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Bishnoi A, Parsad D. Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12968. [PMID: 38632705 DOI: 10.1111/phpp.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. AIMS AND METHODS This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. RESULTS AND DISCUSSION The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital-based and home-based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra-violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti-nuclear antibodies and tailoring approaches for non-photo-adapters are also examined. CONCLUSION In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pradipta NK, Ryoto V, Danarti R, Budiyanto A. Characteristics and decreased Vitiligo Area Scoring Index of vitiligo patients with narrowband-UVB phototherapy in Yogyakarta, Indonesia. Dermatol Reports 2023; 15:9708. [PMID: 38205424 PMCID: PMC10777096 DOI: 10.4081/dr.2023.9708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/23/2023] [Indexed: 01/12/2024] Open
Abstract
Narrowband ultraviolet-B (NB-UVB) phototherapy is the mainstay of vitiligo therapy. The response can be evaluated using the vitiligo area scoring index (VASI) and repigmentation grade. However, few studies used VASI to evaluate phototherapy response and there are no definitive data on the reduction of VASI. This retrospective descriptive study aimed to determine the characteristics and decrease of VASI in patients with vitiligo after 36 and 48 sessions of NB-UVB phototherapy, conducted at Dr. Sardjito General Hospital, Yogyakarta, from December 2021-June 2022. The most common predilection was on the face (71.43%) and acral (61.90%). The most common responses after 36 and 48 phototherapy sessions were minimally improved (decrease in VASI<10%) and improved (reduction in VASI 10-25%). The mean decrease in VASI was 18% and 22% after 36 and 48 phototherapy sessions, respectively. 9.52% and 6.67% of patients experienced a reduction in VASI >50% after 36 and 48 phototherapy sessions, respectively. VASI assessment can be used to evaluate the response to phototherapy in vitiligo. However, VASI cannot show a reduction in vitiligo with slight repigmentation in slow-response patients.
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Affiliation(s)
| | | | | | - Arief Budiyanto
- Department of Dermatology and Venereology Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta; Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Lajevardi V, Hosseini ZSS, Heidari S. Efficacy of using oral methotrexate with phototherapy in the treatment of vitiligo in comparison with single phototherapy treatment: A double-blinded randomized controlled trial. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:657-662. [PMID: 37859524 DOI: 10.1111/phpp.12918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Vitiligo is an acquired skin disease with a worldwide prevalence of 0.5%-2% and a tendency to involve both genders. Although the exact pathologic mechanism is unknown, there is some evidence for the role of autoimmunity in this disease. Based on this theory, various immunosuppressive agents, such as topical or systemic corticosteroids and phototherapy (including narrowband ultraviolet B), are used. Methotrexate is another immunosuppressant that has recently become popular as a single treatment for vitiligo; however, the synergistic effect and its superiority over other treatments are two crucial factors that are still obscure. This study aimed to compare the efficacy of methotrexate+ NB-UVB versus placebo+ NB-UVB in vitiligo patients. METHODS In this double-blinded, randomized controlled trial, 42 patients were randomly allocated into two groups: the first group received three times weekly NB-UVB plus placebo, and the second group was treated with three times weekly NB-UVB in combination with a weekly dose of 12.5 mg MTX. The total duration of treatment was 6 months, patients were followed up every 2 months, and the assessment tools were VASI (repigmentation indicator) and VIDA (disease activity indicator) scores. RESULTS Both treatment groups showed improvement in VASI and VIDA scores during 6-month follow-up, but no statistical significance was found between the two treatment methods. CONCLUSION This study demonstrated that both treatment modalities were equally effective, and further studies are required to evaluate the efficacy of MTX with other medications with longer follow-up and a larger sample size.
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Affiliation(s)
- Vahide Lajevardi
- Department of Dermatology, RAZI Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sama Heidari
- Department of Dermatology, RAZI Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Tanemura A. Understanding of Pathomechanisms and Clinical Practice for Vitiligo. Ann Dermatol 2023; 35:333-341. [PMID: 37830414 PMCID: PMC10579571 DOI: 10.5021/ad.23.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
Vitiligo is a disease caused by the acquired depletion of melanocytes and/or melanocyte precursor cells in response to genetic and environmental factors, resulting in depigmentation of the entire body. It is roughly divided into segmental and non-segmental vitiligo, and it has been found that abnormalities of melanocytes themselves and dysregulation of autoimmune responses to melanocytes are greatly involved in the pathology of non-segmental vitiligo. Segmental vitiligo pathology is largely unknown; however, it has been suggested that it may be caused by skin or melanocyte mosaicism. Treatments for vitiligo include topical therapy, ultraviolet therapy, and surgical transplantation, and it is extremely important to correctly understand the pathology to perform optimal treatment. In recent years, the development of vitiligo treatments using Janus kinase (JAK) inhibitors has progressed rapidly. We herein outline the latest pathology of vitiligo, from general vitiligo treatment to the progress of clinical trials using JAK inhibitors, along with what clinicians should consider in archiving precision medicine, including my own ideas thereon.
