clobetasol and Vitiligo

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.

Topics: Adolescent; Calcitriol; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Glucocorticoids; Humans; Tacrolimus; Treatment Outcome; Vitiligo

Excimer light, topical vitamin D analogues, and topical steroids have been reported to be effective treatments for vitiligo. However, monotherapy often demonstrates unfavorable results for acral vitiligo. This study aimed to evaluate the efficacy and safety of combination treatment with 308-nm excimer light and topical calcipotriol or topical clobetasol ointment for acral vitiligo. A prospective, randomized, double-blind, and intraindividual study was conducted. Combination treatment (excimer light and topical medication) was applied in the first 12 weeks, and monotherapy (topical medication alone) was used in the later 12 weeks. Both hands were irradiated with excimer light three times a week for 12 weeks. Calcipotriol ointment was randomly assigned to one hand, whereas clobetasol ointment was assigned to the other hand. The ointments were applied twice daily for a total of 24 weeks. Repigmentation, clinical improvement, and adverse reactions were assessed. A total of 26 hands completed the study. Of the hands treated with excimer light and calcipotriol, approximately 8% achieved excellent repigmentation at the end of the combination treatment period and 23% achieved good to excellent improvement after 12 weeks of calcipotriol monotherapy. More than 85% and 77% of the hands treated with calcipotriol-based and clobetasol-based regimens showed some repigmentation at the end of the study, respectively (P < .05). Nevertheless, no significant difference was found between the treatments. No serious adverse reactions were observed. In conclusion, the combination of excimer light and topical calcipotriol followed by topical calcipotriol alone is effective and might be a promising treatment regimen for acral vitiligo.

Topics: Calcitriol; Clobetasol; Dermatologic Agents; Humans; Prospective Studies; Treatment Outcome; Vitiligo

Vitiligo is a pigmentary disorder of skin affecting at least 1% of the world population of all races in both sexes. Its importance is mainly due to subsequent social and psychological problems rather than clinical complications. Various treatment choices are available for vitiligo; however, laser-based courses have shown to give more acceptable results.. The aim of this trial was to evaluate the efficacy of Er:YAG laser as a supplementary medicine to topical 5FU and clobetasol in vitiligo patients.. Two comparable vitiligo patches from 38 eligible patients were randomized to receive topical 5FU and clobetasol in control group and additional Er:YAG laser in intervention group. Major outcomes of interest were the size of patch and pigmentation score at randomization and 2 and 4 months after therapy.. Final sample included 18 (47%) male patients and age of 35.66±8.04. The performance Er:YAG group was superior in all sites. Reduction in the size of patches was greater in Er:YAG group (p-value=.004). Also, this group showed a higher pigmentation scores in the trial period than control group (p-value<.001).. Greater reduction in the size and increase in pigmentation score was seen in Er:YAG group especially for short periods after therapy and repeating laser sessions may help improving final outcomes. Er:AYG could help in reducing complications of long-term topical treatments, achieving faster response, and improving patient adherence.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Clobetasol; Combined Modality Therapy; Female; Fluorouracil; Humans; Immunosuppressive Agents; Lasers, Solid-State; Male; Skin Pigmentation; Vitiligo

