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Welcome to the Vitiligo
File
Patients all over the world
have used the information in The Vitiligo File since 1992, when
the Center for Current Research—one of the first 80 companies
on the Internet—was founded. Our highly trained researchers
(all of whom hold Ph.D.s) have searched the advanced medical
database at the National Library of Medicine and compiled a comprehensive
collection of research descriptions on Vitiligo and its care.
As you will see, the following research descriptions detail the
findings published in the most respected journals in the field.
Because the research descriptions are written in medical terms,
most people will bring all or parts of the Vitiligo File to their
doctor for further explanation and discussion. Often your doctor
will have access to full-text articles and other information
that could be useful in planning a successful course of treatment
and prevention. Note that the titles of the journals are abbreviated
according to the National Library of Medicine's format; your
doctor can provide the full title if you need it.
Thank you for accessing the Vitiligo File. We truly hope the
information fosters better health.
Sincerely,
Gregory A. Fraser, Ph.D.
Director of Research
Important Note: The following information
is provided for your education. It should not be relied upon for
personal diagnosis or treatment. If you believe that a
particular therapy applies to you or someone you care about, be
sure to consult a doctor before trying it.
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Latest Research on Vitiligo
Photodermatol Photoimmunol Photomed. 2007 Dec;23(6):258-60.
Photoadaptation of vitiliginous skin to targeted ultraviolet B
phototherapy.
Rivard J, Hexsel C, Owen M, Strickland FM, Lim HW, Hamzavi I.
Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA.
BACKGROUND: Increasing doses of ultraviolet (UV) radiation are tolerated in
patients with vitiligo, due to photoadaptation. In this pilot study, five
patients with Fitzpatrick skin phototypes IV-VI with vitiligo received six
treatments of targeted UVB phototherapy over a 3-week period. METHODS: To
investigate photoadaptation, minimal erythema dose (MED) testing was conducted
on treated and untreated vitiliginous and normal skin at baseline and after
three and six treatments. One patient had unattainable MED values, and was hence
excluded. RESULTS: Percent change in MED from before to after all treatments in
vitiliginous skin ranged from 0% to 128%, with a mean of 48.8%. CONCLUSION: The
pilot phase of this study suggests possible photoadaptation of vitiliginous skin
of some patients to targeted UVB phototherapy.
-----
Dermatology. 2007;215 Suppl 1:45-54. Epub 2007 Dec 18.
Potential new indications of topical calcineurin inhibitors.
Luger T, Paul C.
Department of Dermatology, University of Muenster, Muenster, Germany. luger@uni-muenster.de
The topical calcineurin inhibitors pimecrolimus (Elidel) and tacrolimus (Protopic)
were initially developed for the treatment of atopic eczema (atopic dermatitis),
a chronic or chronically relapsing skin condition most prevalent in infants and
children. Their main advantages compared with conventional topical
corticosteroid therapy are that they are more selective in their mode of action,
do not induce skin atrophy and are not associated with significant systemic
absorption. In addition, topical calcineurin inhibitors may represent a useful
alternative to topical corticosteroids for the treatment of a number of other
inflammatory skin diseases. Preferred sites for the use of topical calcineurin
inhibitors are areas such as the face, neck, flexures, and genital areas, which
are more susceptible to topical corticosteroid side effects. The efficacy of
topical calcineurin inhibitors has been demonstrated for flexural psoriasis,
seborrhoeic, contact and hand eczema. Preliminary da
ta also support the efficacy of topical calcineurin inhibitors in lichen planus,
facial lupus erythematosus, autoimmune bullous dermatosis, and vitiligo. In
these latter indications, controlled studies are needed to better understand the
efficacy and safety of topical calcineurin inhibitors and their role in disease
management.
-----
J Eur Acad Dermatol Venereol. 2007 Nov;21(10):1369-74.
Critical evaluation of the variants influencing the clinical
response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band
phototherapy.
