1
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Khater MH, Abbas RA, Elshobaky OA, Khashaba SA. Prevalence of Hypopigmentary Disorders in Primary School Children in Zagazig City, Sharkia Governorate, Egypt. J Cosmet Dermatol 2021; 21:1208-1215. [PMID: 33942471 DOI: 10.1111/jocd.14192] [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: 02/18/2021] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiologic data derived from population-based studies are very important to understand human diseases and their implications. Highlighting skin problems by identifying their incidence and prevalence is vital to direct suitable medical attention toward them. AIM The aim of the study was to detect the prevalence and most common causes of hypopigmentation in primary school children in Zagazig City. METHODS Cross-sectional study on 185 students selected from two schools. Data were collected by filling a questionnaire, clinical examination, and Wood's light examination to detect hypopigmented skin disorders. RESULTS The prevalence of hypopigmentation among studied population was 45.4%; the commonest cause was pityriasis alba 58.3%, followed by pityriasis versicolor 17.9%, postinflammatory hypopigmentation 10.7%, hypopigmented nevus 9.5%, and finally 3.6% vitiligo. CONCLUSION Hypopigmented skin disorders are important and easy to diagnosis skin diseases that need medical attention.
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Affiliation(s)
- Mohamed H Khater
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reem A Abbas
- Professor of Occupational and Environmental Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ola A Elshobaky
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shrook A Khashaba
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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2
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Saleh R, Ahmed AAE, M Abd-Elmagid W. Efficacy of topical tacrolimus 0.03% monotherapy in the treatment of non-segmental vitiligo: a randomized, controlled trial. J Cosmet Dermatol 2021; 20:3943-3952. [PMID: 33657259 DOI: 10.1111/jocd.14041] [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: 12/14/2020] [Revised: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Topical tacrolimus is increasingly used nowadays in the treatment of vitiligo. OBJECTIVE We evaluated therapeutic outcomes of tacrolimus 0.03% in non-segmental vitiligo (NSV). PATIENTS AND METHODS Sixty-three patients with NSV were divided into groups A and B. Group A received 0.03% tacrolimus ointment (n = 31) and group B received 1% hydrocortisone acetate ointment (n = 32) for 24 weeks. Vitiligo area and severity index (VASI) and repigmentation rates were determined at baseline and 4-week intervals. RESULTS In group A, 24-week VASI [0.5 (0.3, 1.95)] was significantly lower than baseline VASI [0.75 (0.5, 2.1); p = 0.030]. In group B, 24-week VASI [0.75 (0.4, 2.3)] was not significantly different from baseline VASI [0.73 (0.4, 2.1); p = 0.111]. Repigmentation was observed in 14/31 (45.2%) of patients in group A versus 0/32 (0.0%) in group B (p < 0.001). Repigmentation was graded as poor in 6/31 (19.4%), fair in 4/31 (12.9%), good in 1/31 (3.2%), and excellent in 3/31 (9.7%). CONCLUSION Repigmentation was achieved in 45% of patients with NSV following treatment with tacrolimus 0.03% monotherapy for 24 weeks. Tacrolimus-induced repigmentation is more likely in patients with vitiligo vulgaris, head and neck lesions, skin phototype III, and young age.