Conventional treatment of vitiligo on hands and feet often produces an unsatisfactory result. Various ablative treatment methods were tried with favorable results in facial, neck, and truncal areas. The aim of this study is to evaluate the efficacy and safety of combined fractional CO2 laser, narrowband UVB (NB-UVB) phototherapy, and topical clobetasol propionate in managing stable vitiligo in difficult-to-treat areas.. A prospective randomized-intraindividual study was conducted on 27 patients with 27 pair-lesions of non-segmental vitiligo on both hands. The lesions were randomized to receive treatment with fractional CO2 laser, NB-UVB phototherapy, and 0.05% clobetasol propionate cream (Group A) or NB-UVB phototherapy and 0.05% clobetasol propionate cream (Group B). Fractional CO2 laser was performed at 1-week interval for 10 sessions. NB-UVB phototherapy was administered twice weekly for 20 sessions. Patients were evaluated 12 weeks after the last treatment. Outcome was evaluated objectively based on standard digital photographs, patient satisfaction, and adverse events.. Twenty-six patients completed the study. Six vitiligious lesions (23.1%) in group A achieved good to excellent repigmentation compared with one lesion (3.9%) in group B (P = 0.065). The overall mean improvement score was 1.35 (± 1.38) in group A and 0.50 (± 0.95) in group B (P = 0.0004). Patients' satisfaction score was significantly higher for the lesions in group A than group B. Lesions on the dorsum of the hand showed a higher response rate than those on the fingers. No serious side-effects were noted.. This study demonstrates that adding fractional CO2 laser treatment to NB-UVB phototherapy and topical steroids improves the repigmentation rate of vitiliginous lesions on hands in some patients. This technique may be offered to vitiligo patients who are unresponsive to other treatments.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Clobetasol; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Lasers, Gas; Male; Middle Aged; Prospective Studies; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Facial vitiligo is associated with considerable psychological impact. The management is challenging and requires multidisciplinary treatment. Adding fractional carbon dioxide (CO2) to the conventional treatment has been reported as an effective modality. This study aimed to evaluate the efficacy of combined fractional CO2 laser, targeted ultraviolet B (UVB) phototherapy, and topical steroid on facial vitiligo. A prospective, randomized, split face study was conducted on 14 patients with symmetrical non-segmental facial vitiligo. Ten sessions of fractional CO2 laser was performed on the lesions on one side of face with 2-week interval. Immediately after laser, the lesions on both side of face were treated with 10 sessions of 2-week interval targeted UVB phototherapy and twice daily application of topical 0.05 % clobetasol propionate cream. The patients were followed up for 12 weeks after the last treatment. Clinical improvement was graded by blinded dermatologists and patients using a quartile grading scale. Twelve out of 14 patients completed the study. The degree of improvement was not different between both sides in nine patients. One patient showed more improvement on the combined laser side, and two patients showed inferior results on the combined laser side. Two patients with lesser improvement on the laser-treated side had positive Koebner phenomenon on the non-facial area. The combined treatment with laser, targeted UVB, and topical steroids are not superior to targeted UVB and topical steroids in facial vitiligo. Furthermore, laser may retard the response to the standard treatment in patients with Koebner phenomenon on non-treated areas.

Topics: Adult; Aged; Clobetasol; Combined Modality Therapy; Female; Humans; Lasers, Gas; Male; Middle Aged; Prospective Studies; Single-Blind Method; Treatment Outcome; Ultraviolet Therapy; Vitiligo

In recent years, excimer light treatments have come to the fore in localized vitiligo because of their high efficacy and safety.. We aimed to evaluate the efficacy of 308-nm excimer lamp as a monotherapy and its combination with tacrolimus 0.1% or clobetasol 17-propionate 0.05% ointment in localized vitiligo.. We performed a retrospective study including a total of 82 patients who were treated with excimer lamp monotherapy (EL group) (n = 30), excimer lamp + topical tacrolimus (EL + T group) (n = 29), or excimer lamp + topical clobetasol 17-propionate (EL + CS group) (n = 23). We used digital morphometric analysis for the evaluation of repigmentation.. Median healing rate after 24 sessions was significantly higher in EL + T group (69%) than EL (42.5%) and EL + CS (44%) groups (P = 0.008 and P = 0.032). There were not any patients with face lesions in EL + CS group, so when these patients were excluded, EL + T and EL + CS groups had higher healing rates than EL group (P = 0.037 and P = 0.043). It was confirmed that combination with tacrolimus was superior to clobetasol-17 propionate (P = 0.048) with multivariate regression analysis.. We noted that 308-nm excimer lamp therapy was efficacious; adding topical tacrolimus or topical clobetasol-17 propionate could increase response to treatment.

