tacrolimus and Vitiligo

Vitiligo is a common cutaneous depigmentation disorder. Although multiple treatment options are available, no single modality is satisfactory for all patients. Several studies have demonstrated that prostaglandin analogues can potentially treat cutaneous depigmentation, but the evidence is limited to their inconsistent study design.. A systematic review was performed for studies published before 29 June 2021, in PubMed, Embase, Web of Science, or the Cochrane Library. The primary outcome of pooled analysis was the repigmentation efficacy of local prostaglandin analogues compared with other therapies for vitiligo.. Six randomized controlled trials (RCTs) and three non-RCTs were included in this systematic review, and seven studies among them were used for the meta-analysis. The pooled analysis demonstrated that local prostaglandin analogues could significantly increase repigmentation along with narrowband ultraviolet B phototherapy compared with phototherapy alone. Furthermore, the repigmentation efficacy of topical prostaglandin analogues was not significantly different from that of topical tacrolimus. In summary, local prostaglandin analogues either used alone or as add-on therapy could be safe and effective therapies for vitiligo.

Topics: Combined Modality Therapy; Humans; Phototherapy; Prostaglandins, Synthetic; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Topics: Combined Modality Therapy; Humans; Immunosuppressive Agents; Lasers, Excimer; Phototherapy; Tacrolimus; Ultraviolet Therapy; Vitiligo

The objective of this meta-analysis was performed to compare the effects of tacrolimus plus phototherapy in the treatment of patients with vitiligo. Relevant studies were identified by searching PubMed, Embase, and Web of Science databases. The main outcomes of interest included excellent response (≥ 75% repigmentation), good response (50-75% repigmentation), moderate response (25%-50% repigmentation), and poor response (< 25% repigmentation). Risk ratio (RR) with 95% confidence intervals (95% CIs) was used to calculate the data. Eleven studies were included in this study. Compared with phototherapy alone, combination treatment of tacrolimus and phototherapy significantly improved excellent response rate (RR = 1.40, 95% CI 1.16, 1.69; P < 0.001) and reduced the poor response rate (RR = 0.37, 95% CI 0.22, 0.61; P = 0.001). However, the good response rate (RR = 1.00, 95% CI 0.59, 1.69, P = 1.000) and moderate response rate (RR = 0.91, 95% CI 0.60, 1.38; P = 0.653) were not significantly different between the two treatments. Subgroup analysis suggested that combination treatment had a higher excellent response rate than phototherapy alone for lesions located in the face and proximal limbs. Both NB-UVB and EL, when added to tacrolimus, resulted in a significantly higher excellent response rate than they were used alone. Meta-regression analysis showed that age was a predictive factor that influenced the effect of combination treatment on an excellent response, in which children had a high excellent response to the treatment. Other demographic and clinical variables, including gender, disease duration, family history, and type of vitiligo, did not have any impact on the treatment effect. Combination treatment with tacrolimus and phototherapy was more effective than phototherapy monotherapy for patients with vitiligo, especially in the lesions located in the face and proximal limbs. More large-scale, well-performed trials are needed to verify our findings.

Topics: Administration, Cutaneous; Combined Modality Therapy; Humans; Immunosuppressive Agents; Lasers, Excimer; Phototherapy; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Calcineurin Inhibitors; Humans; Skin Pigmentation; Tacrolimus; Vitiligo

Microneedling was initially introduced for skin rejuvenation; however, this minimally invasive procedure is now being used for the treatment of multiple dermatological conditions. Recent reports have shown its efficacy in the treatment of vitiligo. This review analyzes the current literature on microneedling techniques, efficacy, and safety for vitiligo treatment. An extensive PubMed was done to identify the literature on microneedling treatment for vitiligo. Case reports, case series, and clinical trials were included in this review. All 14 articles evaluated showed improvement of vitiligo lesions after microneedling treatment. The combination of microneedling and topical tacrolimus, 5-fluorouracil, topical calcipotriol and betamethasone, narrowband ultraviolet B with or without photodynamic therapy, and triamcinolone acetonide solution yielded more efficacy than microneedling monotherapy. Microneedling is a safe and efficient technique in the treatment of vitiligo. Thus, it can be an alternative treatment for vitiligo especially when the latter is resistant to conventional therapies.

Topics: Combined Modality Therapy; Humans; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

There is currently no definitive treatment for vitiligo; various modalities include immune modulators phototherapy and skin camouflage. We investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo. Electronic systematic search of the literature was carried out using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo have been included in a systematic review and meta-analysis. Meta-analysis was conducted via RevMan, and risk of bias was assessed through the Cochrane quality assessment tool. The protocol was published through PROSPERO (CRD42018112430). A total of 19 studies including 814 patients were included in our systematic review. The random-effects-model meta-analysis of two studies revealed that the tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy rates is better than NB-UVB alone in inducing >75% repigmentation [RR 1.34 (95% CI: 01.05-1.71), P = 0.02]. Tacrolimus and steroids had similar potency in acheiving >75% repigmentation [RR 1.02 (95% CI: 0.19-5.51), P = 0.98]. Meta-analysis of two studies revealed that the fractional laser and tacrolimus combination therapy is no better than tacrolimus alone in causing >75% repigmentation [RR 2.11 (95% CI: 0.87-5.09), P = 0.10]. Further investigating tacrolimus as mono- or adjuvant therapy for vitiligo is highly recommended. Combining tacrolimus to other treatment options such as steroids, phototherapy and laser may be superior to using tacrolimus alone.

Topics: Administration, Topical; Combined Modality Therapy; Humans; Immunosuppressive Agents; Laser Therapy; Phototherapy; Tacrolimus; Vitiligo

Trichomegaly is a known adverse effect of systemic administration of cyclosporine but is less commonly associated with systemic tacrolimus or with topical calcineruin inhibitors. In this report, we describe the first case, to our knowledge, of trichomegaly due to long-term use of topical tacrolimus for periocular vitiligo.

Topics: Administration, Topical; Adolescent; Eyelashes; Facial Dermatoses; Humans; Male; Rare Diseases; Risk Assessment; Tacrolimus; Vitiligo

The treatment of vitiligo is still one of the most difficult dermatological challenges, although there are many therapeutic options. Narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality for generalized vitiligo.. The aim of this study was to explore whether a combination of NB-UVB and topical agents would be superior to NB-UVB alone for treating vitiligo.. We searched the electronic databases such as PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary outcome was the proportion of ≥50% repigmentation (a clinical significance), and secondary outcome was the proportion of ≥75% repigmentation (an excellent response).. Seven randomized controlled trials (RCTs) involving 240 patients (413 lesions) were included in this meta-analysis. The study showed no significant difference between NB-UVB combination therapy (NB-UVB and topical calcineurin inhibitor or vitamin D analogs) and NB-UVB monotherapy in the outcomes of ≥50% repigmentation and ≥75% repigmentation. However, lesions located on the face and neck had better results in ≥50% repigmentation (RR = 1.40, 95% CI 1.08-1.81) and ≥75% repigmentation (RR = 1.88, 95% CI 1.10-3.20) with NB-UVB and topical calcineurin inhibitor combination therapy vs. NB-UVB monotherapy.. The meta-analysis suggested that adding neither topical calcineurin inhibitors nor topical vitamin-D3 analogs on NB-UVB can yield significantly superior outcomes than NB-UVB monotherapy for treatment of vitiligo. However, addition of topical calcineurin inhibitors to NB-UVB may increase treatment outcomes in vitiligo affecting face and neck.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Calcitriol; Chemoradiotherapy; Dermatologic Agents; Dihydroxycholecalciferols; Facial Dermatoses; Humans; Neck; Randomized Controlled Trials as Topic; Skin Pigmentation; Tacrolimus; Ultraviolet Therapy; Vitamin D; 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

Thus far, several small studies and case reports on the use of topical immunomodulators in vitiligo have been published. We undertook a comprehensive literature review, searching for studies evaluating clinical response to tacrolimus topical therapy for vitiligo. A search was performed on PubMed/Medline using the term "vitiligo", combined with "topical" and "ointment". Our inclusion criteria were: use of tacrolimus ointment as monotherapy to treat vitiligo. We found 29 studies from 2002 to 2014. Overall, 709 patients were treated in 29 studies. Pooling the lesions, 50% repigmentation of vitiligo patches was never achieved before 2 months of treatment, with a peak after 6 months of therapy. The best results were obtained on lesions of the cephalic region, especially the face, with tacrolimus 0.1% ointment two times daily. The percentage of non-responsive patients ranged from 0% to 14%. Treatment was generally well-tolerated; only localized adverse effects were reported. Our objective was to verify the effectiveness and safety of tacrolimus ointment monotherapy. It has good efficacy and tolerability. At present, only small trials and case series are available in the literature. Further, standardized investigations on a larger number of patients are needed.

Topics: Administration, Cutaneous; Female; Humans; Immunosuppressive Agents; Male; Ointments; Reproducibility of Results; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

Topical tacrolimus and pimecrolimus are indicated for the treatment of atopic dermatitis, but they have been studied in many off-label uses. We reviewed the English language literature to define their roles in treatment of vitiligo. Double-blind studies show that tacrolimus 0.1% ointment combined with excimer laser is superior to placebo, especially for UV resistant areas, such as bony prominences of the extremities. When used alone, tacrolimus 0.1% ointment is almost as effective as clobetasol propionate 0.05% ointment. Other studies suggest it can also be effective for facial lesions. Double blind studies show that pimecrolimus 1% cream combined with narrow band UVB is superior to placebo, especially for facial lesions. Additional studies would further clarify the role of topical calcineurin inhibitors in vitiligo.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Dermatologic Agents; Humans; Ointments; Skin Cream; Tacrolimus; Vitiligo

Despite much research done involving elucidation of the pathogenesis of vitiligo, a precise cause is still not known. Prevalent hypotheses include the autoimmune, genetic, neural, self-destruction, growth factor deficiency, viral, and convergence theories, which have served as the basis for treatment formulation. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy. Topical treatments used in the treatment of vitiligo include steroids, calcineurin inhibitors, vitamin D analogues, pseudocatalase, and depigmenting agents. Combination therapies are used to improve the success rate of repigmentation. In this article, we have examined randomized controlled trials utilizing topical treatments used as monotherapy or combination therapy. Although psoralen and khellin can be used as topical agents, used in conjunction with UV radiation, we have not included them in the review due to their inability to be used as monotherapy. We have also excluded less used or ineffective topical agents, such as melagenina, topical phenylalanine, topical L-DOPA, coal tar, anacarcin forte oil and topical minoxidil. According to current guidelines, a less than two month trial of potent or very potent topical corticosteroids or topical calcineurin inhibitors may be used for therapy of localized vitiligo (<20% skin surface area). Combinations of topical corticosteroids with excimer laser and UVA seem to be more effective than steroids alone. Pseudocatalase plus NB-UVB does not seem to be more effective than placebo with NB-UVB. Combinations of vitamin D analogues have varied efficacy based on which type is used and the type of UV light. Efficacy of calcineurin inhibitor combinations also vary based on the type used and UV light combined, with tacrolimus being more effective with excimer laser. Pimecrolimus has been effective with NB-UVB and excimer laser on facial lesions, and microdermabrasion on localized areas.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Catalase; Dermatologic Agents; Drug Therapy, Combination; Glucocorticoids; Humans; Lasers, Excimer; Patient Satisfaction; Patient Selection; Phototherapy; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Tacrolimus; Vitamin D; Vitamins; Vitiligo

Topical tacrolimus and pimecrolimus are indicated for treatment of atopic dermatitis, but they have been studied in many off-label uses. Double-blind and open studies have shown favorable results with topical tacrolimus and pimecrolimus in oral lichen planus. In 1 study of oral lichen planus, blood tacrolimus was detected in 54% of patients, but there were no signs of systemic toxicity. Double-blind and open studies of vitiligo have shown favorable results with tacrolimus in combination with excimer laser, especially for lesions over bony prominences and on extremities. Similarly, double-blind studies of vitiligo have shown favorable results when pimecrolimus is combined with narrow-band UVB, especially for facial lesions. Double-blind and open studies of psoriasis have shown favorable results for tacrolimus and pimecrolimus, especially for inverse psoriasis. Topical calcineurin inhibitors have been effective in many other cutaneous disorders, and further studies would help clarify their roles.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Child; Child, Preschool; Crohn Disease; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Female; Humans; Lichen Planus, Oral; Lupus Erythematosus, Cutaneous; Male; Off-Label Use; Psoriasis; Rosacea; Skin Diseases; Tacrolimus; Therapies, Investigational; Vitiligo

