Topical Therapy of Vitiligo Using Sunlight Exposure with Lactic Acid Cream (10%) Versus Methoxsalene Solution

Abstract

Background Vitiligo is a common autoimmune disease to which multiple therapies have been used. Lactic acid in different modes of preparation like 15% topical solution and 1% intralesional injection has been tried effectively in treatment of vitiligo. Objectives to test the efficacy of lactic acid cream10% with sunlight exposure in treatment of vitiligo, and to be compared with topical methoxsalene solution with sunlight exposure. Materials and Methods This is an interventional, therapeutic, single blinded, comparative study that was conducted in the Center of Dermatology, Medical City, Baghdad, Iraq, between April 2018 and June 2019. Patients with generalized and localized vitiligo were included. The diagnosis of vitiligo was based on clinical characteristic loss of skin pigmentation and supported by woods light examination. The demographic features were recorded. Physical examination was done to determine the site and number of patches per patient. The patients were divided into two groups: group A patients, were treated with lactic acid 10% cream followed by sunlight exposure. While in group B, the patients were treated with topical methoxsalene solution followed by sunlight exposure. All patients were assessed, and the surface area of each patch was measured before starting the treatment and every month for 3 months of treatment. The side effects were also recorded. A follow up visit after 3 months was done. A reduction rate in the surface area of vitiliginous patch was calculated. Results sixty patients, 41 (68.3%) females and 19 (31. 7%) males with a female to male ratio was 2.15:1. Their ages ranged between 3 – 42 years with mean± SD of 23.36±11.95 years. The disease duration ranged between 12-120 months. Total number of the lesions was 78 patches with a mean of 1.3 lesions per patient. No statistically significant differences were found between the two groups regarding demographic nor clinical features (P ≥ 0.05). In group A (lactic acid), 32 patients with 45 patches. The reduction rate in surfaces area of patches was increased at each visit. In the second visit, the reduction rate was (6.63%), the third visit, it was (17.45%). While in fourth and follow up visits the reduction rate was (30.22%) and (32.66%) respectively. The mean surface area of the lesions was decreased from 1.98±0.2cm2 to 1.23±0.1cm2 from the baseline visit to the last follow-up visit with P value<0.001 which was highly significant and the mean±SD of reduction rate was 32.66 ± 3.4 from the base line to the last follow-up visit. Group B(methoxsalene): 28 patients with 33 patches. The reduction rate was 13.12% in second visit while (16.32%) in the 3rd visit. In fourth and follow up visits, the reduction rate was (21.33%) and (20.78%) respectively. The mean surface area of the lesions was decreased from 4.63±0.9 cm 2 to 4.22±1.1 cm2 from the baseline visit to the last follow-up visit with P value 0.13 was not statistically significant. Conclusion this study showed that lactic acid 10% cream in combination with sunlight exposure was statistically effective in treatment for vitiligo. Topical methoxsalene with sun light exposure was less effective than lactic acid and with more side effects.