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Al-Smadi K, Ali M, Alavi SE, Jin X, Imran M, Leite-Silva VR, Mohammed Y. Using a Topical Formulation of Vitamin D for the Treatment of Vitiligo: A Systematic Review. Cells 2023; 12:2387. [PMID: 37830601 PMCID: PMC10572240 DOI: 10.3390/cells12192387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Vitamin D is one significant prohormone substance in human organ systems. It is a steroidal hormone produced in the skin upon exposure to UVB rays. This paper presents a systematic review of the utilization of topical vitamin D, specifically cholecalciferol, calcipotriol, and tacalcitol, in the treatment of vitiligo. It considers the role of vitamin D in stimulating the synthesis of melanin and melanogenesis, which can help with the process of repigmentation. The inclusion of calcipotriol or tacalcitol in Narrowband Ultraviolet Phototherapy (NB-UVB) has shown the potential to enhance therapeutic outcomes for vitiligo. However, their effectiveness in combination with Psoralens Long Wave Ultraviolet Radiation (PUVA) and Monochromatic Excimer Light (MEL) treatment for vitiligo is limited. In contrast, combining topical corticosteroids with vitamin D analogues has demonstrated superior efficacy in treating vitiligo compared to using vitamin D analogues alone, while also providing the added benefit of reducing corticosteroid-related adverse effects. In addition, treating stable vitiligo with topical cholecalciferol and microneedling has shown success. Future studies are needed to ascertain an efficient method of administering vitamin D topically as an anti-vitiligo agent.
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Affiliation(s)
- Khadeejeh Al-Smadi
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Masood Ali
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Seyed Ebrahim Alavi
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Xuping Jin
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Mohammad Imran
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Vania R. Leite-Silva
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo, UNIFESP-Diadema, São Paulo 09913-030, Brazil
| | - Yousuf Mohammed
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia
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Mir-Palomo S, Nácher A, Ofelia Vila Busó MA, Caddeo C, Manca ML, Manconi M, Díez-Sales O. Baicalin and berberine ultradeformable vesicles as potential adjuvant in vitiligo therapy. Colloids Surf B Biointerfaces 2018; 175:654-662. [PMID: 30590326 DOI: 10.1016/j.colsurfb.2018.12.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/29/2018] [Accepted: 12/19/2018] [Indexed: 12/27/2022]
Abstract
0.5-1% of the world's population is affected by vitiligo, a disease characterized by a gradual depigmentation of the skin. Baicalin and berberine are natural compounds with beneficial activities, such as antioxidant, anti-inflammatory and proliferative effects. These polyphenols could be useful for the treatment of vitiligo symptoms, and their efficacy can be improved by loading in suitable carriers. The aim of this work was to formulate and characterize baicalin or berberine loaded ultradeformable vesicles, and demonstrate their potential as adjuvants in the treatment of vitiligo. The vesicles were produced using a previously reported simple, scalable method. Their morphology, size distribution, surface charge and entrapment efficiency were assessed. The ability of the vesicles to promote the permeation of the polyphenols was evaluated. The antioxidant and photoprotective effects were investigated in vitro using keratinocytes and fibroblasts. Further, the stimulation of melanin production and tyrosinase activity in melanocytes after treatment with the vesicles were assessed. Ultradeformable vesicles were small in size, homogeneously dispersed, and negatively charged. They were able to incorporate high amounts of baicalin and berberine, and promote their skin permeation. In fact, the polyphenols concentration in the epidermis was higher than 10%, which could be indicative of the formation of a depot in the epidermis. The vesicles showed remarkable antioxidant and photoprotective capabilities, presumably correlated with the stimulation of melanin production and tyrosinase activity. In conclusion, baicalin or berberine ultradeformable vesicles, and particularly their combination, may represent promising nanosystem-based adjuvants for the treatment of vitiligo symptoms.