Brazzelli V, Antoninetti M, Palazzini S, Barbagallo T, De Silvestri A, Borroni
G.
Department of Human and Hereditary Pathology, Institute of Dermatology,
University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
Background The treatment of vitiligo is still a challenge, but ultraviolet B
narrow-band (UVB-NB) therapy has been recently reported to be an effective and
safe therapeutic option in patients with vitiligo. Objective The purpose of this
study is a critical evaluation of the variants (body sites, age, duration of the
disease, and duration of the therapy) influencing the clinical response to UVB-NB
therapy. Methods Sixty patients (23 male and 37 female), aged 6 to 70 years,
with vitiligo, were treated with UVB-NB therapy over a maximum period of 2
years. The evaluation of the percentage of repigmentation was done through
photographs. Results The lesions located on the face obtained a complete
repigmentation in 68% of the patients, on the neck in 57.89%, and on the trunk
in 50% within the first year of the therapy. In young patients vs. adults
patients, the lesions located on the neck obtained a complete repigmentation in
83.33% vs. 46.15%, on the upper limbs in 28.57% vs. 9.52%, and on the lower
limbs in 25% vs. 16.67%. In patients with vitiligo of recent onset, the lesions
located on the neck obtained a complete repigmentation in 83.33%, on the upper
limbs in 33.33%, and on the lower limbs in 28.57%. Hands did not give a positive
response in either groups. Conclusion This study shows that certain body sites
respond better than others to the UVB-NB therapy; patients, aged less than 20
years, with recent vitiligo, achieve more repigmentation; the duration of the
therapy can influence the response of the lesions over hands and lower limbs,
showing only mild repigmentation.
-----
Clin Exp Dermatol. 2007 Nov;32(6):631-6.
Antioxidants and narrow band-UVB in the treatment of vitiligo: a
double-blind placebo controlled trial.
Dell'anna ML, Mastrofrancesco A, Sala R, Venturini M, Ottaviani M,
Vidolin AP, Leone G, Calzavara PG, Westerhof W, Picardo M.
Spedali Civili, Brescia, Italy.
Background. Vitiligo is an acquired depigmenting disease with uncertain
aetiopathogenesis, possibly associated with oxidative stress. Narrowband
ultraviolet B phototherapy (NB-UVB) is the most widely used and effective
treatment. Aim. To evaluate the clinical effectiveness of NB-UVB and the
repairing of oxidative stress-induced damage, using oral supplementation with an
antioxidant pool (AP). Methods. Patients (n = 35) with nonsegmental vitiligo
were enrolled in a randomized, double-blind, placebo-controlled multicentre
trial. The treatment group received, for 2 months before and for 6 months during
the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and
E, and polyunsaturated fatty acids. The area and number of lesions, as well as
some parameters of the oxidation-reduction (redox) status of the peripheral
blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months,
and at the end of the trial. Results. In total, 28 patients completed the study.
After 2 months of AP supplementation, the catalase activity and the production
of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05
and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic
success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs.
18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P
< 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs.
placebo) of the basal value was observed in PBMCs. Finally, the AP intake
maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 :
3.1; P < 0.05), counteracting phototherapy-induced saturation. Conclusions. Oral
supplementation with AP containing alpha-lipoic acid before and during NB-UVB
significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated
oxidative stress.
-----
J Eur Acad Dermatol Venereol. 2007 Aug;21(7):956-63.
Comparison between 308-nm monochromatic excimer light and
narrowband UVB phototherapy (311-313 nm) in the treatment of vitiligo--a
multicentre controlled study.
Casacci M, Thomas P, Pacifico A, Bonnevalle A, Paro Vidolin A, Leone G.
Dermatology Clinic, Huriez Hospital, University of Lille 2, France.