Topics: Administration, Topical; Adult; Clobetasol; Female; Humans; Male; Photochemotherapy; Retrospective Studies; Tacrolimus; Vitiligo

Vitiligo is a non contagious acquired pigmentation disorder with limited treatment possibilities. Clobetasol propionate (CP) is the drug-of-choice for vitiligo which suppresses the immune system by reducing immunoglobulin action and causes the restoration of melanocytes leading to repigmentation of skin. However, despite being effective, its low and variable bioavailability prompt for development of novel carrier that could effectively target CP to site of action without producing undesirable side-effects. Low solubility of CP in subsequent poor in vivo bioavailability was overcome by formulating microemulsion based gel of CP (MBC) which would enhance the percutaneous transport of CP into and across the skin barrier. Comprehensive characterization of MBC was carried out for viscosity, gel strength and rheological behavior. In vitro studies revealed much higher drug release, skin penetration and enhanced skin accumulation as compared to control (Cream of CP). In vitro and in vivo occlusion studies demonstrated similar occlusiveness for MBC and control. MBC exhibited 3.16 times higher stratum corneum CP levels compared to control. Visualization of cutaneous uptake in vivo using laser scanning microscopy confirmed targeting of CP to epidermis and dermis. Dermatopharmacokinetic studies of MBC showed enhanced drug deposition of CP in skin layers. MBC was assessed for in vivo efficacy by single blind randomized pilot clinical study. The efficacy was assessed by vitiligo area scoring index (VASI) method. After completion of trial, repigmentation of vitiligo patches in patients were evaluated and scored. MBC was superior in terms of faster repigmentation and efficacy when compared with control (p value<0.5). Hence, it was concluded that CP loaded MBC possess enhanced skin localization as well as therapeutic activity in vitiligo patients.

Topics: Administration, Cutaneous; Adolescent; Adult; Animals; Biological Transport; Clobetasol; Dermis; Drug Delivery Systems; Emulsions; Epidermis; Female; Gels; Glucocorticoids; Humans; Male; Middle Aged; Permeability; Pilot Projects; Rats; Rats, Wistar; Treatment Outcome; Vitiligo

Both clobetasol propionate 0·05% (CP 0·05%) and tacrolimus 0·1% (T 0·1%) ointments have been shown to be efficacious and safe in treating vitiligo in the paediatric population.. To assess efficacy and safety of these two therapies compared with each other and with placebo.. In this prospective study, children aged 2-16 years with vitiligo, stratified into 'facial' (n = 55) and 'nonfacial' (n = 45) groups, were randomized into three arms: CP 0·05% ointment (n = 30), T 0·1% ointment (n = 31) and placebo (n = 29) for 6 months. Successful repigmentation, defined as > 50% improvement, was evaluated by comparing photographs taken at baseline and at 2, 4 and 6 months.. In the facial group, 58% of the CP 0·05% group responded successfully compared with 58% of the T 0·1% group, and in the nonfacial group, 39% of the CP 0·05% group responded compared with 23% of the T 0·1% group (P > 0·05). There was a significant difference in response between the CP 0·05% group vs. placebo (P < 0·0001) and the T 0·1% group vs. placebo (P = 0·0004). Spontaneous repigmentation was evaluated as 2·4%. No significant clinical adverse events were noted in any group.. Both CP 0·05% and T 0·1% ointments offer similar benefit in paediatric vitiligo, both facial and nonfacial. The facial lesions responded faster than the nonfacial ones.

Topics: Administration, Cutaneous; Adolescent; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Male; Ointments; Photography; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Administration, Topical; Adolescent; Adult; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Tacrolimus; Vitiligo; Young Adult

To assess the safety and efficacy of topical 0.1% tacrolimus vs 0.05% clobetasol propionate.. Randomized double-blind trial.. Department of Dermatology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, México.. From 20 children with vitiligo, 2 symmetrical lesions of about the same size and evolution time were selected. They were devoid of any topical or systemic therapy for 2 months prior to inclusion. Interventions Treatment with topical tacrolimus and clobetasol for a 2-month period.. The grade of repigmentation was evaluated by color slides at baseline and again at every 2-week visit. The slides were analyzed by 2 clinicians unrelated to the study and by a morphometric digitalized computer program. Characteristics of pigment, time of response, symptoms, telangiectasias, and atrophy were evaluated every 2 weeks.. Eighteen (90%) of the 20 patients experienced some repigmentation. The mean percentage of repigmentation was 49.3% for clobetasol and 41.3% for tacrolimus. Lesions in 3 patients using clobetasol presented atrophy, and 2 lesions incurred telangiectasias; tacrolimus caused a burning sensation in 2 lesions.. Tacrolimus proved almost as effective as clobetasol propionate to restore skin color in lesions of vitiligo in children. Because it does not produce atrophy or other adverse effects, tacrolimus may be very useful for younger patients and for sensitive areas of the skin such as eyelids, and it should be considered in other skin disorders currently treated with topical steroids for prolonged periods.

