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Ju HJ, Bae JM. Bridging Molecular Mechanism and Clinical Practice in Vitiligo Treatment: An Updated Review. Dermatology 2024; 240:474-486. [PMID: 38417409 DOI: 10.1159/000537810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Treatment of vitiligo seeks to achieve three goals: cessation of disease progression, regeneration of pigmentation, and prevention of recurrence. SUMMARY Number of nonsurgical interventions are available that suppress the autoimmune response and regenerate the melanocytes from the reservoir: phototherapy including psoralen and ultraviolet A, narrowband ultraviolet B, and 308-nm excimer and 311-nm Titanium:Sapphire lasers; topical agents including topical calcineurin inhibitors, topical corticosteroids, and topical 5-fluorouracil; and systemic agents including corticosteorids, mycophenolate mofetil, cyclosporine, methotrexate, minocycline, afamelanotide, and antioxidants. In recent years, a great advance has been made in the understanding of pathogenesis of vitiligo, and JAK inhibitors are being investigated as a new treatment. Minimally invasive procedures such as fractional lasers or microneedling can help achieve the optimal treatment outcome when used properly. KEY MESSAGES Our review describes various treatment modalities for vitiligo based on their molecular mechanism of action. Bridging the gap between molecular mechanisms and therapeutic options would be a valuable reference for physicians in clinical practice.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Alshiyab D, Al-Qarqaz F, Ba-Shammakh S, Al-Fakih A, Altawalbeh A, Alsheyab S, Sarakbi D, Muhaidat J. Comparison of the efficacy of tacrolimus 0.1% ointment vs calcipotriol/betamethasone in combination with NBUVB in treatment of vitiligo. J DERMATOL TREAT 2023; 34:2252119. [PMID: 37644869 DOI: 10.1080/09546634.2023.2252119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
Purpose: Vitiligo is an idiopathic depigmenting skin disorder. The study compares the efficacy of topical tacrolimus 0.1% with calcipotriol/betamethasone dipropionate in vitiligo patients receiving NB-UVB treatment.Materials and methods: Forty-one adult patients with generalized type vitiligo were recruited. Patients were assigned to phototherapy and then classified into either group one (20 patients), receiving calcipotriol/betamethasone dipropionate cream (D group), or group two (21 patients), receiving tacrolimus 0.1% ointment (T group). They were followed-up at 3 and 6 months.Results: The D group witnessed an increase in the repigmentation area from 35.4% in the third month to 54.7% in the sixth month (p = 0.001) and the T group from 32.2% to 45.6% (p = 0.011). However, the differences between the treatment groups were not statistically significant. Body sites demonstrated different levels of improvement ranging from the highest in the face to the lowest in the Hand & Feet with the other body sites in between. A negative correlation was identified between the duration since diagnosis and the response to D treatment (3 months: r = -0.612, p = 0.007; 6 months: r = -0.755, p = 0.001).Conclusions: Although both combinations are efficacious, they did not significantly differ in efficacy at three and six months follow-up points.Clinical trial registration: The study was registered at clinicaltrials.gov (NCT04440371).
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Affiliation(s)
- Diala Alshiyab
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Al-Qarqaz
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saleh Ba-Shammakh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulqudos Al-Fakih
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, Irbid, Jordan
| | - Aya Altawalbeh
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Safa' Alsheyab
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Danyah Sarakbi
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jihan Muhaidat
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Al-Smadi K, Ali M, Alavi SE, Jin X, Imran M, Leite-Silva VR, Mohammed Y. Using a Topical Formulation of Vitamin D for the Treatment of Vitiligo: A Systematic Review. Cells 2023; 12:2387. [PMID: 37830601 PMCID: PMC10572240 DOI: 10.3390/cells12192387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Vitamin D is one significant prohormone substance in human organ systems. It is a steroidal hormone produced in the skin upon exposure to UVB rays. This paper presents a systematic review of the utilization of topical vitamin D, specifically cholecalciferol, calcipotriol, and tacalcitol, in the treatment of vitiligo. It considers the role of vitamin D in stimulating the synthesis of melanin and melanogenesis, which can help with the process of repigmentation. The inclusion of calcipotriol or tacalcitol in Narrowband Ultraviolet Phototherapy (NB-UVB) has shown the potential to enhance therapeutic outcomes for vitiligo. However, their effectiveness in combination with Psoralens Long Wave Ultraviolet Radiation (PUVA) and Monochromatic Excimer Light (MEL) treatment for vitiligo is limited. In contrast, combining topical corticosteroids with vitamin D analogues has demonstrated superior efficacy in treating vitiligo compared to using vitamin D analogues alone, while also providing the added benefit of reducing corticosteroid-related adverse effects. In addition, treating stable vitiligo with topical cholecalciferol and microneedling has shown success. Future studies are needed to ascertain an efficient method of administering vitamin D topically as an anti-vitiligo agent.