Pimecrolimus is a non-steroidal immunosuppressant derived from ascomycin. This drug inhibits the action of calcineurin phosphatase and blocks the production of inflammatory substances that are thought to be important in causing skin lesions in inflammatory diseases. Pimecrolimus 1% cream (Elidel, Novartis Pharma, East Hanover, NJ, USA) was approved in the European Union, the United States and Japan as second-line therapy for the short- term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children aged 2 years and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. This topical immunomodulator has also an enormous potential as topical treatment for numerous inflammatory skin diseases like psoriasis and vitiligo. Recently, some authors reported its efficacy in the treatment of skin manifestations of Lupus erytematosus.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Calcineurin Inhibitors; Dermatitis, Atopic; Dermatologic Agents; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Lymphocyte Activation; Molecular Structure; Pain; Psoriasis; T-Lymphocytes; Tacrolimus; Vitiligo

Topics: Administration, Cutaneous; Calcitriol; Child; Clinical Trials as Topic; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Glucocorticoids; Humans; Immunosuppressive Agents; Phototherapy; Tacrolimus; Treatment Outcome; Vitiligo

Current treatments for vitiligo, a common pigmentary disorder affecting around 1% of the world's population, are largely unsatisfactory.. We sought to report a Cochrane review of all interventions for the treatment of vitiligo.. We systematically searched a range of databases for randomized controlled trials. At least two reviewers independently assessed study eligibility, methodological quality, and extracted data.. Nineteen trials were included. We found moderate evidence of the benefit of topical steroids. Our search uncovered limited to moderate evidence for various types and regimens of phototherapy (ultraviolet [UV] A and UVB) used alone or in combination with oral and topical treatments. Topical khellin combined with UVA should be questioned in view of the lack of available evidence of benefit. There is limited evidence of the benefit of topical tacrolimus and topical calcipotriol used in conjunction with UV light, and for oral ginkgo biloba, and thin split-thickness grafts.. Studies generally were poorly designed and reported.. Variations in study design and different outcome measures limit the evidence for the different therapeutic options. The best evidence from individual trials showed short-term benefit from topical steroids and various forms of UV light with topical preparations. Long-term follow-up and patient-centered outcomes should be incorporated in study design and psychologic interventions need more attention.

Topics: Administration, Oral; Administration, Topical; Calcitriol; Dermatologic Agents; Evidence-Based Medicine; Ginkgo biloba; Humans; Immunosuppressive Agents; Photochemotherapy; Phytotherapy; Plant Extracts; PUVA Therapy; Randomized Controlled Trials as Topic; Research Design; Skin Transplantation; Steroids; Tacrolimus; Treatment Outcome; Vitiligo

Topical tacrolimus is an immunosuppressant that acts through the inhibition of calcineurin and thus of the T cells. This causes a decrease in the production of interleukins, the granulocyte colony stimulating factor, alpha interferon and tumor necrosis factor. Although the use of topical tacrolimus is only indicated for the treatment of moderate or severe atopic dermatitis, its immunosuppressant effect and fewer side effects regarding topical corticosteroids have lead to the increase of its use in other types of inflammatory skin diseases. The purpose of this article is to review the use of tacrolimus in this group of diseases other than atopic dermatitis, this use not being authorized within the data sheet of the drug.

Topics: Adult; Autoimmune Diseases; Child; Clinical Trials as Topic; Dermatitis; Graft vs Host Disease; Humans; Immunosuppressive Agents; Lichenoid Eruptions; Multicenter Studies as Topic; Off-Label Use; Pruritus; Psoriasis; Pyoderma Gangrenosum; Skin Diseases; Tacrolimus; Uremia; Vitiligo

Vitiligo is an acquired leukoderma that results from the loss of epidermal melanocytes, and is characterized by macules and patches of depigmented skin. With a relatively high rate of prevalence, vitiligo occurs in localized, generalized, or segmental patterns; it can run a rapidly progressive course or remain stationary. The pathogenesis of vitiligo is not yet fully understood, but the autoimmune hypothesis is the most commonly accepted one, based on which, many treatment modalities have been described. Although many therapeutic options exist and new modalities are still emerging, treatment challenges persist, as not all patients respond to available therapies. Variables that affect the choice of treatment include the extent, distribution, and progression rate of the lesions. Another challenge is the lack of a standardized scoring system, which hampers the production of level 1a evidence studies for the treatment of this condition.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Calcitriol; Combined Modality Therapy; Dermatologic Agents; Humans; Immunosuppressive Agents; Low-Level Light Therapy; Phototherapy; Tacrolimus; Vitiligo

Recently, topical macrolide immunomodulators have been successfully introduced in the treatment of atopic dermatitis. With the growing interest in this new line of topical immunosuppressants, research into the efficacy of these medicines in other T-cell-mediated skin diseases, such as psoriasis, lichen planus, and even vitiligo, is expanding rapidly. It is generally accepted that autoimmune factors play an important role in vitiligo. In this article, the possible use and mechanism of topical macrolide immunomodulators in the treatment of vitiligo are discussed, together with the current state of clinical studies and case reports. These limited reports indicate that topical macrolide immunomodulators may play a role in the treatment of vitiligo, particularly in areas where use of potent corticosteroids is contraindicated.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Humans; Immunosuppressive Agents; Macrolides; Tacrolimus; Vitiligo

Hypochromy is a common dermatological disorder. However, its treatment still gives unsatisfactory results. Interesting clues into the understanding of the pathophysiology of hypochromy have been recently brought about thanks to the pigmentary side effects reported with the new tyrosine kinase inhibition treatments. New therapeutic approaches to hypochromy are further discussed.

Topics: Administration, Cutaneous; Antioxidants; Calcineurin Inhibitors; Calcitriol; Combined Modality Therapy; Humans; Keratolytic Agents; Low-Level Light Therapy; Phototherapy; Protein-Tyrosine Kinases; Randomized Controlled Trials as Topic; Tacrolimus; Ultraviolet Therapy; Vitiligo

Vitiligo is an acquired pigmentary skin disorder that affects 0.5-2% of the population. Many patients contact their physician and alternative therapists for help. This review article presents an update of knowledge about vitiligo and is aimed at physicians that treat this patient group.. The article is based on literature identified on PubMed, textbooks in Dermatology and supplemented by clinical experience.. Vitiligo is characterized by the absence of melanocytes in skin and hair follicles. The pathogenesis is complex with genetic, autoimmune and toxic contributors. Clinically well-defined milk-white maculae are seen in the skin, with a wide variety of spread and distribution. The debut of vitiligo is often in childhood and adolescence. Investigations indicate that vitiligo affects quality in life for both children and adults. Treatment of vitiligo is a challenge. Phototherapy with narrowband UVB or topical therapy with tacrolimus ointment or potent steroids may be indicated in some cases, but the effect is not well documented.

Topics: Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Humans; Immunosuppressive Agents; Prognosis; PUVA Therapy; Steroids; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Topics: Adjuvants, Immunologic; Calcitriol; Cell Transplantation; Humans; Immunosuppressive Agents; Melanocytes; Phototherapy; Skin Transplantation; Tacrolimus; Vitiligo

THE EFFICACY OF THE 308 NM EXCIMER LASER in the treatment of common psoriasis has been demonstrated. THE DOSES USED have progressively decreased, hence, limiting the adverse events that appear redhibitory with high doses. THE ADAPTATION OF THE DOSES not to the patients themselves but to each of the plaques treated should reduce the number of sessions and the cumulated close necessary to obtain clinical remission. THE 308 NM EXCIMER LASER is effective and tolerance is good in the treatment of vitiligo. It should be proposed for limited vitiligo and essentially of the "UV sensitive" areas, which have shown aesthetically correct percentage of repigmentation. THE PLACE AND INTEREST of its association with other treatments, notably with topical tacrolimus, remains to be defined. Although the results obtained in the treatment of vitiligo are promising, they have to be confirmed in larger cohorts and ensure the absence of median and long term side effects. This therefore limits its use in combined treatments in the context of controlled clinical traits. THE 30 NM EXCIMER LASER IS AN EFFECTIVE AND WELL TOLERATED TREATMENT in localised and non-nodular forms of mycosis fungoid (MF). Although the number of patients treated is limited, the clinical and histological cure observed demonstrates the interest of this new technique in the treatment of MF. These results must be confirmed in a greater number of patients. THE 308 NM EXCIMER LASER is an interesting therapeutic alternative in the treatment of plaques of alopecia areata, erosive oral lichen planus, post-surgical hypopigmentation, vergetures and localised forms of atopic dermatitis. Because of the sparcity of data and in the absence of long term follow-up, it must not be proposed in first intention.

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Laser Therapy; Mycosis Fungoides; Phototherapy; Pilot Projects; Radiotherapy Dosage; Skin Diseases; Tacrolimus; Time Factors; Ultraviolet Therapy; Vitiligo

Common pediatric skin conditions such as infantile atopic dermatitis, vitiligo, hemangiomas of infancy, warts, and molluscum contagiosum do not always respond to standard therapy. In some settings pediatricians will use "off-label" medications if the benefit-to-risk ratio is favorable. This article reviews important literature from the past year related to "off-label" immune-based treatment of skin disease, using the topical immunomodulators tacrolimus, pimecrolimus, and imiquimod, as well as intravenous Ig.. The topical immunomodulators tacrolimus and pimecrolimus have been embraced by pediatricians as long awaited alternatives for treating atopic dermatitis in children 2 years of age and older. Their unique appeal as nonsteroidal topical agents with good safety profiles has led to their frequent use for unapproved indications. A number of recent publications detail their use in infantile atopic dermatitis in children as young as 3 months of age, as well as use in other conditions such as vitiligo. Imiquimod, another topical immunomodulator, approved for genital wart treatment in adults, has also been examined for "off-label" pediatric use in nongenital warts, molluscum contagiosum, hemangiomas of infancy, and basal cell carcinoma. Finally, "off-label" use of intravenous Ig has been evaluated for the life-threatening dermatoses Stevens-Johnson syndrome and toxic epidermal necrolysis.. In the absence of larger controlled trials, pediatricians must consider the cumulative weight of smaller studies with their personal experience when assessing any role for "off label" therapy. The recent literature reviewed herein will facilitate such assessments of the non-steroid topical immune modifiers tacrolimus, pimecrolimus, and imiquimod as well as intravenous immunoglobulin.

Topics: Adjuvants, Immunologic; Aminoquinolines; Child; Clinical Trials as Topic; Dermatitis, Atopic; Hemangioma; Humans; Imiquimod; Immunoglobulins; Immunologic Factors; Immunosuppressive Agents; Infant; Molluscum Contagiosum; Skin; Skin Diseases; Stevens-Johnson Syndrome; Tacrolimus; Vitiligo; Warts

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.

Topics: Calcineurin Inhibitors; Child; Humans; Immunosuppressive Agents; Infant; Ointments; Tacrolimus; Vitiligo

Vitiligo is an autoimmune skin disorder characterized by circumscribed depigmented macules and patches caused by the loss of functional melanocytes. Although there is no definitive treatment for vitiligo, several treatment options have been associated with relative satisfactory outcomes. The purpose of this study was to compare the efficacy of micro-needling in conjunction with topical 5-fluorouracil (5-FU) versus topical tacrolimus ointment in treating vitiligo patches.. This study included nineteen participants, each of whom received both treatments on two randomly selected vitiligo patches of approximately the same size and location. On one patch, a combination of weekly micro-needling and topical application of 5-FU solution was used every other day, while on the other, 0.1% tacrolimus topical ointment was applied twice daily. The G-score was used to compare treatment outcomes after 3 months.. The median duration of the disease in our population was 7 years. Six patients (32%) in the micro-needling plus topical 5-FU treated group showed a moderate to excellent response, indicating a significant improvement between both treatments (p-value = 0.019). In contrast, all other patches treated with topical tacrolimus showed poor improvement. Lower extremity and trunk responded more to treatment with micro-needling plus topical 5-FU than upper extremity and acral areas. Moreover, none of those who have had the disease for more than ten years have responded to treatment. Mild erythema, pinpoint bleeding, and irritation were detected only in the micro-needling treated group.. The current study showed that using micro-needling in conjunction with 5-FU could treat vitiligo patients more efficiently than tacrolimus monotherapy. Despite showing moderate to excellent improvement in patches treated with micro-needling and 5-FU, this well-tolerated office-based modality still requires additional research.