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Affiliation(s)
- Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Wafaa M Abd-Elmagid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
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3
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Relke N, Gooderham M. The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature. J Cutan Med Surg 2019; 23:298-306. [PMID: 30902022 DOI: 10.1177/1203475419833609] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vitiligo is a common acquired depigmenting disorder characterized by the development of white macules and patches due to the loss of melanocytes. Patients with vitiligo can be stigmatized by society, making the disease a source of psychological stress that can considerably affect quality of life. The goal of vitiligo treatment is to obtain skin repigmentation in the majority of cases, and less commonly to depigment the remaining normal skin. There is no consistent, long-term, durable therapy for vitiligo for all patients, highlighting the unmet need for new safe and effective therapies to control this disease. Recently, JAK inhibitors have been explored as a promising novel treatment option in vitiligo. The JAK and signal transducers and activators of transcription (STAT) pathway is an attractive therapeutic target because IFN-γ-dependent cytokines produced through this pathway have been implicated in the pathogenesis of disease. This literature review describes vitiligo pathophysiology, explains the usefulness of the JAK inhibitors for treatment, and summarizes published case reports, case series, and open-label studies. Research outlined here shows JAK inhibitors in patients with vitiligo have a favorable safety profile and effectively produce repigmentation of lesions, especially with concomitant ultraviolet exposure. Additional studies are required to confirm efficacy, establish safety, and investigate durability of repigmentation.
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Affiliation(s)
| | - Melinda Gooderham
- 1 Queen's University, Kingston, ON, Canada.,2 SKiN Centre for Dermatology, Peterborough, ON, Canada.,3 Probity Medical Research, Waterloo, ON, Canada
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4
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Alomrani AH, Alhazza FI, AlGhamdi KM, El Maghraby GM. Effect of neat and binary vehicle systems on the solubility and cutaneous delivery of piperine. Saudi Pharm J 2018; 26:162-168. [PMID: 30166912 PMCID: PMC6111231 DOI: 10.1016/j.jsps.2017.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/17/2017] [Indexed: 11/20/2022] Open
Abstract
Vitiligo is a skin disease characterized by depigmentation disorders due to lack of melanin production. Piperine, an alkaloid extracted from black piper, is active in melanocytes proliferation. To achieve this, the drug has to reach the melanocytes which exist in the deep layer of the epidermis. Higher drug concentration can be obtained after application of optimized formulation to skin. Accordingly, the aim of this work is to investigate the effect of vehicles on skin penetration of piperine as the first step in development of optimized formulation. The tested vehicles include ethanol (Eth), propylene glycol (PG), polyethylene glycol 400 (PEG), and oleic acid (OA) and their combinations. Water was used as the control and skin permeation was monitored using rabbit ear model skin. The highest piperine solubility (48.6 mg/ml) and flux (40.8 μg/cm2 h) was achieved by Eth and the lowest piperine flux (1.17 μg/cm2 h) was reported for PEG. PG and OA showed piperine flux values comparable to that of the control. Among different combination systems, Eth-OA (75:25) binary system had the highest piperine flux (59.3 μg/cm2 h) followed by Eth-OA (50:50) (32.3 μg/cm2 h) and PG-OA (90:10) (22.7 μg/cm2 h). The study thus introduced a vehicle system as the first step in the development of topical formulation of piperine.
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Affiliation(s)
- Abdullah Hasan Alomrani
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Nanomedicine Unit (NMU-KSU), College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Ibraheem Alhazza
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Mohammed AlGhamdi
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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5
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Ibrahim ZA, Hassan GF, Elgendy HY, Al‐shenawy HA. Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo. J Cosmet Dermatol 2018; 18:581-588. [DOI: 10.1111/jocd.12704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Zeinab A. Ibrahim
- Dermatology and Venereology, Faculty of Medicine Tanta University Tanta Egypt
| | - Ghada F. Hassan
- Dermatology and Venereology, Faculty of Medicine Tanta University Tanta Egypt
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6
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Chen W, Zhou Y, Huang FR, Luo D, Wang DG. Preliminary study on the treatment of vitiligo with carbon dioxide fractional laser together with tacrolimus. Lasers Surg Med 2018; 50:829-836. [PMID: 29635693 DOI: 10.1002/lsm.22821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Wei Chen
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Yuan Zhou
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Fei-ran Huang
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Dan Luo
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
| | - Da-guang Wang
- Department of Dermatology; The First Affiliated Hospital with Nanjing Medical University; Guangzhou Road 300, Nanjing City Jiangsu Province, China 210029