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Affiliation(s)
- Khadeejeh Al-Smadi
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Masood Ali
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Seyed Ebrahim Alavi
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Xuping Jin
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Mohammad Imran
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
| | - Vania R. Leite-Silva
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo, UNIFESP-Diadema, São Paulo 09913-030, Brazil
| | - Yousuf Mohammed
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia; (K.A.-S.); (M.I.)
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia
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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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Eleftheriadou V, Bergqvist C, Kechichian E, Shourick J, Ju HJ, van Geel N, Bae JM, Ezzedine K. Has the core outcome (domain) set for vitiligo been implemented? An updated systematic review on outcomes and outcome measures in vitiligo randomized clinical trials. Br J Dermatol 2023; 188:247-258. [PMID: 36763863 DOI: 10.1093/bjd/ljac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 2015, a major achievement in vitiligo research was the development of an internationally agreed upon core outcome domain set for randomized clinical trials (RCTs). Three outcomes were identified as being essential: repigmentation, side-effects/harms and maintenance of gained repigmentation. Four items were further recommended for inclusion. The following recommendations then followed: repigmentation should be assessed by measuring the percentage of repigmentation in quartiles (0-25%, 26-50%, 51-79%, 80-100%) and cosmetic acceptability of the results should be assessed using the Vitiligo Noticeability Scale. OBJECTIVES The primary objective of this study was to assess uptake of the core outcome domain set for RCTs in vitiligo. Secondary objectives were to update the systematic review on outcomes reported in vitiligo RCTs, and to assess whether repigmentation and cosmetic acceptability of the results were measured using the above-mentioned recommended scales. METHODS We searched PubMed, Cochrane Library (CENTRAL and Systematic Reviews) and ClinicalTrials.gov for vitiligo RCTs between November 2009 and March 2021. Screening and data extraction were independently performed on title and summary by two researchers. All outcomes and outcome measures reported in eligible RCTs were retrieved and collated. RESULTS In total, 174 RCTs were identified: 62 were published between 2009 and 2015, and 112 were published between 2016 and 2021.Thirty-eight different outcomes were reported. Repigmentation was the primary outcome in 89% of trials (150 of 169). Forty-nine different tools were used to measure repigmentation. Side-effects and harms were reported in 78% of trials (136 of 174). Maintenance of gained repigmentation was reported in only 11% of trials (20 of 174) and duration of follow-up varied greatly from 1 to 14 months. Cosmetic acceptability of the results and cessation of disease activity were assessed in only 2% of trials (four of 174). Quality of life of patients with vitiligo was assessed in 13% of trials (22 of 174). Finally, only 11 of 112 RCTs (10%) published between 2016 and 2021 reported all three essential core outcome domains (repigmentation, side-effects and maintenance of gained repigmentation) and none of the trials reported both essential and recommended core outcome domains. CONCLUSIONS Efforts are still needed to close the gap between set recommendations and RCT outcome reporting.