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Affiliation(s)
- Silvia Mir-Palomo
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain
| | - Amparo Nácher
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain; Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
| | | | - Carla Caddeo
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Maria Letizia Manca
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Maria Manconi
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Octavio Díez-Sales
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain; Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
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Gianfaldoni S, Wollina U, Tchernev G, Lotti J, França K, Lotti T. Vitiligo in Children: A Review of Conventional Treatments. Open Access Maced J Med Sci 2018; 6:213-217. [PMID: 29484026 PMCID: PMC5816302 DOI: 10.3889/oamjms.2018.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/17/2017] [Accepted: 11/08/2017] [Indexed: 11/05/2022] Open
Abstract
Vitiligo is an important skin disease of childhood, which may lead to deep psychological trauma, resulting in a poor quality of life and low self-esteem. The Authors discuss a short review of the more conventional therapies available for the treatment of vitiligo in children.
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Affiliation(s)
| | - Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria
| | - Jacopo Lotti
- University G. Marconi of Rome - Dept. of Nuclear, Subnuclear and Radiation Physics, Rome, Italy
| | - Katlein França
- University of Miami School of Medicine Ringgold standard institution, Miami, Florida, United States and Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy
| | - Torello Lotti
- University G. Marconi of Rome, Dermatology and Venereology, Rome, Italy
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Rokni GR, Golpour M, Gorji AH, Khalilian A, Ghasemi H. Effectiveness and safety of topical tacrolimus in treatment of vitiligo. J Adv Pharm Technol Res 2017; 8:29-33. [PMID: 28217552 PMCID: PMC5288968 DOI: 10.4103/2231-4040.197388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vitiligo is one of the most primitive well-known dermatoid disorders with different suggested therapies. Therefore, this study investigated the efficiency and safety of topical tacrolimus in treatment of patients with vitiligo. This study was a clinical randomized designed study pre- post-test method, has been conducted on thirty cases with vitiligo who have referred to polyclinic and dermatology clinic. Participant's evaluated and demographic information recorded in designed checklist. In the next stage, the disease activity scored by vitiligo index disease activity system. Photography and depigmentation percent has recorded before treatment and further in 4th, 8th, 12th, 16th, 20th, and 24th weeks. Finally, gathered data compared through SPSS-20 software. The final sample comprised 30 persons including: 12 men (40%) and 18 women (60%). The average of patient's age in this study was 26/13 ± 18/20 (2-76-year-old). Eleven persons was ≤15 years old and rest was older than 15. Sixty-six lesions have funded in patients that maximum has accrued on face and neck (37/87%) and trunk (21/21%). In addition, minimum of lesions is related to genitalia (9/09%). In the in 4th, 8th, 12th, 16th weeks, improvement in face and neck had increased significantly, into the past weeks. In the 20th and 24th weeks, the improvement has increased although it was not significant enhancement. Also about trunk, in the 4th week the improvement does not have significant increasing in compare to the past week. In the eighth, 12th, 16th, 20th, and 24th weeks the improvement has been increased significantly in compare to the past weeks. Although in the case of limbs and genitalia, the improvement was lower. There was no significant difference between male and females and age. Although the improvement was, slow in older persons. Study results, has presented applying topical tacrolimus in vitiligo, particularly in face and neck, could be effective and does not seen any specified adverse effects during consumption of tacrolimus, it could be effective in decreasing effects in use of corticosteroid.
