Treatment Of Vitiligo In Children Research Articles

Treatment of vitiligo in children

Vitiligo - idiopathic disease of skin hypopigmentation, which often manifests in childhood and can lead to deep psychological trauma, and consequently to a deterioration in the child’s quality of life and low self-esteem. This review presents current and effective methods of vitiligo treatment in pediatric patients.

Impacts of exposure to topical calcineurin inhibitors on metabolism in vitiligo infants.

Tacrolimus ointment is a recently developed topical immunomodulator that has been approved for use in patients with vitiligo older than 2 years. Concern regarding potential systemic toxic effects has limited treatment options for children younger than 2 years. We wanted to determine whether topical tacrolimus therapy is safe and effective in patients with vitiligo younger than 2 years. The present 6-month clinical trial was conducted to evaluate the efficacy and safety of 0.03% tacrolimus in the treatment of vitiligo in children under 2 years of age. Meanwhile, serum and urine samples were collected, and liquid chromatography-mass spectrometry was performed to generate the serum and urine metabolic profile data of patients and healthy controls. The overall response rate at the sixth month, which was defined by the degree of re-pigmentation, was 100%. As revealed by blood monitoring and metabolite detection 6 months later, there was no difference between the treatment group and the control group. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. Tacrolimus ointment appears to be effective and safe in the treatment of vitiligo in children younger than 2 year. http://www.chictr.org.cn identifier: ChiCTR 2100045920. We first reported the efficacy and safety of topical application of 0.03% tacrolimus ointment in infants with vitiligo characterized by the metabolites. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. This study provide evidence for the TCI treatment of infants with vitiligo.

Comparison of efficacy and safety of traditional Chinese patent medicine in the treatment of vitiligo in children or adults: A protocol for systematic review and network meta-analysis.

Background:Vitiligo is a common depigmented skin disease in children or adults, which usually causes considerable psychological burden to life and work for the reason that it affects appearance. The conventional therapies, including external 308 nm excimer laser therapy along with oral administration of western medicine, are associated with distinct disadvantages. Notably, traditional Chinese patent medicine (TCPM) exerts a vital part in treating vitiligo. Currently, no existing research has examined the effectiveness and safety of different TCPMs in treating vitiligo among either child or adult patients. As a result, the present network meta-analysis was carried out for the systematic comparison of the effectiveness of different TCPMs in treating vitiligo.Methods:The electronic databases, like PubMed, Web of Science, EMBASE, The Cochrane Library, Chinese Scientific Journals Database, China National Knowledge Infrastructure, Wanfang database and China BioMedical Literature, were searched systemically by 2 reviewers independently from inception to August 2020 to identify relevant randomized controlled trial (RCTs) according to our study inclusion criteria. In data extraction, risk of bias among those enrolled articles was also detected. Besides, the Bayesian network meta-analysis method was utilized to evaluate the evidence and data collected. This adopted the STATA and Win BUGS software for analysis.Results:The present work assessed the safety and efficacy of different TCPMs in treating vitiligo among child or adult patients.Conclusion:Our findings can shed precious lights on applying TCPMs in clinic and help the clinicians to formulate the efficient diagnostic and therapeutic strategies.Ethics and dissemination:No ethical approval was needed in this study.INPLASY registration number:INPLASY2020120050.

A comparative study in treatment of childhood vitiligo 0.03% tacrolimus versus 0.03% tacrolimus and topical steroids