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Affiliation(s)
- Viktoria Eleftheriadou
- Department of Dermatology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France
| | - Elio Kechichian
- Department of Dermatology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Hyun-Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital, Créteil, France.,EA 7379 EpidermE, Faculty of Medicine, Université Paris-Est Créteil, UPEC, Créteil, France
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Chernyshov PV, Tomas-Aragones L, Manolache L, Pustisek N, Salavastru CM, Marron SE, Bewley A, Svensson A, Poot F, Suru A, Salek SS, Augustin M, Szepietowski JС, Koumaki D, Katoulis AC, Sampogna F, Abeni D, Linder DM, Speeckaert R, van Geel N, Seneschal J, Ezzedine K, Finlay AY. Quality of life measurement in vitiligo. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes with external experts. J Eur Acad Dermatol Venereol 2023; 37:21-31. [PMID: 36259656 DOI: 10.1111/jdv.18593] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
Members of the European Academy of Dermatology and Venereology (EADV) Task Force on Quality of Life (QoL) and Patient Oriented Outcomes reviewed the instruments available for health-related (HR) QoL assessment in vitiligo and together with external vitiligo experts (including representatives of the EADV Vitiligo Task Force) have made practical recommendations concerning the assessment of QoL in vitiligo patients. The Dermatology Life Quality Index (DLQI) was the most frequently used HRQoL instrument, making comparison of results between different countries possible. Several vitiligo-specific instruments were identified. The vitiligo Impact Scale (VIS) is an extensively validated vitiligo-specific HRQoL instrument with proposed minimal important change and clinical interpretation for VIS-22 scores. VIS-22 was developed for use in India, where there are some specific cultural beliefs concerning vitiligo. The EADV Task Force on QoL and Patient Oriented Outcomes recommends use of the DLQI and the Children's Dermatology Life Quality Index (CDLQI) as dermatology-specific instruments in vitiligo. There is a strong need for a valid (including cross-cultural validation) vitiligo-specific instrument that can be either a new instrument or the improvement of existing instruments. This validation must include the proof of responsiveness.
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Affiliation(s)
- Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | | | | | - Nives Pustisek
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Carmen Maria Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Servando E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - Anthony Bewley
- Barts Health NHS Trust, London, UK.,Queen Mary University, London, UK
| | - Ake Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - Françoise Poot
- Department of Dermatology, University Hospital Erasme, Brussels, Belgium
| | - Alina Suru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sam S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacek С Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Dimitra Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Alexander C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | | | | | - Dennis Michael Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, University of Bordeaux, Bordeaux, France
| | - Khaled Ezzedine
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Créteil, France
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Picardo M, Huggins R, Jones H, Marino R, Ogunsola M, Seneschal J. The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol 2022; 36:1507-1523. [PMID: 35366355 PMCID: PMC9790455 DOI: 10.1111/jdv.18129] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/04/2022] [Indexed: 12/30/2022]
Abstract
Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.
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Affiliation(s)
- M. Picardo
- San Gallicano Dermatological Institute IRCCSRomeItaly
| | | | - H. Jones
- Incyte CorporationWilmingtonDEUSA
| | | | | | - J. Seneschal
- Department of Dermatology and Pediatric DermatologyNational Reference Center for Rare Skin DisordersHôpital Saint‐AndréCNRS, UMR‐5164, ImmunoConCept, F‐33000BordeauxFrance
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Licata G, Arisi M, Venturini M, Rossi M, Tomasi C, Calzavara-Pinton I, Calzavara-Pinton P. Pretreatment with an Aerosol Foam Containing Calcipotriene and Betamethasone Strongly Improves the Efficacy of Narrow-Band UVB Phototherapy. Dermatol Ther (Heidelb) 2022; 12:2161-2171. [PMID: 36018478 PMCID: PMC9464281 DOI: 10.1007/s13555-022-00792-0] [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: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Narrow-band (NB) UVB has been combined with a number of topical treatments. However, there have been no specific data regarding treatment results of a fixed combination of calcipotriene 50 μg/g plus betamethasone 0.5 mg/g aerosol foam (Cal/BD) combined with NB-UVB phototherapy so far. OBJECTIVES To assess the efficacy of Cal/BD foam coupled to twice-weekly NB-UVB and whether this combined regimen requires fewer UVB treatments and a lower cumulative UVB dose compared to phototherapy alone. METHODS This cross-sectional, prospective, parallel-group study enrolled 187 consecutive moderate-to-severe psoriatic patients who were allocated to two groups in a 1:2 ratio. The overall duration of the treatment cycle was 12 weeks. At baseline and after 2, 4, 8 and 12 weeks, we registered the modified (not considering head lesions) PASI, the number of Cal/BD applications, the NRS score for itching and the adverse effects. RESULTS The combined regimen was more effective in clearing psoriasis [final mPASI: 2.1 (0; 8.2) versus 4.4 (0; 19.6); p < 0.01] and reducing itching [(final NRS score for itching: 0 (0; 3) versus 1 (0; 4); p < 0.01]. Fewer exposures [12 (4; 20) versus 24 (8; 24); p < 0.01] and a lower cumulative UVB dose [6.1 (5.4; 9.3) J cm-2 versus 13.1 (9.8; 19.7) J cm-2; p < 0.01] were required. A higher number of patients achieved complete clearance [47 (74.6%) versus 58 (46.8%) patients (p < 0.001)]. Both treatments were well tolerated without acute adverse effects. CONCLUSION Cal/BD + NB-UVB is a very effective treatment that produces a rapid improvement in clinical lesions and itching and can be considered a valuable alternative to systemic treatments for psoriasis.
