Treatment Of Non-segmental Vitiligo Research Articles

Fractional CO2 laser versus Microneedling followed by Topical 5 Fluorouracil in the treatment of Non-Segmental Vitiligo

Fractional CO2 laser versus Microneedling followed by Topical 5 Fluorouracil in the treatment of Non-Segmental Vitiligo

Assessing effectiveness of adding niosomal atorvastatin 1% ointment to topical calcineurin inhibitor treatment in non-segmental vitiligo.

Treatment of vitiligo is still a big challenge for dermatologists. The efficacy of statins in the treatment of vitiligo is controversial. We studied possible therapeutic effect of topical 1% niosomal atorvastatin ointment combined with topical 0.1% tacrolimus in treatment of non-segmental vitiligo. This is a triple blind, pilot, randomized placebo-controlled trial (RCT) that was performed in dermatology clinic. All the patients used topical 0.1% tacrolimus cream twice daily (BD). Moreover, the intervention group participants used topical 1% niosomal atorvastatin ointment, and control group participants were prescribed placebo ointment, BD. Patients were evaluated using vitiligo area surface index (VASI) score and patients' satisfaction at baseline and after 3 months treatment. The mean patient satisfaction in the intervention and control groups were 5 ± 1.4 and 3.5 ± 1.9; the difference between groups was not statistically significant (p = 0.9). We found statistically significant difference in VASI score before and after treatment in both intervention and control groups (p = 0.01 and p = 0.03, respectively). However, comparison of the VASI score between groups was not statistically significant (p = 0.62). We also found no significant correlation between VASI score and other variables. The result of this study indicates that adding of niosomal atorvastatin 1% ointment to topical calcineurin inhibitor has no additional effect on non-segmental type of vitiligo. Further large studies with different combinations are recommended before any conclusive result can be concluded on efficacy of statins in vitiligo.

Comparative Study of Topical Latanoprost, Tacrolimus and Clobetasol Propionate in Combination with Microneedling and Narrow-Band Ultraviolet B in the Treatment of Non-Segmental Vitiligo

Abstract Background Vitiligo is a common skin disease in both sex. There are multiple options in the treatment of vitiligo but the response is unsatisfactory. In this comparative study we will study the effect of topical latanoprost, tacrolimus, clobetasol propionate in combination with microneedling and narrow-band ultraviolet B (NB-UVB) in the treatment of non-segmental vitiligo. Objective To evaluate and compare the efficacy and safety of topical latanoprost, tacrolimus, clobetasol propionate when combined with microneedling and NB-UVB in the treatment of nonsegmental vitiligo lesions. Patients and Methods This randomized self-controlled clinical trial included 30 vitiligo patients with at least 5 patches of stable vitiligo (150 patches), the patches were divided into five groups according to the treatment modality. The patients were recruited from the outpatient clinic of dermatology of Ain Shams University Hospital in the period from July 2019 to September 2020. Results Regarding safety of considered therapies, pain and erythema was reported with Microneedling + latanoprost and NB-UVB and Microneedling + topical tacrolimus and NB-UVB. Itching was associated with Microneedling + topical clobetasol propionate and NB-UVB while burning and dryness were associated with NB-UVB therapy. Conclusion Combination therapy in treatment of vitiligo showed higher efficiency compared to monotherapy. Microneedling + latanoprost and NB-UVB treatment combined therapy showed the maximal repigmentation in included patients followed by Microneedling + tacolimus and NB-UVB treatment. Monotherapy using NB-UVB showed minimal response when compared to other combination modalities.

Exploring the Potential Molecular Mechanism of Sijunzi Decoction in the Treatment of Non-Segmental Vitiligo Based on Network Pharmacology and Molecular Docking.