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Affiliation(s)
- Atsushi Tanemura
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Iwanowski T, Kołkowski K, Nowicki RJ, Sokołowska-Wojdyło M. Etiopathogenesis and Emerging Methods for Treatment of Vitiligo. Int J Mol Sci 2023; 24:ijms24119749. [PMID: 37298700 DOI: 10.3390/ijms24119749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Vitiligo is an acquired chronic depigmenting disorder of skin. It is mostly asymptomatic and characterized by amelanotic macules and patches that affects 0.5% to 2% of the world's population. The etiology of vitiligo has not been clearly elucidated and multiple theories have been proposed regarding the causes of the disorder. Among the most prevalent theories, the genetic predisposition, oxidative stress theory, promotion of cellular stress and pathologic influence of lymphocytes T have been highlighted. As a result of increases in in-depth knowledge concerning the pathogenetic processes in vitiligo, we review the most recent information concerning its etiopathogenesis and treatment methods including topical and oral Janus kinase inhibitors, prostaglandins and their analogues, namely afamelanotide, Wnt/β-catenin-signaling agonists and cell-based therapies. Topical ruxolitinib has been registered for vitiligo treatment, whereas other agents as oral ritlecitinib, afamelanotide and latanoprost have been studied in ongoing clinical trials. New highly effective therapeutic strategies may be developed thanks to molecular and genetic studies.
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Affiliation(s)
| | - Karol Kołkowski
- Dermatological Students Scientific Association, Department of Dermatology, Venerology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Roman Janusz Nowicki
- Department of Dermatology, Venerology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Małgorzata Sokołowska-Wojdyło
- Department of Dermatology, Venerology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
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Kim HJ, Del Duca E, Pavel AB, Singer GK, Abittan BJ, Chima MA, Kimmel G, Bares J, Baum D, Gagliotti M, Genece J, Chu J, Lebwohl MG, Guttman-Yassky E. Apremilast and narrowband ultraviolet B combination therapy suppresses Th17 axis and promotes melanogenesis in vitiligo skin: a randomized, split-body, pilot study in skin types IV-VI. Arch Dermatol Res 2023; 315:215-221. [PMID: 35279741 DOI: 10.1007/s00403-022-02343-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 12/01/2022]
Abstract
Improved repigmentation of generalized vitiligo in skin types IV-VI has been reported in clinical response to combined therapy with apremilast and narrowband (NB)-UVB; however, tissue responses to combined therapy versus NB-UVB monotherapy have not been elucidated. We compared the change from baseline in cellular and molecular markers in vitiligo skin after combined therapy versus NB-UVB monotherapy. We assessed lesional and nonlesional skin samples from enrolled subjects and evaluated for immune infiltrates, inflammatory, and melanogenesis-related markers which were compared across different treatment groups. Combined therapy resulted in significant reduction of CD8+T cells and CD11c+ dendritic cells, downregulation of PDE4B and Th17-related markers, and upregulation of melanogenesis markers. This study was limited to small sample size, skin types IV-VI, and high dropout rate. Our molecular findings support the clinical analysis that apremilast may potentiate NB-UVB in repigmentation of generalized vitiligo in skin types IV-VI.
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Affiliation(s)
- Hee J Kim
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA.
| | - Ester Del Duca
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA.,Department of Biomedical Engineering, University of Mississippi, University, MS, USA
| | - Giselle K Singer
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Brian J Abittan
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Margot A Chima
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Grace Kimmel
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Jennifer Bares
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Danielle Baum
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Matthew Gagliotti
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Jordan Genece
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Justin Chu
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA
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Zhu B, Liu C, Zhang L, Wang J, Chen M, Wei Y. Comparison of NB-UVB combination therapy regimens for vitiligo: A systematic review and network meta-analysis. J Cosmet Dermatol 2023; 22:1083-1098. [PMID: 36456176 DOI: 10.1111/jocd.15534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Vitiligo was an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance repigmentation. OBJECTIVES To compare the effectiveness of current NB-UVB combination regimen at the improvement in repigmentation through a systematic review and network meta-analysis. METHODS We searched the electronic databases for randomized controlled trials related to NB-UVB combination therapy for vitiligo till October 2022. STATA15.0 software was applied to carrying out data analysis. RESULTS A total of 28 eligible studies involving 1194 participants were enrolled in the analysis. The NMA results revealed that compared with NB-UVB, carboxytherapy [OR = 32.35, 95% CI (1.79, 586.05)], Er: YAG laser+ topical 5% 5-FU [OR = 10.74, 95% CI (4.05, 28.49)], needling/micro-needling [OR = 3.42, 95% CI (1.18, 9.88)], betamethasone intramuscular injection [OR = 3.08, 95% CI (1.17, 8.13)], topical tacrolimus [OR = 2.54, 95% CI (1.30, 4.94)], and oral Chinese herbal medicine compound [OR = 2.51, 95% CI (1.40, 4.50)] integrated with NB-UVB were more efficacious in excellent to complete repigmentation response rate (≥75%). Besides, NB-UVB+ Er: YAG laser+ topical 5% 5-FU [OR = 0.17, 95% CI (0.04, 0.67)] and NB-UVB+ needling/micro-needling [OR = 0.24, 95% CI (0.06, 0.88)] were less likely evaluated as ineffective repigmentation response (≤25%). CONCLUSIONS All combination therapies ranked higher than NB-UVB monotherapy in inducing successful repigmentation and avoiding failed treatment in patients with vitiligo. Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5% 5-FU and NB-UVB+ needling/microneedling would be the preferred therapeutic approaches.