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Affiliation(s)
- Gaetano Licata
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Mariachiara Arisi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Marina Venturini
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Mariateresa Rossi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Cesare Tomasi
- Department of Experimental and Applied Medicine, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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Jowkar F, Godarzi H, Parvizi MM. Can we consider silymarin as a treatment option for vitiligo? A double-blind controlled randomized clinical trial of phototherapy plus oral Silybum marianum product versus phototherapy alone. J DERMATOL TREAT 2019; 31:256-260. [DOI: 10.1080/09546634.2019.1595506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Farideh Jowkar
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Godarzi
- Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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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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11
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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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Mohammad TF, Silpa-Archa N, Griffith JL, Lim HW, Hamzavi IH. Home phototherapy in vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017. [DOI: 10.1111/phpp.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Narumol Silpa-Archa
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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Mou KH, Han D, Liu WL, Li P. Combination therapy of orally administered glycyrrhizin and UVB improved active-stage generalized vitiligo. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000800605. [PMID: 27464024 PMCID: PMC4964896 DOI: 10.1590/1414-431x20165354] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022]
Abstract
Glycyrrhizin has been used clinically for several years due to its beneficial effect on immunoglobulin E (IgE)-induced allergic diseases, alopecia areata and psoriasis. In this study, glycyrrhizin, ultraviolet B light (UVB) or a combination of both were used to treat active-stage generalized vitiligo. One hundred and forty-four patients between the ages of 3 and 48 years were divided into three groups: group A received oral compound glycyrrhizin (OCG); group B received UVB applications twice weekly, and group C received OCG+UVB. Follow-ups were performed at 2, 4, and 6 months after the treatment was initiated. The Vitiligo Area Scoring Index (VASI) and the Vitiligo Disease Activity (VIDA) instrument were used to assess the affected body surface, at each follow-up. Results showed that 77.1, 75.0 and 87.5% in groups A, B and C, respectively, presented repigmentation of lesions. Responsiveness to therapy seemed to be associated with lesion location and patient compliance. Adverse events were limited and transient. This study showed that, although the three treatment protocols had positive results, OCG and UVB combination therapy was the most effective and led to improvement in disease stage from active to stable.
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Affiliation(s)
- K H Mou
- Department of Dermatology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - D Han
- Department of Dermatology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - W L Liu
- Department of Dermatology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - P Li
- Center for Translational Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Abstract
Vitiligo, an acquired depigmentation disorder, manifests as white macules on the skin and can cause significant psychological stress and stigmatization. Recent advances have shed light on key components that drive disease onset and progression as well as therapeutic approaches. Vitiligo can be triggered by stress to the melanin pigment-producing cells of the skin, the melanocytes. The triggers, which range from sunburn to mechanical trauma and chemical exposures, ultimately cause an autoimmune response that targets melanocytes, driving progressive skin depigmentation. The most significant progress in our understanding of disease etiology has been made on three fronts: (1) identifying cellular responses to stress, including antioxidant pathways and the unfolded protein response (UPR), as key players in disease onset, (2) characterizing immune responses that target melanocytes and drive disease progression, and (3) identifying major susceptibility genes. The current model for vitiligo pathogenesis postulates that oxidative stress causes cellular disruptions, including interruption of protein maturation in the endoplasmic reticulum (ER), leading to the activation of the UPR and expression of UPR-regulated chemokines such as interleukin 6 (IL-6) and IL-8. These chemokines recruit immune components to the skin, causing melanocytes to be targeted for destruction. Oxidative stress can further increase melanocyte targeting by promoting antigen presentation. Two key components of the autoimmune response that promote disease progression are the interferon (IFN)-γ/CXCL10 axis and IL-17-mediated responses. Several genome-wide association studies support a role for these pathways, with the antioxidant gene
NRF2, UPR gene
XBP1, and numerous immune-related genes including class I and class II major histocompatibility genes associated with a risk for developing vitiligo. Novel approaches to promote repigmentation in vitiligo are being investigated and may yield effective, long-lasting therapies.
