Recent clinical studies in journals and poster presentations from this year’s American Academy of Dermatology meeting offer further insight into the treatment of vitiligo.
Here’s a sampling of research.
Combining High-Dose Prednisolone with PUVA
Systemic corticosteroids curtail repigmentation in vitiligo and have unacceptable side effects. With that in mind, researchers wanted to study high-dose prednisolone therapy (which has been previously studied) to minimize the side-effects of systemic steroids, and they wanted to combine this with phototherapy — which has not been studied.
They gave 36 patients with vitiligo I.V. methylprednisolone for 3 days and psoralen plus ultraviolet A (PUVA) twice a week.
Results. After 6 months, vitiligo lesions were reduced by:
- 57.5% on the face
- 34.5% on the upper extremities
- 30.4% on the trunk
- 26.3% on the lower extremities.
Overall, 13 patients (36.1%) experienced >50% repigmentation. Side effects were mild and transient.
Conclusion: Combined treatment with high-dose prednisolone therapy and PUVA may represent a highly effective option for generalized vitiligo.
Source: Lee Y, Seo YJ, Lee JH, Park JK. High-dose prednisolone and psoralen ultraviolet A combination therapy in 36 patients with vitiligo. Clin Exp Dermatol. 2007 Jul 2.
Comparing the Efficacy of PUVa vs. Narrowband UVB
In this study 56 patients with nonsegmental vitiligo were randomized to receive oral psoralen-UVA (PUVA) or narrowband-UVB (NB-UVB) phototherapy twice a week.
Outcomes were assessed after 48 therapy sessions and 12 months after therapy ended.
Results. The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB group (p=.03).
NB-UVB Group. 16 (64%) of 25 patients showed >50% improvement in body surface area affected.
The color match of the repigmented skin was excellent in all patients in this group.
PUVA Group. 9 (36%) of 25 patients had >50% improvement in body surface area affected.
The color match of the repigmented skin was excellent in only 11 (44%) in the PUVA group (p<.001).
In patients who completed 48 sessions, improvement in vitiligo-affected body surface area was greater with NB-UVB therapy than with PUVA therapy (p=.007).
Twelve months later. The superiority of NB-UVB tended to be maintained.
Conclusion. When treating nonsegmental vitiligo, NB-UVB therapy is superior to oral PUVA therapy.
Source: Yones SS, Palmer RA, Garibaldinos TM, Hawk JL. Randomized Double-blind Trial of Treatment of Vitiligo: Efficacy of Psoralen-UVA Therapy vs Narrowband-UVB Therapy. Arch Dermatol. 2007 May;143(5):578-584.
Evaluating the Efficacy of Pimecrolimus for Vitiligo
The topical immunomodulator tacrolimus has been studied with success for treating vitiligo, but these authors note only one case study and other study that has evaluated pimecrolimus.
In this study of 16 patients, researchers selected two vitiligo lesions of similar size and time of disease onset in each patient and applied 1% pimecrolimus to one lesion and 0.05% clobetasol propionate to the other twice a day in a double-blind randomized way. Every 2 weeks for a total period of 8 weeks, the lesions were evaluated for repigmentation and adverse events.
Results. Overall results were as follows.
Clobetasol propionate. In 13 of 14 patients who completed the study (92.8%), some repigmentation was noted. The mean percentage of repigmentation was 57.7%. In three (21.4%) patients, adverse events, including atrophy, telangiectasia and acneiform changes, were noted.
Pimecrolimus. Nine (64.2%) patients experienced some repigmentation; mean percentage of repigmentation was 32.1%. No adverse events were noted.
Conclusion. Pimecrolimus can attain some repigmentation efficacy; however, clobetasol propionate was more effective. Yet, pimecrolimus could offer a safer alternative for long-term treatment.
Source: Seckin D, Eryilmaz A, Baba M. A.
A double-blind randomized trial of 1% pimecrolimus versus 0.05% clobetasol propionate for the treatment of vitiligo. Poster Presentation. Winter AAD. 2007; Washington, D.C.
Reporting on 5% Polyphenone in a Hydrophilic Ceam
In this study, researchers evaluated the clinical efficacy, tolerability and safety of a 5% polyphenone (epigallocatechin gallate [-EGCg]) incorporated into a hydrophilic cream to treat vitiligo.
Participants included 120 men and women aged 15 to 70 years with vitiligo. The study group was broken into two segments and randomized to receive treatment with the active ingredient or placebo, which was applied twice a day for 8 weeks.
Results. Researchers noted the following:
- Participants who received the 5% polyphenone (-EGCg) (61.6%) had statistically significant repigmentation compared with the placebo group (p<0.0001).
Source: Syed T, Ahmad SA, Aly R, Govil V. Phase II management of vitiligo with 5% polyphenone (-EGCg) in a hydrophilic cream. A placebo-controlled, double-blind study. Poster Presentation. Winter AAD. 2007; Washington, D.C.
Tracking the Long-term Results of Narrowband UVB for Vitiligo
In this uncontrolled study, 70 patients with vitiligo were treated twice weekly with narrowband UVB (NB-UVB).
Results. Cosmetically acceptable (>75%) repigmentation was achieved in 34.4% of patients with facial lesions and in 7.4% of patients with lesions on the body.
Patients with phototypes III to V were more likely to achieve >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 treatment ended.
Conclusion. Patients with vitiligo who have lesions on the face, darker phototypes, and early response to treatment are more likely to achieve satisfactory repigmentation after NB-UVB. n
Source: Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007 Feb;56(2):274-8.