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Affiliation(s)
- Baohua Zhu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Lan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Wang
- Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Mingling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuegang Wei
- Nanjing University of Chinese Medicine, Nanjing, China
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8
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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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Hu W, Lin F, Lei J, Xu AE. Impacts of exposure to topical calcineurin inhibitors on metabolism in vitiligo infants. Pediatr Res 2023; 93:661-665. [PMID: 35681095 DOI: 10.1038/s41390-022-02133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tacrolimus ointment is a recently developed topical immunomodulator that has been approved for use in patients with vitiligo older than 2 years. Concern regarding potential systemic toxic effects has limited treatment options for children younger than 2 years. We wanted to determine whether topical tacrolimus therapy is safe and effective in patients with vitiligo younger than 2 years. METHODS The present 6-month clinical trial was conducted to evaluate the efficacy and safety of 0.03% tacrolimus in the treatment of vitiligo in children under 2 years of age. Meanwhile, serum and urine samples were collected, and liquid chromatography-mass spectrometry was performed to generate the serum and urine metabolic profile data of patients and healthy controls. RESULTS The overall response rate at the sixth month, which was defined by the degree of re-pigmentation, was 100%. As revealed by blood monitoring and metabolite detection 6 months later, there was no difference between the treatment group and the control group. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. CONCLUSIONS Tacrolimus ointment appears to be effective and safe in the treatment of vitiligo in children younger than 2 year. TRIAL REGISTRATION http://www.chictr.org.cn identifier: ChiCTR 2100045920. IMPACT We first reported the efficacy and safety of topical application of 0.03% tacrolimus ointment in infants with vitiligo characterized by the metabolites. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. This study provide evidence for the TCI treatment of infants with vitiligo.
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Affiliation(s)
- Wenting Hu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fuquan Lin
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiehao Lei
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-E Xu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Reduced Elastin Fibers and Melanocyte Loss in Vitiliginous Skin Are Restored after Repigmentation by Phototherapy and/or Autologous Minigraft Transplantation. Int J Mol Sci 2022; 23:ijms232315361. [PMID: 36499690 PMCID: PMC9739647 DOI: 10.3390/ijms232315361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is a hypopigmentation disease characterized by melanocyte death in the human epidermis. However, the mechanism of vitiligo development and repigmentation is largely unknown. Dermal fiber components might play an important role in vitiligo development and repigmentation. Indeed, our preliminary study demonstrated that elastin fibers were decreased in vitiliginous skin, suggesting that the elastin fiber is one of the factors involved in vitiligo development and repigmentation. To confirm our hypothesis, we investigated whether elastin fibers can be restored after treatment using phototherapy and/or autologous skin transplantation. Punch biopsies from 14 patients of stable nonsegmental vitiligo vulgaris were collected from nonlesional, lesional, and repigmented skin, and processed to dopa and combined dopa-premelanin reactions. Melanocytes positive to the dopa reaction and melanoblasts/melanocytes positive to the combined dopa-premelanin reaction were surveyed. Moreover, elastin fibers were detected by Victoria blue staining. Numerous melanocytes and melanoblasts were observed in the epidermis of repigmented skin after the treatment. Moreover, in the dermis of repigmented skin, elastin fibers were completely recovered or even upregulated. These results suggest that melanocyte loss in the vitiliginous skin, as well as melanocyte differentiation in repigmented skin, may be at least in part regulated by elastin fibers in the dermis.
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Nimkar P, Wanjari A. Vitiligo and the Role of Newer Therapeutic Modalities. Cureus 2022; 14:e31022. [DOI: 10.7759/cureus.31022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Feng Y, Lu Y. Advances in vitiligo: Update on therapeutic targets. Front Immunol 2022; 13:986918. [PMID: 36119071 PMCID: PMC9471423 DOI: 10.3389/fimmu.2022.986918] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
Vitiligo, whose treatment remains a serious concern and challenge, is an autoimmune skin disease characterized by patches of depigmentation. The increasing application of molecular-targeted therapy in skin diseases, such as psoriasis and systemic lupus erythematosus, has dramatically improved their condition. Besides, there is a favorable effect of repigmentation in the treatment of the above diseases combined with vitiligo, implying that molecular-targeted therapy may also have utility in vitiligo treatment. Recently, the role of cytokine and signaling pathways in vitiligo pathogenesis are increasingly recognized. Thus, investigations are underway targeting the molecules described above. In this paper, we present a synopsis of current practices in vitiligo treatment and introduce the improvement in identifying new molecular targets and applying molecular-targeted therapies, including those under development in vitiligo treatment, providing valuable insight into establishing further precision medicine for vitiligo patients.
