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Evidence-Based, Non-Surgical Treatments for Vitiligo

A Review

  • Evidence-Based Review Article
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American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Vitiligo is an acquired pigmentary disorder characterized by depigmented macules and patches secondary to the loss of functional melanocytes. It is a chronic disease that affects between 0.1% and 2% of the general population, affecting both sexes and all races. The appearance and the unpredictable course are psychologically and socially devastating. The success of current therapeutic options is limited.

The objective of this review was to assess non-surgical treatments of vitiligo and to determine if comparing these studies can lead to (1) practical applications in the clinical setting and (2) recommendations for future research including study design and topics to be investigated further.

Combination therapies were found to be more effective than monotherapy, and most combinations included a form of phototherapy, of which narrow-band-UVB was found to be most effective with the least adverse effects. Topical treatment with corticosteroids, immunomodulators, vitamin D analogs, and psoralens had mixed outcomes. Oral therapies including antioxidants were helpful adjuvants to treatment. Studies lacked consistent design, mechanism of disease assessment, and long-term follow-up. Sample size was also frequently limited.

This review found that while several non-surgical therapies exist for the treatment of vitiligo, their usefulness, especially in the long term, is not well understood. Those studies that were able to elicit repigmentation often lacked an assessment on quality of life and/or patient satisfaction. More standardized methods of study design and assessment are needed to compare outcomes and make definitive conclusions on treatment effectiveness.

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References

  1. Casacci M, Thomas P, Pacifico A, et al. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo: a multi-centre controlled study. J Eur Acad Dermatol Venereol 2007; 21: 956–63

    Article  PubMed  CAS  Google Scholar 

  2. Arca E, Tastan HB, Erbil AH, et al. Narrow-band ultraviolet B as monotherapy and in combination with topical calipotiol in the treatment of vitiligo. J Dermatol 2006; 33: 338–43

    Article  PubMed  CAS  Google Scholar 

  3. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, et al. Treatment of vitiligo vulgaris with a narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol 2007; 21: 942–50

    Article  PubMed  CAS  Google Scholar 

  4. Lo YH, Cheng GS, Huang CC, et al. Efficacy and safety of topical tacrolimus for the treatment of face and neck vitiligo. J Dermatol 2010; 37: 125–9

    Article  PubMed  CAS  Google Scholar 

  5. Gavalas NG, Akhtar S, Gawkrodger DJ, et al. Analysis of allelic variants in the catalase gene inpatients with the skin depigmenting disorder vitiligo. Biochem Biophys Res Commun 2006; 345: 1586–91

    Article  PubMed  CAS  Google Scholar 

  6. Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. Philadelphia (PA): Mosby, 2008: 913–20, 2030, 2064

    Google Scholar 

  7. Dell’Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band UVB in the treatment of vitiligo: a double-blind, placebo-controlled trial. Clin Exp Dermatol 2007; 32: 631–6

    Article  PubMed  Google Scholar 

  8. Sassi F, Cazzaniga S, Tessari G, et al. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol 2008; 159: 1186–91

    PubMed  CAS  Google Scholar 

  9. Whitton ME, Pinart M, Batchelor J, et al. Interventions for vitiligo. Cochrane Database Syst Rev 2010 Jan 20; (1): CD003263

  10. Whitton ME, Ashcroft DM, Gonzalez U. Therapeutic interventions for vitiligo. J Am Acad Dermatol 2008 Oct; 59: 713–7

    Article  PubMed  Google Scholar 

  11. Hamzavi I, Jain H, Mclean D, et al. Parametric modelingof narrowband UV-B phototherapy for vitiligo using a novel quantitative tool. Arch Dermatol 2004; 140: 677–83

    Article  PubMed  Google Scholar 

  12. Mehrabi D, Pandya A. A randomized, placebo-controlled, double-blind trial comparing narrowband UV-B plus 0.1% tacrolimus ointment with narrowband UV-B plus placebo in the treatment of vitiligo. Arch Dermatol 2006; 142: 927–9

    PubMed  Google Scholar 

  13. Bhatnagar A, Kanwar AJ, Parsad D, et al. Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study. J Eur Acad Dermatol Venereol 2007; 21: 638–42

    Article  PubMed  CAS  Google Scholar 

  14. Yones SS, Palmer RA, Garibaldinos TM, et al. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UVA therapy vs. narrowband UV-B therapy. Arch Dermatol 2007; 143: 578–84

    Article  CAS  Google Scholar 

  15. Hartmann A, Lurz C, Hamm H, et al. Narrow-band UVB 311nm vs. broad-band UVB therapy in combination with topical calcipotriol vs. placebo in vitiligo. Int J Dermatol 2004; 44: 736–42

    Google Scholar 

  16. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol 2007; 21: 891–6

    Article  PubMed  CAS  Google Scholar 

  17. Pathak MA, Mosher DB, Fitzpatrick TB. Safety and therapeutic effectiveness of 8-methoxypsoralen, 4,5′,8-trimethylpsoralen, and 4,5′,8-trimethylpsoralen, and psoralen in vitiligo. Natl Cancer Inst Monogr 1984; 66: 165–73