Non-segmental vitiligo is a common decolorized skin disease. The purpose of this study was to reveal the active components of Sijunzi decoction (SJZD) and the target genes for the treatment of non-segmental vitiligo. Based on TCMSP and GEO databases, effective components and targets of SJZD in the treatment of non-segmental vitiligo were revealed by network pharmacology. GO and KEGG were used to analyze the biological functions of SJZD targets. The Cytoscape-cytoHubba plugin was used to identify hub target genes. SsGSEA method was used to analyze the infiltration level of immune cells in non-segmental vitiligo. Molecular docking was performed to predict the interaction between active compounds and hub target genes. Finally, real-time PCR detection was also performed. It was found that 104 active compounds may be effective ingredients in the treatment of non-segmental vitiligo. These 104 compounds acted on 42 differentially expressed target genes. KEGG analysis showed that target genes were significantly enriched in immune-related pathways such as MAPK and TNF signaling pathways. A total of 6 hub target genes (AKT1, CASP3, PPARG, SIRT1, TNF and TP53) were identified using the Cytoscape-cytoHubba plugin. Molecular docking showed that active compounds quercetin, kaempferol, formononetin and naringenin had good binding to hub target genes. We also found that Type 2 T helper cells, CD56bright natural killer cell and CD56dim natural killer cell infiltration levels were abnormal in non-segmental vitiligo and correlated with AKT1. The results of this study indicate that quercetin, kaempferol, formononetin and naringenin in SJZD may play an important role in the treatment of non-segmental vitiligo by acting on AKT1, CASP3, PPARG, SIRT1, TNF and TP53 to regulate immune cell infiltration and multiple signaling pathways.

EFFICACY OF TOPICAL MINOXIDIL 5% AND BETAMETHASONE VALERATE 0.1% VERSUS BETAMETHASONE VALERATE 0.1% MONOTHERAPY IN NON-SEGMENTAL VITILIGO

Background 
 Vitiligo is a common depigmentation disorder of the skin. Circumscribed amelanotic patches characterize it due to the destruction of melanocytes. It affects 0.5-2.0% of general population. Many combinations of medical therapies have been studied, but the optimal treatment has yet to be identified.
 Objectives 
 To evaluate the efficacy of topical minoxidil 5% plus betamethasone valerate 0.1% compared to betamethasone valerate 0.1% monotherapy in the treatment of non-segmental vitiligo
 Materials and Methods
 This open-label, comparative, therapeutic clinical trial was conducted at the Sulaimani dermatology teaching center from May 2021 to February 2022. In this trial, 30 patients with non-segmental vitiligo were divided into two groups, 15 patients each; group A treated with topical minoxidil 5% spray & betamethasone valerate 0.1% cream, and group B was treated with betamethasone valerate 0.1% cream alone, the two regimens were used twice a day and patients were followed up for three months.
 Results
 The mean percentage of depigmentation in groups A and B were (21.9%) & (16%), respectively. 
 Conclusion
 Topical minoxidil & betamethasone valerate combination achieved a higher grade of depigmentation, especially in the vitiligo of the hair-bearing areas of the head & neck. However, there was no significant difference compared to betamethasone valerate alone (P value = 0.8).

The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: clinical, histopathologic, and histometric evaluation

Treatment of vitiligo with intralesional steroid (ILS) injections has shown to be successful in quite a few studies. It is a simple and safe treatment when used with caution with a better response in localized lesions. The aim of the present study is to explore the efficacy and safety of using different concentrations of intralesional corticosteroid combined with NB-UVB phototherapy in the treatment of non-segmental vitiligo (NSV) patients. Twenty patients with non-segmental vitiligo were subjected to different concentrations of ILS injections (triamcinolone acetonide); that was carried out monthly for six sessions. All patients were also subjected to twice-weekly sessions of NB-UVB for 6 months. Punch biopsy was taken from each patch before and at the end of treatment sessions. Each biopsy was stained with hematoxylin and eosin (H&E), Orcein, and Masson's trichrome stains. There was a significant difference between all groups in their repigmentation response (P = 0.017). After treatment, the epidermal thickness (histometry) was decreased (epidermal atrophy), especially with concentrations of 2.5 and 5 mg/ml of intralesional triamcinolone acetonide injection with decreased and disorganized collagen fibers. Intralesional corticosteroid injections combined with NB-UVB showed a good and well-tolerated therapeutic option for vitiligo. The concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest with fewer side effects and complications. However, higher concentrations of 2.5 and 5 mg/ml were more effective but with more side effects.

Efficacy of topical tacrolimus 0.03% monotherapy in the treatment of non-segmental vitiligo: a randomized, controlled trial.