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Liu X, Yao Z, Wang Y, Chai L, Zhou X. Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies. Int Immunopharmacol 2022; 109:108789. [DOI: 10.1016/j.intimp.2022.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
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Esmat SM, El-Mofty M, Rasheed H, Mostafa WZ, Anbar TS, Abdallah M, Bassiouny D, Abdel-Halim D, Hegazy R, Eid AA, Nassar A, Abdel-Aziz RT, Fawzy MM, Gawdat HI, El Hawary M, Sany I, Shalaby S, Ragab N, Abdel-Gaber RM, Tawfik YM, El-Bassiouny M, El-Husseiny R, Attia MS, Farid C, Genedy RM, Mogawer RM. Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:277-287. [PMID: 34726808 DOI: 10.1111/phpp.12749] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. PURPOSE To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). METHODS This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6 months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. RESULTS In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. CONCLUSION NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.
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Affiliation(s)
- Samia M Esmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Medhat El-Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H Rasheed
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wedad Z Mostafa
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tag S Anbar
- Department of Dermatology, STDs and Andrology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa Abdallah
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Dalia Bassiouny
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdel-Halim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Abulfotooh Eid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Nassar
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Rasha Ta Abdel-Aziz
- Department of Dermatology, STDs and Andrology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa M Fawzy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa El Hawary
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Sany
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan Shalaby
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nanis Ragab
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham M Abdel-Gaber
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmin M Tawfik
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Mahy El-Bassiouny
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Rania El-Husseiny
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Miriam Samir Attia
- Dermatology, Venereology and Andrology Department, Ain Shams University, Cairo, Egypt
| | - Carmen Farid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rasha Mahmoud Genedy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania M Mogawer
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Bouceiro Mendes R, Alpalhão M, Filipe P. UVB phototherapy in the treatment of vitiligo: State of the art and clinical perspectives. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:215-223. [PMID: 34626483 DOI: 10.1111/phpp.12740] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/12/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022]
Abstract
Vitiligo is a chronic pigmentary skin disorder that results in white, hypopigmented macules and patches. It causes a considerable psychological and emotional burden on the affected individuals and their families. Several therapeutic options have been employed in vitiligo including topical and oral drugs, surgical techniques, and phototherapy which is considered the cornerstone treatment. Different wavelengths and modalities are available, but narrowband UVB (NB-UVB) is considered the safest and the most effective phototherapy alternative. NB-UVB acts on multiple steps in vitiligo pathogenesis, and it is capable of inducing stabilization and repigmentation of vitiligo lesions. Technological advances have led to the development of both new phototherapy devices and new medical and surgical therapeutic options that can be combined with phototherapy to achieve optimal results. There is no standard treatment, and individual patient and disease characteristics should be considered. We review the current evidence in what concerns UVB phototherapy for vitiligo treatment, including novel combination treatments that may help to provide the best care for these patients.
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Affiliation(s)
- Rita Bouceiro Mendes
- Dermatology Department, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal
| | - Miguel Alpalhão
- Dermatology Department, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal.,Lisbon Medical School, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal.,Lisbon Medical School, Lisbon, Portugal
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16
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1-Leitlinie: Diagnostik und Therapie der Vitiligo. J Dtsch Dermatol Ges 2022; 20:365-379. [PMID: 35304960 DOI: 10.1111/ddg.14713_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Jo Ana Schunter
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Klaus Fritz
- Hautarztpraxis und Laserzentrum Landau, Landau, Deutschland
| | - Carmen Salavastru
- Universität Carol Davila, Pädiatrische Dermatologie, Bukarest, Rumänien
| | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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17
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Böhm M, Schunter JA, Fritz K, Salavastru C, Dargatz S, Augustin M, Tanew A. S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges 2022; 20:365-378. [PMID: 35246935 DOI: 10.1111/ddg.14713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Vitiligo is a common skin disorder characterized by immune-mediated destruction of melanocytes. Non-segmental vitiligo, the most common clinical subtype, has usually a chronic course and often results in significant psychosocial consequences for the affected patient. Early recognition, awareness of comorbidity, precise assessment of disease extent and activity, evaluation of impairment of quality of life as well as rapid initiation of treatment based on currently available evidence-based therapies are crucial cornerstones in the management of vitiligo. This S1 guideline helps German dermatologists to better diagnose and treat vitiligo.
