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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Previous Vitiligo Research: 2002-2006   
The Vitiligo File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Vitiligo, click HERE.
 

Latest Research on Vitiligo
  
Cell Transplant. 2008;17(3):351-60.
Cultured melanocytes: from skin biopsy to transplantation.
Ghosh D, Shenoy S, Kuchroo P.
Tissue Engineering Group, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, India. deepa_ghosh@relbio.com

Restoration of cutaneous pigmentation has been achieved in stable vitiligo by autologous melanocyte transplantation. This study was aimed to develop a methodology to deliver melanocytes to vitiliginous area following their processing and culture in a centralized facility. Here we report a methodology to culture melanocytes on carrier films, transport the cells, and graft them on vitiliginous areas. The salient features of this study include: 1) development of polylactic acid (PLA) films that support melanocyte attachment, growth, and delivery; 2) establish transport conditions for skin biopsies from hospitals; 3) establish transport conditions for cultured cells from cell processing center to hospitals. Results suggest that PLA films could serve as carriers for melanocytes during transport. "Upside-down" application of the graft results in the migration of cells from the films into the dermabraded area. The transport conditions ensure cell viability for 96 h. This system could help clinicians, who do not have access to cell culture facilities, transplant cultured melanocytes in a cost-effective manner.

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BMC Dermatol. 2008 May 22;8:2.
A systematic review of natural health product treatment for vitiligo.
Szczurko O, Boon HS.
Leslie Dan Faculty of Pharmacy, University of Toronto, Canada. oszczurko@utoronto.ca

BACKGROUND: Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected. METHODS: Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality. RESULTS: Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that Ginkgo biloba monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting. CONCLUSION: Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral Ginkgo biloba as monotherapy show promise and warrant further investigation.

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Curr Dir Autoimmun. 2008;10:244-57.
The genetics of generalized vitiligo.
Spritz RA.
Human Medical Genetics Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA. Richard.Spritz@uchsc.edu

Generalized vitiligo is an acquired disorder in which patches of depigmented skin, overlying hair and oral mucosa result from progressive autoimmune loss of melanocytes from the involved areas. Perhaps the most common pigmentary disorder, vitiligo results from a complex interaction of environmental, genetic and immunologic factors that ultimately contribute to melanocyte destruction, resulting in the characteristic depigmented lesions. In the past few years, studies of the genetic epidemiology of generalized vitiligo have led to the recognition that vitiligo is part of a broader, genetically determined, autoimmune and autoinflammatory diathesis. Attempts to identify genes involved in vitiligo susceptibility have involved gene expression studies, allelic association studies of candidate genes and genome-wide linkage analyses to discover new genes, and these studies have begun to shed light on the mechanisms of vitiligo pathogenesis. It is anticipated that the discovery of biological pathways of vitiligo pathogenesis will provide novel therapeutic and prophylactic targets for future approaches to the treatment and prevention of vitiligo and its associated autoimmune diseases.

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Curr Dir Autoimmun. 2008;10:227-43.
Autoimmune etiology of generalized vitiligo.
Le Poole IC, Luiten RM.
Department of Pathology, Oncology Institute, Loyola University, Chicago, IL, USA. ilepool@lumc.edu

Vitiligo is characterized by progressive skin depigmentation resulting from an autoimmune response targeting epidermal melanocytes. Melanocytes are particularly immunogenic by virtue of the contents of their melanosomes, generating the complex radical scavenging molecule melanin in a process that involves melanogenic enzymes and structural components, including tyrosinase, MART-1, gp100, TRP-2 and TRP-1. These molecules are also prime targets of the immune response in both vitiligo and melanoma. The immunogenicity of melanosomal proteins can partly be explained by the dual role of melanosomes, involved both in melanin synthesis and processing of exogenous antigens. Melanocytes are capable of presenting antigens in the context of MHC class II, providing HLA-DR+ melanocytes in perilesional vitiligo skin the option of presenting melanosomal antigens in response to trauma and local inflammation. Type I cytokine-mediated immunity to melanocytes in vitiligo involves T cells reactive with melanosomal antigens, similar to T cells observed in melanoma. In vitiligo, however, T cell tuning allows T cells with higher affinity for melanocyte differentiation antigens to enter the circulation after escaping clonal deletion in primary lymphoid organs. The resulting efficacious and progressive autoimmune response to melanocytes provides a roadmap for melanoma therapy.