Topical tacrolimus is increasingly used nowadays in the treatment of vitiligo. We evaluated therapeutic outcomes of tacrolimus 0.03% in non-segmental vitiligo (NSV). Sixty-three patients with NSV were divided into groups A and B. Group A received 0.03% tacrolimus ointment (n=31) and group B received 1% hydrocortisone acetate ointment (n=32) for 24weeks. Vitiligo area and severity index (VASI) and repigmentation rates were determined at baseline and 4-week intervals. In group A, 24-week VASI [0.5 (0.3, 1.95)] was significantly lower than baseline VASI [0.75 (0.5, 2.1); p=0.030]. In group B, 24-week VASI [0.75 (0.4, 2.3)] was not significantly different from baseline VASI [0.73 (0.4, 2.1); p=0.111]. Repigmentation was observed in 14/31 (45.2%) of patients in group A versus 0/32 (0.0%) in group B (p<0.001). Repigmentation was graded as poor in 6/31 (19.4%), fair in 4/31 (12.9%), good in 1/31 (3.2%), and excellent in 3/31 (9.7%). Repigmentation was achieved in 45% of patients with NSV following treatment with tacrolimus 0.03% monotherapy for 24weeks. Tacrolimus-induced repigmentation is more likely in patients with vitiligo vulgaris, head and neck lesions, skin phototype III, and young age.

EVALUATION OF THE EFFICACY OF TOPICAL PIPERINE OIL COMBINED WITH EXCIMER LIGHT PHOTOTHERAPY IN THE TREATMENT OF NON-SEGMENTAL VITILIGO: COMPARATIVE INTRA INDIVIDUAL STUDY

Background: Vitiligo is an acquired idiopathic disease that appears as skin depigmented patches due to a loss of melanocytes that are responsible for producing melanin pigment in the skin, hair, mucous membranes and retina. Objective: To evaluate the efficacy of topical piperine oil combined with excimer light phototherapy in the treatment of non-segmental vitiligo: comparative intra individual study. Patients and methods: Our study was carried out on 30 patients complaining of vitiligo from December 2019 to September 2020. Thirty subjects with two comparable patches were treated by excimer light phototherapy; one of them was randomly selected and treated with daily topical piperine oil at home. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals. Results: The present study showed improvement in patches treated with piperine plus excimer light phototherapy as excellent response in 60% of patients, good response in 6.6% of patients, fair response in 26.6% of patients and poor response in 6.6% of patients. Improvement in patches treated with excimer light phototherapy only as excellent response in 6.6% of patients, good response in 46.6% of patients, fair response in 26.6% of patients and poor response in 20% of patients. Conclusion: Using piperine combined with Excimer light phototherapy was a promising method for vitiligo treatment.

Patients' perspective on current treatments and demand for novel treatments in vitiligo.

BackgroundThe treatment of non‐segmental vitiligo (NSV) remains a challenge. Current treatments often achieve suboptimal clinical results. To improve these treatment results, several new therapies are being developed and investigated. There is, however, little evidence on the actual need for novel therapies.ObjectiveTo assess patients’ perspective on current and novel therapies for vitiligo.MethodsA prospective questionnaire study was conducted in a large cohort of vitiligo patients that consecutively visited the outpatient clinic of the Amsterdam University Medical Centre between April 2017 and January 2019. Patients were requested to fill in a digital questionnaire on patient characteristics, disease burden, quality of life, efficacy and satisfaction of current treatments and aspects regarding new treatments.ResultsA total of 325 vitiligo patients completed the questionnaire (60% response rate). Of the respondents, 94% believed that new and improved treatments are needed and 86% would be willing to participate in clinical trials investigating a new therapy. Sixty‐nine per cent would agree on taking weekly injections if it led to effective treatment results. Of the patients that had received therapy before, 49% reported that the current treatments were not effective and 50% was not satisfied with the current treatments. Sixty‐seven per cent of the patients experienced facial lesions as an extreme burden, whereas this was, 25%, 12% and 10% for lesions on the hands, trunk and feet, respectively. The emotional burden score was significantly higher in dark skin types compared with light skin types (respectively, 8 vs 5, U P < 0.05).ConclusionThere is a substantial need for new vitiligo therapies. A considerable number of patients in our study are dissatisfied with current treatments and are emotionally burdened by the disease. Moreover, the vast majority demands novel treatments and is willing to participate in clinical trials.

Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5-fluorouracil in the treatment of nonsegmental vitiligo; A prospective comparative study.

A prospective comparative study was enrolled with 32 patients with vitiligo who were assigned to two equal groups. Each containing 16 patients; group 1 was treated by microneedling followed by TCA 70%, group 2 was treated by intradermal 5-FU injection. This was done every 2 weeks for 2 months. According to the Physician's Global Assessment, there was no significant (P < .05) difference in the therapeutic response between the two studied groups. Both microneedling plus TCA 70% and 5-FU intradermal injection are a simple means of treating vitiligo with cosmetically accepted repigmentation of all age groups, as well as a relatively safe alternative or additive method that can be used before (or in combination with) any of the well-known and widely approved method for stable nonsegmented vitiligo treatment.

The Efficacy of Tricholoroacetic Acid 70% after Microneedling in the Treatment of Non-Segmental Vitiligo.

AbstractIntroduction: Vitiligo is a common disorder characterized by progressive depigmentation of the skin due to selective destruction of melanocytes. Although its cause is still to be exactly defined, the hypothesis of an autoimmune etiology is supported by increasing evidence.Objective: To assess the efficacy of TCA 70% after skin microneedling using dermapen in the treatment of non segmental vitiligo.Patients and Methods: This current study was conducted on 34 patients of both sexes at outpatient clinic of Dermatology, Venereology and Andrology Department at Zagazig University during the period from January 2018 to November 2018. A written informed consent was taken from each patient after explaining to them the details about the nature of study and after obtaining approval from Institutional Review Board (IRB).IRB approval number is (4587).The patients received 4 sessions of microneedling followed by TCA 70% at 2 weeks interval, followed up monthly for 3 monthsResults:Evaluation of repigmentation by the qualitative method showed that the improvement was good to excellent (repigmentation >50%) in 53% of patients, the improvement was moderate (26-50%) in 14.8% of patients, there was no effect in 8.2% of patients. Conclusion: Microneedling plus TCA 70% is considered a simple modality to treat vitiligo of all age groups with cosmetically acceptable repigmentation and a relatively safe alternative or additive method that can be used prior to (or in conjunction with) any of the well-known and widely approved treatment modalities of stable, non-segmental vitiligo.

The efficacy, safety, and stability of tacrolimus 0.03% ointment in treatment of nonsegmental vitiligo

Background Topical immunoarm adulators have been successfully used as a monotherapy or in combination with other therapeutic modalities in vitiligo treatment. Topical tacrolimus has been reported to promote melanoblast differentiation and groth. Additionally, it promotes a favorable environement that enhances the proliferation of melanocytes/ melanoblasts through an interaction with keratinocytes, and thereby repopulating vitigiginous skin lesions. Aim To detect the effect of tacrolimus ointements in treatment of nonsegmental vitiligo. Method A total of 35 patients with vitiligo were enrolled in Tacrolimus this randomized placebo-controlled study. Two vitiliginous patches were chosen in each patient. The firstt lesion (A) was treated by tacrolimus 0.03% ointment, and the second lesion (B) was treated by panthenol cream as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiliginous patches were assessed at baseline and monthly for 6 months. Results Moderate to excellent response was observed in 25.7% of lesions A compared with 0% of lesions B (P = 0.002). Disease duration has a negative effect on therapeutic response. No adverse effects were noted to tacrolimus ointment except for mild erythema in 6% of the patients. Coclusion Given its immunomodulatory properties and lack of cutaneous adverse effects, tacrolimus is a potential therapeutic alternative for vitiligo, with an improved benefit-risk ratio.