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Affiliation(s)
- Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Jo Ana Schunter
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Klaus Fritz
- Dermatology Office and Laser Center Landau, Landau, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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18
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Myers E, Kheradmand S, Miller R. An Update on Narrowband Ultraviolet B Therapy for the Treatment of Skin Diseases. Cureus 2021; 13:e19182. [PMID: 34873522 PMCID: PMC8634827 DOI: 10.7759/cureus.19182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/25/2022] Open
Abstract
The objective of this review is to provide an update on narrowband ultraviolet B (NB-UVB) as a treatment for various skin conditions. NB-UVB works by suppressing the cutaneous cell-mediated immune response and has been shown to be an efficacious and clinically tolerable treatment for a range of inflammatory dermatoses. A literature search was conducted by advanced searches of PubMed for NB-UVB treatment of dermatologic skin diseases with a focus on reports from 2010 to 2021, including both office-based and home-based phototherapy (HBPT). Data were prioritized based on studies with a high level of evidence using the Oxford Evidence-Based Medicine guidance. We found that NB-UVB continues to serve as an effective form of therapy for several cutaneous conditions, including vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, and other inflammatory dermatoses. The recent introduction of Janus kinase inhibitors in combination with NB-UVB suggests future promise in the treatment of vitiligo. Despite its rise in popularity, a decline was seen in office-based NB-UVB treatment during the coronavirus disease 2019 pandemic. Options are available to deliver NB-UVB at home with comparable efficacy to office-based treatments. In conclusion, for a select group of patients and conditions, NB-UVB continues to serve as an effective treatment modality with minimal side effects, with HBPT serving as an option to improve patient compliance.
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Affiliation(s)
- Elisha Myers
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Shiva Kheradmand
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
| | - Richard Miller
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
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19
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Kubelis-López DE, Zapata-Salazar NA, Said-Fernández SL, Sánchez-Domínguez CN, Salinas-Santander MA, Martínez-Rodríguez HG, Vázquez-Martínez OT, Wollina U, Lotti T, Ocampo-Candiani J. Updates and new medical treatments for vitiligo (Review). Exp Ther Med 2021; 22:797. [PMID: 34093753 PMCID: PMC8170669 DOI: 10.3892/etm.2021.10229] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Vitiligo is a multifactorial disease characterized by the loss of skin pigment, which results in achromic macules and patches. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. These treatments alone or combined have exhibited varying degrees of pigmentation, and the majority are safe and effective. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Individualized treatment is appropriate according to the location, clinical presentation and the presence of disease activity. The present review summarizes the medical treatments available for vitiligo: Systemic and topic pharmacological therapies, physical and depigmentation treatments. Several treatments are still underway and have not yet been approved. However, due to the promising preliminary results, these are also mentioned in the present review.
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Affiliation(s)
- David Emmanuel Kubelis-López
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Natalia Aranza Zapata-Salazar
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Salvador Luis Said-Fernández
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Celia Nohemí Sánchez-Domínguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | | | - Herminia Guadalupe Martínez-Rodríguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Osvaldo Tomás Vázquez-Martínez
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
| | - Uwe Wollina
- Department of Dermatology and Allergology and Skin Cancer Center, Städtisches Klinikum Dresden, D-01067 Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome G. Marconi, I-00193 Rome, Italy.,Department of Dermatology and Communicable Diseases, First Medical State University of Moscow I. M. Sechenev Ministry of Health, Moscow 119991, Russia
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, México
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20
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Liao YH, Chen WS, Jee SH. The additive efficacy of therapeutic low-intensity pulsed ultrasound in the treatment of vitiligo: A randomized, left-right comparison clinical trial. Dermatol Ther 2020; 34:e14648. [PMID: 33296553 DOI: 10.1111/dth.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Repigmentation of vitiligo relies on the proliferation and migration of melanoblasts from hair follicles to the epidermis to replenish epidermal melanin. Our previous study has demonstrated low-intensity pulsed ultrasound (LIPUS) can stimulate melanoblast migration in vitro. We sought to evaluate the potential additive efficacy and safety of LIPUS for repigmentation of vitiligo. Twenty-seven adult patients with stable generalized vitiligo on the face or trunk were recruited in this randomized, open, left-right comparison study. In each patient, two symmetric lesional sites were randomly selected; one was assigned as the target lesion, which was treated with add-on LIPUS twice weekly for 24 weeks, and the other as the control lesion, which was administrated with sham sonification. The primary outcome was the difference of repigmentation degree between the target and control lesions at week 24, based on the 7-point physician global assessment score. At the end of study, 23 patients with vitiligo on the face (n = 10) or trunk (n = 13) completed the 24-week treatment course. Enhanced repigmentation for vitiligo receiving LIPUS as compared to sham sonification was observed in 38.5% (5/13) of the patients with truncal vitiligo, but none of those with facial vitiligo. Truncal vitiligo (P = .046) and higher intensity of LIPUS administered (P = .01) were statistically significantly associated with the effectiveness of additive LIPUS treatment. The LIPUS treatment was well-tolerated without remarkable adverse effects. This pilot study showed that LIPUS could provide therapeutic benefits and could be considered as a treatment adjunct for truncal vitiligo.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
