Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo
Keywords:
Vitiligo, narrowband ultraviolet B, topical tacrolimusAbstract
Objective To determine the efficacy of combined treatment with narrowband ultraviolet B phototherapy (NB-UVB) and topical tacrolimus in comparison with NB-UVB alone with placebo control in the treatment of vitiligo affecting face and neck. Methods We included 60 patients with vitiligo affecting face and neck with or without involvement of the rest of body, in this randomized, double-blind, placebo-controlled trial. The patients were randomly allocated in two groups as A and B. Topical 0.1% tacrolimus ointment was given for vitiligo patches twice daily in group A, while placebo ointment was given to be applied in similar way for vitiligo patches in group B. Tri-weekly NB-UVB for depigmented areas with starting dose of 0.1J/cm2 with increment of 10% at every visit was given to the patients in both groups. Percentage of depigmented patches was calculated at the baseline, 1, 2 and 3 months.    Results All patients completed the treatment period of 3 months. The mean response at the end of the 3rd month revealed excellent response (>75% repigmentation) in 16 (53.3%) patients in group A and 9 (30%) patients in group B. Good response (50-75% repigmentation) was seen in 11 (36.7%) in group A and 12 (40%) patients in group B. Moderate response (25-49% repigmentation) was shown by 3 (10%) patients in group A and 5 (16.7%) patients in group B. None of the patient showed poor response (<25% repigmentation) in group A, however 4 (13.3%) patients showed poor response in group B. Comparison of efficacy in both groups show excellent and efficacious response in 16 (53.5%) of patients  in group A and in only 9 (30%) of patients in group B (P <0.05). Conclusion Combined treatment with NB-UVB and topical 0.1% tacrolimus ointment in comparison with NB-UVB with placebo control in the treatment of vitiligo affecting face and neck is more effective.ÂReferences
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.
Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment vitiligo: A review. J Am Acad Dermatol. 2009;60:470-7.
Habib A, Sheikh ZI, Khan Q, Rahman SB. Efficacy and safety of oral dexamethasone pulse treatment for vitiligo. Pak Armed Forces Med J. 2006;56:111-5.
Lotti T, Buggiani G, Troiano M et al. Targeted and combination treatment for vitiligo. Comparative evaluation of different current modalities in 458 subjects. Dermatol Ther. 2008;21:S20-6.
Berti S, Buggiani G, Lotti T. Use of tacrolimus ointment in vitiligo alone or in combination therapy. Skin Therapy Lett. 2009;14:5-7.
Moretti S, Amato L, Bellandi S, Fabbri P. Focus on vitiligo: a generalized skin disorder. Eur J Inflamm.2006;4:21-30.
Yones SS, Palmer RA, Garibaldinos TM. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UVA versus narrowband-UVB therapy. Arch Dermatol. 2007;143:578-84.
Majid I. Does topical tacrolimus ointment enhance the efficacy of narrowband ultraviolet B therapy in vitiligo? A left-right comparison study. Photodermatol Photoimmunol Photomed. 2010;26:230-4.
Ogawa Y, Adachi A, Tomita Y. The successful use of topical tacrolimus treatment for a chronic actinic dermatitis patient with complications of idiopathic leukopenia. J Dermatol. 2003;30:805-9.
Mayuzumi N, Ikeda S, Kawada H, Ogawa H. Effects of drugs and anticytokine antibodies on expression of ATP2A2 and ATP2C1 in cultured normal human keratinocytes. Br J Dermatol. 2005;152:920-4.
Lan CC, Yu HS, Wu CS. FK506 inhibits tumour necrosis factor-alpha secretion in human keratinocytes via regulation of nuclear factor-kappa B. Br J Dermatol. 2005;153:725-32.
Nordal EJ, Guleng GE, Rönnevig JR. Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study. J Eur Acad Dermatol Venereol. 2011;25:1440-3.