BACKGROUND: Vitiligo is an acquired pigmentary disorder characterized by areas
of depigmented skin resulting from loss of epidermal melanocytes. Recently, it
has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more
effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating
vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some
advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of
this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm
MEL in vitiligo patients. METHODS: The study was done in a randomized,
investigator-blinded and half-side comparison design. Twenty-one subjects with
symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on
one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB
phototherapy was used to treat lesions on the opposite side. RESULTS: At the end
of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion
(6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while
four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with
NB-UVB showed a good repigmentation (score 3). CONCLUSIONS: It appears that
308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it
induces repigmentation more rapidly.
-----
J Eur Acad Dermatol Venereol. 2007 Aug;21(7):942-50.
Treatment of vitiligo vulgaris with narrow-band UVB and oral
Polypodium leucotomos extract: a randomized double-blind placebo-controlled
study.
Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W.
Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic
Medical Center, 1100 DD Amsterdam, The Netherlands. m.a.middelkamphup@amc.uva.nl
BACKGROUND: The first choice treatment for vitiligo vulgaris is narrow-band UVB
(NB-UVB), but no satisfactory treatment exists. OBJECTIVES: To investigate if
Polypodium leucotomos, an antioxidative and immunomodulatory plant extract,
improves NB-UVB-induced repigmentation. METHODS: Fifty patients with vitiligo
vulgaris randomly received 250 mg oral P. leucotomos or placebo three times
daily, combined with NB-UVB twice weekly for 25-26 weeks. RESULTS:
Repigmentation was higher in the P. leucotomos group vs. placebo in the head and
neck area (44% vs. 27%, P = 0.06). Small repigmentation increases (P = n.s.)
were observed for the trunk (6% increased repigmentation), extremities (4%), and
hands and feet (5%) in the P. leucotomos group vs. placebo. Patients attending
more than 80% of required NB-UVB sessions showed increased repigmentation in the
head and neck area in the P. leucotomos group vs. placebo (50% vs. 19%, P <
0.002); no significant differences were seen in the other body areas. Patients
with skin types 2 and 3 showed more repigmentation in the head and neck area in
the P. leucotomos group vs. placebo (47% vs. 21%, P = 0.01), and no significant
differences were seen in the other body areas. No conclusions could be drawn on
skin types 4 and 5 due to low patient numbers. CONCLUSION: There is a clear
trend towards an increase in repigmentation of vitiligo vulgaris affecting the
head and neck area when NB-UVB phototherapy is combined with oral P. leucotomos.
This effect may be more pronounced in light skin types.
-----
J Eur Acad Dermatol Venereol. 2007 Aug;21(7):916-20.
Narrow-band UVB phototherapy combined with tacrolimus ointment in
vitiligo: a review of 110 patients.
Fai D, Cassano N, Vena GA.
Phototherapy Unit, Dermatology Service, AUSL LE2, Gagliano del Capo-Maglie, Via
Umberto I 16, 73052 Parabita (LE), Salento, Italy. hello@dariofai.it
BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy and topical
tacrolimus are included among the most innovative approaches to vitiligo.
OBJECTIVE: To evaluate the efficacy and tolerability of combined treatment with
NB-UVB and topical tacrolimus in vitiligo. METHODS: After informed consent,
adult patients with chronic (> 1-year duration) stable vitiligo refractory to
conventional treatments were enrolled in an open-labelled prospective study.
Treatment regimen consists of once-daily application, in the evening, of
tacrolimus 0.03% ointment to the lesions of the face, or tacrolimus 0.1%
ointment to the vitiligous patches located on other areas. Concomitant NB-UVB
phototherapy was performed twice weekly for 16 weeks. RESULTS: Study population
included 110 patients (mean age, 42) with a total of 403 lesions. Within the
treatment period, variable repigmentation was evident on more than 70% of
lesions. Clinical response (repigmentation more than 50%) was observed in 42%
of lesions. Response was strictly dependent on the site, being more frequent for
face lesions (73%), followed by limbs (68%) and trunk (53.5%). The therapeutic
effect on the extremities and genital areas was quite disappointing. Treatment
was well tolerated. CONCLUSIONS: Our preliminary data suggest that the
combination of topical tacrolimus with NB-UVB phototherapy can represent an
alternative highly effective approach to refractory vitiligo located on the
face, trunk and limbs. Long-term safety data and randomized controlled trials on
a large number of patients are required.
