) Gawkrodger DJ. Pseudocatalase and narrowband ultraviolet B for vitiligo: clearing the picture. Br J Dermatol. 2009 Oct;161(4):721-2.

(7) Felsten LM, Alikhan A, Petronic-Rosic V. Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol. 2011 Sep;65(3):493-514.

(8) Silverberg JI, Silverberg AI, Malka E, Silverberg NB. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010 Jun;62(6):937-41.

(9) Gawkrodger DJ, Ormerod AD, Shaw L et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol 2008; 159: 1051-76.

(10) AAD. (2013). Vitiligo: Diagnosis, treatment, and outcome. American Academy of Dermatology. Retrieved September 2, 2013 from http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u---w/vitiligo/diagnosis-treatment

(11) Schallreuter KU, Moore J, Behrens-Williams S, Panske A, Harari M. Rapid initiation of repigmentation in vitiligo with Dead Sea climatotherapy in combination with pseudocatalase (PC-KUS). Int J Dermatol. 2002 Aug;41(8):482-7.

(12) AVRF. (2013). Medical treatments. American Vitiligo Research Foundation. Retrieved September 2, 2013 from http://www.avrf.org/treatments/medical.htm

(13) Kriegel MA, Manson JE, Costenbader KH. Does vitamin D affect risk of developing autoimmune disease?: a systematic review. Semin Arthritis Rheum. 2011 Jun;40(6):512-531.

(14) Travis LB, Silverberg NB. Calcipotriene and corticosteroid combination therapy for vitiligo. Pediatr Dermatol 2004;21: 495-8.

(15) AVRF. (2013). Surgical treatments. American Vitiligo Research Foundation. Retrieved September 2, 2013 from http://www.avrf.org/treatments/surgical.htm

(16) Papadopoulos L, Bor R, Legg C. Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy. Br J Med Psychol 1999; 72(pt 3):385-96.

(17) Schallreuter KU, Moore J, Behrens-Williams S, Panske A, Harari M. Rapid initiation of repigmentation in vitiligo with Dead Sea climatotherapy in combination with pseudocatalase (PC-KUS). Int J Dermatol. 2002 Aug;41(8):482-7.

(18) Schallreuter KU, Wood JM, Lemke KR, Levenig C. Treatment of vitiligo with a topical application of pseudocatalase and calcium in combination with short-term UVB exposure: a case study on 33 patients. Dermatology. 1995;190(3):223-9.

(19) Gawkrodger DJ. Pseudocatalase and narrowband ultraviolet B for vitiligo: clearing the picture. Br J Dermatol. 2009 Oct;161(4):721-2.

(20) Schallreuter KU, Krüger C, Würfel BA, Panske A, Wood JM. From basic research to the bedside: efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo. Int J Dermatol. 2008 Jul;47(7):743-53.

(21) Bakis-Petsoglou S, Le Guay JL, Wittal R. A randomized, double-blinded, placebo-controlled trial of pseudocatalase cream and narrowband ultraviolet B in the treatment of vitiligo. Br J Dermatol. 2009 Oct;161(4):910-7.

(22) Schallreuter KU. Effectiveness of pseudocatalase formulations in vitiligo. Clin Exp Dermatol. 2003 Sep;28(5):562-3.

(23) Schallreuter KU, Salem MA, Holtz S, Panske A. Basic evidence for epidermal H2O2/ONOO--mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS. FASEB J. 2013 Aug;27(8):3113-22.

(24) Bazian. (2013, May 12). No evidence of cure to prevent hair going grey. NIH Behind the headlines. Retrieved on September 2, 2013 from http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2013-05-12-no-evidence-of-cure-to-prevent-hair-going-grey/

(25) Genes. (2013, Sept 23). TYR. Genetics Homes Reference. Retrieved September 25, 2013 from http://ghr.nlm.nih.gov/gene/TYR

(26) Schallreuter KU, Moore J, Wood JM, Beazley WD, Peters EM, Marles LK, Behrens-Williams SC, Dummer R, Blau N, Thöny B. Epidermal H(2)O(2) accumulation alters tetrahydrobiopterin (6BH4) recycling in vitiligo: identification of a general mechanism in regulation of all 6BH4-dependent processes? J Invest Dermatol. 2001 Jan;116(1):167-74.

(27) Brazzelli V, Antoninetti M, Palazzini S, Barbagallo T, De Silvestri A, Borroni G. Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band phototherapy. J Eur Acad Dermatol Venereol 2007;21:1369-74.

(28) Percivalle S, Piccinno R, Caccialanza M, Forti S. Narrowband ultraviolet B phototherapy in childhood vitiligo: evaluation of results in 28 patients. Pediatr Dermatol. 2012 Mar-Apr;29(2):160-5.

(29) Patel DC, Evans AV, Hawk JL. Topical pseudocatalase mousse and narrowband UVB phototherapy is not effective for vitiligo: an open, single-centre study. Clin Exp Dermatol. 2002 Nov;27(8):641-4.

(30) www.vitiligosupport.com/whatis.cfm  Accessed April 18, 2005

(31) http://www.niams.nih.gov/hi/topics/vitiligo/vitiligo.htm  Accessed April 18, 2005

(32) http://www.homephototherapy.com/vit-pcat.htm  Accessed April 18, 2005

(33) http://www.brad.ac.uk/acad/biomed/STAFF/KUS/home.html  Accessed April 19,2005

(34) Schallreuter KU, Wood JM, Lemke KR, Levenig C.  Treatment of vitiligo with a topical application of pseudoctalase and calcium in combination with short-term UVB exposure: a case study on 33 patients.  Dermatology.  1995;190(3):223-9.

(35) Schallreuter KU, Moore J, Behrens-Williams S, Panske A, Harari M.  Rapid initiation of repigmentation in vitiligo with Dead Sea climatotherapy in combination with pseudocatalase (PC-KUS).  International Journal of Dermatology.  2002;41(8):482-7.