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21
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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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22
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Chang HC, Sung CW. Efficacy of combination therapy of narrowband-ultraviolet B phototherapy or excimer laser with topical tacrolimus for vitiligo: An updated systematic review and meta-analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 37:74-77. [PMID: 32654300 DOI: 10.1111/phpp.12593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/19/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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23
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Phan K, Phan S, Shumack S, Gupta M. Repigmentation in vitiligo using janus kinase (JAK) inhibitors with phototherapy: systematic review and Meta-analysis. J DERMATOL TREAT 2020; 33:173-177. [PMID: 32096671 DOI: 10.1080/09546634.2020.1735615] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Vitiligo is an autoimmune disorder characterized by progressive loss of melanocytes, leading to cutaneous depigmentation. Vitiligo has significant psychosocial impacts on patients and is challenging to manage with limited treatment options. Recent studies have suggested promising results for JAK1/3 inhibitors including tofacitinib and ruxolitinib.Objective: To determine the expected response of vitiligo to JAK inhibitor therapy and factors which influence response rates.Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. Good response was defined as repigmentation >50% or a 'good' or 'excellent' outcome as described by authors. Partial response was defined as some repigmentation <50%.Results: From the 9 eligible studies, individual patient data from 45 cases were pooled. Good response was achieved in 57.8%, partial response in 22.2%, and none or minimal response in 20% of cases. When subgrouped according to site, facial vitiligo had the highest good response rate (70%), compared to extremities (27.3%) and torso/non-sun exposed areas (13.6%). Concurrent phototherapy was significant associated with higher rates of good overall response (p < .001) and good facial response (p < .001).Conclusions: There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in vitiligo. Concurrent UVB phototherapy appears to improve efficacy of JAK inhibitors for vitiligo.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,St George Dermatology and Skin Cancer Centre, Sydney, Australia
| | - Steven Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Shumack
- St George Dermatology and Skin Cancer Centre, Sydney, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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24
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Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
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25
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Guenther L, Lynde C, Poulin Y. Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders. J Cutan Med Surg 2020; 23:27S-34S. [PMID: 31476936 DOI: 10.1177/1203475419857668] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.
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Affiliation(s)
| | - Charles Lynde
- 2 Lynde Dermatology, Probity Medical Research, Markham, ON, and Department of Medicine, University of Toronto, ON, Canada
| | - Yves Poulin
- 3 Laval University and Centre dermatologique du Québec métropolitain and Centre de Recherche Dermatologique du Québec métropolitain, Canada
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26
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Singer S, Berneburg M. Phototherapy. J Dtsch Dermatol Ges 2019; 16:1120-1129. [PMID: 30179320 DOI: 10.1111/ddg.13646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
The efficacy of phototherapy is based on the interaction between ultraviolet (UV) radiation and the skin. The photobiological effects thus achieved depend on the wavelengths used. Targeted use of UVA and UVB, where indicated in combination with a photosensitizer such as psoralen, provides the dermatologist with a broad armamentarium for the treatment of a multitude of skin diseases. The spectrum of indications ranges from superficial dermatitis, psoriasis, and malignancies, such as cutaneous T-cell lymphoma, to deep sclerosing conditions such as morphea. The objective of the present review is to highlight the photobiological effects of the various types of UV radiation as well as the resultant clinical indications for phototherapy.
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Affiliation(s)
- Sebastian Singer
- Department of Dermatology, Regensburg University Medical Center, Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, Regensburg University Medical Center, Regensburg, Germany
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27
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Singer S, Berneburg M. Phototherapie. J Dtsch Dermatol Ges 2019; 16:1120-1131. [PMID: 30179327 DOI: 10.1111/ddg.13646_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
Die Phototherapie nutzt die photobiologische Wirkung von ultravioletter (UV-)Strahlung auf unseren Organismus. Die verschiedenen Wellenlängen der Strahlung rufen dabei ganz unterschiedliche Effekte hervor. Der gezielte Einsatz von UV-A und UV-B, gegebenenfalls auch in Kombination mit dem Photosensibilisator Psoralen im Rahmen einer PUVA-Therapie, ermöglicht dem Dermatologen die effektive Behandlung der verschiedensten Hautkrankheiten. Das Indikationsspektrum der Phototherapie reicht von oberflächlichen Ekzemerkrankungen, Psoriasis, malignen Erkrankungen wie dem kutanen T-Zell-Lymphom, bis hin zu tief in der Dermis lokalisierten sklerosierenden Erkrankungen wie der Sklerodermie. Das Verständnis der zugrunde liegenden photobiologischen Wirkmechanismen der verschiedenen Bereiche der UV-Strahlung und die sich daraus ableitenden Indikationen für eine Phototherapie soll der folgende Artikel ermöglichen.