-----
J Eur Acad Dermatol Venereol. 2007 Aug;21(7):891-6.
Narrowband UVB therapy for vitiligo: does the repigmentation
last?
Sitek JC, Loeb M, Ronnevig JR.
Department of Dermatology, Ulleval University Hospital, Oslo, Norway. jcsitek@online.no
BACKGROUND: Since 1997, a number of trials have shown promising results in
treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults
and children. However, there is little knowledge concerning the duration and
permanency of the treatment-induced repigmentation. OBJECTIVE: Our main
objective was to perform a follow-up trial of successfully treated patients
receiving narrowband UVB for generalized vitiligo. METHODS: We have investigated
to what degree the treatment-induced repigmentation remains stable for up to 2
years post-treatment. We performed an initial open trial including 31 patients
with generalized vitiligo. They received narrowband UVB thrice weekly for up to
12 months. Patients experiencing > 75% repigmentation were defined responders
and were included in the follow-up trial. Responders were followed every 6
months for up to 2 years after cessation of treatment. We observed the
pigmentation status and registered any changes indicating loss of
pigmentation and relapse. RESULTS: Eleven of the 31 treated patients were
included in the follow-up trial. Six patients had relapse and five patients had
stable response 24 months after cessation of treatment. Four out of six relapses
were within 6 months post-treatment. CONCLUSION: In our study population of 31
patients with generalized vitiligo, five patients (16%) experienced > 75% stable
repigmentation 2 years after cessation of a treatment programme of up to 1 years
narrowband UVB therapy.
-----
J Dtsch Dermatol Ges. 2007 Jun;5(6):467-75.
Current state of vitiligo therapy--evidence-based analysis of the
literature.
[Article in English, German]
Forschner T, Buchholtz S, Stockfleth E.
Department of Dermatology, Venereology and Allergy, Charité Universitätsmedizin
Berlin, Germany. tobias.forschner@charite.de
Vitiligo is a skin disease with a worldwide prevalence ranging from 0.5% to 4%.
Conservative therapies include photochemotherapy, phototherapy with UVB
radiation (broadband UVB 290-320 nm, narrow band UVB 311 nm), systemic steroids
and pseudocatalase. Modern therapeutic options include treatment with topical
immunomodulators (tacrolimus, pimecrolimus), analogues of vitamin D3, excimer
laser and surgery/transplantation. Our analysis compares these therapies for
vitiligo and the evidence levels supporting their effectiveness. CONCLUSIONS:
The face and neck respond best to all therapeutic approaches, while the acral
areas are least responsive. For generalized vitiligo, phototherapy with UVB
radiation is most effective with the fewest side effects; PUVA is the second
best choice.Topical corticosteroids are the preferred drugs for localized
vitiligo. They may be replaced by topical immunomodulators which display
comparable effectiveness and fewer side effects.The effectiveness of vitamin D
analogues is controversial with limited data. Surgical therapy can be very
successful, but requires an experienced surgeon and is very demanding of time
and facilities, thus limiting its widespread use. L-phenylalanine therapy
appears effective on the face but enjoys neither widespread use nor extensive
data support. No single therapy for vitiligo can be regarded as the most
effective as the success of each treatment modality depends on the type and
location of vitiligo.
-----
Arch Dermatol. 2007 May;143(5):578-584.
Randomized Double-blind Trial of Treatment of Vitiligo: Efficacy
of Psoralen-UV-A Therapy vs Narrowband-UV-B Therapy.
Yones SS, Palmer RA, Garibaldinos TM, Hawk JL.
Dip Der, FCD, Photobiology Unit, Second Floor, St John's Institute of
Dermatology, Division of Genetics and Molecular Medicine, Guy’s, King's and St
Thomas' School of Medicine, King's College, London SE1 7EH, England. yones5@yahoo.com.