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7
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Xu P, Chen J, Tan C, Lai RS, Min ZS. Pimecrolimus increases the melanogenesis and migration of melanocytes in vitro. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2017; 21:287-292. [PMID: 28461770 PMCID: PMC5409113 DOI: 10.4196/kjpp.2017.21.3.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/03/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022]
Abstract
Vitiligo is an intriguing depigmentary disorder and is notoriously difficult to be treated. The ultimate goal of vitiligo treatment is to replenish the lost melanocytes by immigration from hair follicle and to restore the normal function of melanogenesis by residual melanocytes. There are two types of topical calcineurin inhibitors called tacrolimus and pimecrolimus, and are recommended as the first-line treatments in vitiligo. Although pimecrolimus is efficacious for the repigmentation of vitiligo, its intrinsic mechanisms have never been investigated in vitro. This research aimed to study the ability of pimecrolimus on stimulating melanogenesis, melanocyte migration and MITF (microphthalmia associated transcription factor) protein expression. Results showed that pimecrolimus at the dosages of 1, 10, 102 nM were neither mitogenic nor cytotoxic to melanocytes. The addition of pimecrolimus at 10, 102 and 103 nM significantly increased intracellular tyrosinase activity, which was consistent with the elevated content of melanin content at the same concentrations. The peak effect was seen at 72 h in response to 102 nM pimecrolimus. Results of the wound scratch assay and Transwell assays indicate that pimecrolimus is effective in facilitating melanocyte migration on a collagen IV-coated surface. In addition, MITF protein yield reached the highest by pimecrolimus at 102 nM. In brief, pimecrolimus enhances melanin synthesis as well as promotes migration of melanocytes directly, possibly via their effects on MITF protein expression.
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Affiliation(s)
- Ping Xu
- First Clinical College, Nanjing University of Chinese Medicine, Nanjing 210029, China.,Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Jie Chen
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Cheng Tan
- First Clinical College, Nanjing University of Chinese Medicine, Nanjing 210029, China.,Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Ren-Sheng Lai
- First Clinical College, Nanjing University of Chinese Medicine, Nanjing 210029, China.,Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Zhong-Sheng Min
- First Clinical College, Nanjing University of Chinese Medicine, Nanjing 210029, China.,Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
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8
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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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9
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Fatani M, AlSharif S, Alfif K, Khan A, Hussain W, Banjar A. The clinical patterns of vitiligo “hospital-based study” in Makkah region, Saudi Arabia. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2014. [DOI: 10.1016/j.jssdds.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Ismail SA, Sayed DS, Abdelghani LN. Vitiligo management strategy in Jeddah, Saudi Arabia as reported by dermatologists and experienced by patients. J DERMATOL TREAT 2013; 25:205-11. [DOI: 10.3109/09546634.2012.762638] [Citation(s) in RCA: 5] [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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11
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Saldanha KDD, Machado Filho CDS, Paschoal FM. Action of topical mometasone on the pigmented halos of micrografting in patients with vitiligo. An Bras Dermatol 2012; 87:685-90. [DOI: 10.1590/s0365-05962012000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/23/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Vitiligo is a prevalent skin pigmentation disorder worldwide. The treatments available still offer limited results to some patients. For patients with clinically stable vitiligo, melanocyte transplantation is an appropriate treatment option, and the technique of autologous punch grafting shows good repigmentation. OBJECTIVE: To evaluate the effect of topical mometasone on the halos of repigmentation after autologous punch grafting in patients with clinically stable vitiligo. METHODS: Between 2009 and 2010, 11 patients with clinically stable vitiligo (7 generalized, 2 focal and 2 segmental) underwent autologous punch grafting in the achromic patches. According to the clinical type of vitiligo, patients were instructed to use the corticosteroid ointment during 6 months, only on a few grafted lesions. In the first month, the mometasone ointment was used twice a day and after that just once. They were reassessed 1, 3 and 6 months after the procedure. Grafted halos were photographed and recorded using the software fotofinder. After 6 months, all the treated and untreated areas of the repigmentation halos were measured and analyzed comparatively. RESULTS: The median area of the repigmentation halos after 6 months of treatment with mometasone was larger (25,96 mm² ) than the one of the untreated halos (13,86 mm² ), showing a statistically significant difference (p = 0,026). CONCLUSION: In this study, the use of mometasone ointment increased the area of the repigmentation halos after punch grafting. However, this should be further investigated in larger samples in order to validate this positive action in the treatment of stable vitiligo.