Topics: Administration, Topical; Adolescent; Age Factors; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Double-Blind Method; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Vitiligo is a hypopigmented skin condition that usually requires a combination of treatment options.. To demonstrate the effectiveness of topical and oral L-phenylalanine in combination with light plus 0.025% clobetasol propionate at night.. We have performed an open trial on a group of 70 patients with evolutive vitiligo. Participants were treated with oral (100 mg/Kg/day) and topical (gel at 10%) L-phenylalanine, exposed to sunlight (spring-summer) or UVA lamps (autumn-winter), and given 0.025% clobetasol propionate at night. All patients were revisited every 6 months while in the study, with a maximum of 4 revisits. Biochemical studies were performed at the beginning of the treatment and at each revisit.. Overall, 90.9% of participants showed improvement, with 68.5% of patients achieving an improvement of 75% or more. This 75% improvement rate was reached 87.9% of the time on the face, 60.4% on the trunk, and 54.6% on the limbs. However, there was a moderate response to the treatment in patients with focal and segmental vitiligo. There was a slight additional improvement in patients receiving UVA lamp light. No biochemical abnormalities were found in any patients.. L-phenylalanine in combination with 0.025% clobetasol propionate and sunlight during sunny months or UVA lamps in winter, appears to improve evolutive vitiligo without side effects, and therefore is especially recommended on the face or for children.

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Female; Glucocorticoids; Humans; Male; Phenylalanine; PUVA Therapy; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Adolescent; Adult; Anti-Inflammatory Agents; Atrophy; Child; Child, Preschool; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Ointments; Skin; Skin Diseases, Vesiculobullous; Skin Pigmentation; Telangiectasis; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Atrophy; Child; Clobetasol; Drug Eruptions; Follow-Up Studies; Humans; Methoxsalen; Ointments; PUVA Therapy; Remission Induction; Skin; Skin Pigmentation; Sunlight; Vitiligo

For an effective treatment of vitiligo, it is as important to arrest the progression of the disease (if it is still active) as it is to induce repigmentation in existing lesions. In patients having limited and slow-spreading vitiligo, we evaluated the efficacy of levamisole to control the activity of the disease process and to induce repigmentation of the vitiliginous areas.. Levamisole was given to 64 patients in an oral dose of 150 mg on two consecutive days every week for periods varying from 4-48 months. In 14 patients levamisole was used alone, in 38 patients it was combined with topical 0.1% fluocinolone acetonide acetate ointment massaged on the lesions once a day, and in 12 patients it was combined with topical 0.05% clobetasol propionate used in the same way. There was no other adjuvant therapy.. In 34 of the 36 patients (94%) having active disease, the progression of the disease could be arrested within 2-4 months. A variable degree of spontaneous repigmentation of the vitiliginous areas was seen in 9 patients (64%) treated with levamisole alone, 33 patients (87%) treated with levamisole and topical fluocinolone, and all the 12 patients treated with levamisole and topical clobetasol. The side effects with levamisole were minimal except in two cases where treatment had to be discontinued. Topical fluocinolone was fairly safe in the Indian patients, but clobetasol frequently produced atrophy and telangiectasia.. Levamisole seems to be a simple, safe, and fairly effective remedy for controlling the activity of the disease process in vitiligo patients who have limited and slow-spreading disease. Some patients develop spontaneous repigmentation as well. To achieve a faster rate of repigmentation, levamisole can be combined with other treatment methods such as topical corticosteroids.