OBJECTIVE: To compare the efficacy of oral psoralen-UV-A (PUVA) with that of
narrowband-UV-B (NB-UVB) phototherapy in patients with nonsegmental vitiligo.
DESIGN: Double-blind randomized study. SETTING: Phototherapy unit in a
university hospital. Patients Fifty-six patients with nonsegmental vitiligo.
Interventions Twice-weekly therapy with PUVA or NB-UVB. MAIN OUTCOME MEASURES:
The change in body surface area affected by vitiligo and the color match of
repigmented skin compared with unaffected skin were assessed after 48 sessions
of therapy, at the end of the therapy course, and 12 months after the end of
therapy. RESULTS: The results in the 25 patients each in the PUVA and NB-UVB
groups who began therapy were analyzed. The median number of treatments was 47
in the PUVA-treated group and 97 in the NB-UVB-treated group (P = .03); we
suspect this difference was because of the differences in efficacy and adverse
effects between the 2 modalities, such that patients in the NB-UVB group wanted
a longer course of treatment. At the end of therapy, 16 (64%) of 25 patients in
the NB-UVB group showed greater than 50% improvement in body surface area
affected compared with 9 (36%) of 25 patients in the PUVA group. The color match
of the repigmented skin was excellent in all patients in the NB-UVB group but in
only 11 (44%) of those in the PUVA group (P<.001). In patients who completed 48
sessions, the improvement in body surface area affected by vitiligo was greater
with NB-UVB therapy than with PUVA therapy (P = .007). Twelve months after the
cessation of therapy, the superiority of NB-UVB tended to be maintained.
Conclusion In the treatment of nonsegmental vitiligo, NB-UVB therapy is superior
to oral PUVA therapy.
-----
J Eur Acad Dermatol Venereol. 2007 May;21(5):638-42.
Comparison of systemic PUVA and NB-UVB in the treatment of
vitiligo: an open prospective study.
Bhatnagar A, Kanwar AJ, Parsad D, De D.
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India.
BACKGROUND: Vitiligo is a common pigmentary disorder with great cosmetic and
psychological morbidity. No treatment available is a definitive cure. Systemic
psoralen and ultraviolet A (PUVA) has been the mainstay of treatment.
Narrow-band ultraviolet B (NB-UVB) has been recently introduced. Although
retrospective comparative study of systemic PUVA and NB-UVB has been published
from our centre, no prospective study has been reported to date. AIMS: To
investigate the position of NB-UVB vis-à-vis PUVA in terms of efficacy, time to
repigment and adverse effects and to help decide if one therapy has an advantage
over another in the treatment of vitiligo. SUBJECTS AND METHODS: It was a
randomized, open, prospective study of 50 patients divided equally in TMP PUVA
and NB-UVB groups. The study period was from January 2004 to June 2005. RESULTS:
The mean degree of repigmentation attained in the NB-UVB group was 52.24% over a
mean treatment period of 6.3 months, whereas in the PUVA group it was 44.7% in a
mean period of 5.6 months (P=0.144). After excluding the results of
therapy-resistant sites, that is, hands and feet, the mean degree of
repigmentation in the NB-UVB group was 67.57%, whereas in the PUVA group it was
54.2% (P=0.007). CONCLUSIONS: NB-UVB performed better in comparison to TMP PUVA
in terms of mean total repigmentation when traditionally considered
therapy-resistant sites were excluded.
-----
Am J Clin Dermatol. 2007;8(3):157-73.
The role of topical calcineurin inhibitors for skin diseases
other than atopic dermatitis.
Wollina U.
Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt,
Dresden, Germany.