Topics: Fluorouracil; Humans; Immunosuppressive Agents; Ointments; Tacrolimus; Treatment Outcome; Vitiligo

Acral vitiligo is a significantly distressing condition and tends to be treatment-resistant. The occurrence of new lesions on acral areas further causes greater psychological trauma. Topical tacrolimus has been widely used in the management of vitiligo and its role in preventing flares in other dermatoses such as atopic dermatitis has been well documented.. To assess the role of topical tacrolimus as preventive therapy in unstable acral vitiligo.. In this single-centre randomized prospective study, 60 patients aged 16-60 years having unstable acral vitiligo with symmetrical lesions were enrolled and randomized (1:1) into two groups. Patients in group A were instructed to apply topical tacrolimus 0.1% ointment on both vitiliginous and normal skin while patients in group B were instructed to apply topical tacrolimus 0.1% ointment only on vitiliginous skin for 6 months. Only the distal hand till the wrist joint was chosen for observation. Vitiliginous patches were assessed monthly for 6 months for a change in the number of lesions and total area involved, extension of preexisting lesions and adverse effects if any.. A reduction in the number of lesions was observed in both groups. The decrease in the number of lesions in group A was 5.6% as compared to 2.3% in group B (p-0.001). The decrease in depigmented area in group A was 10.5% as compared to 4.6% in group B (p-0.048). Treatment failure was seen in 11 out of 60 (18.3%) patients.. Tacrolimus 0.1% ointment application showed effectiveness in preventing the appearance of new lesions in unstable acral vitiligo and hastening the repigmentation when applied on both lesional and perilesional skin in vitiligo.

Topics: Humans; Immunosuppressive Agents; Ointments; Prospective Studies; Tacrolimus; Treatment Outcome; Vitiligo

Treatment of vitiligo represents a highly therapeutic challenge in spite of the continuous development of new modalities. Combination therapies of vitiligo can help improve treatment response, and reduce recurrence potential. To compare the efficacy and adverse effects of microneedling combined with-fluorouracil, pimecrolimus, and trichloroacetic acid (TCA) in the treatment of localized, stable vitiligo. The study included 75 patients with non-segmental, stable vitiligo who were randomly assigned to three equal groups: group received a combination of microneedling and -FU, group 2 received microneedling and pimecrolimus, and group 3 received microneedling and TCA. The procedure was done every 2 weeks for a maximum of six sessions. Combined microneedling and TCA was associated with the highest + 5-fluorouracil, and lastly combined microneedling + pimecrolimus. The difference between the three groups was statistically significant in favor of the combined microneedling and TCA. Pain, erythema, post-inflammatory hyperpigmentation, infection, and scarring were variably reported adverse effects in the three groups. Combination therapy seems to be a promising modality for the treatment of vitiligo. Combined microneedling and TCA is superior to combined microneedling with either-fluorouracil or pimecrolimus.

Topics: Combined Modality Therapy; Fluorouracil; Humans; Tacrolimus; Treatment Outcome; Trichloroacetic Acid; Vitiligo

This study aimed to assess and compare the clinical efficacy and safety of a triple combination treatment using 2940 nm Er:YAG laser, triamcinolone acetonide solution combined with either 308 nm excimer laser or 0.1% tacrolimus for the treatment of stable segmental vitiligo. Patients with stable segmental vitiligo were randomly divided into two groups and received a 5-month treatment with 2940 nm Er:YAG laser followed by triamcinolone acetonide and, either 308 nm excimer laser (Group A, N = 8) or 0.1% tacrolimus (Group B, N = 13). General information and imaging data were collected before and at 1 month after treatments. Marked repigmentation and overall repigmentation rates were analyzed and any adverse skin reactions were recorded. Both treatments significantly reduced the percent of skin lesions per total body surface area (p < 0.05) and no significant differences in repigmentation were observed between the two groups (p > 0.05). The marked repigmentation rate of Group A was 42.11% and overall repigmentation rate was 94.74%, while for Group B these rates were 51.16% and 100%, respectively. There were no significant differences in the number of fingertip units at each time point (p > 0.05). While there was a significant effect for time on the number of fingertip units without considering other factors (p < 0.05), the time x treatment interaction was not significant (p > 0.05). One Group A patient developed adverse reactions consisting of erythema, burning sensation and blisters and one Group B patient developed mild erythema and burning sensations. Both treatments demonstrated a high level of efficacy and safety in the treatment of stable segmental vitiligo.

Topics: Humans; Lasers, Excimer; Lasers, Solid-State; Pilot Projects; Prospective Studies; Tacrolimus; Treatment Outcome; Triamcinolone Acetonide; Vitiligo

The pathogenesis of vitiligo is complex and multifactorial, accumulating evidence of increased oxidative stress and reduction in catalase levels in vitiligo patients has been shown, hence, pseudocatalase/superoxide dismutase (PSD) gel has been used as treatment option for vitiligo.. To assesses the synergic effect of PSD when combines with Tacrolimus 0.1% ointment. A randomized controlled trial that included 49 children with vitiligo with limited area (10% or less). Patients were randomized into two groups: Group 1 (24 patients) were treated only with Tacrolimus 0.1% ointment whereas Group 2 (25 patients) were treated with Tacrolimus 0.1% ointment plus PSD. Degree of repigmentation compared to baseline was assessed at 3, 6, and 9 months.. The median age was 10.05 years (range 2-18). The percentages of pigmentation on 3, 6, and 9 months for Group 1 were 23.9%, 40.4%, and 60%, respectively and for Group 2 were 23.2%, 40.7%, and 62.4%, respectively. There was no significant difference according to repigmentation percentages between the two groups (. The results showed that the addition of PSD to Tacrolimus ointment in children with limited vitiligo was not associated with any therapeutic benefit.

Topics: Adolescent; Catalase; Child; Child, Preschool; Humans; Immunosuppressive Agents; Ointments; Superoxide Dismutase; Tacrolimus; Treatment Outcome; Vitiligo

Miconeedling has been used to augment the transdermal drug delivery. Combination modalities may accelerate and improve the repigmentation in vitiligo.. To determine the efficacy and tolerability of combined microneedling with tacrolimus vs tacrolimus 0.1% ointment for the treatment of vitiligo.. Forty-eight patients with vitiligo were randomized into two groups: group I applied tacrolimus once daily for 6 months. Group II received microneedling with topical tacrolimus at 2 weeks intervals for a maximum of 6 months. The assessment was based on the clinical improvement and immunohistochemical changes. Skin biopsies were taken at baseline and after the treatment for c-kit + expression.. After treatment, the repigmentation >75% was observed in 50% of the patients in group II compared to 29.2% in group I (. The results suggest the superiority of the combination regimen (tacrolimus and microneedling) for vitiligo treatment.

Topics: Administration, Cutaneous; Humans; Immunosuppressive Agents; Skin; Tacrolimus; Treatment Outcome; Vitiligo

Vitiligo is a common acquired pigmentary disorder. Bimatoprost ophthalmic solution was indicated in the treatment of open-angle glaucoma and eyebrow hypotrichosis. However, lid hyperpigmentation was reported as a complication.. To study the efficacy and safety of 0.01% bimatoprost solution compared with 0.1% tacrolimus ointment in patients with nonsegmental facial vitiligo.. Patients with more than 2 vitiliginous patches on the face were enrolled. Vitiliginous patches were randomized to receive topical 0.1% tacrolimus ointment or 0.01% bimatoprost ophthalmic solution, applied twice daily for 12 weeks. The vitiligo surface area (VSA, cm. Ten patients completed the study. At the baseline, the mean VSA was comparable between the two groups. By week 12, the VSA decreased at a statistically significant level among both groups compared to the baseline (P < .05). However, there was not a statistically significant difference between both groups. In terms of repigmentation at week 12, 20% of the patients in the bimatoprost group and 10% in the tacrolimus group achieved >50% repigmentation; the overall grading score between two groups were not different at a statistically significant level. The side effects of bimatoprost were reported as itching and burning. There were no changes in intraocular pressure in 2 patients who had lid involvement.. Topical bimatoprost solutions were safe and effective for the treatment of nonsegmental facial vitiligo with comparable results to tacrolimus ointment. It can be considered as an alternative treatment for facial vitiligo.

Topics: Bimatoprost; Face; Humans; Tacrolimus; Treatment Outcome; Vitiligo

Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use.. This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo.. This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension.. Participants included were adult patients with recent facial vitiligo target lesions (<2 years) without changes in pigmentation or size over the previous 3 months.. Patients received either tacrolimus 0.1% ointment or vehicle twice daily.. The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians' global assessment scores and patients' satisfaction scores, safety data, and the rate of relapse at week 48.. A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P < 0.0001). Only 40% of relapse was observed at 48 weeks.. Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo.. This study was registered at ClinicalTrials.gov (identifier: NCT02466997).

Topics: Administration, Cutaneous; Adult; Calcineurin Inhibitors; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ointments; Patient Satisfaction; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

Vitiligo is an acquired pigmentation disorder due to loss of melanocytes. Topical tacrolimus is effective in vitiligo treatment with minimal effect on extra-facial lesions.. To assess different methods of enhancing the absorption of topical tacrolimus in extra-facial vitiligo sites using microneedling and occlusion.. This study included 20 adult patients of both sexes with non-segmental vitiligo. Four extra-facial vitiligo lesions in each patient were randomly labeled A, B, C, and D and treated as follows: area A: tacrolimus ointment (0.03%) application twice/day, area B: microneedling once/week and tacrolimus ointment application directly after microneedling and twice/day the rest of the week, area C: microneedling once/week alone, and area D: tacrolimus ointment application twice/day under occlusion by polyethylene foil. The evaluation was done clinically by calculating the re-pigmentation percent after 6 months of treatment.. Responders in area B were 45%, and 35% in area C, and 25% in both areas A and D. No statistically significant difference was detected regarding the re-pigmentation percent between the four areas (p > 0.05). No correlations were detected between re-pigmentation percent and patients' data.. Combination of microneedling and topical tacrolimus has an edge over monotherapy in vitiligo, and further studies are needed to verify such results.

Topics: Adult; Face; Female; Humans; Male; Pigmentation Disorders; Tacrolimus; Treatment Outcome; Vitiligo

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 24 weeks. 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 24 weeks. Tacrolimus-induced repigmentation is more likely in patients with vitiligo vulgaris, head and neck lesions, skin phototype III, and young age.

Topics: Combined Modality Therapy; Humans; Skin; Tacrolimus; Treatment Outcome; Vitiligo

Dinoprostone (DNP), a prostaglandin E2 (PGE2) analogue, has been found to cause repigmenation in vitiliginous lesions. Combined medical and surgical therapy might be more useful for successful treatment of vitiligo.. In this study, we aimed to evaluate the efficacy and safety of dermabrasion followed by dinoprostone gel and to compare it with tacrolimus ointment following the same procedure in the treatment of localized stable vitiligo.. 40 patients of stable vitiligo were enrolled which were divided in two groups of 20 patients each. In group 1, dermabrasion followed by tacrolimus 0.1% ointment was done and in group 2, dermabrasion followed by dinoprostone gel was done.. Group 1 patients showed slightly better response (P=0.039), whereas the side effect profile was better for group 2.. DNP and tacrolimus have immunomodulatory and melanocyte stimulating effect and are well tolerated when combined with dermabrasion. Their effect on skin pigmentation could be enhanced by dermabrasion. J Drugs Dermatol. 2021;20(5):519-522. doi:10.36849/JDD.5751.

