A combination of excimer laser treatment and topical tacrolimus ismore effective in treating vitiligo than either therapy alone for the initial 6months, but not thereafter.

Abstract

There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus. To evaluate the clinical efficacy according to the duration of treatment and invitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo. In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser. After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P<0.001 and P<0.01, respectively) for the first 6months. However, this superiority was not observed after the initial 6months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone. A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6months, but continuation of this therapy for >6months might not provide a better final outcome than monotherapy.