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Affiliation(s)
| | - Massoud Golpour
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Alireza Khalilian
- Department of Epidemiology and Biostatistics, Health Science Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamta Ghasemi
- GP, Mazandaran University of Medical Sciences, Sari, Iran
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Pei T, Zheng C, Huang C, Chen X, Guo Z, Fu Y, Liu J, Wang Y. Systematic understanding the mechanisms of vitiligo pathogenesis and its treatment by Qubaibabuqi formula. JOURNAL OF ETHNOPHARMACOLOGY 2016; 190:272-287. [PMID: 27265513 DOI: 10.1016/j.jep.2016.06.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 05/16/2016] [Accepted: 06/01/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Vitiligo is a depigmentation disorder, which results in substantial cosmetic disfigurement and poses a detriment to patients' physical as well as mental. Now the molecular pathogenesis of vitiligo still remains unclear, which leads to a daunting challenge for vitiligo therapy in modern medicine. Herbal medicines, characterized by multi-compound and multi-target, have long been shown effective in treating vitiligo, but their molecular mechanisms of action also remain ambiguous. MATERIALS AND METHODS Here we proposed a systems pharmacology approach using a clinically effective herb formula as a tool to detect the molecular pathogenesis of vitiligo. This study provided an integrative analysis of active chemicals, drug targets and interacting pathways of the Uygur medicine Qubaibabuqi formula for curing Vitiligo. RESULTS The results show that 56 active ingredients of Qubaibabuqi interacting with 83 therapeutic proteins were identified. And Qubaibabuqi probably participate in immunomodulation, neuromodulation and keratinocytes apoptosis inhibition in treatment of vitiligo by a synergistic/cooperative way. CONCLUSIONS The drug-target network-based analysis and pathway-based analysis can provide a new approach for understanding the pathogenesis of vitiligo and uncovering the molecular mechanisms of Qubaibabuqi, which will also facilitate the application of traditional Chinese herbs in modern medicine.
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Affiliation(s)
- Tianli Pei
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China; Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, China
| | - Chunli Zheng
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Chao Huang
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Xuetong Chen
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Zihu Guo
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Yingxue Fu
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Jianling Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, China
| | - Yonghua Wang
- Center of Bioinformatics, College of Life Science, Northwest A & F University, Yangling, Shaanxi 712100, China.
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Upala S, Sanguankeo A. Low 25-hydroxyvitamin D levels are associated with vitiligo: a systematic review and meta-analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:181-90. [DOI: 10.1111/phpp.12241] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Sikarin Upala
- Department of Internal Medicine; Bassett Medical Center and Columbia University College of Physicians and Surgeons; Cooperstown NY USA
- Department of Preventive and Social Medicine; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Anawin Sanguankeo
- Department of Internal Medicine; Bassett Medical Center and Columbia University College of Physicians and Surgeons; Cooperstown NY USA
- Department of Preventive and Social Medicine; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
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Abdel Latif AA, Ibrahim SMA. Monochromatic excimer light versus combination of topical steroid with vitamin D3 analogue in the treatment of nonsegmental vitiligo: a randomized blinded comparative study. Dermatol Ther 2015; 28:383-9. [DOI: 10.1111/dth.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Azmy Ahmed Abdel Latif
- Department of Dermatology and Venereology, Faculty of Medicine; Al-Azhar University; Cairo Egypt
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Abstract
Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.
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Faria AR, Tarlé RG, Dellatorre G, Mira MT, Castro CCSD. Vitiligo--Part 2--classification, histopathology and treatment. An Bras Dermatol 2015; 89:784-90. [PMID: 25184918 PMCID: PMC4155957 DOI: 10.1590/abd1806-4841.20142717] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 11/22/2022] Open
Abstract
In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.