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Acta Dermatovenerol Alp Panonica Adriat. 2008 Mar;17(1):12-6.
Oxidative stress in the blood of patients with active localized vitiligo.
Arican O, Kurutas EB.
Department of Dermatology, Trakya University, Medical Faculty, Sükrüpasa Mh. Caglarim Sitesi B3 Blok K:5 D:11, TR-22000 Edirne, Turkey. ozerari@gmail.com

OBJECTIVES: Vitiligo is an acquired skin disease characterized by white areas on the skin. The pathogenesis of the disease is still unclear. Some findings show that oxidative stress could be an important phenomenon in the pathophysiology of vitiligo. METHODS: We evaluated 16 consecutive localized vitiligo patients and 16 healthy controls of a similar age and sex distribution. We measured their indicators of oxidative stress such as catalase (CAT), superoxide dismutase (SOD), glucose 6-phosphate dehydrogenase (G6PD) in erythrocytes, and plasma malondialdehyde (MDA) by spectrophotometry. RESULTS: SOD activities and MDA levels of patients were significantly higher than controls (p < 0.001). CAT and G6PD activities of patients were significantly lower than controls (p < 0.05 and p < 0.001, respectively). CONCLUSION: Our results confirmed that oxidative stress may play an important role in the pathogenesis of vitiligo. Melanocyte damage in vitiligo might be linked to generalized oxidative stress. This study is the first report on some antioxidant parameters of localized-type vitiligo patients.

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Dermatol Ther. 2008 Mar-Apr;21(2):110-7.
Vitiligo: new and emerging treatments.
Lotti T, Gori A, Zanieri F, Colucci R, Moretti S.
Department of Dermatological Sciences, University of Florence, Florence, Italy.

Vitiligo is a cosmetically disfiguring condition, and, although there is no therapeutic full solution yet, some treatment may induce good results in most patients. The disease can be successfully treated with various medical options. Both nonfocused or focused narrowband ultraviolet B phototherapy represents the current treatment of choice, to minimize side effects and reach optimal clinical results. Topical novel approaches are also considered. Surgical methods, consisting of autologous transplantation methods, is generally recommended for focal/stable vitiligo, after medical therapy has failed. Finally, for patients with extensive vitiligo, depigmentation of the residual melanin should be taken into account.

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J Drugs Dermatol. 2008 Mar;7(3):258-63.
A pilot study to determine the safety and efficacy of monochromatic excimer light in the treatment of vitiligo.
Chimento SM, Newland M, Ricotti C, Nistico S, Romanelli P.
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

BACKGROUND AND OBJECTIVE: According to a European pilot study, the 308-nanometer (nm) Excilite mu (DEKA, Florence, Italy) system may be a promising tool for patients with vitiligo by offering targeted phototherapy, a rapid onset of repigmentation, and few adverse effects. The objective of this study was to evaluate the clinical efficacy and safety of the 308-nm Excilite mu in the treatment of vitiligo. METHODS AND LIMITATIONS: Ten patients with stable vitiligo were exposed to 10 weeks of targeted phototherapy with the Excilite mu device, followed by 5 weeks of observation. Skin types 1 and 2 were not included in the cohort, and Wood's light examination was not documented. RESULTS: At 2 weeks, repigmentation was observed in 60% of the subjects, according to patient assessment, and 50% of the subjects, according to the treating physician and independent observer assessments. All patients maintained the repigmentation during the 5-week, follow-up period. CONCLUSION: The 308-nm Excilite mu is a safe and fast-acting therapeutic option in patients with stable vitiligo and skin types 3 through 6.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.
  
Previous Vitiligo Research: 2002-2006   
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