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Clobetasol; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Humans; Levamisole; Male; Vitiligo

Twenty-five patients with vitiligo lesions were treated intermittently with topical clobetasol propionate cream over a period of eight months or less. After six months of treatment, 22 of the 25 patients showed at least 90% repigmentation. The age of the patient, duration and anatomic site of the lesion, and presence or absence of achromotrichia proved to be significant prognosticators of the response to therapy. The results of the study suggest a possible simplified therapeutic option for this skin disorder.

Topics: Administration, Topical; Adolescent; Adult; Betamethasone; Child; Child, Preschool; Clinical Trials as Topic; Clobetasol; Female; Humans; Male; Middle Aged; Philippines; Vitiligo

0-05% clobetasol proprionate (CP) in its proprietary cream base was significantly superior to the cream base alone in the treatment of vitiligo. Twelve of twenty-three patients partially repigmented during 4 months' treatment with CP. All patients showed dermal atrophy with the CP.

Topics: Betamethasone; Clinical Trials as Topic; Clobetasol; Female; Humans; Skin Pigmentation; Vitiligo

Vitiligo is a refractory disease in which treatment modalities are not yet established. We aim to assess results obtained 10 years after the initiation of a therapeutic protocol which combines very potent topical corticosteroids (TCS), vitaminotherapy (B12 and C), and suppression of microtraumas in the management of nonsegmental vitiligo in Madagascar.. It was a prospective and descriptive study over a period of 6 years (2011-2016) in the Department of Dermatology, Joseph Raseta Befelatanana, Antananarivo, Madagascar. The diagnosis of vitiligo was based on clinical data. Patients who agreed to follow the treatment protocol, which combined very potent TCS (two applications/day for 10 days, and then one application/day for the following 10 days), oral vitamin C 500 mg/day for 20 days, and oral vitamin B12 100 mg/day for 20 days, were included in the study. Two successive courses of treatment were made 10 days apart.. The details of 308 vitiligo patients were analyzed. The mean age of patients was 33.3 years. There was a female preponderance (sex ratio: 0.6). The duration of treatment in our patients varied from 3 to 18 months. Two hundred and thirty-nine patients had good therapeutic compliance and attended regular follow-up. Excellent repigmentation (more than 76% area repigmented) was noted in 50 patients (65.7%) less than 14 years of age. Lesions evolving in less than 1 year in 31 patients (36.9%) had excellent response to treatment. Localized lesions responded favorably to treatment with excellent repigmentation in 108 patients.. These results show that therapeutic response is better in young people, lesions less than 1 year of evolution, and for localization of vitiligo in the face and neck.

Topics: Administration, Oral; Adolescent; Adult; Age Factors; Ascorbic Acid; Child; Clobetasol; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Madagascar; Male; Middle Aged; Prospective Studies; Skin Cream; Treatment Outcome; Vitamin B 12; Vitiligo; Young Adult

Topics: Adrenal Cortex Hormones; Clobetasol; Humans; Single-Blind Method; Tacrolimus; Vitiligo

Vitiligo, depigmenting disorder of the skin and mucous membranes, affects up to 1% of the population worldwide. It is classified into four major types: segmental, non-segmental, mixed, and unclassified type. Non-segmental vitiligo refers to non-dermatomal distribution of lesions, while dermatomal distribution of lesions is present in patients with segmental vitiligo. Segmental vitiligo can also follow Blaschko lines - pathways of epidermal cell migration and proliferation during the development of the fetus. Here, we present patient with segmental and non-segmental vitiligo following Blaschko lines with excellent therapeutic response to combined therapy. Prior to our report, a case of segmental and non-segmental vitiligo followed by Blaschko lines was never described, therefore we suggest the term "mixed vitiligo of Blaschko lines" to describe this entity. This is also a rare case in which 90% repigmentation was achieved in patient with segmental and nonsegmental vitiligo following Blaschko lines in only 2 months of combined therapy.