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12
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Fu LF, Zhang DM, Xu AE. De-epithelialization of vitiliginous area for transplantation of cultured autologous melanocyte: a case report of two patients with different methods. Int J Dermatol 2012; 51:747-9. [PMID: 22233097 DOI: 10.1111/j.1365-4632.2010.04611.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Bhuvana K, Sarala N, Singh G, Kumar TN. Effect of 0.1% tacrolimus ointment in localized vitiligo: an open uncontrolled trial. Indian J Dermatol 2011; 56:445-6. [PMID: 21965863 PMCID: PMC3179018 DOI: 10.4103/0019-5154.84735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- K Bhuvana
- Department of Pharmacology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India. E-mail:
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14
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UDOMPATAIKUL M, BOONSUPTHIP P, SIRIWATTANAGATE R. Effectiveness of 0.1% topical tacrolimus in adult and children patients with vitiligo. J Dermatol 2010; 38:536-40. [DOI: 10.1111/j.1346-8138.2010.01067.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Köse O, Arca E, Kurumlu Z. Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo. J DERMATOL TREAT 2010; 21:133-9. [PMID: 20394489 DOI: 10.3109/09546630903266761] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With regard to the lack of effective treatment modalities for childhood localized vitiligo, the search for newer therapeutic agents continues. OBJECTIVE To conduct an open, comparative trial to evaluate the clinical efficacy and safety of topical mometasone cream and pimecrolimus cream in the treatment of childhood vitiligo. METHODS Fifty patients with childhood vitiligo were included in the study. Patients were treated for 3 months either with mometasone cream (0.1%) once daily or with pimecrolimus cream (1%) twice daily. RESULTS Forty patients, 20 from each group, completed the study. The two drugs were found to be statistically significantly effective for diminishing lesion size (Z = 3.070,p = 0.002 andZ = 3.845,p < 0.001, respectively). There were no statistical differences between the two drugs:Z = 1.427,p = 0.154 (mometasone non-inferiority to pimecrolimus). The mean repigmentation rate was 65% in the mometasone group and 42% in the pimecrolimus group at the end of therapy. Atrophy, telangiectasia and erythema were observed in two patients (10%) in the mometasone cream group and a burning sensation and pruritus were observed in two patients (10%) in the pimecrolimus cream group; drop-out was not related to the observed adverse effects. CONCLUSION Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body except for the face in childhood localized vitiligo.
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Affiliation(s)
- Osman Köse
- Department of Dermatology, Gülhane School of Medicine, Ankara, Turkey.