&lt;p&gt;Effect of Topical 5-Fluorouracil Alone versus Its Combination with Erbium:YAG (2940 nm) Laser in Treatment of Vitiligo&lt;/p&gt;

PurposeTo compare the efficacy of topical 5-FU as monotherapy to combined therapy of topical 5-FU and Er:YAG (2940 nm) laser in the treatment of non-segmental vitiligo (NSV).MethodsThis is a prospective randomized comparative study. Thirty patients diagnosed with NSV were recruited from the dermatology outpatient clinics of the Medical Research Centre of Excellence, the National Research Centre and the National Institute of Laser Enhanced Sciences. Our study group was divided into two subgroups, Group 1 was subjected to ablative Er:YAG and 5-FU cream and Group 2 applied topical 5-FU cream. Three treatment sessions were repeated every 4 to 6 weeks and patients were followed up to 9 months. Repigmentation was assessed by digital photography and subsequent computer based image analysis.ResultsRepigmentation of Group 1 patients ranged from 0 to 70% (mean 12±7%) whilst in Group 2 this ranged from 0 to 5% (mean 1.4±0.8%). In Group 1 repigmentation was mild in 22/30 (73.3%) and moderate to severe in 3/30 (10%) starting after 3 months and persisted or increased during the period of follow up to 9 months. Groups 1 and 2 were subdivided into A and B, vitiligo involving non-resistant and resistant areas respectively. Group 1A showed more repigmentation (mean 13.8±8.5%) than Group 1B (mean 9.8±4.5%) and Group 2A showed more repigmentation (mean 1.5±1%) than Group 2B (mean 1.3±0.5%).ConclusionThe combination of Er:YAG with 5-FU is safe and effective in treating and improving outcome in vitiligo especially of non-resistant areas. Computer based image analysis of vitiliginous lesions and assessing post-therapy response is an easy, quick, and reliable method.

Treatment of Non-Segmental Vitiligo with Narrowband UVB Phototherapy (311 Nm): Clinical Efficacy and Mechanisms of Action

Objective: To estimate efficacy of narrowband UVB phototherapy (311 nm) in non-segmental vitiligo and its effect on subpopulations of T-cells and dendritic cells in vitiligo lesions. Methods: 56 patients with progressive non-segmental vitiligo underwent narrowband UVB phototherapy (311 nm). 11 patients had biopsies before and after therapy from lesional (depigmentation area), marginal, and perilesional skin for immunohistochemical studies of CD4+, CD8+, CD1a+ and CD83+ cells in epidermis and derma. Results: Median number of UVB procedures per course was 71, median total radiation dose-91.8 J/cm2, median percent of repigmentation-49%. Repigmentation of >25% of the affected area was reached in 67.9% of patients and repigmentation of 76-100% in 19.6% . VIDA index decreased from 2 to 1 post-treatment (P<0.035). In a subgroup who underwent immunohistochemical studies median number of UVB procedures per course was 88, median total dose of radiation-140.2 J/cm2, and median percent of repigmentation-50%. Significant activation of T-cellular immune reactions was found in lesions before treatment. There was a statistically significant increase in CD8+ lymphocytes and CD1a+ dendritic cells in marginal and perilesional normally pigmented skin in epidermis. There was an increase in CD4+ and CD8+ lymphocytes and CD83+ dendritic cells in all three zones in derma. Normalization of CD8+ and CD1+ cells in epidermis of the affected skin was observed post-treatment. There was only partial reduction of CD4+, CD8+ and CD1+ cells in dermis. Conclusions: Narrowband UVB phototherapy (311 nm) is an effective method of treatment of nonsegmental vitiligo. T-lymphocytes and Langerhans cells play a critical immunoregulatory role in narrowband UVB phototherapy (311 nm)-induced immune suppression. Lack of full normalization of immunological parameters in the skin after treatment indicates a need for optimization of narrowband UVB phototherapy (311 nm): conduction of longer courses including 150-200 procedures, or combinations of this treatment with immunosuppressive drugs.