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Affiliation(s)
- Prashiela Manga
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, 10016, USA
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El Mofty M, Essmat S, Youssef R, Sobeih S, Mahgoub D, Ossama S, Saad A, El Tawdy A, Mashaly HM, Saney I, Helal R, Shaker O. The role of systemic steroids and phototherapy in the treatment of stable vitiligo: a randomized controlled trial. Dermatol Ther 2016; 29:406-412. [PMID: 27528547 DOI: 10.1111/dth.12384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pathogenesis of vitiligo is believed to be multifactorial disease with a wide variety of therapeutic modalities. The aim of this work is to assess the efficacy of oral mini-pulse steroids (OMP) plus Nb-U.V.B in comparison to OMP alone and Nb-U.V.B alone in treating stable vitiligo. A prospective randomized controlled study including 45 patients categorized into three groups receiving therapy for 3 months; Group A received Nb-U.V.B plus OMP, Group B received OMP alone while Group C received Nb-U.V.B alone. Clinical assessment and PCR evaluation of bFGF, ICAM1, and ELISA for AMA were done. Patients receiving Nb-U.V.B plus OMP and using Nb-U.V.B alone gave statistically significant clinical response than those treated with OMP alone. Statistically significant rise of BFGF was noticed after treatment with Nb-U.V.B plus OMP and with Nb-U.V.B alone. Patients treated with OMP alone and with Nb-U.V.B alone showed statistically significant drop of ICAM-1 after therapy. NB-U.V.B plus OMP and Nb-U.V.B alone were found to be clinically superior over OMP alone in treating stable vitiligo patients, hence suggesting that adding OMP to Nb-U.V.B can maintain clinical and laboratory success for a longer period of time and with less relapse.
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Affiliation(s)
- Medhat El Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Essmat
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Randa Youssef
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherine Sobeih
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Mahgoub
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherine Ossama
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akmal Saad
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira El Tawdy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba M Mashaly
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Saney
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rana Helal
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olfat Shaker
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Stanimirovic A, Kovacevic M, Korobko I, Šitum M, Lotti T. Combined therapy for resistant vitiligo lesions: NB-UVB, microneedling, and topical latanoprost, showed no enhanced efficacy compared to topical latanoprost and NB-UVB. Dermatol Ther 2016; 29:312-316. [DOI: 10.1111/dth.12363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrija Stanimirovic
- Department of Clinical Medicine; University of Applied Health Sciences; Zagreb Croatia
- Croatian Vitiligo Association; Zagreb Croatia
| | - Maja Kovacevic
- Croatian Vitiligo Association; Zagreb Croatia
- Dermatology and Venereology Division; Guglielmo Marconi University; Roma Italy
| | | | - Mirna Šitum
- Department of Dermatology and Venereology; University Hospital Center “Sestre milosrdnice,”; Zagreb Croatia
| | - Torello Lotti
- Dermatology and Venereology Division; Guglielmo Marconi University; Roma Italy
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A comparative study of combined treatment with fractional carbon dioxide and targeted ultraviolet B phototherapy for facial vitiligo. Lasers Med Sci 2016; 31:1343-9. [DOI: 10.1007/s10103-016-1982-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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Whitton M, Pinart M, Batchelor JM, Leonardi-Bee J, Gonzalez U, Jiyad Z, Eleftheriadou V, Ezzedine K. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol 2016; 174:962-9. [PMID: 26686510 DOI: 10.1111/bjd.14356] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/18/2023]
Abstract
Vitiligo affects around 1% of the world's population. Despite it being relatively common, there is still no effective treatment. The objective of this study was to update the Cochrane systematic review of randomized clinical trials (RCTs) to evaluate the efficacy of treatments for vitiligo. We carried out searches of a range of databases to October 2013 for RCTs of interventions for vitiligo regardless of language or publication status. At least two reviewers independently assessed study eligibility and methodological quality and extracted data using data extraction forms approved by the Cochrane Skin Group. Our primary outcomes of interest were quality of life, > 75% repigmentation and adverse effects. We retrieved 96 studies, of which 39 were new studies, with an overall total of 4512 participants. Repigmentation was assessed in all studies, although only five reported on all three of our primary outcomes. Regarding our two secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation at 2 years' follow-up. Most of the studies evaluated combination treatments, which generally showed better repigmentation than monotherapies. Of