    PubMed  CAS  Google Scholar 

  18. Valkova S, Trashlieva M, Christova P. Treatment of vitiligo with local khellin and UVA: comparison with systemic PUVA. Clin Exp Dermatol 2004; 29: 180–4

    Article  PubMed  CAS  Google Scholar 

  19. Hartmann A, Brocker EB, Hamm H. Occlusive treatment enhances efficacy of tacrolimus 0.1% ointment in adult patients with vitiligo: results of a placebo controlled 12-month prospective study. Act Derm Venereol 2008; 88: 272–9

    Google Scholar 

  20. Dawid M, Veensalu M, Grassberger M, et al. 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

    Article  PubMed  Google Scholar 

  21. Radakovic S, Breier-Maly J, Konschitzky R, et al. Response of vitiligo to once vs. twice-daily topical tacrolimus: a controlled prospective, randomized, observer-blinded trial. J Eur Acad Dermatol Venereol 2009; 23: 951–3

    Article  CAS  Google Scholar 

  22. Stinco G, Piccirillo F, Forcione M, et al. An open randomized study to compare NB-UVB, topical pimecrolimus and topical tacrolimus in the treatment of vitiligo. Eur J Dermatol 2009; 19: 588–93

    PubMed  Google Scholar 

  23. Lepe V, Moncada B, Castanedo-Cazares JP, et al. A double-blind randomized trial of 0.1% tacrolimus vs. 0.5% clobetasol for the treatment of childhood vitiligo. Arch Dermatol 2003; 139: 581–5

    CAS  Google Scholar 

  24. Eryilmaz A, Seckin D, Baba M. Pimecrolimus: a new choice in the treatment of vitiligo? J Eur Acad Dermatol Venereol 2009; 23: 1327–49

    Article  Google Scholar 

  25. Kumaran MS, Kaur I, Kumar B. Effect of topical calcipotriol, betamethasone dipropionate and their combination in the treatment of localized vitiligo. J Eur Acad Dermatol Venereol 2006; 20: 269–73

    Article  PubMed  CAS  Google Scholar 

  26. Hofer A, Hassan AS, Legat FJ, et al. Optimal weekly frequency of 308-nm excimer laser treatment in vitiligo patients. Br J Dermatol 2005; 152: 981–5

    Article  PubMed  CAS  Google Scholar 

  27. Le Duff F, Fontas E, Giacchero D, et al. 308-nm excimer lamp vs. 308-nm excimer laser for treating vitiligo: a randomized study. Br J Dermatol 2010; 163: 188–92

    Google Scholar 

  28. Khalid M, Mujtaba G, Haroon TS. Comparison of 0.05% clobetasol propionate cream and topical PUVASol in childhood vitiligo. Int J Dermatol 1995; 34: 203–5

    Article  PubMed  CAS  Google Scholar 

  29. Kawalek AZ, Spencer JM, Phelps RG. Combined excimer laser and topical tacrolimus for the treatment of vitiligo: a pilot study. Dermatol Surg 2004; 30: 130–5

    Article  PubMed  Google Scholar 

  30. Passeron T, Ostovari N, Zakaria W, et al. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol 2004; 140: 1065–9

    Article  PubMed  CAS  Google Scholar 

  31. Farajzadeh S, Daraei A, Esfandiarpour I, et al. The efficacy of pimecrolimus 1% cream combined with microdermabrasion in the treatment of non-segmental childhood vitiligo: a randomized placebo-controlled study. Pediatr Dermatol 2009; 3: 286–91

    Article  Google Scholar 

  32. Esfandiarpour I, Ekhlasi A, Farajzadeh S, et al. The efficacy of pimecrolimus 1% cream plus narrow-band ultraviolet B in the treatment of vitiligo: a double-blind, placebo-controlled clinical trial. J Dermatolog Treat 2009; 20: 14–8

    Article  PubMed  CAS  Google Scholar 

  33. Hui-Lan Y, Xiao-Yan H, Jian-Yong F, et al. Combination of 308-nm excimer laser with topical pimecrolimus for the treatment of childhood vitiligo. Pediatr Dermatol 2009; 26: 354–5

    Article  PubMed  Google Scholar 

  34. Sanclemente G, Garcia JJ, Zuleta JJ, et al. A double-blind, randomized trial of 0.05% betamethasone vs. topical catalase/dismutase superoxide in vitiligo. J Eur Acad Dermatol Venereol 2008; 22: 1359–64

    Article  CAS  Google Scholar 

  35. Asawanonda P, Kijluakiyat J, Korkij W, et al. Targeted broadband ultraviolet B phototherapy produces similar responses to targeted narrowband ultraviolet B phototherapy for vitiligo: a randomized, double-blind study. Acta Derm Venereol 2008; 88: 376–81

    PubMed  Google Scholar 

  36. Ermis O, Alpsoy E, Cetin L, et al. Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebocontrolled double-blind study. Br J Dermatol 2001; 145: 472–5