Background: Vitiligo is an idiopathic, acquired cutaneous achromia, characterized by circumscribed milky white macules. It develops before the age of 20 years in 50% of the patients and before the age of 10 years in 25% of the patients. Methods: This was a 2-year, prospective, comparative study conducted in vitiligo patients with 1 year of active intervention. Fifty patients in the age group of 2–14 years were enrolled in the study. Randomization was performed according to computer-generated random code. Patients with code A received treatment with 0.03% tacrolimus alone and patients with code B received treatment with 0.03% tacrolimus and topical steroids. The primary efficacy variable was the Vitiligo Area Severity Index (VASI), and the secondary efficacy parameter includes the Physician's Global Improvement Score which was computed at the end of the study. The statistical analysis was carried out using statistical software STATA 6.0. Results: Out of these 50 patients, 47 patients completed the study for a period of 1 year. The area-wise VASI reduction and VASI reduction in vitiligo types were analyzed in patients with code A and code B. The mean Physician's Global Assessment Score was 3.041 in the tacrolimus group, and it was 3.261 in the tacrolimus with steroid group. Conclusion: This shows that 0.03% tacrolimus can be effectively used as topical monotherapy in patients with localized stable vitiligo without the adverse effects of topical steroids.

Vitiligo in Children: A Review of Conventional Treatments.

Vitiligo is an important skin disease of childhood, which may lead to deep psychological trauma, resulting in a poor quality of life and low self-esteem. The Authors discuss a short review of the more conventional therapies available for the treatment of vitiligo in children.

Role of Narrow-band Ultraviolet B Phototherapy with Topical Tacrolimus 0.03% for Treatment of Childhood Vitiligo

ABSTRACT Vitiligo in children is a challenging disease to treat, as fewer safe options are available compared with the adult population. The combination of topical tacrolimus (0.03%) with narrowband ultraviolet B (NBUVB) phototherapy is a safer option and hence we decided to explore this in our study. The extent of repigmentation was assessed at baseline, 12 weeks, and 24 weeks by photographic documentation. We observed that out of 16 patients, 3 (18.75%) had <25% repigmentation, 7 (43.75%) had 25 to 75% repigmentation, and 6 (37.5%) achieved >75% repigmentation. Combined therapy with topical tacrolimus and NBUVB phototherapy is an excellent and safe modality in childhood vitiligo. How to cite this article Dixit A, Yadav P, Rathore PK, Goyal S. Role of Narrow-band Ultraviolet B Phototherapy with Topical Tacrolimus 0.03% for Treatment of Childhood Vitiligo. Int J Adv Integ Med Sci 2017;2(1):37-39.

Pharmacologic Treatment of Vitiligo in Children and Adolescents: A Systematic Review.

The true pathogenic mechanism of vitiligo is still unknown. About half of the patients with this disease have onset before the age of 20 years, making it a serious dermatologic disorder in childhood. The objective of this study was to review the literature in a systematic way and identify the main pharmacologic treatments and outcomes in children and adolescents with vitiligo. Four databases-the National Library of Medicine (MEDLINE-PubMed), Web of Science, Scopus, and Latin American and Caribbean Health Sciences (LILACS)-were used for the search up to January 2015. All electronic search titles, selected abstracts and full-text articles were independently reviewed by a minimum of two reviewers. There were 15 articles from 13 different countries: 3 were retrospective and 12 were prospective; the number of participants in the studies varied between 9 and 400, ages ranged from 0 to 18 years, and the duration of disease ranged from 1 to 17 years. The most commonly used drugs were tacrolimus alone (or combined with clobetasol), pimecrolimus, corticosteroids, and calcipotriol. Treatment duration ranged from 10 days to 6 months with a topical route of administration. The main outcome measurements were morphometric analysis performed using a computer program, hematologic or biochemical change, and photography (predominant). It is unclear which was the most effective treatment for vitiligo, however, it was found that these therapies are all promising in the treatment of the disease. With proper care, disease control and repigmentation, even if partial, can be achieved.