Topics: Adult; Antioxidants; Clobetasol; Combined Modality Therapy; Female; Humans; Phototherapy; Vitiligo

Marginal vitiligo, or inflammatory vitiligo with raised borders is a unique subset of vitiligo vulgaris presenting with scattered depigmented, pruritic patches surrounded by a raised, erythematous border. Alternative diagnoses include discoid lupus erythematosus and cutaneous T-cell lymphoma.. To properly guide treatment, it is important to exclude other conditions that present with a similar pattern of depigmentation. This requires the ability to identify specific cutaneous and histologic clues that support this diagnosis.. A 22 year-old man presented with a history of depigmented, pruritic patches and surrounding raised, erythematous borders. Several areas of depigmentation on the scalp were associated with alopecia. Punch biopsy of the rim of a patch was performed and sent for routine hematoxylin and eosin staining and direct immunofluorescence.. Histopathology revealed a spongiotic dermatitis with superficial dermal lymphocytic infiltrate and eosinophils; DIF demonstrated no immunoreactants. A diagnosis of inflammatory vitiligo with raised borders was thus made based on consistent clinical and histopathologic features. The symptoms improved with topical clobetasol 0.05% cream twice daily.

Topics: Administration, Cutaneous; Clobetasol; Diagnosis, Differential; Glucocorticoids; Humans; Lupus Erythematosus, Discoid; Lymphoma, T-Cell, Cutaneous; Male; Vitiligo; Young Adult

The aim of the present investigation was to evaluate microemulsion as a vehicle for dermal drug delivery and to develop microemulsion based gel (MBC) of clobetasol propionate (CP) for the effective treatment of vitiligo. D-Optimal mixture experimental design was adopted to optimize the amount of oil (X(1)), S(mix) (mixture of surfactant and cosurfactant) (X(2)) and water (X(3)) in the microemulsion. The formulations were assessed for globule size (nm) (Y(1)) and solubility of CP in microemulsion (mg/ml) (Y(2)). The microemulsion containing 3% oil, 45% S(mix) and 50% water was selected as the optimized batch (ME). The globule size and solubility of CP in ME were 18.26 nm and 36.42 mg/ml respectively. Transmission electron microscopy showed that ME globules were spherical in shape. Carbopol 934P was used to convert microemulsion containing drug into gel form without affecting its structure. Ex-vivo permeation studies showed that cumulative amount of CP permeated (Q(n)) from ME, MBC and market formulation (MFCP) at 8h after application were 53.6±2.18, 28.43±0.67 and 37.73±0.77 μg cm(-2) respectively. MBC showed greater retention of CP in to skin layers than ME and MFCP. Skin irritation studies showed MBC to be significantly less irritating than MFCP. Photomicrographs and scanning electron micrographs of skin sections treated with MBC showed significant changes in the skin structure, which was attributed to the interaction of microemulsion components with skin resulting in permeation enhancement and retention of CP into skin layers. It was concluded that CP loaded gel could be a promising formulation for effective treatment of vitiligo.

Topics: Animals; Clobetasol; Gels; Microscopy, Electron, Scanning; Microscopy, Electron, Transmission; Rabbits; Skin; Skin Absorption; Surface-Active Agents; Vitiligo

Topics: Adult; Clobetasol; Female; Glucocorticoids; Humans; Vitiligo; Vulvar Lichen Sclerosus

A 49-year-old woman presented with a seven-year history of pruritic, erythematous, scaling plaques on sun-exposed skin that localized only to pre-existing depigmented patches. Histopathologic examination showed changes consistent with cutaneous lupus erythematosus with lichenoid features and confirmed contiguous vitiligo. Diagnosis of chronic cutaneous lupus erythematosus localized to areas of vitiligo was determined by clinicopathologic correlation and may reflect an autoimmune diathesis. Consequently, hydroxychloroquine and topical glucocorticoids therapy were initiated with reported improvement in pruritus, erythema, and scale. Clinical monitoring for development of squamous-cell carcinoma in areas of chronic inflammation and sun-exposure is imperative.