    Article  PubMed  CAS  Google Scholar 

  37. Parsad D, Saini R, Verma N. Combination of PUVAsol and topical calcipotriol in vitiligo. Dermatology 1998; 197: 167–70

    Article  PubMed  CAS  Google Scholar 

  38. Leone G, Pacifico A, Iacovelli P, et al. Tacalcitol and narrow-band phototherapy in patients with vitiligo. Clin Exp Dermatol 2006; 31: 200–5

    Article  PubMed  CAS  Google Scholar 

  39. Tang L, Wen-wen F, Lei-hong X, et al. Topical tacalcitol and 308-nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo. Photodermatol Photoimmunol Photomed 2006; 22: 310–4

    Article  CAS  Google Scholar 

  40. Rodriguez-Martin M, Bustinduy MG, Rodriguez MS, et al. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. Br J Dermatol 2009; 160: 409–14

    Article  PubMed  CAS  Google Scholar 

  41. Ada S, Sahin S, Boztepe G, et al. No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo. Photodermatol Photoimmunol Photomed 2004; 21: 79–83

    Article  Google Scholar 

  42. Baysal V, Yildirim M, Erel A, et al. Is the combination of calcipotriol and PUVA effective in vitiligo? J Eur Acad Dermatol Venereol 2003; 17: 299–302

    Article  PubMed  CAS  Google Scholar 

  43. Elgoweini M, Nour El Din N. Response of vitiligo to narrowband ultraviolet B and oral antioxidants. J Clin Pharmacol 2009; 49: 852–5

    Article  PubMed  CAS  Google Scholar 

  44. Procaccini EM, Riccio G, Monfrecola G. Ineffectiveness of topical khellin in photochemotherapy of vitiligo. J Dermatolog Treat 1995; 6: 117–20

    Article  Google Scholar 

  45. Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol 2003; 28: 285–7

    Article  PubMed  CAS  Google Scholar 

  46. Tjioe M, Gerritsen MJP, Juhlin L, et al. Treatment of vitiligo vulgaris with narrowband UVB (311 nm) for one year and the effectof additionof folic acid and vitamin B12. Acta Derm Venereol 2002; 82: 369–72

    Article  PubMed  CAS  Google Scholar 

  47. Anbar TS, Westerhof W, Abdel-Rahman AT, et al. Effect of one session of ER:YAG laser ablation plus topical 5-fluorouracil on the outcome of shortterm NB-UVB phototherapy in the treatment of non-segmental vitiligo: aleft-right comparative study. Photodermatol Photoimmunol Photomed 2008; 24: 322–9

    Article  PubMed  Google Scholar 

  48. Bakis-Persoglou S, Le Guay JL, Wittal R. A randomized, double-blinded, placebo controlled trial of pseudocatalase cream and narrowband ultraviolet B in the treatment of vitiligo. Br J Dermatol 2010; 161: 910–7

    Article  Google Scholar 

  49. Yuksel EP, Aydin F, Senturk N, et al. Comparison of the efficacy of narrow band ultraviolet B and narrow band ultraviolet B plus topical catalase-superoxide dismutase treatment in vitiligo patients. Eur J Dermatol 2009; 19: 341–4

    PubMed  CAS  Google Scholar 

  50. Rath N, Kar HK, Sabhanani S. An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP) alone, OMP with PUVA and broad/narrowband UVB phototherapy in progressive vitiligo. Indian J Venereol Leprol 2008; 74: 357–60

    Article  Google Scholar 

  51. Radmanesh M, Saedi K. The efficacy of combined PUVA and low-dose aza-thioprine for early and enhanced repigmentation in vitiligo patients. J Dermatolog Treat 2006; 17: 151–3

    Article  PubMed  CAS  Google Scholar 

  52. Westerhof W, Nieuweboer-Krobotova L, Mulder P, et al. Left-right comparison study of the combination of fluticasone propionate and UVA vs. either fluticasone propionate or UVA alone for the long-term treatment of vitiligo. Arch Dermatol 1999; 135: 1061–6

    PubMed  CAS  Google Scholar 

  53. Njoo MD, Spuls PI, Bos JD, et al. Nonsurgical repigmentation therapies in vitiligo: meta-analysis of the literature. Arch Dermatol 1998; 134: 1532–40

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology, Tulane University Health Sciences Center, 1430 Tulane Avenue, Box 8036, New Orleans, Louisiana, LA 70118, USA

    Robert M. Bacigalupi & Ronald S. Davis MD, MS

  2. Tulane University School of Medicine, New Orleans, Louisiana, USA

    Anna Postolova

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  1. Robert M. Bacigalupi
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  2. Anna Postolova
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  3. Ronald S. Davis MD, MS
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Correspondence to Ronald S. Davis MD, MS.

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Bacigalupi, R.M., Postolova, A. & Davis, R.S. Evidence-Based, Non-Surgical Treatments for Vitiligo. Am J Clin Dermatol 13, 217–237 (2012). https://doi.org/10.2165/11630540-000000000-00000

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