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16
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AlGhamdi KM. A survey of vitiligo management among dermatologists in Saudi Arabia. J Eur Acad Dermatol Venereol 2009; 23:1282-8. [DOI: 10.1111/j.1468-3083.2009.03310.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Taher ZA, Lauzon G, Maguiness S, Dytoc MT. Analysis of interleukin-10 levels in lesions of vitiligo following treatment with topical tacrolimus. Br J Dermatol 2009; 161:654-9. [PMID: 19438859 DOI: 10.1111/j.1365-2133.2009.09217.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitiligo is an acquired dermatological condition that is characterized by depigmentation of patches of skin. It is relatively common, occuring in about 0.38-0.50% of the general population, and can engender significant cosmetic disfigurement and psychological sequelae in the affected individual. Recent studies demonstrate that topical tacrolimus (Protopic; Astellas, Markham, ON, Canada) is efficacious in the treatment of vitiligo. We propose that the successful treatment of vitiligo with topical tacrolimus involves the unique immunosuppressive actions of the T lymphocyte T-helper (Th) 2 cytokine, interleukin (IL)-10. OBJECTIVES We aimed to monitor clinical changes in lesions of vitiligo treated with topical tacrolimus 0.1% ointment and quantify IL-10 cytokine levels in nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. METHODS Clinical evaluation of lesions of vitiligo on the basis of surface area and follicular repigmentation under Wood's lamp was performed in 20 enrolled adult patients. Biopsy specimens were obtained from nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Specimens were processed and analysed for expression of IL-10 using the method of enzyme-linked immunosorbent assay. RESULTS A statistically significant mean +/- SEM decrease in vitiligo lesion size of 41.0 +/- 5.2% was observed following 3 months of treatment. A pattern of follicular repigmentation was noted by the third month of treatment for all patients completing the study. In addition, there was a statistically significant difference between IL-10 expression in vitiligo lesions following treatment for 3 months with topical tacrolimus compared with untreated vitiligo lesions (P = 0.017) and normal skin (P = 0.004). CONCLUSIONS These results confirm that topical tacrolimus is an effective treatment for vitiligo. We propose that topical tacrolimus increases IL-10 expression in vitiligo lesions, and thereby inhibits melanocyte destruction triggered by unchecked Th1 pathways in vitiligo.
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Affiliation(s)
- Z A Taher
- University of Alberta Medical School, Edmonton, Alberta, Canada
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Sendur N, Karaman G, Saniç N, Savk E. Topical pimecrolimus: A new horizon for vitiligo treatment? J DERMATOL TREAT 2009; 17:338-42. [PMID: 17853306 DOI: 10.1080/09546630601028711] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the efficacy of pimecrolimus cream 1% in vitiligo and to evaluate the effects of age of the patients, age of onset and duration of disease on response rate. MATERIALS AND METHODS Twenty-three patients with vitiligo were enrolled in our study; 19 patients (seven male, 12 female) completed the 6-month study period. Patients were treated with topical pimecrolimus 1% cream once daily. The response was evaluated as excellent (76-100%), moderate (51-75%), mild (26-50%), minimal (1-25%), or no response. RESULTS The mean age of the 19 patients was 29.3+/-16.6 (range 7-62 years) and the mean duration of vitiligo was 68.4+/-81.3 months. Three patients demonstrated an excellent response to the therapy. Four patients had moderate, six patients had mild and five patients had minimal responses; one patient had no response to the treatment. Side effects were noted as a burning and stinging sensation in only three patients. The correlations between response rate and duration of the disease (r = 0.02, p = 0.95), onset age (r = -0.17, p = 0.48), and age of the patients (r = -0.16, p = 0.53) were not significant. CONCLUSIONS Pimecrolimus has a mild therapeutic effect on vitiligo without significant side effects and can be an alternative therapy agent.
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Affiliation(s)
- Neslihan Sendur
- Department of Dermatology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey.
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Abstract
Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Abstract
Melanocytes are pigmented cells derived from the neural crest; their proliferation is restrained by immune system. The eruption of nevi after an immunosuppressive condition is a peculiar phenomenon indicating that the immune system may play a major role in limiting proliferation of melanocytes. In this review, we analyze the role of immunosuppressive regimens on melanocyte proliferation. In particular, we discuss the eruptive nevi phenomenon, which is determined by the inability of the immune system to inhibit melanocyte proliferation. These clinical observations indicate that the immune system has a pivotal role in restraining melanocyte proliferation. However, although the role of the immune system in the development of nonmelanoma skin cancer has been shown clearly in several studies involving organ transplant patients, the role of immunosuppression in melanoma genesis has not yet been established. Further investigations are required to establish the real immunogenicity of melanoma, particularly in the light of the dichotomy between the eruptive nevi phenomenon in immunosuppressed patients and the low incidence of melanoma in transplanted patients.