Topics: Adolescent; Adult; Dermabrasion; Dinoprostone; Female; Gels; Humans; Male; Melanins; Melanocytes; Middle Aged; Ointments; Severity of Illness Index; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topical immunomodulators have been successfully used as monotherapy or in combination with other therapeutic modalities in treating vitiligo. To the best of our knowledge, no previous studies have evaluated the combination of tacrolimus 0.03% ointment and microdermabrasion as a therapeutic modality to hasten response time and improve repigmentation rate in vitiligo vulgaris.. To explore the efficacy and safety of the combination of MDA and topical tacrolimus (0.03%) as a novel therapeutic approach for stable vitiligo vulgaris.. Thirty-five patients with vitiligo were enrolled in this randomized placebo-controlled study. Three vitiligenous patches were chosen in each patient. The first lesion (A) was treated by tacrolimus 0.03% ointment, the second lesion (B) was treated by tacrolimus and microdermabrasion, and the third lesion (C) was treated by petrolatum as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiligenous patches were assessed at baseline and monthly for 6 months.. Moderate to excellent response was observed in 65.7% of lesions B, compared with 25.8% of lesions A (P = .001). Improvement in VASI score was significantly better in patients treated by the combination therapy (P = .000). Disease duration has a negative impact on therapeutic response. Patients were more satisfied with the combination treatment.. Microdermabrasion combined with tacrolimus 0.03% ointment represents a new therapeutic option for the treatment of vitiligo which appears to be an easy, safe, and effective.

Topics: Administration, Cutaneous; Adolescent; Adult; Child; Combined Modality Therapy; Dermabrasion; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Severity of Illness Index; Single-Blind Method; Skin Pigmentation; Tacrolimus; Treatment Outcome; Visual Analog Scale; Vitiligo; Young Adult

Combination therapies have reported to augment the repigmentation in vitiligo. Microneedling (Mn) facilitates drug delivery across the skin barrier.. To evaluate and compare the efficacy and safety of Mn combined with tacrolimus vs Mn alone or tacrolimus 0.1% ointment for treatment of localized and stable vitiligo.. Ninety patients with vitiligo were randomized into three groups: group I received microneedling with tacrolimus, group II microneedling only both at 2 weeks interval for twelve sessions, and group III applied tacrolimus ointment 0.1% twice daily for 6 months. Skin biopsies were taken at baseline and after treatment.. The overall improvement (76.6%) was significantly higher in the combined group compared with other groups. Repigmentation was excellent in 66.6 of group I vs 33.3% in the other two groups (P .03). A highly significant improvement of the extremities was observed in the combined group than in the other groups (P < .001). A fewer number of sessions have reported in the combined group (I) than in the microneedling group (II; P < .001). Immunohistochemical results showed a significantly higher expression of HMB-45 in group I than in other two groups (P .04). Side effects were mild and tolerable in all groups.. The combination group has shown promising results over the other two groups.

Topics: Administration, Cutaneous; Adolescent; Adult; Child; Combined Modality Therapy; Dry Needling; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Administration, Topical; Combined Modality Therapy; Erythema; Female; Humans; Lasers, Excimer; Male; Middle Aged; Tacrolimus; Vitiligo

The efficacy of topical calcineurin inhibitors (TCIs) for the treatment of infants with vitiligo aged less than 2 years remains to be fully determined.. This aim of this pilot study was to assess the efficacy and tolerability of the TCIs tacrolimus and pimecrolimus in infants with vitiligo aged under 2 years.. Infants with vitiligo aged < 2 years were randomly assigned to receive either tacrolimus ointment 0.03% or pimecrolimus cream 1% for a period of 6 months. During this period, topical treatment was applied twice daily. The proportion of body surface area of the treated lesions, locations, and possible adverse effects were recorded. In addition, the overall satisfaction scores of the patients' parents was evaluated by virtue of the visual analog scale (VAS).. Forty-six infants with vitiligo were enrolled in this study. The overall response rate (> 0% repigmentation) was 100%, while the effective rate (> 50% repigmentation) of the tacrolimus and pimecrolimus groups was 69.6% and 65.2%, respectively. Meanwhile, the effective rates for vitiligo located on the head and neck, trunk, and extremities were 70%, 64.3% and 50%, respectively, while the response rates for non-segmental and segmental vitiligo were 74.4% and 28.6%, respectively. Only a low incidence of local adverse reactions (including mild redness and skin picking) was reported during the treatment process.. Topical tacrolimus ointment 0.03% or pimecrolimus cream 1% have efficacy for vitiligo in infants, which serves to achieve an appropriate level of safety and tolerability during the 6-month period of applications. Thus, TCIs proved to be a therapeutic option for vitiligo in infants under 2 years of age.

Topics: Administration, Topical; Calcineurin Inhibitors; Child, Preschool; Female; Humans; Infant; Male; Pilot Projects; Tacrolimus; Vitiligo

Vitiligo is common acquired pigmentary disorder affecting skin of 1% of the world population, India 3% to 8% incidences approximately. Treatment is tough challenge. The combination treatments have proven beneficial due to different mechanisms. There is need to find drug targeting different mechanisms of action. Test medicine is decapeptide derived from basic Fibroblast Growth Factor (bFGF) treating vitiligo. The current study was to compare efficacy and safety of BFGF related decapeptide solution plus Tacrolimus 0.1% (M + T) Ointment versus Tacrolimus monotherapy 0.1% (T) Ointment in patients with stable vitiligo. The randomized, open label, comparative, prospective, multicentre study in patients with stable vitiligo was conducted. The primary endpoint was improvement in extent of repigmentation in target lesion after 12 months of treatment from baseline. The secondary endpoints were extent of repigmentation at end of 6 months, patient global assessment (PGA) and safety at end of 6 months. This shows interim analysis results. Total 94 patients were randomized to M + T (n = 40) and T (n = 44), 10 patients were lost to follow up. Extent of repigmentation (>50%) was significantly greater at end of 8 weeks in M + T group 22.5% (p ≤ .05) while 6.8% in T group. In grade of repigmentation, significant difference (p ≤ .05) was observed, M + T had better grade. PGA was significantly greater (p ≤ .05) in M + T-group than T. All these parameters showed significant improvement in M + T-group than group T at end of 6 months. No adverse events were reported during the study. It is an interim analysis report so complete data is not available for analysis. Addition of bFGF related decapeptide solution to Tacrolimus gave better results than Tacrolimus alone therapy. It also has a favorable safety profile and was well tolerated.

Topics: Adult; Drug Therapy, Combination; Female; Fibroblast Growth Factor 2; Humans; Male; Middle Aged; Ointments; Oligopeptides; Prospective Studies; Solutions; Tacrolimus; Vitiligo

Topics: Adult; Asian People; Betamethasone; Calcineurin Inhibitors; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Lasers, Excimer; Low-Level Light Therapy; Male; Middle Aged; Skin Pigmentation; Tacrolimus; Vitiligo

Vitiligo is a common pigmentary disorder affecting about 1% of the general population. There are numerous medical and surgical treatments. Microneedling is an evolving treatment technique for an expanding number of dermatologic conditions. It is used also to augment transdermal drug delivery through pores created in the stratum corneum.. To evaluate the efficacy of microneedling with tacrolimus versus its efficacy with calcipotriol plus betamethasone in vitiligo treatment.. Twenty-five patients having vitiligo were selected and their symmetrical patches were divided into side A (right side) which received microneedling with dermapen and topical calcipotriol plus betamethasone and side B (left side) which received microneedling and topical tacrolimus. Every patient received a session every 2 weeks for a maximum 6 months (12 sessions) and follow-up for 3 months. Skin biopsies were taken before and after the treatment to evaluate the clinical results.. On side A, 60% of the patients showed excellent improvement while 32% showed excellent response on side B. The mean percentage of improvement was significantly higher on side A than side B (P = 0.017. The combination of microneedling with calcipotriol plus betamethasone is more effective than its combination with tacrolimus. They are both effective in resistant sites. Both methods are safe, cheap, and good tolerated office techniques with minimal side effects.

Topics: Acupuncture Therapy; Administration, Cutaneous; Adolescent; Adult; Betamethasone; Calcitriol; Child; Combined Modality Therapy; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Needles; Skin; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Fractional CO

Topics: China; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Lasers, Excimer; Lasers, Gas; Low-Level Light Therapy; Male; Preliminary Data; Prospective Studies; Skin Pigmentation; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo

We evaluated the efficiency of using a 308-nm excimer laser with either tacrolimus, pimecrolimus, or halometasone for the treatment of childhood vitiligo. Patients who received combined treatments had significantly higher rates of repigmentation in comparison with individuals who underwent excimer laser alone therapy. Moreover, patients who received treatment with excimer laser and halometasone had significantly higher rates of repigmentation, even higher than individuals who were treated with tacrolimus combined or pimecrolimus combined. This regimen was more effective on the face, neck, and limbs. We conclude that the use of a combined excimer laser and halometasone cream has a greater therapeutic effect than laser alone.

Topics: Administration, Topical; Betamethasone; Child; Combined Modality Therapy; Dermatologic Agents; Humans; Lasers, Excimer; Prospective Studies; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Adult; Betamethasone; Combined Modality Therapy; Face; Female; Humans; Injections, Intramuscular; Lasers, Excimer; Low-Level Light Therapy; Male; Middle Aged; Neck; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

Tacrolimus is a conventional medication for the treatment of vitiligo, but the effect of a single medication is limited.. This paper aims at observing the effects, adverse responses, and repigmentation results of the joint treatment of vitiligo by Carbon dioxide (CO. Forty-five patients with vitiligo were randomly divided into two groups: treatment (T) group and control (C) group, and each group was further divided into three subgroups (face, torso and limbs, and hand and foot) according to the location of the skin defect. Both groups used topical 0.1% tacrolimus cream, but the T group was given one CO. Compared to the C group, the T group showed better improvement in both objective and subjective assessments. When the treatment time was increased, the efficacy was also improved, and the repigmentation in the T group occured in three ways: perifollicular repigmentation, marginal repigmentation and diffuse repigmentation. There were three cases of isomorphic responses (2 cases in the rapid progression stage, one case in the progression stage), and 1 case formed scarring on the neck in the T group.. The treatment of vitiligo by CO

Topics: Adult; Calcineurin Inhibitors; Combined Modality Therapy; Female; Humans; Lasers, Gas; Low-Level Light Therapy; Male; Tacrolimus; Treatment Outcome; 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

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.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Ointments; Prospective Studies; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

The risk of relapse after successful repigmentation in vitiligo is estimated to 40% within the first year. It has been shown in atopic dermatitis that continuous low-level use of topical corticosteroids and calcineurin inhibitors in previously affected skin can prevent new flares. We hypothesized that a twice-weekly application of 0.1% tacrolimus ointment might be effective for maintaining repigmentation in therapeutically repigmented lesions of vitiligo patients. After randomization, sixteen patients with 31 patches were assigned to the placebo group and 19 patients with 41 patches were assigned to the tacrolimus group. In the intention-to-treat analysis, 48.4% of lesions showed depigmentation in the placebo group, whereas 26.8% did in the tacrolimus group (P=0.059). The intention-to-treat results did not remain significant after adjustment for within-patient clustering, odds ratio (OR) 2.55; 95% confidence interval (CI; 0.65-9.97); P=0.1765. The per-protocol analysis (n=56) showed that 40% of lesions had some depigmentation in the placebo group, whereas only 9.7% did in the tacrolimus group (P=0.0075). The per-protocol results remained significant after adjustment for within-patient clustering: OR 6.22; 95% CI (1.48-26.12); P=0.0299. Our study shows that twice-weekly application of 0.1% tacrolimus ointment is effective in preventing the depigmentation of vitiligo patches that have been previously successfully repigmented.

Topics: Administration, Topical; Adult; Calcineurin Inhibitors; Cluster Analysis; Dermatologic Agents; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Odds Ratio; Pigmentation; Quality of Life; Recurrence; Skin; Tacrolimus; Treatment Outcome; Vitiligo

The aim of the present study was to evaluate the efficacy and safety of narrowband UVB (NB-UVB) compared with tacrolimus ointment 0.1% in patients with bilateral vitiligo.. In this comparative study, four groups of patients were randomized. Each group was composed by 12 patients with bilateral vitiligo; in each group, every patient was irradiated with NB-UVB (length: 311 nm) twice a week for 9 months and applied tacrolimus ointment 0.1% twice a day on the other area in the same period. Before starting therapy and after 3, 6 and 9 months of therapy, a clinical and photographic evaluation of percentage of repigmentation was performed and Dermatology Life Quality Index Questionnaire was fulfilled.. A repigmentation at least partial occurred in 71% of patients after 36 weeks of treatment with tacrolimus ointment 0.1%; in the whole sample, 14 patients (29%) showed no repigmentation at all, with 2 of them discontinuing the therapy because of side effects (erythema and folliculitis-like manifestations). A homogeneous repigmentation at least partial occurred in 69% of patients after 36 weeks of treatment with NB-UVB; in the whole sample 15 patients (31%) showed no repigmentation at all, with 1 of them discontinuing the therapy because of side effects.. The present study confirmed that the efficacy of NB-UVB phototherapy in vitiligo is comparable to tacrolimus ointment 0.1% therapy. On the basis of our study, we may suggest tacrolimus ointment 0.1% as an alternative to NB-UVB therapy for treating vitiligo.