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Affiliation(s)
- Sebastian Singer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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28
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Abstract
Vitiligo is an acquired disorder of skin pigmentation that produces significant psychological impact especially in those with skin of color. Narrow-band ultraviolet B (NB-UVB) therapy, which was first used in vitiligo in 1997 by Westerhof and Nieuweboer-Krobotova, has emerged as one of the safest and most effective therapy for this dermatosis. The light source used for NB-UVB phototherapy is the TL-01 lamp, and the most common model of the NB-UVB phototherapy device is the upright in-office booth or chamber which has 24-48 such lamps. In recent years, there have been several advances in the understanding of the mechanism of action of NB-UVB and the use of combination treatments, many of which increase the efficacy of NB-UVB. In 2017, the Vitiligo Working Group made vital recommendations on the dosage, frequency, and safety of NB-UVB in vitiligo. Furthermore, home phototherapy devices are gaining popularity as they lead to an improved patient compliance. There is still need for large multicenter randomized controlled trials to assess benefits of home phototherapy in vitiligo and studies investigating additional benefits of phototherapy following surgical therapy.
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Affiliation(s)
- Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sujay Khandpur
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
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29
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Hirobe T, Enami H. Excellent color-matched repigmentation of human vitiligo can be obtained by mini-punch grafting using a machine in combination with ultraviolet therapy. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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Uitentuis SE, Narayan VS, Wind BS, Bekkenk MW, de Rie MA, Wolkerstorfer A. Patient reported outcomes for intensified versus conventional NB-UVB treatment in non-segmental vitiligo. J DERMATOL TREAT 2018; 30:594-597. [DOI: 10.1080/09546634.2018.1543851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sanne E. Uitentuis
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Vidhya S. Narayan
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Bas S. Wind
- Department of Dermatology, Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands
| | - Marcel W. Bekkenk
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno A. de Rie
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Albert Wolkerstorfer
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Hirobe T, Enami H. Activation of melanoblasts and melanocytes after treatment with monochromatic excimer light and narrowband-ultraviolet B of skin of vitiligo patients. Int J Dermatol 2018; 58:210-217. [DOI: 10.1111/ijd.14216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/14/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
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Ohtsuki M, Morimoto H, Nakagawa H. Tacrolimus ointment for the treatment of adult and pediatric atopic dermatitis: Review on safety and benefits. J Dermatol 2018; 45:936-942. [PMID: 29927498 PMCID: PMC6099320 DOI: 10.1111/1346-8138.14501] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022]
Abstract
Atopic dermatitis (AD) requires long-term management, mainly with topical anti-inflammatory agents. Topical corticosteroids (TCS) and tacrolimus ointment (TAC-O) are recommended as first-line treatments for AD. However, the long-term use of TCS is limited by cutaneous adverse events such as skin atrophy. For TAC-O, Japanese and US labelings were updated in 2003 and 2006, respectively, to include a boxed warning about a theoretical risk of skin cancer and lymphoma in patients treated with topical calcineurin inhibitors. However, TAC-O has been used worldwide for longer than 15 years to treat adult and pediatric patients with AD. Available data suggest that TAC-O is effective and well tolerated, and can improve quality of life. TAC-O has successfully been used in the proactive management of AD consisting of long-term intermittent use to prevent, delay or reduce the occurrence of AD flares. Systemic drug absorption after TAC-O application is negligible and unlikely to result in systemic immunosuppression. There is currently no strong evidence of an increased rate of malignancy in treated patients, and observational data from postmarketing surveillance studies have shown no safety concerns. In the absence of robust evidence, the warning about the carcinogenic potential in the Japanese labeling for TAC-O does not appear justified and should be reconsidered. This mitigation of description would allow adult and pediatric patients with AD to receive the effective treatment more appropriately.