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Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2014; 56:85-92. [DOI: 10.1111/ajd.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Richard Wittal
- University of New South Wales; Sydney New South Wales Australia
- Skin and Cancer Foundation; Sydney New South Wales Australia
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Abstract
BACKGROUND Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. OBJECTIVE The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. METHODS A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. RESULTS A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. CONCLUSION Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
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Sheth VM, Guo Y, Qureshi AA. Comorbidities associated with vitiligo: a ten-year retrospective study. Dermatology 2013; 227:311-5. [PMID: 24107643 DOI: 10.1159/000354607] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitiligo is a common disorder of depigmentation that has been associated with other autoimmune diseases. No recent large-scale data exist on the rates of comorbidities associated with vitiligo from the United States population. OBJECTIVES To identify the prevalence of comorbidities as well as associated laboratory abnormalities in vitiligo patients. METHODS All medical records dating from January 1, 2000 to June 21, 2011 within the Research Patient Data Repository were evaluated retrospectively using a novel artificial intelligence-based computer program. A total of 3,280 patients carrying the diagnosis of vitiligo were identified using ICD-9 code 709.01. We randomly selected 300 patients and validated the diagnosis by manually reviewing their medical records. These results were used to create a model that was then applied to the larger set yielding 2,441 true vitiligo patients. 1,657 (68%) were diagnosed by dermatologists and 784 (32%) by non-dermatologists. We identified the prevalence of other comorbid autoimmune conditions by searching problem lists of vitiligo patients and collected laboratory data from the first available data point in the system for each patient. RESULTS Women were more frequently represented (57.6%) than men (42.4%). The majority of vitiligo patients were White/Caucasian (56.9%), followed by Hispanic/Latino (19.4%). 565 (23%) had one of the following comorbidities: 287 thyroid-related, 186 psoriasis, 72 rheumatoid arthritis, 59 alopecia areata, 55 inflammatory bowel disease, 53 systemic lupus and 20 type I diabetes mellitus. 41% had elevated anti-nuclear antibody levels. Almost half of the patients tested had elevated thyroid peroxidase antibodies. Over 50% of the patients tested had low or insufficient levels of 25-OH vitamin D. CONCLUSION We found a high prevalence of comorbidities among individuals with vitiligo presenting to teaching hospitals in Boston, Mass. Comorbid autoimmune conditions were seen in 23% of vitiligo patients, thyroid disorders and psoriasis being the most common. Screening for these conditions, especially thyroid disorders, should be considered in vitiligo patients.
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Affiliation(s)
- Vaneeta M Sheth
- Clinical Research Program, Department of Dermatology, Brigham and Women's Hospital, Boston, Mass., USA
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Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
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Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
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Konishi Y, Yamanaka K, Mizutani H. Treatment of vitiligo vulgaris with the combination therapy of topical steroid and vitamin D3 compound. Dermatol Reports 2012; 4:e8. [PMID: 25386318 PMCID: PMC4212668 DOI: 10.4081/dr.2012.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 04/07/2012] [Accepted: 04/20/2012] [Indexed: 11/22/2022] Open
Abstract
We report here two cases of vitiligo vulgaris successfully treated with the combination therapy of topical steroid and vitamin D3 compound and currently maintained by vitamin D3 analog without any adverse effects: skin atrophy, striae or telangiectasia on the exposed areas. The best-known mechanism of topical vitamin D3 analog is the enhancement of keratinocytes differentiation and anti-proliferative effects. Vitamin D3 analog is also reported to suppress T-cell mediated immunity, T-cell skin recruitment, and skin infiltration via down-regulating cutaneous lymphocyte antigen expression. Furthermore, vitamin D3 compounds are known to influence melanocyte maturation and differentiation and also to up-regulate melanogenesis. Autoreactive lymphocytes against melanocytes are one of the causes. Topical vitamin D3 analog may control vitiligo itself, however stronger immunosuppressive effects of topical corticosteroid may contribute to rapid re-pigmentation suppressing auto-reactive lymphocytes. The topical combination therapy is a simple, effective and safe option for vitiligo vulgaris in sun-exposed areas.
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Affiliation(s)
- Yoko Konishi
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie, Japan
| | - Hitoshi Mizutani
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie, Japan
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Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol 2011; 65:493-514. [PMID: 21839316 DOI: 10.1016/j.jaad.2010.10.043] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/17/2010] [Accepted: 10/01/2010] [Indexed: 02/04/2023]
Abstract
Vitiligo is a common skin disorder that results in depigmentation. With the appropriate management, many patients can minimize disease progression, attain repigmentation, and achieve cosmetically pleasing results. There are numerous medical and surgical treatments aimed at repigmentation; therapies for depigmentation are available for patients with recalcitrant or advanced disease. The use of cosmetics at all stages of treatment may be vital to the patient's quality of life. Understanding all the available options helps choose the appropriate treatment plan and tailor it to your patient. Part II of this two-part series on vitiligo discusses the indications for, evidence behind, and adverse effects associated with many of the therapies used for vitiligo. Both conventional medical and surgical options are discussed in addition to several alternative and promising new therapies.