Topics: Adolescent; Adult; Aged; Child; Epidermis; Erythema; Folliculitis; Humans; Immunosuppressive Agents; Melanocytes; Middle Aged; Prospective Studies; Skin Pigmentation; Surveys and Questionnaires; Tacrolimus; Ultraviolet Therapy; Vitiligo; Young Adult

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

Topics: Follow-Up Studies; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

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

Narrow band ultraviolet B (UVB) is an effective and safe option for the treatment of vitiligo. However, a complete and long-lasting repigmention of vitiligo patches is difficult to achieve. Combined treatments with novel sources of phototherapy and topical agents represent possible new strategies.. The purpose of this study was to compare the efficacy of combined tacrolimus and 308-nm excimer light (MEL) vs 308-nm MEL monotherapy in treating vitiligo in a controlled study.. Fifty-three patients affected by vitiligo were enrolled in this open prospective study. Patients were divided into three groups: Group I included 20 patients treated with MEL 308 nm twice weekly and oral vitamin E; Group II included 20 patients treated with MEL 308 nm twice weekly combined with 0.1% tacrolimus once a day and oral vitamin E; and Group III included 13 patients treated only with oral vitamin E. Efficacy was assessed at the end of 12 weeks based on the percentage of repigmentation.. Fifty-two patients completed 12 weeks of treatment. Group I (MEL + vitamin E) showed a moderate repigmentation in 35% of patients, good repigmentation in 30%, excellent repigmentation in 25%, and poor repigmentation in 10%; Group II (MEL + tacrolimus 0.1%+ vitamin E) presented moderate repigmentation in 25% of patients, good repigmentation in 40%, excellent repigmentation in 30%, and poor repigmentation in 5%; Group III (vitamin E) showed moderate repigmentation in 16% and 84% did not show signs of repigmentation.. Our results demonstrate that the combination treatment of 0.1% tacrolimus ointment plus 308-nm MEL and 308-nm MEL monotherapy are effective, safe, and well tolerated for the treatment of vitiligo compared to treatment with vitamin E. Furthermore, this study suggests that an association with topical immunomodulators could enhance the clinical response in vitiligo, especially in more resistant anatomical sites.

Topics: Administration, Topical; Adolescent; Adult; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Lasers, Excimer; Low-Level Light Therapy; Male; Middle Aged; Ointment Bases; Tacrolimus; Vitiligo; Young Adult

Topical corticosteroids and phototherapy are the conventional treatments of vitiligo. However, the acrofacial and segmental types are often unresponsive to these treatments. Nowadays, a few studies have been conducted on efficacy of topical tacrolimus in treatment of vitiligo including vulgaris and segmental types. Nevertheless, the acrofacial type has never been investigated with this topical therapy. The aim of our study is to evaluate the effectiveness of 0.1% tacrolimus ointment in patients including all types of vitiligo. Forty-two patients with vitiligo (22 adults, 20 children) were enrolled in this study. They were treated with 0.1% tacrolimus ointment twice daily for 6 months. Of these 42 patients, 38 of them completed the treatment process. The mean age of the patients was 27.8 years. The response rate was 76.09%. The vulgaris and focalis had a maximum response rate of 94.12%. The response rates for segmentalis and acrofacialis were 76.92% and 56.25% respectively. Concerning the response, age groups, types and location of vitiligo, there was significant difference in all variables (P = 0.001, P = 0.001, P = 0.025, respectively). Children had approximately nine times higher odds (95% CI = 1.09, 81.88) of having better response to the treatment than adults. The disease duration of 5 years or less also showed a better response. In conclusion, topical tacrolimus can be used for the treatment of patients with vitiligo. We recommend that, other than in the vulgaris type, topical tacrolimus may be considered as a treatment for two difficult to treat types of vitiligo, acrofacialis and segmentalis, before considering other modalities.

Topics: Administration, Cutaneous; Adult; Child; Female; Humans; Immunosuppressive Agents; Male; Tacrolimus; 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

Only a few, small double-blind clinical trials have been reported for the treatment of vitiligo. Narrowband-ultraviolet B (NB-UVB) is an established form of treatment for this condition. Tacrolimus ointment is assumed to have an effect in some patients.. To assess the additive effect of tacrolimus ointment (0.1%) once daily in vitiligo patients treated with NB-UVB.. In a randomized double-blind trial, patients with stable symmetrical vitiligo were treated half-side with tacrolimus ointment (0.1%) and half-side with placebo ointment. Whole body NB-UVB was given twice or thrice weekly for at least 3 months. As a morphometric device, Visitrak(TM) was used to measure the area of the vitiligo target lesions.. Of 40 patients, 27 had a better effect on the tacrolimus side. The degree of improvement was significantly better on the tacrolimus side (P = 0.005). The median reduction in the target lesion areas was 42.1% on the tacrolimus side and 29% on the placebo side. There was a correlation between the effect and the number of topical tacrolimus applications (P = 0.044), but there was no correlation with the number of UV treatments given; neither any significance of gender, age, skin type, duration of disease, familial occurrence of vitiligo nor presence of other autoimmune disease or atopy was observed. We found a significant reduction in the patients' subjective disease impact during the treatment period (P < 0.001).. According to this study, the combination of NB-UVB and tacrolimus ointment (0.1%) is more effective than UV treatment alone in patients with vitiligo. The effect is tacrolimus total dose-dependent.

Topics: Adult; Aged; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Placebos; Tacrolimus; Ultraviolet Rays; Vitiligo

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Tacrolimus; Vitiligo; Young Adult

New topical immunomodulators have been reported to cause repigmentation of vitiligo lesions. However, time-kinetics of such repigmentation in different anatomic locations is not well known. We performed a randomized double-blind placebo control study with tacrolimus versus the vehicle and a nonrandomized control study with pimecrolimus to evaluate the time to reach significant pigmentation, its duration and extent in treated areas. Antioxidant status of serum was also assessed. Twenty patients, in the tacrolimus study, had one pair of lesions on different localizations, and 20 on face and/or upper limbs for pimecrolimus. The extent of repigmentation was evaluated by slides and mapmakings at baseline and every 4 weeks during 7 months. Adverse events were recorded. The derivatives of oxygen metabolites, the ferric reducing ability of serum and vitamin E were assessed. Three groups of patients were identified with the tacrolimus study. Eight had no significant change in response characterized by a parallel increase of repigmentation or none in treated and control areas. Nine had a better repigmentation to tacrolimus at fifth month of treatment. Three had a marked repigmentation in control areas at the end of treatment. Repigmentation was significant on the face compared to upper-limbs with pimecrolimus from fourth to seventh month. A significant reduction of oxidative stress and an increase in antioxidant capacity in serum of patients treated with topical tacrolimus was observed, while those treated with pimecrolimus did not show any significant changes but an increase in vitamin E. Our work defines three periods in repigmentation, triggering during the first 4 months, increase in pigmentation with tacrolimus and a plateau or a sustained repigmentation. The continuity of the treatment seems necessary to ensure a prolonged repigmenting effect and even an enhanced one, such as the one we observed on the face with pimecrolimus. The extent of repigmentation was more significant on the face compared to other locations probably due to differences in melanocyte density. Furthermore, we did not find any relationship between repigmentation and the duration of vitiligo. Tacrolimus was able to reduce the systemic oxidative stress independently from its repigmenting capacity. Both drugs were well tolerated.

Topics: Adolescent; Adult; Aged; Antioxidants; Double-Blind Method; Female; Humans; Male; Middle Aged; Oxidative Stress; Skin Pigmentation; Tacrolimus; Vitiligo

Vitiligo is a common acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. The conventional treatments are limited by their inconsistent and incomplete responses, relapse rate, inconvenience to apply, side-effects and especially long-term effects. The aim of the present study was to determine the efficacy and safety of topical tacrolimus as monotherapy for the treatment of face/neck vitiligo in Taiwan. This was a multicenter, open-label, non-comparative study. Patients were at least 16 years old and had vitiligo lesions with Vitiligo Index of Disease Activity score +1 or more on face or neck. Patients received a monotherapy with 0.1% of tacrolimus ointment twice daily for 12 weeks. The efficacy was measured by the percentage of repigmentation of target lesion, which was graded as minimal (1-25%), mild (26-50%), moderate (51-75%) or excellent (76-100%). Patients who had at least mild repigmentation were defined as responders. A total of 61 patients were enrolled in this investigation. Most of the patients showed repigmentation at week 4. At the end of treatment, all patients showed repigmentation and 45.9% of patients were responders. During the study, 15 adverse events related to the ointment were reported. All the reported adverse events were mild and similar to the well-known adverse effect of tacrolimus in the treatment of atopic dermatitis. Tacrolimus ointment is effective and well tolerated for the treatment of patients with vitiligo in Taiwan. It will be another drug of choice for persons with vitiligo who are unable to receive regular phototherapy and fear the side-effects of topical steroid in long-term use.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Child; Dermatitis, Atopic; Face; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Neck; Prospective Studies; Skin Pigmentation; Tacrolimus; Taiwan; Vitiligo; Young Adult

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

Narrowband ultraviolet B (NB-UVB) therapy has emerged as one of the most favored treatment options in patients with generalized vitiligo. The aim of combining topical agents is to improve the efficacy of NB-UVB in causing repigmentation in vitiligo.. The present study aims to study the effect of combining topical tacrolimus to NB-UVB therapy in causing repigmentation in vitiligo lesions.. This prospective single-blind study was performed on 80 patients of generalized vitiligo above 12 years of age who had symmetrically distributed vitiligo lesions on the face, trunk or limbs. The patients applied topical tacrolimus 0.1% ointment twice daily on selected symmetrically distributed lesions on the left side of the body. No topical agent was applied on the corresponding lesions on the right side. The patients also received whole-body NB-UVB exposure three times every week on non-consecutive days according to a set protocol. Lesions selected for the comparison analysis were photographed serially and assessed by a single-blinded observer for the extent or repigmentation achieved. The extent of repigmentation achieved was calculated on the basis of VASI scoring. The time taken for the initial repigmentation to start, the overall repigmentation achieved as well as any adverse effects were noted down and compared between the selected lesions on the two sides.. Seventy-four patients with 234 symmetrical vitiligo lesions were available for comparison analysis at the end of study period. The mean repigmentation achieved on the left-sided study lesions was approximately 71% (VASI score of approximately 4.0) as compared with 60.5% on the symmetrically distributed right-sided lesions (VASI score of 3.4). Moreover, the repigmentation started earlier on the study lesions on left side than on the right-sided ones. No significant adverse events were reported with the combination treatment.. Addition of topical tacrolimus increases the extent of overall repigmentation achieved with NB-UVB therapy in vitiligo and also reduces the cumulative NB-UVB dose needed to achieve a therapeutic benefit in affected patients.

Topics: Adolescent; Adult; Analysis of Variance; Child; Female; Humans; Immunosuppressive Agents; Male; Ointments; Prospective Studies; Single-Blind Method; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo; Young Adult

Recently, narrow-band ultraviolet B (NB-UVB) and topical immunomodulators have been successfully used in the treatment of vitiligo.. To determine whether the combination of pimecrolimus with NB-UVB accelerates the response time and/or improves the degree of response in patients with vitiligo.. Sixty-eight patients with vitiligo enrolled in this randomized, double-blind, placebo-controlled study. The patients were randomized into two groups and treated with NB-UVB plus either pimecrolimus or placebo for 3 months. Tri-weekly radiation was started at 280 mJ/cm(2), with 15% increments for each subsequent treatment until erythema was reported or a maximum of 800 mJ/cm was achieved. At baseline and 6 and 12 weeks after commencement of therapy, vitiliginous patches were measured.. Fifty patients completed the 3-month study. No significant side effects except self-limited erythema and pruritus were observed. After 12 weeks of treatment, repigmentation of the facial lesions was higher in patients treated with combined pimecrolimus and NB-UVB compared with the placebo plus NB-UVB group (64.3 vs 25.1%) (p < 0.05%). There was no statistically significant difference in the repigmentation rate between the two groups on other body areas.. On the face, NB-UVB works better if combined with pimecrolimus 1% cream rather than used alone.