Comparison of efficacy of narrow band UVB therapies with UVB alone, in combination with calcipotriol, and with betamethasoneand calcipotriol in vitiligo

Objective: The purpose of this study is to compare the efficacy of three therapies in the treatment of non-segmental vitiligo: a combination of topical calcipotriol, narrowband-ultraviolet B (NB-UVB), and betamethasone therapies; a combination of NB-UVB and topical calcipotriol; and NB-UVB alone. Material and methods: Forty-five patients with non-segmental vitiligo presenting to our Dermatology clinic were recruited to participate in the study. Patients were randomly divided into three groups. For each patient the size of the depigmented areas was assessed according to the rule of nines. The first group was treated with a combination of topical calcipotriol, NB-UVB, and betamethasone therapies. The second group was treated with a combination of NB-UVB and topical calcipotriol and third group was treated with NB-UVB alone. Since the patients' vitiligo lesions had similar phototypes, all patients were started with 0.1 j/cm2, regardless of their skin phototype. The dose of NB-UVB was increased 10% in each session and no further increment was done after reaching 2.5 j/cm2. Treatment effectiveness was evaluated according to the percentage improvement in repigmentation. The quality of life of the patients was measured by the Dermatology Life Quality Index (DLQI). Results: The patients were aged from 13 to 55 years (mean: 25.29). The duration of disease ranged from 3 months to 20 years. Family history was positive for vitiligo in 10 patients (22.2%). The percentage of recovery after treatment was 63.33% ± 7.55 in group 1, 60.67% ± 5.75 in group 2, and 46.67% ± 7.98 in group 3. There was no statistically significant difference between groups 1 and 2, and groups 2 and 3, but there was a statistically significant difference between groups 1 and 3 (p = 0.0048). Conclusions: In conclusion, NB-UVB-alone therapy and the combined therapies are effective treatment options in the treatment of vitiligo. Future studies with larger groups are warranted to confirm our results.

Tumor necrosis factor-α in vitiligo: direct correlation between tissue levels and clinical parameters

Background: Experimental evidences have shown that tumor necrosis factor (TNF)-α may play a role in the pathogenesis of nonsegmental vitiligo, and successful cases of vitiligo treated with TNF-α inhibitors have been recently reported.Materials and methods: Two cases of refractory generalized vitiligo, which showed high tissue levels of TNF-α, were commenced anti-TNF-α antibody etanercept 50 mg weekly. A retrospective study, considering chart review and immunohistochemical staining for TNF-α, was then carried out on eight additional patients affected by untreated vitiligo.Results: Etanercept achieved improvement of vitiligo in two patients at 6-month follow-up. Five out of eight specimens showed a strong cytoplasmic staining for TNF-α. Considering all 10 cases, patients with a strong TNF-α staining were characterized by a higher vitiligo disease activity score than patients with a weak staining.Discussion: These findings, albeit limited in significance by the low number of cases and the retrospective nature of the study, confirm a probable role of TNF-α in the pathogenesis of vitiligo. The intensity of TNF-α staining in vitiligo lesions may be worth to be further studied as a biomarker for potentially successful anti-TNF-α treatment of nonsegmental vitiligo in cases refractory to conventional treatment.

Randomized Double-blind Trial of Treatment of Vitiligo

To compare the efficacy of oral psoralen-UV-A (PUVA) with that of narrowband-UV-B (NB-UVB) phototherapy in patients with nonsegmental vitiligo. Double-blind randomized study. Phototherapy unit in a university hospital. Fifty-six patients with nonsegmental vitiligo. Interventions Twice-weekly therapy with PUVA or NB-UVB. The change in body surface area affected by vitiligo and the color match of repigmented skin compared with unaffected skin were assessed after 48 sessions of therapy, at the end of the therapy course, and 12 months after the end of therapy. The results in the 25 patients each in the PUVA and NB-UVB groups who began therapy were analyzed. The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB-treated group (P = .03); we suspect this difference was because of the differences in efficacy and adverse effects between the 2 modalities, such that patients in the NB-UVB group wanted a longer course of treatment. At the end of therapy, 16 (64%) of 25 patients in the NB-UVB group showed greater than 50% improvement in body surface area affected compared with 9 (36%) of 25 patients in the PUVA group. The color match of the repigmented skin was excellent in all patients in the NB-UVB group but in only 11 (44%) of those in the PUVA group (P<.001). In patients who completed 48 sessions, the improvement in body surface area affected by vitiligo was greater with NB-UVB therapy than with PUVA therapy (P = .007). Twelve months after the cessation of therapy, the superiority of NB-UVB tended to be maintained. In the treatment of nonsegmental vitiligo, NB-UVB therapy is superior to oral PUVA therapy.