Topics: Autoimmunity; Carcinoma, Squamous Cell; Clobetasol; Diabetes Complications; Diagnostic Errors; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Humans; Hydroxychloroquine; Lupus Erythematosus, Discoid; Middle Aged; Photosensitivity Disorders; Pruritus; Psoriasis; Skin Neoplasms; Sunlight; Ultraviolet Rays; Vitiligo

Because the etiopathogenesis of depigmentation in vitiligo is still obscure, the source of pigmentation in the repigmentating lesion and its stability is also not fully known. Several authors have shown on histopathology and electron microscopy predominantly a perifollicular spread of pigment. The aim of this study was to clinically assess the types of repigmentation patterns obtained with different treatment modalities and their correlation with speed and stability of repigmentation. A total of 125 patients with vitiligo on treatment with psoralens (topical and systemic psoralen-UVA [PUVA]), steroids (both topical and systemic), and topical calcipotriol, alone or in combination were enrolled. Representative lesions of vitiligo excluding mucosal sites were selected in each patient and photographed at baseline. Repigmentation was assessed and labeled as marginal, perifollicular, diffuse, or combined. The preselected patches were evaluated at 3 months to assess the speed of repigmentation. Retention of pigment (stability) was noted at 6 months, after the stoppage of active treatment. Of the 352 vitiligo patches selected, 194 (55%) showed predominant perifollicular repigmentation, of which a majority (127; 65.5%) were on systemic PUVA and 35 (18%) were on topical PUVA. Diffuse pigmentation was observed in 98 patches (27.8%) of which 66 (67.3%) were on topical steroids. Marginal repigmentation was seen in 15, of which the majority (80%) were on systemic PUVA and topical calcipotriol. Of the 28 total lesions showing marked repigmentation at 3 months, 22 lesions pigmented in a diffuse manner, 2 in a perifollicular pattern, and 4 showed a combined type of repigmentation. On follow-up, marginal repigmentation was the most stable (93.3%), followed by perifollicular (91.7%) and combined type (84.4%). Diffuse repigmentation was the least stable (78.5%). Psoralens predominantly exhibit a perifollicular pattern of repigmentation and steroids (topical/systemic), a diffuse type. The speed of repigmentation is much faster when initial repigmentation is of the diffuse type as compared with follicular repigmentation. The marginal and perifollicular repigmentation is more stable than the diffuse type of repigmentation.

Topics: Adolescent; Adult; Calcitriol; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Female; Humans; Male; Middle Aged; PUVA Therapy; Time Factors; Vitiligo

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calcitriol; Clinical Trials as Topic; Clobetasol; Dermatologic Agents; Female; Glucocorticoids; Humans; Male; Ointments; Vitiligo

Topics: Administration, Cutaneous; Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Keratolytic Agents; Male; Middle Aged; Treatment Outcome; Tretinoin; Vitiligo

Topics: Administration, Cutaneous; Betamethasone; Clobetasol; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Male; Ointments; Vitiligo

Topics: Adolescent; Adult; Aged; Betamethasone; Child; Clobetasol; Female; Humans; Male; Middle Aged; Photochemotherapy; PUVA Therapy; Vitiligo

The treatment of vitiligo is still unsatisfactory in many patients. The only two methods that have been evaluated in numerous patients are classic psoralen-light therapy and local treatment with potent fluorinated corticosteroids. These two methods in addition to some more recent therapies that have still been insufficiently investigated are reviewed in light of the data in the newer literature.

Topics: Adrenal Cortex Hormones; Clobetasol; Combined Modality Therapy; Humans; Hydroquinones; PUVA Therapy; Skin; Skin Pigmentation; Vitiligo

Topics: Betamethasone; Clobetasol; Eyelid Diseases; Humans; Vitiligo

Seventy-five patients with vitiligo were treated with intermittent topical applications of clobetasol propionate for varying times within a three-year period. The best results occurred in the facial lesions of Asian or black patients. Repigmentation of 90% to 100% was achieved in more than 80% of patients with vitiligo of the face and more than 40% of patients with vitiligo on other parts of the body. Progressive repigmentation continued even after the treatment stopped. Intermittent therapy helped to avoid the problems of adverse local effects from the use of potent adrenal steroids.

Topics: Administration, Topical; Adolescent; Adult; Asian People; Betamethasone; Black People; Child; Child, Preschool; Clobetasol; Female; Humans; Male; Middle Aged; Skin Pigmentation; Vitiligo; White People