The topical calcineurin inhibitors (TCIs) pimecrolimus and tacrolimus are
approved for atopic dermatitis but have additional potential in other
inflammatory skin diseases. This article reviews their clinical use in non-atopic
dermatitis diseases. In seborrheic dermatitis, asteatotic eczema, and contact
dermatitis, TCIs are of great benefit and can compete with topical
corticosteroids. In psoriasis, TCIs have shown clinical efficacy and safety in
facial and intertriginous lesions. Further investigations into possible
combinations of TCIs with other established treatments such as UVB irradiation
in this disorder are necessary. Initial studies in cutaneous lupus erythematosus
have been promising, whereas the response in rosacea and rosacea-like eruptions
has been mixed. TCIs have been associated with good clinical responses in oral
lichen planus and anogenital lichen sclerosus et atrophicus. In vitiligo, TCIs
are associated with some degree of repigmentation, with better results being
seen in children and in facial and neck areas. TCIs have a synergistic effect
with UVB irradiation in vitiligo. There is a long list of small series and case
reports documenting use of TCIs in various other skin conditions that warrant
further validation. Although the established mode of action of TCIs is T-cell
control, other effects also need to be considered. Specifically, TCIs reduce
pruritus and erythema, which cannot be explained by T-cell interactions, and
further investigations are needed in these fields.
-----
J Eur Acad Dermatol Venereol. 2007 Apr;21(4):504-8.
Combination of 308-nm xenon chloride excimer laser and topical
calcipotriol in vitiligo.
Goldinger SM, Dummer R, Schmid P, Burg G, Seifert B, Läuchli S.
Department of Dermatology, University of Zurich, Zurich, Switzerland.
BACKGROUND: A large variety of therapeutic agents are being used for the
treatment of vitiligo, but treatment remains a challenge. Recently,
monochromatic phototherapies such as 311-nm narrowband ultraviolet B therapy and
308-nm xenon chloride excimer laser have been reported to be an effective and
safe therapeutic option in children and adult patients with vitiligo. Single
reports stipulate that the addition of topically applied calcipotriol to
phototherapy increases its effectiveness. OBJECTIVE: The purpose of the present
pilot study was to determine if the addition of topical calcipotriol increases
the efficacy of the 308-nm xenon chloride excimer in the treatment of vitiligo.
METHODS: Ten patients with vitiligo with essentially bilateral symmetrical
lesions were enrolled in this prospective right/left comparative, single-blinded
trial conducted over a 15-month period. All patients received 308-nm XeCl
excimer laser therapy three times weekly. Calcipotriol ointment (Daivonex) was
applied to lesions on one side of the body twice daily. RESULTS: After 24
treatments (8 weeks), nine patients were evaluated. Eight patients showed
evidence of repigmentation on both body sides, with no significant difference
between the body side treated with calcipotriol and excimer laser and the side
treated with excimer laser alone. The mean repigmentation rate was 22.4%
(1-37%). CONCLUSION: The addition of calcipotriol ointment to 308-nm xenon
chloride excimer laser phototherapy does not significantly enhance its efficacy.
Small additive effects must be investigated in a larger trial.
-----
J Am Acad Dermatol. 2007 Feb;56(2):274-8.
Efficacy, predictors of response, and long-term follow-up in
patients with vitiligo treated with narrowband UVB phototherapy.
Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD.
First Department of Dermatology, University of Athens School of Medicine,
Andreas Sygros Hospital, Greece.
BACKGROUND: Narrowband UVB (NB-UVB) phototherapy is considered an accepted
therapy for vitiligo. OBJECTIVE: We sought to estimate the effectiveness of NB-UVB
in patients with vitiligo, identify predictive factors of response, and assess
the stability of NB-UVB-induced repigmentation. METHODS: In all, 70 patients
with vitiligo were treated twice weekly with NB-UVB. RESULTS: Cosmetically
acceptable (>75%) repigmentation was achieved in 34.4% of patients with lesions
on the face and in 7.4% of patients with lesions on the body. Patients with
phototypes III to V had a greater chance to achieve greater than 75%
repigmentation on the face. Patients who responded in the first month of
treatment were more likely to achieve better repigmentation rates.