Treatment of Childhood Vitiligo Using Tacrolimus Ointment with Narrowband Ultraviolet B Phototherapy

A combination of narrowband ultraviolet B (NBUVB) phototherapy plus topical tacrolimus has been used in adult vitiligo but has not yet been explored in children. We therefore sought to highlight the efficacy of this synergistic combination in childhood vitiligo. The objective was to study the clinical efficacy and safety of a combination of NBUVB with topical tacrolimus ointment 0.03% in childhood vitiligo. In this open-label study, 20 children, 4 to 14 years of age, with symmetrical vitiligo lesions were enrolled for 24 weeks. All were instructed to apply tacrolimus ointment 0.03% on a target patch on the left side of the body twice daily and no topical on a target patch on the right side. The whole body was irradiated with NBUVB three times per week. All patients were examined and the same dermatologist photographed lesions to assess for repigmentation at 4-week intervals. Response was noted as the percentage of repigmentation (none, 0%; poor, 1-25%; moderate, 26-50%; good, 51-75%; excellent, >75%). Our study found a statistically significant difference in the mean percentage of repigmentation at 4 and 6 months between combination therapy and NBUVB monotherapy. The mean cumulative dose and average number of exposures for the first clinically visible response were significantly lower with combination therapy. No serious adverse events were noted during the study period. Our preliminary data suggest that a combination of NBUVB phototherapy with topical tacrolimus is a highly effective and promising therapeutic option for vitiligo in children, whose treatment options are very limited, but long-term studies are needed to evaluate the future risk of malignancy.

A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children.

Vitiligo is a common inflammatory skin disease with a worldwide prevalence of 0.5% to 2.0% of the population. In the pediatric population, the exact prevalence of vitiligo is unknown, although many studies state that most cases of vitiligo are acquired early in life. The disease is disfiguring, with a major psychological impact on children and their parents. Half of vitiligo cases have a childhood onset, needing thus a treatment approach that will minimize treatment side effects while avoiding psychological impacts. Management of vitiligo should take into account several factors, including extension, psychological impact, and possible associations with other autoimmune diseases. This review discusses the epidemiology of vitiligo and outlines the various clinical presentations associated with the disorder and their differential diagnosis. In addition, the pathophysiology and genetic determinants, the psychological impact of vitiligo, and management strategies are reviewed.

Effect of Topical Tacrolimus on Vitiligo in Children

Background: Considering safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. Hence, new immunomodulatory agents such as calcineurinantagonists, frequently referred to as topical immunomodulators (TIMs) have recently been introduced as new promising tools to treat acquired hypopigmentary disorders. Tacrolimus is safe in treating children due to lack of skin atrophy and less data are available on effect of topical tacrolimus on vitiligo.Objective: To see the effect of topical tacrolimus on vitiligo in children.Materials and Methods: This prospective study was done in outpatient department of Dermatology and Venereology, Chittagong Medical College Hospital (CMCH), Bangladesh. Clinically diagnosed vitiligo patients of up to 12 years age visiting Skin & VD OPD, CMCH during study period were the study population (total 30). The study was carried out from November 2007 to April 2008.Results: A total of 30 patients, 13 (43.33%) males and 17 (56.66%) females with focal, segmental or generalized vitiligo were studied. Seventy percent of study subjects were from 7–12 years of age. Topical tacrolimus 0.03% ointment was administered twice daily for 12 weeks to each patient. Repigmentation was complete (>75%) in 43.33% cases (13/30), was moderate (50–75%) in 33.33% (10/30), mild (<50%) in 13.33% (4/30). Clinical adverse effects were noted in 6.67% (2/30) of cases where pruritus was in 3.33% (1/30) and burning in 3.33% (1/30). None of the reactions was severe, all were mild and well-tolerated and most occurred within the first month of initiation of treatment and resolved with continued use of drug and completely cured after the treatment completed. Nobody had to discontinue the therapy for side effects.Conclusion: In conclusion, tacrolimus ointment may be a rapidly efficacious and safe option for the treatment of vitiligo in children. The ease of topical self-administration with minimal side effects makes this novel immunomodulatory agent a promising addition to the therapeutic armamentarium for vitiligo in children.J Enam Med Col 2016; 6(1): 33-37

308 nm excimer lamp in combination with topical tacrolimus: A retrospective study of its efficacy and safety in childhood vitiligo