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Affiliation(s)
| | | | - Hidemi Nakagawa
- Department of DermatologyThe Jikei University School of MedicineTokyoJapan
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Bishnoi A, Parsad D. Clinical and Molecular Aspects of Vitiligo Treatments. Int J Mol Sci 2018; 19:ijms19051509. [PMID: 29783663 PMCID: PMC5983813 DOI: 10.3390/ijms19051509] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
Vitiligo is an asymptomatic but cosmetically disfiguring disorder that results in the formation of depigmented patches on skin and/or mucosae. Vitiligo can be segmental or non-segmental depending upon the morphology of the clinical involvement. It can also be classified as progressing or stable based on the activity of the disease. Further, the extent of involvement can be limited (localized disease) or extensive (generalized disease). The treatment of vitiligo therefore depends on the clinical classification/characteristics of the disease and usually comprises of 2 strategies. The first involves arresting the progression of active disease (to provide stability) in order to limit the area involved by depigmentation. The second strategy aims at repigmentation of the depigmented area. It is also important to maintain the disease in a stable phase and to prevent relapse. Accordingly, a holistic treatment approach for vitiligo should be individualistic and should take care of all these considerations. In this review, we shall discuss the vitiligo treatments and their important clinical and molecular aspects.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
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Wang LM, Zhang B, Li JJ, Zhou YC, Wang DX. The expression change of RORγt, BATF, and IL-17 in Chinese vitiligo patients with 308 nanometers excimer laser treatment. Dermatol Ther 2018; 31:e12598. [PMID: 29642271 DOI: 10.1111/dth.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/21/2017] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Abstract
This study aims to explore the expression of RORγt, BATF, and IL-17 in Chinese vitiligo patients with 308 nm excimer laser treatment. One hundred and sixty-four vitiligo patients treated with 308 nm excimer laser were enrolled as Case group and 137 health examiners as Control group. Quantitative real-time polymerase chain reaction and immunohistochemistry were conducted to detect the expressions of RORγt, BATF, and IL-17. Expression of RORγt, BATF, IL-17A, and IL-17F were higher in Case group than Control group, with the diagnostic accuracy of 88.04, 87.38, 97.34, and 89.04%, respectively. Pearson correlation analysis showed a positive correlation in RORγt, BATF, IL-17A, and IL-17F mRNAs in vitiligo patients. Moreover, their expressions were higher in active vitiligo patients than stable ones. Besides, the expressions of RORγt, BATF, IL-17A, and IL-17F in vitiligo skin were significantly higher than those in non lesional skin and normal controls. After treatment, their expressions were significantly decreased. Active vitiligo and the high expressions of RORγt, BATF, and IL-17F were the independent risk factors for the ineffectiveness of 308 nm excimer laser treatment. The expressions of RORγt, BATF, IL-17 were significantly enhanced in vitiligo patients, which were correlated with the activity of vitiligo and 308 nm excimer laser therapeutic effects.
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Affiliation(s)
- Lu-Mei Wang
- Department of Dermatology, Dong Guan People's Hospital, Guangdong Province, Dongguan 523018, People's Republic of China
| | - Bin Zhang
- Department of Gynaecology and Obstetrics, Dong Guan People's Hospital, Guangdong Province, Dongguan 523018, People's Republic of China
| | - Jun-Jie Li
- Department of Dermatology, Dong Guan People's Hospital, Guangdong Province, Dongguan 523018, People's Republic of China
| | - Yun-Cong Zhou
- Department of Dermatology, Dong Guan People's Hospital, Guangdong Province, Dongguan 523018, People's Republic of China
| | - Dong-Xia Wang
- Department of Interventional Therapy, Dong Guan People's Hospital, Guangdong Province, Dongguan 523018, People's Republic of China
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Zheleva A, Nikolova G, Karamalakova Y, Hristakieva E, Lavcheva R, Gadjeva V. Comparative study on some oxidative stress parameters in blood of vitiligo patients before and after combined therapy. Regul Toxicol Pharmacol 2018; 94:234-239. [DOI: 10.1016/j.yrtph.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
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Liu LY, Strassner JP, Refat MA, Harris JE, King BA. Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure. J Am Acad Dermatol 2017; 77:675-682.e1. [PMID: 28823882 DOI: 10.1016/j.jaad.2017.05.043] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/19/2017] [Accepted: 05/21/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vitiligo is an autoimmune disease in which cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors. OBJECTIVE To evaluate the efficacy of the JAK 1/3 inhibitor tofacitinib in the treatment of vitiligo. METHOD This is a retrospective case series of 10 consecutive patients with vitiligo treated with tofacitinib. Severity of disease was assessed by body surface area of depigmentation. RESULTS Ten consecutive patients were treated with tofacitinib. Five patients achieved some repigmentation at sites of either sunlight exposure or low-dose narrowband ultraviolet B phototherapy. Suction blister sampling revealed that the autoimmune response was inhibited during treatment in both responding and nonresponding lesions, suggesting that light rather than immunosuppression was primarily required for melanocyte regeneration. LIMITATIONS Limitations include the small size of the study population, retrospective nature of the study, and lack of a control group. CONCLUSION Treatment of vitiligo with JAK inhibitors appears to require light exposure. In contrast to treatment with phototherapy alone, repigmentation during treatment with JAK inhibitors may require only low-level light. Maintenance of repigmentation may be achieved with JAK inhibitor monotherapy. These results support a model wherein JAK inhibitors suppress T cell mediators of vitiligo and light exposure is necessary for stimulation of melanocyte regeneration.
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Affiliation(s)
- Lucy Y Liu
- Yale University School of Medicine, New Haven, Connecticut
| | - James P Strassner
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Maggi A Refat
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Brett A King
- Department of Dermatology, New Haven, Connecticut.
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