Topics: Administration, Topical; Adolescent; Adult; Age Factors; Aged; Combined Modality Therapy; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ointments; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Statistics, Nonparametric; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo; Young Adult

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

A few studies on the treatment of vitiligo with topical tacrolimus have been published and showed promising results. However, most of these trials were uncontrolled.. This study aims to assess the response of vitiligo to once- or twice-daily treatment with 0.1% tacrolimus in a controlled, randomized, observer-blinded study.. Seventeen patients with generalized vitiligo were enrolled in this study. In each patient, two lesions were selected and randomized to treatment with either once- or twice-daily application of 0.1% tacrolimus for a total period of 6 months. In 10 patients, a third patch was left untreated to serve as a control.. Fifteen patients with 40 target lesions completed the study. Twice-daily treatment induced excellent (> 75%) repigmentation in two lesions, moderate (> 25-50%) and poor (1-25%) repigmentation in four lesions each, and no response in five lesions. Once-daily treatment resulted in moderate repigmentation in two lesions and poor repigmentation in five lesions, whereas no effect was observed in the remaining eight lesions. One out of 10 control lesions developed moderate spontaneous repigmentation, the other nine remained unchanged. Besides the frequency of tacrolimus application, the treatment outcome was determined by the localization of the affected areas with the facial region showing the best response.. Tacrolimus ointment appears to be an effective treatment option for facial vitiligo. A guarded prognosis is advisable for vitiliginous lesions on other localizations. Treatment must be applied twice daily for optimum response.

Topics: Administration, Topical; Adolescent; Adult; Child; Dose-Response Relationship, Drug; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Prospective Studies; Single-Blind Method; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Administration, Topical; Adult; Aged; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Male; Middle Aged; Single-Blind Method; Skin Pigmentation; Tacrolimus; Ultraviolet Therapy; Vitiligo

Topical tacrolimus was recently introduced as a novel therapeutic option in vitiligo. Excellent results were seen mainly on the face and neck areas. We treated 30 adult vitiligo patients with tacrolimus 0.1% ointment twice daily, and compared the results with those of placebo ointment. In 20 patients, defined areas on the right arm or leg were occluded overnight with 3 different dressings. Repigmentation was evaluated quantitatively and qualitatively. Quality of life changes were assessed with the Dermatology Life Quality Index. After 6 months, treatment was stopped in 7 of 30 patients as they did not show any repigmentation, 5 of them had no occlusive therapy. After 12 months, 17 of 21 patients (81%) with facial involvement showed repigmentation of the face. Although no or minimal repigmentation occurred on the extremities when using tacrolimus ointment alone, 80% of the patients showed repigmentation on the arms when using additional occlusive, especially hydrocolloid dressings. Hands, feet and lower legs were unresponsive. The best results were obtained in patients with long-standing vitiligo. Only minimal side-effects were noted. There was no significant elevation in tacrolimus blood levels, taking into account that occlusion was performed only on limited parts of the body. In conclusion, tacrolimus 0.1% ointment proved an effective and safe treatment option for adult patients with vitiligo. Beyond the face and neck areas, repigmentation could be achieved only by additional occlusion.

Topics: Adult; Antibodies; Antibodies, Antinuclear; Female; Humans; Immunoglobulin E; Immunosuppressive Agents; Male; Occlusive Dressings; Ointments; Prospective Studies; Quality of Life; Severity of Illness Index; Tacrolimus; Thyroid Gland; Thyroxine; Vitiligo

Topics: Administration, Cutaneous; Double-Blind Method; Humans; Immunosuppressive Agents; PUVA Therapy; Severity of Illness Index; Tacrolimus; Treatment Outcome; Ultraviolet Rays; Ultraviolet Therapy; Vitiligo

Vitiligo is an acquired, pigmentary skin disorder which is disfiguring and difficult to treat. In an earlier open label study in adult patients with vitiligo, pimecrolimus cream 1% was reported to have similar efficacy as clobetasol propionate 0.05%. We performed a double-blind, intrapatient comparison of pimecrolimus cream 1% with placebo cream.. Twenty adult Caucasians with symmetrical vitiligo (predominantly on extremities, none in the face) were treated b.i.d. for 6 months left/right with pimecrolimus/vehicle (N = 10) or vehicle/pimecrolimus (N = 10), respectively. Primary efficacy endpoint was the size of the target lesion at month 6 and secondary efficacy endpoint was re-pigmentation.. Treatment with pimecrolimus cream 1% or vehicle resulted in no significant change in mean target lesion size. Modest repigmentation (1-25%) was noted with pimecrolimus at month 2 in 12 of 17 patients (vehicle: 9 of 17 patients). Afterwards, the number of patients who experienced an improvement of pigmentation steadily decreased (3 of 14 patients with pimecrolimus and 2 of 14 with placebo at month 6). Treatment was well tolerated. There were no treatment-related adverse events, no induction of skin atrophy nor any other application site side effects.. In this group of adult patients with symmetrical vitiligo, treatment of body lesions (except face) with pimecrolimus cream 1% could not be shown to be effective.

Topics: Administration, Topical; Adolescent; Adult; Child; Dermatologic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebo Effect; Risk Assessment; Risk Factors; Tacrolimus; Treatment Outcome; Vitiligo

The purpose of this study was to assess the efficacy of pimecrolimus cream 1% in vitiligo and to evaluate the effects of age of the patients, age of onset and duration of disease on response rate.. Twenty-three patients with vitiligo were enrolled in our study; 19 patients (seven male, 12 female) completed the 6-month study period. Patients were treated with topical pimecrolimus 1% cream once daily. The response was evaluated as excellent (76-100%), moderate (51-75%), mild (26-50%), minimal (1-25%), or no response.. The mean age of the 19 patients was 29.3+/-16.6 (range 7-62 years) and the mean duration of vitiligo was 68.4+/-81.3 months. Three patients demonstrated an excellent response to the therapy. Four patients had moderate, six patients had mild and five patients had minimal responses; one patient had no response to the treatment. Side effects were noted as a burning and stinging sensation in only three patients. The correlations between response rate and duration of the disease (r = 0.02, p = 0.95), onset age (r = -0.17, p = 0.48), and age of the patients (r = -0.16, p = 0.53) were not significant.. Pimecrolimus has a mild therapeutic effect on vitiligo without significant side effects and can be an alternative therapy agent.

Topics: Administration, Cutaneous; Adolescent; Adult; Age Factors; Child; Dermatologic Agents; Dosage Forms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo

Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease.. To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder.. Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board-approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results.. Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy.. Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease.

Topics: Administration, Topical; Adult; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Laser Therapy; Male; Middle Aged; Pilot Projects; Tacrolimus; Treatment Outcome; Vitiligo

Previous studies have documented humoral and cell-mediated immunologic defects in patients with vitiligo.. This 24-week study assessed the efficacy and safety of tacrolimus 0.1% ointment in patients with generalized vitiligo as well as the pretreatment and post-treatment expression of cytokines in the depigmented and normal skin of patients compared with controls.. Twenty-three patients were enrolled in this investigation, and 19 patients completed the study; 8 were male and 11 were female. Fifteen age-, race-, and sex-matched control subjects were also included. Patients were treated with tacrolimus 0.1% ointment applied twice daily. Repeat evaluations were performed at 4, 8, 12, 16, 20, and 24 weeks. Three-millimeter punch biopsy specimens were taken from the depigmented, non-sun-exposed skin and adjacent normal skin of patients at baseline and 24 weeks, and from normal, non-sun-exposed skin of controls. Cellular messenger RNA expression for interleukin 2 (IL-2), IL-4, IL-10, tumor necrosis factor alfa (TFN-alpha), and interferon gamma (IFN-gamma) were determined by real-time quantitative polymerase chain reaction.. At 24 weeks, 17 of 19 patients (89%) achieved varying levels of repigmentation. There was a statistically significant decrease in overall disease severity scores at 24 weeks. Thirteen patients (68%) had greater than 75% repigmentation of face and/or neck lesions. Signs and symptoms of irritation were minimal. At baseline, compared with healthy controls, vitiligo patients demonstrated a statistically significant increase in the expression of IFN-gamma in involved and adjacent uninvolved skin (P=.05 and P=.02, respectively); significantly increased TNF-alpha expression in involved and uninvolved skin (P=.01 and P=0.02, respectively); and significantly increased IL-10 expression in involved and uninvolved skin (P=.01 and P=.04, respectively). Posttreatment, TNF-alpha expression decreased in the depigmented and adjacent uninvolved skin (P <.001). There was no statistically significant change in IL-10 or IFN-gamma posttreatment. These data suggest that tacrolimus 0.1% ointment is a safe and effective therapy for patients with vitiligo. It further suggests that an imbalance in local cytokine expression may play a role in the pathogenesis of vitiligo. Suppression of TNF-alpha after topical tacrolimus application may be associated with repigmentation of vitiligo.

Topics: Administration, Cutaneous; Adult; Female; Humans; Immunosuppressive Agents; Interferon-gamma; Interleukin-10; Male; Middle Aged; Polymerase Chain Reaction; RNA, Messenger; Severity of Illness Index; Skin; Tacrolimus; Tumor Necrosis Factor-alpha; Vitiligo

To compare the efficacy of combined tacrolimus and 308-nm excimer laser therapy vs 308-nm excimer laser monotherapy in treating vitiligo.. Comparative, prospective, randomized, intraindividual study.. Fourteen patients, aged 12 to 63 years, with Fitzpatrick skin types II to IV.. For each patient, 4 to 10 target lesions were chosen. The treatment applied to each target lesion was randomized by drawing lots. Each lesion was treated twice a week by the 308-nm excimer laser, for a total of 24 sessions. Initial fluences were 12 mcal/cm(2) (50 mJ/cm(2)) less than the minimal erythemal dose in vitiliginous skin. Then, fluences were increased by 12 mcal/cm(2) every second session. Moreover, topical 0.1% tacrolimus ointment was applied twice daily on target lesions receiving the combined tacrolimus and excimer laser treatment (group A). Group B target lesions received only excimer laser monotherapy. For each treated lesion, the untreated lesion on the opposite side served as the control. Tolerance was evaluated by a visual analog scale, and secondary events were recorded at each session.. Treatment efficacy, which was blindly evaluated by 2 independent physicians by direct and polarized light photographs taken before and after treatment.. Forty-three lesions were treated (23 in group A and 20 in group B). All patients completed the study. Repigmentation was observed in all group A lesions (100%) and in 17 (85%) of the 20 group B lesions. Repigmentation was not observed in the untreated lesions (control group). A repigmentation rate of 75% or more was obtained in 16 (70%) of the 23 group A lesions and in 4 (20%) of the 20 group B lesions. In UV-sensitive areas (the face, neck, trunk, and limbs, with the exception of bony prominences and extremities), 10 (77%) of 13 group A lesions had a repigmentation rate of 75% or more vs 4 (57%) of 7 group B lesions. In classically UV-resistant areas, 6 (60%) of 10 group A lesions had a repigmentation rate of 75% or more vs 0 of the 13 group B lesions. The mean number of sessions necessary for an improvement of repigmentation was 10 in group A and 12 in group B. Adverse effects have been limited, and tolerance was excellent.. The combination treatment of 0.1% tacrolimus ointment plus the 308-nm excimer laser is superior to 308-nm excimer laser monotherapy for the treatment of UV-resistant vitiliginous lesions (P<.002). The efficacy and the good tolerance of the 308-nm excimer laser in monotherapy for treating localized vitiligo were also confirmed, but this treatment regimen should be proposed only for UV-sensitive areas.

Topics: Administration, Topical; Adolescent; Adult; Child; Combined Modality Therapy; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Low-Level Light Therapy; Male; Middle Aged; Patient Satisfaction; Probability; Prospective Studies; Radiation Dosage; Reference Values; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. This study was designed to evaluate the role of topical tacrolimus in the treatment of childhood vitiligo. Twenty-five children with vitiligo were treated with topical 0.03% tacrolimus ointment applied twice daily for 12 weeks. Response was noted as marked to complete (> 75% repigmentation), moderate (50-75% repigmentation) and mild (< 50% repigmentation). Twenty-two children (9 boys and 13 girls) of mean age 7.2 +/- 1.4 years completed the study. Twelve (54.5%) children had vitiligo vulgaris, nine (40.9%) had focal vitiligo and one (4.5%) had segmental vitiligo. The mean duration of disease was 8 +/- 3 months. Nineteen (86.4%) children showed some repigmentation at the end of 3 months and other three had no response. Of these 19 children, repigmentation was marked to complete in 11 (57.9%), moderate in five (26.3%) and mild in three (15.7%) children. Side effects were minimal, such as the pruritus and burning noted in only three patients. Topical tacrolimus is an effective and well-tolerated treatment modality in Asian children with vitiligo.