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Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of tarcrolimus cream 0.1% in the treatment of vitiligo. Int J Dermatol 2009; 48:86-90. [DOI: 10.1111/j.1365-4632.2009.03852.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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CHOI CW, CHANG SE, BAK H, CHOI JH, PARK HS, HUH CH, KIM CW, KIM SE, MUN SK, KIM BJ, KIM MN. Topical immunomodulators are effective for treatment of vitiligo. J Dermatol 2008; 35:503-7. [DOI: 10.1111/j.1346-8138.2008.00511.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol 2007; 21:916-20. [PMID: 17659000 DOI: 10.1111/j.1468-3083.2006.02101.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Narrow-band ultraviolet B (NB-UVB) phototherapy and topical tacrolimus are included among the most innovative approaches to vitiligo. OBJECTIVE To evaluate the efficacy and tolerability of combined treatment with NB-UVB and topical tacrolimus in vitiligo. METHODS After informed consent, adult patients with chronic (> 1-year duration) stable vitiligo refractory to conventional treatments were enrolled in an open-labelled prospective study. Treatment regimen consists of once-daily application, in the evening, of tacrolimus 0.03% ointment to the lesions of the face, or tacrolimus 0.1% ointment to the vitiligous patches located on other areas. Concomitant NB-UVB phototherapy was performed twice weekly for 16 weeks. RESULTS Study population included 110 patients (mean age, 42) with a total of 403 lesions. Within the treatment period, variable repigmentation was evident on more than 70% of lesions. Clinical response (repigmentation more than 50%) was observed in 42% of lesions. Response was strictly dependent on the site, being more frequent for face lesions (73%), followed by limbs (68%) and trunk (53.5%). The therapeutic effect on the extremities and genital areas was quite disappointing. Treatment was well tolerated. CONCLUSIONS Our preliminary data suggest that the combination of topical tacrolimus with NB-UVB phototherapy can represent an alternative highly effective approach to refractory vitiligo located on the face, trunk and limbs. Long-term safety data and randomized controlled trials on a large number of patients are required.
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Affiliation(s)
- D Fai
- Phototherapy Unit, Dermatology Service, AUSL LE2, Gagliano del Capo-Maglie, Via Umberto I 16, 73052 Parabita (LE), Salento, Italy.
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Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy ? evidence-based analysis of the literature. J Dtsch Dermatol Ges 2007; 5:467-75. [PMID: 17537039 DOI: 10.1111/j.1610-0387.2007.06280.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Vitiligo is a skin disease with a worldwide prevalence ranging from 0.5% to 4%. Conservative therapies include photochemotherapy, phototherapy with UVB radiation (broadband UVB 290-320 nm, narrow band UVB 311 nm), systemic steroids and pseudocatalase. Modern therapeutic options include treatment with topical immunomodulators (tacrolimus, pimecrolimus), analogues of vitamin D3, excimer laser and surgery/transplantation. Our analysis compares these therapies for vitiligo and the evidence levels supporting their effectiveness. CONCLUSIONS The face and neck respond best to all therapeutic approaches, while the acral areas are least responsive. For generalized vitiligo, phototherapy with UVB radiation is most effective with the fewest side effects; PUVA is the second best choice.Topical corticosteroids are the preferred drugs for localized vitiligo. They may be replaced by topical immunomodulators which display comparable effectiveness and fewer side effects. The effectiveness of vitamin D analogues is controversial with limited data. Surgical therapy can be very successful, but requires an experienced surgeon and is very demanding of time and facilities, thus limiting its widespread use. L-phenylalanine therapy appears effective on the face but enjoys neither widespread use nor extensive data support. No single therapy for vitiligo can be regarded as the most effective as the success of each treatment modality depends on the type and location of vitiligo.