the new studies, seven were surgical interventions. The majority of the studies had fewer than 50 participants. The quality of the studies was poor to moderate at best. Very few studies specifically included children or participants with segmental vitiligo. Five years after the last update of this review, there are still important variations in study design and outcome measures in clinical trials for vitiligo, limiting the evidence for the efficacy of different therapeutic options. The best evidence from individual trials showed short-term benefit from topical corticosteroids and various forms of ultraviolet radiation combined with topical preparations. Long-term follow-up and patient-rated outcomes should be incorporated into study design, and more studies should assess psychological interventions.
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Affiliation(s)
- M Whitton
- Cochrane Skin Group, University of Nottingham, Nottingham, U.K
| | - M Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Hospital del Mar Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - J Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - U Gonzalez
- Unit of Dermatology, CLÍNICA GO&FER, Barcelona, Spain
| | - Z Jiyad
- Department of Dermatology, St George's Hospital, London, U.K
| | - V Eleftheriadou
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - K Ezzedine
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France.,EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPEC, Créteil, France.,Université Paris-Est Créteil, Créteil, France
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19
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Efficacy and Safety of 308-nm Monochromatic Excimer Lamp Versus Other Phototherapy Devices for Vitiligo: A Systematic Review with Meta-Analysis. Am J Clin Dermatol 2016; 17:23-32. [PMID: 26520641 DOI: 10.1007/s40257-015-0164-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method. OBJECTIVE We aimed to systematically review and meta-analyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo. METHODS A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy. RESULTS The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50% repigmentation [risk ratio (RR) = 0.97, 95% confidence interval (CI) 0.84-1.11] and ≥75% repigmentation (RR = 0.96, 95% CI 0.71-1.30). Likewise, no study found significant differences between excimer lamps and NB-UVB (RR = 1.14, 95% CI 0.88-1.48 for ≥50% repigmentation; RR = 1.81, 95% CI 0.11-29.52 for ≥75% repigmentation). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment. CONCLUSIONS To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo. Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. Safety, effectiveness, and cost are considerations when choosing treatment. PROSPERO REGISTRATION NUMBER CRD42014015237.
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Madigan LM, Al-Jamal M, Hamzavi I. Exploring the gaps in the evidence-based application of narrowband UVB for the treatment of vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:66-80. [DOI: 10.1111/phpp.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Iltefat Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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21
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McClean M, Silverberg JI. Statistical reporting in randomized controlled trials from the dermatology literature: a review of 44 dermatology journals. Br J Dermatol 2015; 173:172-83. [PMID: 25989239 DOI: 10.1111/bjd.13907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The validity of randomized controlled trials (RCTs) is determined by several statistical factors. OBJECTIVES To determine the level of recent statistical reporting in RCTs from the dermatology literature. METHODS We searched MEDLINE for all RCTs published between 1 May 2013 and 1 May 2014 in 44 dermatology journals. RESULTS Two hundred and ten articles were screened, of which 181 RCTs from 27 journals were reviewed. Primary study outcomes were met in 122 (67.4%) studies. Sample size calculations and beta values were reported in 52 (28.7%) and 48 (26.5%) studies, respectively, and nonsignificant findings were supported in only 31 (17.1%). Alpha values were reported in 131 (72.4%) of studies with 45 (24.9%) having two-sided P-values, although adjustment for multiple statistical tests was performed in only 16 (9.9% of studies with ≥ two statistical tests performed). Sample size calculations were performed based on a single outcome in 44 (86.3%) and multiple outcomes in six (11.8%) studies. However, among studies that were powered for a single primary outcome, 20 (45.5%) made conclusions based on multiple primary outcomes. Twenty-one (41.2%) studies relied on secondary/unspecified outcomes. There were no differences for primary outcome being met (Chi-square, P = 0.29), sample size calculations (P ≥ 0.55), beta values (P = 0.89), alpha values (P = 0.65), correction for multiple statistical testing (P = 0.59), two-sided alpha (P = 0.64), support of nonsignificant findings (Fisher's exact, P = 0.23) based on the journal's impact factor. CONCLUSIONS Levels of statistical reporting are low in RCTs from the dermatology literature. Future work is needed to improve these levels of reporting.