Topics: Administration, Cutaneous; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Ointments; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

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

Topics: Granuloma Annulare; Humans; Ointments; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Vitiligo is an acquired depigmenting disorder in which destruction of skin melanocytes. In recent years, 308-nm excimer laser (308-nm EL) and topical tacrolimus have been extensively used to treat vitiligo. This study aimed to investigate the effectiveness and safety of combined treatment of 308-nm EL and topical tacrolimus for treating periocular vitiligo compared to 308-nm EL monotherapy. This study is a retrospective observational study, involving 58 Chinese patients of periocular vitiligo, divided into two groups: the control group (28 patients) treated with 308-nm EL; and the experimental group (30 patients) treated with 308-nm EL and topical tacrolimus 0.1% ointment. Repigmentation was assessed at four grades. In the control group, there were four patients (14%) with poor repigmentation, eleven patients (39%) with moderate repigmentation, ten patients (36%) with good repigmentation, three patients (11%) with excellent repigmentation. In the experimental group, two patients (7%) experienced poor repigmentation, six patients (20%) experienced moderate repigmentation, fifteen patients (50%) experienced good repigmentation, seven patients (23%) experienced excellent repigmentation. The experimental group efficacy rate (good and excellent repigmentation) was 73.3%, higher than 46.4% for the control group (p = 0.037). Our findings suggest that both treatments are safe and the combination of tacrolimus and 308-nm EL is more effective than 308-nm EL alone for periocular vitiligo.

Topics: Combined Modality Therapy; Humans; Lasers, Excimer; Retrospective Studies; Tacrolimus; Treatment Outcome; Vitiligo

Vitiligo is a complex multifactorial disorder of depigmentation affecting 0.5 to 2% of the world's population without specific gender or racial prevalence.1 Though no treatments are FDA approved to repigment vitiligo, topical medications along with phototherapy alone or in combination remain the mainstay of therapy. While Janus Kinase inhibitors and other agents are in development, current topical options are mainly limited to steroid formulations of various potencies or immunomodulatory steroid-sparing agents such as tacrolimus 0.03% or 0.1%.

Topics: Emollients; Humans; Immunosuppressive Agents; Phototherapy; Steroids; Tacrolimus; Treatment Outcome; Vitiligo

Topics: BNT162 Vaccine; Colitis, Ulcerative; COVID-19; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Vitiligo

Topical Tacrolimus, especially when combined with Nb-UVB, has been proven clinically to be effective in the treatment of vitiligo. However, no histological study has evaluated the repigmentation mechanism of tacrolimus ointment in combination therapy with Nb-UVB. In this study, the histological findings in patients receiving Nb-UVB were compared with those receiving topical tacrolimus combined with Nb-UVB. Twenty patients were recruited and received Nb-UVB treatment. The first ten patients were selected for the combination therapy and instructed to apply tacrolimus 0.1% ointment twice daily on the specified lesion of interest. The remaining ten patients did not receive any other topical treatments. Skin biopsy was performed at baseline from the depigmented area and 2-3 months post-treatment from the repigmented area. Biopsy specimens were stained with haematoxylin-eosin-safran (HES), Fontana Masson, HMB45, Melan A, MITF, SOX10 and Nestin. Clinically, in the combination therapy group, interfollicular repigmentation in addition to the perifollicular and marginal pattern was observed. Histologically, in the combination therapy group, besides the migration of melanocytes from the bulge of the hair follicle seen in the monotherapy group, for the first time, we observed dermal melanocyte precursors located in mid- and superficial dermis.

Topics: Administration, Cutaneous; Adult Stem Cells; Biopsy; Combined Modality Therapy; Dermis; Follow-Up Studies; Hair Follicle; Humans; Melanocytes; Ointments; Severity of Illness Index; Skin Pigmentation; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Vitiligo, an autoimmune disease, is a depigmentation skin disorder characterized by hypopigmentation spots and patches that are difficult to treat. The purpose of this study is to analyze the clinical efficacy of simvastatin in the treatment of vitiligo. From December 2016 to October 2019, five vitiligo patients from Peking Union Medical College Hospital were treated with simvastatin and tacrolimus. For simvastatin, the first three patients (patient 1, patient 2, and patient 3) began to take 40 mg/day, and the latter two patients began to take 20 mg/day. From week 5, patients 1 and 2 received 20 mg simvastatin once a day. And the 0.1% tacrolimus ointment was used topically. The response was measured using the Vitiligo European Task Force (VETF) scoring system at baseline and at the fourth and eighth weeks of treatment. The results of the VETF score showed that three of the patients achieved significant clinical efficacy. There was no significant improvement in the other two cases. No serious acute or chronic side effects were observed. In conclusion, our results suggest that conventional oral simvastatin is safe, although it may not be effective in the treatment of vitiligo.

Topics: China; Humans; Simvastatin; Tacrolimus; Treatment Outcome; Vitiligo

Vitiligo pathophysiology is mediated by antigen-specific cytotoxic T cells. Environmental stressors cause susceptible melanocytes to secrete damage-associated molecular patterns (DAMPs). DAMPs are recognized by receptors such as the endocytic low-density lipoprotein receptor-related protein (LRP1/CD91), expressed in antigen-presenting cells, which activate self-reactive CD8+ T cells, leading to melanocyte destruction. Within this response, interferon gamma triggers production of cytokine CXCL10, recruiting more activated T cells causing further melanocytic damage. We hypothesized that expression of LRP1/CD91 was higher in vitiligo patients compared to non-vitiligo individuals. And further that levels/expression of CXCL10 in plasma were linked to disease severity. We enrolled forty individuals in this study: 18 patients with vitiligo and 22 healthy volunteers. We assessed LRP1/CD91 expression and plasma CXCL10 in patients with vitiligo and healthy volunteers. Additionally, vitiligo patients received combined treatment for 16 weeks following which the said parameters were reassessed. Vitiligo Area Scoring Index was calculated before and after treatment for these patients. Analysis of LRP1/CD91 MFI values in monocytes from vitiligo patients showed high surface levels of LRP1/CD91 than from healthy volunteers (10.50 ± 0.77 vs. 6.55 ± 0.77 MFI units, p < 0.001). This expression did not change after treatment. Plasma levels of CXCL10 were higher in vitiligo patients than healthy volunteers (93.78 ± 7.73 vs. 40.17 ± 6.25 pg/ml). The patients with a good clinical response to treatment had a parallel reduction in plasma CXCL10 levels (105.8 ± 18.44 vs. 66.13 ± 4.87 pg/ml) before and after treatment. LRP1/CD91 expression may reflect susceptibility to vitiligo. Plasma levels of CXCL10 can represent a biomarker for monitoring treatment response. LRP1 and CXCL10 may represent therapeutic targets.

Topics: Administration, Cutaneous; Adult; Aged; Biomarkers; Case-Control Studies; Chemokine CXCL10; Female; Humans; Immunosuppressive Agents; Khellin; Low Density Lipoprotein Receptor-Related Protein-1; Male; Middle Aged; Monocytes; Severity of Illness Index; Skin Cream; Skin Pigmentation; Tacrolimus; Ultraviolet Therapy; Vasodilator Agents; Vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO

Topics: Calcitriol; Carbon Dioxide; Combined Modality Therapy; Humans; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

The course of dermatologic findings in Vogt-Koyanagi-Harada disease is variable. Herein, we report the remarkable repigmentation of widespread facial vitiligo lesions in an adolescent girl with Vogt-Koyanagi-Harada disease. The patient was treated with a combination of fractional erbium:YAG laser, topical tacrolimus, and phototherapy.

Topics: Adolescent; Environment; Female; Humans; Lasers, Solid-State; Tacrolimus; Uveomeningoencephalitic Syndrome; Vitiligo

Topics: Administration, Cutaneous; Adolescent; Adrenal Cortex Hormones; Adult; Brazil; Combined Modality Therapy; Cosmetic Techniques; Female; Fluorouracil; Humans; Immunosuppressive Agents; Latanoprost; Male; Middle Aged; Needles; Phototherapy; Tacrolimus; Vitiligo

Topics: Administration, Topical; Eyelids; Female; Humans; Hydroquinones; Immunosuppressive Agents; Lasers, Solid-State; Middle Aged; Pigmentation Disorders; Tacrolimus; Vitiligo

Topics: Administration, Cutaneous; Aged; Alcohol Drinking; Female; Flushing; Food-Drug Interactions; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

Topics: Betamethasone; Humans; Hypopigmentation; Lasers, Excimer; Tacrolimus; Vitiligo

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Case-Control Studies; Combined Modality Therapy; Dermoscopy; Female; Humans; Male; Middle Aged; Phototherapy; Reference Values; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Several treatment modalities had been used for the treatment of vitiligo, but the optimal treatment has not yet been identified.. To study the efficacy of microneedling with 5-flurouracil vs its efficacy with tacrolimus in the treatment of vitiligo.. Twenty-five patients with vitiligo were subjected to microneedling of 2 patches of vitiligo with dermapen, then application of 5-fluorouracil to 1 patch and tacrolimus on the other patch. This procedure was repeated every 2 weeks for every patient for maximum 6 months (12 sessions). The patients were followed up for 3 months after the last session.. The overall repigmentation was significantly higher in 5-fluorouracil-treated patches compared with tacrolimus. Excellent improvement occurred in 48% of 5- flurouracil-treated patches while only in 16% of tacrolimus-treated patches. In the acral parts, 40% of the patches treated with 5-fluorouracil achieved excellent improvement (repigmentation >75%), while no patch in the acral parts achieved excellent improvement with tacrolimus. However, there was significant difference between the 2 drugs,regarding inflammation, ulceration, and hyperpigmentation which occurred with 5-fluorouracil.. Microneedling combined with 5-fluorouracil or tacrolimus is safe and effective treatment of vitiligo. However, 5-fluorouracil achieved a greater percentage of repigmentation than tacrolimus particularly in the acral parts.

Topics: Administration, Cutaneous; Cosmetic Techniques; Dermatologic Agents; Female; Fluorouracil; Humans; Hyperpigmentation; Immunosuppressive Agents; Inflammation; Male; Needles; Occlusive Dressings; Skin Ulcer; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Adolescent; Bandages, Hydrocolloid; Dermatitis, Irritant; Humans; Immunosuppressive Agents; Male; Occlusive Dressings; Skin Pigmentation; Tacrolimus; Vitiligo

Topics: Autoimmunity; Black People; Diagnosis, Differential; Female; Humans; Hypopigmentation; Immunosuppressive Agents; Melanoma; Middle Aged; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Adult; Aged; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Tacrolimus; Time Factors; Treatment Outcome; Ultraviolet Therapy; Vitiligo; Young Adult

Topics: Child; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lentigo; Mouth; Tacrolimus; Vitiligo

Vitiligo is a pigmentary disorder and autoimmune pathogenesis seems most likely. Decreased vitamin D levels have been related to several autoimmune diseases. Little is known about the association of vitiligo and vitamin D. We aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D] levels in children with vitiligo and to determine the efficacy of oral vitamin D therapy on the repigmentation of vitamin D deficient patients.. Thirty patients aged 6-17 years with vitiligo and 30 sex- and age-matched apparently healthy controls were included in this prospective study. Size of the vitiligo representative area was estimated using the point counting method and blood samples were obtained at the beginning and month six. By the end of the study, all patients treated with topical tacrolimus for six months and the patients who were vitamin D deficient (n = 14) had been on combination treatment of oral vitamin D and topical tacrolimus. A dose of 1500 IU/day vitamin D was given if the serum 25(OH)D levels <20 ng/ml and 3000 IU/day was given if the levels <10 ng/ml for six months. Serum 25(OH)D levels were measured by high-performance liquid chromatography.. Serum 25(OH)D levels of patients and controls were not significantly different (p > 0.05). Lesion size decreased from 66.1 ± 58.3 cm. Although we did not determine decreased serum 25(OH)D levels in children with vitiligo, we showed that combination treatment with oral vitamin D and topical tacrolimus is more effective in reaching repigmentation than topical tacrolimus alone. Oral vitamin D supplementation might be useful for children with vitiligo who are also deficient in vitamin D.