Repigmentation was stable in 14.3% of patients 4 years after cessation of
treatment. LIMITATIONS: The study was uncontrolled. Treatment frequency was
twice weekly. These results may not be representative of different treatment
regimens. CONCLUSION: Patients with vitiligo who have lesions on the face,
darker phototypes, and early response to treatment have a greater chance to
achieve satisfactory repigmentation after NB-UVB phototherapy.
-----
J Am Acad Dermatol. 2007 Feb;56(2):236-41. Epub 2006 Oct 20.
High-potency steroid use in children with vitiligo: a
retrospective study.
Kwinter J, Pelletier J, Khambalia A, Pope E.
Faculty of Medicine, University of Ottawa, Canada.
BACKGROUND: Data on efficacy and safety of treatments in children with vitiligo
are limited. OBJECTIVE: We sought to describe the clinical outcomes and safety
of children with vitiligo treated with high-potency topical corticosteroids.
METHODS: Clinical improvement and laboratory data were retrospectively analyzed
in 101 children (0-18 years) with vitiligo treated with moderate- to
high-potency topical corticosteroids. RESULTS: Of patients, 64% (45 of 70) had
repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of
70) were worse than at the initial presentation. Local steroid side effects were
noted in 26% of patients at 81.7 +/- 44 days of follow-up. Cortisol levels were
abnormal in 29% of patients (21 of 73). Two children with low cortisol levels
were given the diagnosis of steroid-induced adrenal suppression. Children with
normal and abnormal cortisol levels were not significantly different by sex, age
of onset, potency of the corticosteroid use, or family history. However,
children with head and/or neck affected areas were 8.36 times more likely to
have an abnormal cortisol level compared with children affected in other body
areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n = 72). Of patients,
8% (6 of 74) had an abnormal thyrotropin test result. LIMITATIONS: The
retrospective design of this study presents inherent limitations. CONCLUSION:
Moderate- to high-potency topical corticosteroids are efficacious in children
with vitiligo, but may be associated with systemic absorption.
-----
J Dtsch Dermatol Ges. 2006 Nov;4(11):942-6.
Efficacy and safety of pimecrolimus cream 1% in adult patients
with vitiligo: results of a randomized, double-blind, vehicle-controlled study.
[Article in English, German]
Dawid M, Veensalu M, Grassberger M, Wolff K.
Division of General Dermatology, Department of Dermatology, University of
Vienna, Vienna General Hospital, Vienna, Austria.
BACKGROUND: Vitiligo is an acquired, pigmentary skin disorder which is
disfiguring and difficult to treat. In an earlier open label study in adult
patients with vitiligo, pimecrolimus cream 1% was reported to have similar
efficacy as clobetasol propionate 0.05%. We performed a double-blind,
intrapatient comparison of pimecrolimus cream 1% with placebo cream. PATIENTS
AND METHODS: Twenty adult Caucasians with symmetrical vitiligo (predominantly on
extremities, none in the face) were treated b.i.d. for 6 months left/right with
pimecrolimus/vehicle (N = 10) or vehicle/pimecrolimus (N = 10), respectively.
Primary efficacy endpoint was the size of the target lesion at month 6 and
secondary efficacy endpoint was re-pigmentation. RESULTS: Treatment with
pimecrolimus cream 1% or vehicle resulted in no significant change in mean
target lesion size. Modest repigmentation (1-25%) was noted with pimecrolimus at
month 2 in 12 of 17 patients (vehicle: 9 of 17 patients). Afterwards, the number
of patients who experienced an improvement of pigmentation steadily decreased (3
of 14 patients with pimecrolimus and 2 of 14 with placebo at month 6).Treatment
was well tolerated.There were no treatment-related adverse events, no induction
of skin atrophy nor any other application site side effects. CONCLUSION: In this
group of adult patients with symmetrical vitiligo, treatment of body lesions
(except face) with pimecrolimus cream 1% could not be shown to be effective.
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