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Hu JJ, Xu AE, Wu XG, Sun XC, Luo XY. Small-sized lesions of childhood vitiligo treated by autologous epidermal grafting. J DERMATOL TREAT 2011; 23:219-23. [DOI: 10.3109/09546634.2010.543122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Vitiligo is a common depigmenting disorder affecting about 1-2% of the world population. Approximately half of the affected individuals develop the disease before adulthood. Etiologic hypotheses for vitiligo include biochemical, neural and autoimmune mechanisms. The most compelling of these suggests a combination of genetic and immunologic factors that result in an autoimmune melanocyte destruction. We reviewed studies carried out on various treatment modalities used in childhood vitiligo. Topical corticosteroids were found to have excellent repigmentation rates, whereas calcineurin inhibitors have comparable efficacy and a better safety profile compared with topical corticosteroids. These two groups of topical medications are good first-line treatment modalities for localized vitiligo. For the treatment of generalized vitiligo, phototherapy has excellent efficacy. Narrow-band ultraviolet B (UVB) has better overall repigmentation rates and safety profile than either topical or oral psoralens and ultraviolet A (PUVA). Other treatment modalities may be considered depending on a patient's specific condition, such as surgical options and depigmentation. With adequate sun protection, the option of no treatment with or without corrective camouflage, is an innocuous alternative to any of these treatment modalities.
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Abstract
PURPOSE OF REVIEW This review addresses recent changes in the understanding and the treatment of vitiligo vulgaris. RECENT FINDINGS Two target genes for vitiligo have been identified, NACHT-leucine-rich-repeat protein-1 (NALP1), part of the inflammasome cascade, and tyrosinase, the enzyme that produces melanin. Identification of reactive oxidation species has furthered the understanding of melanocyte destruction. Comorbid autoimmune disease, including thyroid autoimmunity seen in 25%, is genetically linked to generalized vitiligo and is noted in both childhood vitiligo patients and their families. Screening for vitamin deficiencies and concurrent autoimmunity can be beneficial to the overall health of the child with vitiligo. About half of all vitiligo vulgaris patients have onset of their illness during childhood, causing increased psychological stress during the formative years. Fortunately, therapy has improved as well, with the development of newer topical agents for vitiligo, including topical calcineurin inhibitors; new topical combinations such as topical corticosteroids and calcipotriene; and new technological advances including narrowband ultraviolet B and excimer laser. SUMMARY A cyclic approach to therapy should be used wherein topical agents are altered every 6-8 months and technology is used as an alternative after achievement of maximal topical response. With cyclic therapy and early disease intervention, good cosmetic outcomes may be achievable, particularly in localized cases.
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Abstract
BACKGROUND Vitiligo is an acquired depigmentary disorder affecting around 1% of the world's population. In 25% of cases it has its onset prior to the age of 14 years. DATA SOURCES Articles on vitiligo in children published after 1995 were retrieved from PubMed. The prevalence, etiology, clinical presentation, differential diagnosis, treatment and management of vitiligo in children were summarized. RESULTS Vitiligo is characterized by acquired, sharply demarcated depigmented macules or patches on the skin, the mucous membranes and/or white hair and it is mainly differentiated from congenital achromic skin lesions. It is frequently associated with various autoimmune diseases. Hashimoto's thyroiditis is the most common association in children. Information on the nature, possible causes and course of the disease leads to acceptance of the disorder and higher compliance with the treatment. The choice of medical treatment depends on the type, location and duration of lesions as well as the eagerness of the child and his/her parents to pursue therapy. CONCLUSION The management of childhood vitiligo includes information and reassurance of young patients and their parents on the disease, thyroid investigation, avoidance of trigger factors, topical treatment and proper follow-up.