Background: Vitiligo is a chronic, polygenic dyschromia that presents with multiple depigmented macules and patches. Among the various therapeutic modalities for treatment of vitiligo in children, phototherapy as one of the mainstay treatments has varying therapeutic efficacy. There is limited data regarding the use of combination of tacrolimus and 308 nm excimer lamp for treatment of vitiligo in children. Aim: The aim of the present study is to retrospectively assess the efficacy and tolerability of 308 nm Excimer lamp in combination with topical tacrolimus to treat vitiligo in children below 17 years with skin type III, IV and V. Methods: Case sheets and photographs of 47 vitiligo patches from 24 children (male = 9, female = 15), Results: Of the 47 patches, 35 patches achieved repigmentation accounting to 74.4% of the total patches. The repigmentation response was good in ultraviolet (UV) sensitive areas but minimal in UV resistant areas. All the patches retained pigmentation during the follow-up period of 12-18 months. Conclusion: The degree of repigmentation achieved with topical tacrolimus and excimer lamp in a period of 4-6 weeks is much higher than other contemporary vitiligo therapies in children. This dual therapy of topical tacrolimus and 308 nm Excimer lamp is a safe and effective therapy showing an early response, for localized vitiligo in children.

Efficacy of 308-nm excimer laser combined with topical tacrolimus cream for the treatment of childhood vitiligo on the face or neck

Objective To assess the efficacy and safety of 308-nm excimer laser combined with topical tacrolimus 0.03％ cream for the treatment of childhood vitiligo on the face or neck.Methods Sixty-eight children aged ＜ or =14 years with vitiligo on the face or neck were enrolled in this study,and divided into two groups based on lesional sites,i.e.,skin group with lesions on the forehead,cheek,lower mandible,neck or in the periortic region and mucosa group with lesions in the perioral or periorbital region.All the patients received 308-nm excimer laser irradiation once or twice weekly and topical tacrolimus 0.03％ cream twice daily.Twenty sessions of irradiation served as a treatment course.Efficacy was evaluated at the end of the treatment course.The effects of erythema reaction and cumulative irradiation dose on efficacy were assessed.Results After 20 times of laser therapy,an excellent response was achieved in 78.4％ of the patients in the skin group,and 54.8％ in the mucosa group (P ＜ 0.05).During the treatment,the average frequency of erythema reaction lasting 48 hours or longer was significantly lower in the skin group than in the mucosa group (5.84 vs.9.12,P ＜ 0.01).After 10 and 20 times of laser therapy,the cumulative radiation dose was 4215 mJ/cm2 and 10 453 mJ/cm2 in the skin group,respectively,compared to 3364 mJ/cm2 and 7430 mJ/cm2 in the mucosa group,respectively (both P ＜ 0.01).Conclusions The 308-nm excimer laser combined with topical tacrolimus cream is effective and safe for the treatment of childhood vitiligo on the face or neck.Vitiligo on the forehead,cheek,lower mandible,neck and in the periortic region appears to respond better to this therapy with a weaker erythema reaction than that in the perioral or periorbital region.

Childhood vitiligo: Treatment paradigms

Childhood vitiligo differs from the adults by showing a higher incidence in females, segmental vitiligo being more common and less frequent association with other systemic autoimmune and endocrine disorders. Childhood vitiligo is often associated with a marked psychosocial and long lasting effect on the self-esteem of the affected children and their parents, hence an adequate treatment is very essential. Treatment of vitiligo is indeed a tough challenge for the dermatologists’ more so in the background of childhood vitiligo. Although multiple therapeutic modalities are available in the therapeutic armamentarium, not all can be used in children. This brief report updates regarding various therapies available in the treatment of childhood vitiligo.