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Affiliation(s)
- M McClean
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N. St Clair St, Chicago, IL, 60611, U.S.A
| | - J I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N. St Clair St, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N. St Clair St, Chicago, IL, 60611, U.S.A
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Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K. Interventions for vitiligo. Cochrane Database Syst Rev 2015; 2015:CD003263. [PMID: 25710794 PMCID: PMC10887429 DOI: 10.1002/14651858.cd003263.pub5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Around 1% of the world's population has vitiligo, a disease causing white patches on the skin. Several treatments are available. Some can restore pigment but none can cure the disease. OBJECTIVES To assess the effects of all therapeutic interventions used in the management of vitiligo. SEARCH METHODS We updated our searches of the following databases to October 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 10), MEDLINE, Embase, AMED, PsycINFO, CINAHL and LILACS. We also searched five trials databases, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effects of treatments for vitiligo. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and methodological quality, and extracted data. MAIN RESULTS This update of the 2010 review includes 96 studies, 57 from the previous update and 39 new studies, totalling 4512 participants. Most of the studies, covering a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, however only five reported on all of our three primary outcomes which were quality of life, > 75% repigmentation and adverse effects. Of our secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation resulting from treatment at two years follow-up.Most of the studies assessed combination therapies which generally reported better results. New interventions include seven new surgical interventions.We analysed the data from 25 studies which assessed our primary outcomes. We used the effect measures risk ratio (RR), and odds ratio (OR) with their 95% confidence intervals (CI) and where N is the number of participants in the study.We were only able to analyse one of nine studies assessing quality of life and this showed no statistically significant improvement between the comparators.Nine analyses from eight studies reported >75% repigmentation. In the following studies the repigmentation was better in the combination therapy group: calcipotriol plus PUVA (psoralen with UVA light) versus PUVA (paired OR 4.25, 95% CI 1.43 to 12.64, one study, N = 27); hydrocortisone-17-butyrate plus excimer laser versus excimer laser alone (RR 2.57, 95% CI 1.20 to 5.50, one study, N = 84); oral minipulse of prednisolone (OMP) plus NB-UVB (narrowband UVB) versus OMP alone (RR 7.41, 95% CI 1.03 to 53.26, one study, N = 47); azathioprine with PUVA versus PUVA alone (RR 17.77, 95% CI 1.08 to 291.82, one study, N = 58) and 8-Methoxypsoralen (8-MOP ) plus sunlight versus psoralen (RR 2.50, 95% CI 1.06 to 5.91, one study, N = 168). In these three studies ginkgo biloba was better than placebo (RR 4.40, 95% CI 1.08 to 17.95, one study, N = 47); clobetasol propionate was better than PUVAsol (PUVA with sunlight) (RR 4.70, 95% CI 1.14 to 19.39, one study, N = 45); split skin grafts with PUVAsol was better than minipunch grafts with PUVAsol (RR 1.89, 95% CI 1.25 to 2.85, one study, N = 64).We performed one meta-analysis of three studies, in which we found a non-significant 60% increase in the proportion of participants achieving >75% repigmentation in favour of NB-UVB compared to PUVA (RR 1.60, 95% CI 0.74 to 3.45; I² = 0%).Studies assessing topical preparations, in particular topical corticosteroids, reported most adverse effects. However, in combination studies it was difficult to ascertain which treatment caused these effects. We performed two analyses from a pooled analysis of three studies on adverse effects. Where NB-UVB was compared to PUVA, the NB-UVB group reported less observations of nausea in three studies (RR 0.13, 95% CI 0.02 to 0.69; I² = 0% three studies, N = 156) and erythema in two studies (RR 0.73, 95% CI 0.55 to 0.98; I² = 0%, two studies, N = 106), but not itching in two studies (RR 0.57, 95% CI 0.20 to 1.60; I² = 0%, two studies, N = 106).Very few studies only assessed children or included segmental vitiligo. We found one study of psychological interventions but we could not include the outcomes in our statistical analyses. We found no studies evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high- quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR. .