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Affiliation(s)
- Tobias Forschner
- Department of Dermatology, Venereology and Allergy, Charité Universitätsmedizin Berlin, Germany.
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Generali J, Cada DJ. Tacrolimus (Topical): Vitiligo. Hosp Pharm 2007. [DOI: 10.1310/hpj4204-309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Off-Label Drug Uses — This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
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Affiliation(s)
- Joyce Generali
- Drug Information Center, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160
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Seirafi H, Farnaghi F, Firooz A, Vasheghani-Farahani A, Alirezaie NS, Dowlati Y. Pimecrolimus Cream in Repigmentation of Vitiligo. Dermatology 2007; 214:253-9. [PMID: 17377388 DOI: 10.1159/000099592] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 12/08/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitiligo is a chronic disease that mostly affects children and young adults. Nowadays many treatment options are available; however, most of them have limited efficacy and in most cases would result in undesirable complications. OBJECTIVE To determine the extent of repigmentation according to the location of the lesions after applying topical cream pimecrolimus 1% in vitiligo patients. MATERIALS AND METHODS Thirty consecutive patients with vitiligo lesions affecting less than 20% of body surface area without any previous history of spontaneous repigmentation were treated with pimecrolimus cream 1% twice daily for 12 weeks. The extent of repigmentation in vitiligo lesions was determined in each patient after 6 and 12 weeks. RESULTS Moderate to excellent response (repigmentation >26%) was observed in 6.6 and 25.9% of vitiligo lesions 6 and 12 weeks after treatment, respectively. More responsive lesions were located on the trunk, face and elbow (85.7, 75 and 70%). CONCLUSION Pimecrolimus cream 1% results in repigmentation in vitiligo in different extents according to the location of the lesion; however, to clearly prove its efficacy as monotherapy or in combination with other available treatment options, double-blind placebo-controlled studies are essential.
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Dawid M, Veensalu M, Grassberger M, Wolff K. Efficacy and safety of pimecrolimus cream 1% in adult patients with vitiligo: Results of a randomized, double-blind, vehicle-controlled study. J Dtsch Dermatol Ges 2006; 4:942-6. [PMID: 17081269 DOI: 10.1111/j.1610-0387.2006.06124.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vitiligo is an acquired, pigmentary skin disorder which is disfiguring and difficult to treat. In an earlier open label study in adult patients with vitiligo, pimecrolimus cream 1% was reported to have similar efficacy as clobetasol propionate 0.05%. We performed a double-blind, intrapatient comparison of pimecrolimus cream 1% with placebo cream. PATIENTS AND METHODS Twenty adult Caucasians with symmetrical vitiligo (predominantly on extremities, none in the face) were treated b.i.d. for 6 months left/right with pimecrolimus/vehicle (N = 10) or vehicle/pimecrolimus (N = 10), respectively. Primary efficacy endpoint was the size of the target lesion at month 6 and secondary efficacy endpoint was re-pigmentation. RESULTS Treatment with pimecrolimus cream 1% or vehicle resulted in no significant change in mean target lesion size. Modest repigmentation (1-25%) was noted with pimecrolimus at month 2 in 12 of 17 patients (vehicle: 9 of 17 patients). Afterwards, the number of patients who experienced an improvement of pigmentation steadily decreased (3 of 14 patients with pimecrolimus and 2 of 14 with placebo at month 6). Treatment was well tolerated. There were no treatment-related adverse events, no induction of skin atrophy nor any other application site side effects. CONCLUSION In this group of adult patients with symmetrical vitiligo, treatment of body lesions (except face) with pimecrolimus cream 1% could not be shown to be effective.
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Affiliation(s)
- Markus Dawid
- Division of General Dermatology, Department of Dermatology, University of Vienna, Vienna General Hospital, Vienna, Austria
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