mometasone-furoate and Vitiligo

Evidence for the effectiveness of vitiligo treatments is limited.. To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo.. A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015.. In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment).. Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.

Topics: Adrenal Cortex Hormones; Adult; Child; Combined Modality Therapy; Humans; Mometasone Furoate; Ointments; Treatment Outcome; Ultraviolet Therapy; Vitiligo

To assess the efficacy and safety of bimatoprost 0.03% alone and in combination with a topical steroid (mometasone) compared with mometasone alone in patients with nonsegmental vitiligo on nonfacial areas in a proof-of-concept study.
. This randomized, double-blind, controlled study was conducted over a 20-week treatment period. Patients were randomized to 1 of 3 treatment groups: bimatoprost monotherapy (n=11), bimatoprost plus mometasone (n=10), and mometasone plus placebo (n=11). The primary outcome was global response at week 20, based on an investigator's assessment of improvement score of at least 5 (at least 50%-75% improvement from baseline) on an 8-point scale (0=worse; 7=cleared). Other outcomes included global response at other visits, response by anatomic site, change from baseline lesion severity (overall and by site), and safety.
. Because of a lack of response observed for the primary end point, a post hoc analysis with a less stringent definition of response (score of ≥4 [25%-50% improvement]) was conducted. In this analysis, 46% of the bimatoprost plus mometasone group responded overall compared with 18% in the bimatoprost monotherapy group, and no patients in the mometasone plus placebo group. Greater response rates were observed in both bimatoprost groups compared with the mometasone plus placebo group starting at week 12. There were no differences among groups in signs and symptoms of irritation.
. Bimatoprost alone or with mometasone provided greater repigmentation than treatment with mometasone alone. Larger studies that also assess facial lesions are warranted.

J Drugs Dermatol. 2016;15(6):703-710.

Topics: Adult; Bimatoprost; Double-Blind Method; Drug Compounding; Drug Therapy, Combination; Follow-Up Studies; Humans; Middle Aged; Mometasone Furoate; Pharmaceutical Solutions; Skin Pigmentation; Treatment Outcome; Vitiligo

Vitiligo is a common skin disorder affecting about 1 to 2% of the world population. The prevalence in Nepal is 2-3%. This disease is associated with profound psychological distress. Though many treatment options are available none of these are universally effective. The main objective of the study is to compare the efficacy and rate of repigmentation with use of topical steroid and topical placental extract versus topical steroid and topical tacrolimus 0.1% in treating patients with localized vitiligo. One hundred patients visiting the dermatology outpatient department of Nepal Medical College and Teaching Hospital with the diagnosis of vitiligo involving less than 10% of body surface area were taken. 50 of these patients (Category A) were randomly selected and treated with topical steroid (Mometasone furoate 0.1% cream) and Topical placental extract gel. Other 50 patients (Category B) were given the same topical steroid with Topical Tacrolimus 0.1% cream. The patients were examined every month and final outcome was seen at the end of 3 months. Of the total 100 patients 51% were male and 49% were female. Seventeen percent of patients had lesions over face and neck, 49% had lesions over the extremities and 34% had lesions over trunk. At the end of 3 months the rate of repigmentation was better in patients of Category B than Category A and the result was statistically significant. Topical Tacrolimus 0.1% ointment could be better option for the treatment of localized vitiligo when compared to topical placental extract but in combination with a steroid cream.

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mometasone Furoate; Placental Extracts; Pregnadienediols; Prospective Studies; Tacrolimus; Vitiligo; Young Adult

In this study, we developed an in vivo vitiligo induction model to explore the underlying mechanisms leading to Koebner's phenomenon and to evaluate the efficacy of therapeutic strategies. The model consisted of 12 pigmented test regions on the back of generalized vitiligo patients that were exposed to three Koebner induction methods: cryotherapy, 755 nm laser therapy, and epidermal abrasion. In addition, four cream treatments (pimecrolimus, tacrolimus, steroid and placebo) were randomly applied. Koebnerization was efficiently induced by all three induction methods. In general, cryotherapy was the best method of Koebner induction, followed by 755 nm laser therapy and epidermal abrasion. Reproducible results were obtained, which showed enhanced depigmented surface areas and higher amounts of T lymphocytes in placebo-treated test zones compared to active treated areas. Tacrolimus and local steroids were better inhibitors of Koebner's process (P < 0.05) compared to pimecrolimus. Our in vivo vitiligo induction model is very informative to investigate vitiligo induction and to determine the efficacy of topical treatments in vitiligo. This proof of concept confirms the efficient comparison of head-to-head therapeutic strategies intra-individually in a standardized, specific and better timed way.

Topics: Administration, Cutaneous; Adult; Cryotherapy; Dermabrasion; Double-Blind Method; Female; gp100 Melanoma Antigen; Humans; Immunosuppressive Agents; Langerhans Cells; Low-Level Light Therapy; Male; MART-1 Antigen; Middle Aged; Mometasone Furoate; Ointments; Pregnadienediols; Reproducibility of Results; T-Lymphocyte Subsets; Tacrolimus; Triamcinolone Acetonide; Vitiligo

With regard to the lack of effective treatment modalities for childhood localized vitiligo, the search for newer therapeutic agents continues.. To conduct an open, comparative trial to evaluate the clinical efficacy and safety of topical mometasone cream and pimecrolimus cream in the treatment of childhood vitiligo.. Fifty patients with childhood vitiligo were included in the study. Patients were treated for 3 months either with mometasone cream (0.1%) once daily or with pimecrolimus cream (1%) twice daily.. Forty patients, 20 from each group, completed the study. The two drugs were found to be statistically significantly effective for diminishing lesion size (Z = 3.070,p = 0.002 andZ = 3.845,p < 0.001, respectively). There were no statistical differences between the two drugs:Z = 1.427,p = 0.154 (mometasone non-inferiority to pimecrolimus). The mean repigmentation rate was 65% in the mometasone group and 42% in the pimecrolimus group at the end of therapy. Atrophy, telangiectasia and erythema were observed in two patients (10%) in the mometasone cream group and a burning sensation and pruritus were observed in two patients (10%) in the pimecrolimus cream group; drop-out was not related to the observed adverse effects.. Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body except for the face in childhood localized vitiligo.

Topics: Administration, Topical; Adolescent; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Mometasone Furoate; Ointments; Pregnadienediols; Probability; Prospective Studies; Severity of Illness Index; Statistics, Nonparametric; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Adrenal Cortex Hormones; Humans; Mometasone Furoate; Psoriasis; Ultraviolet Therapy; Vitiligo

Topics: Administration, Cutaneous; Adult; Dermatologic Agents; Erythema; Female; Humans; Mometasone Furoate; Skin; Skin Diseases, Genetic; Skin Pigmentation; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Both alopecia areata and vitiligo are common skin disorders that are considered to be caused by an autoimmune response targeted to hair follicle and melanocyte antigens, respectively. The association of these two diseases in the same patient is well known, however, coexistence of alopecia areata and vitiligo within the same lesion is very rare. Herein, we report an 8-year-old boy who had colocalization of alopecia areata and vitiligo on the frontal portion of his scalp.

Topics: Alopecia Areata; Anti-Inflammatory Agents; Child; Humans; Male; Mometasone Furoate; Pregnadienediols; Scalp Dermatoses; Vitiligo