Evaluation of clinical efficacy of three different placental preparations in the treatment of childhood vitiligo

Objective To evaluate the clinical efficacy of three different placental preparations in the treatment of childhood vitiligo.Methods Eighty-two children with vitiligo were divided into 3 groups to be topically treated with melagenine,human placental tissue fluid and human placental lipopolysaccharide respectively.All the patients were additionally treated with infrared rays for 20 minutes twice daily.The drugs were topically applied with an interval of 5 minutes during the irradiation.Results The response rate was 75.65％,35.00％ and 44.44％ respectively in the melagenine-,human placental tissue fluid- and human placental lipopolysaccharide-treated patients,and significant differences were observed between the three groups of patients (all P ＜ 0.05).In particular,melagenine was superior to the other two preparations for the treatment of large areas of vitiligo on the scalp.Conclusion The 3 placental preparations combined with infrared irradiation show favorable efficacy for the treatment of childhood vitiligo.

Treatment of vitiligo in children and adolescents by autologous cultured pure melanocytes transplantation with comparison of efficacy to results in adults

Transplantation of autologous cultured pure melanocytes is a well-established procedure for the treatment of refractory and stabilized vitiligo. However, there was no report specifically comparing the efficacy with the regard to defined age groups (children-adolescence-adult). We analysed the efficacy of this procedure in the treatment of vitiligo in children and adolescents and compare it with the results in adults treated during the same period and using identical procedures. Melanocytes were isolated from the roof of suction blister, cultured and expanded with Hu16 medium in vitro, and transplanted to laser-denuded receipt area. A total of 12 children (8-12 years), 20 adolescents (13-17 years) and 70 adults with vitiligo were treated using this procedure. The patients obtained satisfactory results (repigmentation of 50% or more) results in children, adolescents and adults were 83.3%, 95.0% and 84.0% respectively. The mean extent of repigmentation in children, adolescents and adults was 80.7%, 78.9% and 76.6% respectively. There was no statistical difference in repigmentation among these three groups. After adjusting for all factors (gender, type of vitiligo, period of stability, location of the lesion or transplanted cell density) individually or totally using multiple regression analysis, age still did not correlate to the extent of repigmentation. The satisfactory results obtained in the treatment of vitiligo in children and adolescents by transplantation of cultured autologous pure melanocytes are comparable with the results in adults. Therefore, this procedure can be considered in refractory and stable vitiligo in children and adolescents, especially in patients with large vitiliginous lesions.

Recent advances in the treatment of childhood vitiligo

Vitiligo can be treated using traditional, new and experimental therapies, and newly available treatments can be divided into medical, physical and surgical types. Medical treatments include topical corticosteroids and other topical treatments, such as antioxidants, tacrolimus and pimecrolimus, prostaglandin E and vitamin D derivates. Physical therapies include narrow-band UVB light (NB-UVB), NB-UVB microphototherapy, NB-UVB excimer laser and monochromatic excimer light. All can be safely used in children. NB-UVB is recommended for generalized vitiligo, while the others are indicated in patients affected by segmental and bilateral symmetrical vitiligo with a cutaneous involvement of less than 20%. They enable drastic reduction of the total dose of radiation, even though they preserve a potential long-term carcinogenic risk that has to be considered in this type of patient. Surgical therapies are reserved for adolescent or adult patients with a stable vitiligo.

Treatment of Childhood Vitiligo

AAP Grand Rounds, August 2003, 10:21 After the two months of treatment with clobetasol or tacrolimus, does the improvement persist indefinitely once the medications are stopped, or do the lesions recur? If they recur, do those patients have to be on and off tacrolimus for the rest of their lives?

Treatment of Childhood Vitiligo

Treatment of Childhood Vitiligo

Oral trimethylpsoralen in vitiligo in children: a preliminary report.

Summary.— Oral trimethylpsoralen was given to 12 children with different clinical types of vitiligo in a dosage of 5–10 mg daily, followed by exposure to sunlight. The response to this therapy was favourable. Vitiligo areata responded the best as compared to the other types. No cutaneous or systemic side effects were seen. Trimethylpsoralen is therefore recommended for the treatment of vitiligo in children.