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Affiliation(s)
- Talia Kakourou
- First Pediatric Department Athens University, Aghia Sophia Children's Hospital, Athens, Greece.
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Affiliation(s)
- Arin L Isenstein
- Department of Dermatology, University of North Carolina, Chapel Hill 27599-7287, USA.
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Birlea SA, Costin GE, Norris DA. New insights on therapy with vitamin D analogs targeting the intracellular pathways that control repigmentation in human vitiligo. Med Res Rev 2009; 29:514-46. [DOI: 10.1002/med.20146] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
We present a 11-year-old girl with an 8-month history of vitiligo vulgaris on her postcervical, periocular, and periauricular regions. The region topically treated with 0.0002% tacalcitol ointment (vitamin D3 ointment) and sunlight exposure healed completely, while the region treated with the ointment alone did not improve. A combination therapy with tacalcitol ointment and sunlight exposure instead of UV irradiation can be recommended as an alternative therapy for vitiligo vulgaris because the treatment is safe and increases compliance in children.
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Affiliation(s)
- Hiroo Amano
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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Kwinter J, Pelletier J, Khambalia A, Pope E. High-potency steroid use in children with vitiligo: A retrospective study. J Am Acad Dermatol 2007; 56:236-41. [PMID: 17224367 DOI: 10.1016/j.jaad.2006.08.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 08/01/2006] [Accepted: 08/03/2006] [Indexed: 12/15/2022]
Abstract
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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Arca E, Taştan HB, Erbil AH, Sezer E, Koç E, Kurumlu Z. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. J Dermatol 2006; 33:338-43. [PMID: 16700666 DOI: 10.1111/j.1346-8138.2006.00079.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vitiligo is a common, idiopathic, acquired, depigmenting disease characterized by loss of normal melanin pigments in the skin. The most interesting treatment methods for extensive vitiligo involve psoralen plus ultraviolet A (PUVA) therapy and ultraviolet (UV)-B phototherapy, particularly narrow-band UV-B. In this randomized and comparative study, we investigated the safety and efficacy of narrow band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo. Of the 40 vitiligo patients enrolled in the study, 15 were treated with the calcipotriol plus narrow-band UV-B (NBUVB) and 25 with narrow band UV-B alone. The patients were randomized into two NBUVB treatment groups. The first group, consisting of 24 patients (all male), received only NBUVB treatment; the second group, consisting of 13 patients (all male) applied 0.05% topical calcipotriol ointments twice daily. Both groups were irradiated with NBUVB (311 nm). In the NBUVB group, the percentage of the body surface affected was reduced from 27.21 +/- 10.41% to 16.25 +/- 8.54% after a mean of 30 treatment sessions. The mean repigmentation percentage was 41.6 +/- 19.4%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 19 patients (19/24; 79.17%) had clinically good results. In the NBUVB plus calcipotriol group, the percentage of the body surface affected was reduced from 23.35 +/- 6.5% to 13.23 +/- 7.05% after a mean of 30 treatment sessions. The mean repigmentation percentage was 45.01 +/- 19.15%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 10 patients (10/13; 76.92%) had clinically good results. Statistically significant intragroup reductions from the baseline percentage of the body surface affected were seen at the endpoint of treatment for the two treatment groups (P < 0.001). However, there was no statistically significant difference between the two treatment groups at the end of therapy with respect to the reduction of repigmentation rates (P > 0.05). The present study reconfirmed the efficacy of NBUVB phototherapy in vitiligo. It can be a therapeutic option considered in the management of patients with vitiligo. However, addition of topical calcipotriol to NBUVB did not show any advantage.
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Affiliation(s)
- Ercan Arca
- Department of Dermatology, Gülhane Military Medical Academy, School of Medicine Etlik, Ankara, Turkey.
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