minocycline and Vitiligo

Vitiligo is an autoimmune skin condition characterized by depigmented macules and patches, and has a huge psychosocial impact on patients. Treatment of vitiligo aims to prevent the spread of disease and facilitate repigmentation of affected lesions. The mainstay of treatment for unstable vitiligo has been topical agents (corticosteroids, calcineurin inhibitors) and phototherapy. However, systemic treatments are increasingly being shown to have a significant impact on the course of the disease as monotherapy or adjunctive therapy. Of note, oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors and certain supplements have been used in the systemic treatment of vitiligo. We review the underlying evidence supporting the use of each of these systemic treatments.

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; alpha-MSH; Anti-Bacterial Agents; Calcineurin Inhibitors; Combined Modality Therapy; Cyclosporine; Dermatologic Agents; Humans; Janus Kinase Inhibitors; Methotrexate; Minocycline; Neoadjuvant Therapy; Outcome Assessment, Health Care; Phototherapy; Psychology; Vitiligo

Medical treatments alone, or in combination with phototherapy, are key approaches for treating nonsegmental vitiligo and, to a lesser extent, segmental vitiligo. The treatments are useful for halting disease progression and have been proven effective for inducing repigmentation and decreasing risk of relapses. Although the treatments have side effects and limitations, vitiligo often induces a marked decrease in quality of life and in most cases the risk:benefit ratio is in favor of an active approach. Systemic and topical agents targeting the pathways involved in loss of melanocytes and in differentiation of melanocyte stem cells should provide more effective approaches in the near future.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; alpha-MSH; Anti-Bacterial Agents; Calcineurin Inhibitors; Dinoprostone; Humans; Immunosuppressive Agents; Low-Level Light Therapy; Methotrexate; Minocycline; Oxytocics; Phototherapy; Piperidines; Protein Kinase Inhibitors; Pyrimidines; Pyrroles; Ultraviolet Therapy; Vitamin D; Vitiligo

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p = 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

Topics: Humans; Hyperpigmentation; Minocycline; Phototherapy; Pilot Projects; Treatment Outcome; Ultraviolet Therapy; Vitiligo