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Komen L, da Graça V, Wolkerstorfer A, de Rie M, Terwee C, van der Veen J. Vitiligo Area Scoring Index and Vitiligo European Task Force assessment: reliable and responsive instruments to measure the degree of depigmentation in vitiligo. Br J Dermatol 2015; 172:437-43. [DOI: 10.1111/bjd.13432] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2014] [Indexed: 12/16/2022]
Affiliation(s)
- L. Komen
- Netherlands Institute for Pigment Disorders/Department of Dermatology; Academic Medical Centre; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - V. da Graça
- Netherlands Institute for Pigment Disorders/Department of Dermatology; Academic Medical Centre; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders/Department of Dermatology; Academic Medical Centre; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M.A. de Rie
- Netherlands Institute for Pigment Disorders/Department of Dermatology; Academic Medical Centre; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Dermatology; EMGO Institute for Health and Care Research; VU Medical Centre; Amsterdam the Netherlands
| | - C.B. Terwee
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU Medical Centre; Amsterdam the Netherlands
| | - J.P.W. van der Veen
- Netherlands Institute for Pigment Disorders/Department of Dermatology; Academic Medical Centre; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Dermatology; MC Haaglanden; Den Haag the Netherlands
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Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2014; 56:85-92. [DOI: 10.1111/ajd.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Richard Wittal
- University of New South Wales; Sydney New South Wales Australia
- Skin and Cancer Foundation; Sydney New South Wales Australia
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25
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Khullar G, Kanwar A, Singh S, Parsad D. Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB-UVB vs. NB-UVB alone in the treatment of vitiligo: a 24-week prospective right-left comparative clinical trial. J Eur Acad Dermatol Venereol 2014; 29:925-32. [DOI: 10.1111/jdv.12726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- G. Khullar
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - A.J. Kanwar
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - S. Singh
- Department of Dermatology, Venereology and Leprology; Employees' State Insurance Corporation Medical College and Hospital; NH-3 NIT Faridabad Haryana India
| | - D. Parsad
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Sonawane R, Harde H, Katariya M, Agrawal S, Jain S. Solid lipid nanoparticles-loaded topical gel containing combination drugs: an approach to offset psoriasis. Expert Opin Drug Deliv 2014; 11:1833-47. [DOI: 10.1517/17425247.2014.938634] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Yazdani Abyaneh M, Griffith R, Falto-Aizpurua L, Nouri K. Narrowband ultraviolet B phototherapy in combination with other therapies for vitiligo: mechanisms and efficacies. J Eur Acad Dermatol Venereol 2014; 28:1610-22. [DOI: 10.1111/jdv.12619] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Yazdani Abyaneh
- Department of Dermatology and Cutaneous Surgery; University of Miami Leonard M. Miller School of Medicine; Miami FL 33136 USA
| | - R.D. Griffith
- Department of Dermatology and Cutaneous Surgery; University of Miami Leonard M. Miller School of Medicine; Miami FL 33136 USA
| | - L. Falto-Aizpurua
- Department of Dermatology and Cutaneous Surgery; University of Miami Leonard M. Miller School of Medicine; Miami FL 33136 USA
| | - K. Nouri
- Department of Dermatology and Cutaneous Surgery; University of Miami Leonard M. Miller School of Medicine; Miami FL 33136 USA
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