Topics: Administration, Oral; Adolescent; Age Factors; Autoimmune Diseases; Blood Chemical Analysis; Body Mass Index; Child; Dietary Supplements; Female; Humans; Male; Prospective Studies; Sex Factors; Tacrolimus; Turkey; Vitamin D; Vitamin D Deficiency; Vitiligo

Topics: Administration, Topical; Adolescent; Contraindications; Ectodermal Dysplasia 1, Anhidrotic; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Skin; Tacrolimus; Time Factors; Vitiligo; Young Adult

There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus.. To evaluate the clinical efficacy according to the duration of treatment and in vitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo.. In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser.. After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P < 0.001 and P < 0.01, respectively) for the first 6 months. However, this superiority was not observed after the initial 6 months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone.. A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6 months, but continuation of this therapy for > 6 months might not provide a better final outcome than monotherapy.

Topics: Administration, Topical; Adolescent; Adult; Aged; Analysis of Variance; Blotting, Western; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Infant; Intramolecular Oxidoreductases; Logistic Models; Male; Melanins; Melanocytes; Middle Aged; Monophenol Monooxygenase; Phototherapy; Tacrolimus; Time Factors; Trypsin; Vitiligo; Young Adult

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

Topics: Acute Disease; Administration, Cutaneous; Amoxicillin-Potassium Clavulanate Combination; Autoimmune Diseases; Dermatologic Agents; Drug Hypersensitivity Syndrome; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Ointments; Sinusitis; Tacrolimus; Vitiligo

Topics: Administration, Oral; Administration, Topical; Adult; Combined Modality Therapy; Eyebrows; Eyelids; Humans; Hypopigmentation; Low-Level Light Therapy; Male; Melanins; Prednisolone; Recovery of Function; Tacrolimus; Treatment Outcome; Vitiligo

Prostaglandins and their analogues are beneficial as topical agents in vitiligo treatment, yet neither of the previous study addressed their comparative efficiency with conventional topical agents used in vitiligo treatment. In this pilot (24 patients) left-right comparative study we addressed efficiency of prostaglandin F2α analogue latanoprost versus tacrolimus when combined with narrow-band ultraviolet B and microneedling in repigmentation of nonsegmental vitiligo lesions. Our results confirm potency of prostaglandins, in particular, that of latanoprost, in inducing repigmentation, with the efficiency being at least comparable to that of tacrolimus, while contribution of microneedling remains unclear. In summary, results of our study provide further evidences for justified use of prostaglandins, in particular, latanoprost, in vitiligo treatment. In turn, this warrants future studies on the topic aiming to conclusively introduce prostaglandin-based formulations as conventional agents for vitiligo management.

Topics: Administration, Cutaneous; Adult; Aged; Combined Modality Therapy; Cosmetic Techniques; Dermatologic Agents; Equipment Design; Female; Humans; Latanoprost; Male; Middle Aged; Miniaturization; Needles; Pilot Projects; Prostaglandins F, Synthetic; Skin Pigmentation; Tacrolimus; Time Factors; Treatment Outcome; Ultraviolet Therapy; Vitiligo; Young Adult

Topics: Dermatology; Drug Delivery Systems; Equipment Design; Humans; Immunosuppressive Agents; Needles; Punctures; Skin Absorption; Tacrolimus; Vitiligo

Vitiligo is an acquired pigmentary skin disorder which is disfiguring and difficult to treat. Cure and response rates for vitiligo are significantly lower. This study was conducted to evaluate the effectiveness of topical corticosteroid, topical calcineurin inhibitors (tacrolimus) and combination of them in the treatment of vitilligo in two tertiary care Hospital, in the Department of Dermatology and Venereology OPD (out patient department) in Mymensingh Medical College Hospital and Jahurul Islam Medical College Hospital, Bajitpur, Kishoregonj from January 2015 to December 2015. Newly diagnosed 112 vitiligo patients, aged more than 1 year to 70 years were assigned for therapy and to observe the response. This study indicates that, in case of vitiligo treatment topical tacrolimus was the most effective drug. Topical tacrolimus, topical corticosteroid and combination of them are to be effective in the treatment of vitiligo with reduction in the number of vitiliginous spots by increased repigmentation. But topical tacrolimus was the most effective drug, as it caused highest percentage of repigmentation of vitiliginous spot.

Topics: Administration, Topical; Adolescent; Adult; Aged; Animals; Calcineurin Inhibitors; Child; Child, Preschool; Dermatologic Agents; Humans; Infant; Middle Aged; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Calcineurin Inhibitors; Child, Preschool; Humans; Male; Nevus, Pigmented; Tacrolimus; Vitiligo

An objective tool to quantify treatment response in vitiligo is currently lacking. This study aimed to objectively evaluate the treatment response in vitiligo by using a computerised digital imaging analysis system (C-DIAS) and to compare it with the physician's global assessment (PGA). Tacrolimus ointment 0.1% (Protopic; Astellas Pharma Tech,Toyama, Japan) was applied twice daily on selected lesions which were photographed every 6 weeks for 24 weeks. The primary efficacy end-point was the mean percentage of repigmentation (MPR), as assessed by the digital method (MPR-C-DIAS) or by the PGA. The response was categorised into none (0%), mild (1-25%), moderate (26-50%), good (51-75%) and excellent (76-100%).. Out of 56 patients, 44 (79%) responded. Overall, the response was mild in 22 (39%), moderate in 21(40%) and good in one (2%) patient(s). A total of 39 (70%) patients responded as measured by PGA. The repigmentation was mild in 27(48%), moderate in 10 (18%) and good to excellent in two (4%) patients. The κ test of consistency was 0.17 (P = 0.053), which shows poor agreement between the two assessment methods, although this is not statistically significant. The C-DIAS can be used to perform an objective analysis of repigmentation or depigmentation in vitiligo skin lesions in response to treatment.

Topics: Adolescent; Adult; Aged; Female; Humans; Image Processing, Computer-Assisted; Immunosuppressive Agents; Male; Middle Aged; Prospective Studies; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Adrenal Cortex Hormones; Cross-Sectional Studies; Humans; Immunosuppressive Agents; Patient Satisfaction; Registries; Skin Transplantation; Tacrolimus; Ultraviolet Therapy; Vitiligo

Topics: Dermatology; Humans; Randomized Controlled Trials as Topic; Skin Diseases; Tacrolimus; Vitiligo

Segmental vitiligo (SV) is characterized by a unilateral and localized distribution, early onset, and stable disease after rapid progression. And SV is often associated with poor response to various treatment modalities.. We sought to evaluate the effectiveness of combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for SV, and to search for factors associated with the treatment response.. A retrospective interventional case-series study was performed on 159 patients with SV who were treated with the combination therapy for more than 3 months.. The rate of 75% or more repigmentation was 50.3% after a median treatment duration of 12.1 months; 36.5% and 13.8% of the patients showed nearly complete (75%-99%) and complete (100%) repigmentation, respectively. Multivariable analysis showed the following to be independent factors with poor response: disease duration longer than 12 months (odds ratio 0.372, 95% confidence interval 0.157-0.882, P = .025), poliosis (odds ratio 0.494, 95% confidence interval 0.247-0.988, P = .046), and plurisegmental subtype (odds ratio 0.175, 95% confidence interval 0.065-0.474, P = .001).. This was a retrospective study.. The combination therapy is effective for SV. Prolonged disease duration, poliosis, and plurisegmental subtype were shown to be independent prognostic factors of poor response in patients with SV.

Topics: Administration, Topical; Adolescent; Adult; Child; Child, Preschool; Combined Modality Therapy; Female; Glucocorticoids; Humans; Infant; Lasers, Excimer; Male; Middle Aged; Prednisolone; Prognosis; Retrospective Studies; Tacrolimus; Time Factors; Vitiligo; Young Adult

Topics: Adolescent; Adult; Aged; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Phototherapy; Pilot Projects; Tacrolimus; Vitiligo; Young Adult

Usage of 308-nm excimer laser (EL) is an effective treatment in vitiligo. As genetic predispositions along with type of skin and rate of sun exposure are known factors influencing the treatment outcomes, we tried to evaluate the treatment results of using 308 nm-excimer laser alone in comparison with the combined therapy of EL and topical tacrolimus in Iranian patients with vitiligo.. We reviewed the medical files of 150 patients with vitiligo who were referred to the Behsima Laser Center between April 2012 and April 2013. Seventy five patients who received combined therapy of 308 nm EL and topical tacrolimus three times a week entered the study. Seventy-five controls with matched characteristics and who received only EL were also selected. The amount of repigmentation was estimated by an expert dermatologist and was classified in 5 ranks.. In the case group, 33.3% (n: 25) showed 50-75% repigmentaion and 49.3% (n:37) had more than 75% response to therapy, whereas among the patients in the control group 29.3% (n: 22) showed no repigmentation and only 8% (n: 6) demonstrated more than 75% repigmentation response. The higher efficiency of the combination therapy on repigmentation was statistically significant (P: 0.006).. Our study shows that Iranian patients with vitiligo who received a combined treatment course with 308-nm EL and tacrolimus 0.1% experienced significantly higher levels of repigmentation in comparison with laser therapy alone.

Topics: Administration, Cutaneous; Adult; Combined Modality Therapy; Cosmetic Techniques; Female; Humans; Iran; Lasers, Excimer; Low-Level Light Therapy; Male; Middle Aged; Retrospective Studies; Tacrolimus; Vitiligo

Segmental vitiligo (SV) is usually characterized by a unilateral-dermatomal distribution, earlier onset and rapid progression followed by stabilization. The response to phototherapy in patients with SV is limited. We evaluated the treatment response in 39 cases of SV according to disease duration. Ten cases (50.0%) of Group 1 (duration ≤ 5 months) and five cases (26.3%) of Group 2 (duration > 5 months) showed more than 50% repigmentation. Contrary to previous reports, patients in our study responded well to medical treatments like oral steroids, topical calcineurin inhibitors and phototherapy when treated early after onset. The results suggest that early treatment is important.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Phototherapy; Retrospective Studies; Steroids; Tacrolimus; Time Factors; Vitiligo; Young Adult

Topics: Administration, Topical; Adolescent; Black or African American; Calcitriol; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Face; Female; Humans; Immunosuppressive Agents; Skin Pigmentation; Tacrolimus; Vitiligo

Topics: Administration, Topical; Adult; Humans; Immunosuppressive Agents; Male; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

Vitiligo is an acquired pigmentary disorder caused by the destruction of melanocytes. Two of the major theories regarding the pathogenesis of vitiligo are the autoimmune theory and autocytotoxicity theory, but, the precise pathogenetic mechanism is still not clarified.. We investigated the effects of ET-1, tacrolimus and tumour necrosis factor-α (TNF-α) on proliferation and migration of cultured normal human melanocytes (NHMs). We also sought to clarify the theoretical rationale underlying the topical tacrolimus monotherapy or tacrolimus-UV combination therapy as tools for vitiligo treatment.. The effects of ET-1, tacrolimus and TNF-α on proliferation/migration of cultured NHMs were investigated by MTT assay/Boyden chamber transwell migration assay. We also examined roles of CXC-chemokine receptor II (CXCR II) and matrix metalloproteinases (MMPs) in such conditions.. ET-1 exerted a stimulatory effect on melanocyte proliferation and migration, but, tacrolimus exerted a stimulatory effect only on melanocyte migration higher than ET-1. TNF-α inhibited melanocyte proliferation in a dose-dependent manner. Paradoxically, TNF-α-pretreated NHMs exhibited an enhanced proliferative efficiency after being switched to ET-1. We found CXCRII was highly expressed in TNF-α-incubated melanocytes than the agents-free control, and ET-1 treatment after TNF-α preincubation showed the higher levels of CXCRII expression than the condition incubated with TNF-α alone. Moreover, the greater activities of MMP-2 and MMP-9 induced by tacrolimus than ET-1, reflected tacrolimus would enhance migration stimulatory effect in cultured NHMs.. Topical tacrolimus can be used an effective agent for vitiligo treatment as monotherapy, maybe due to its migration stimulatory action or TNF-α inhibitory property, and also as a component in combination therapy with UV treatment, considering the more upregulated MMPs activities are induced and the more effective migrations are feasible by itself than ET-1.

Topics: Cell Movement; Cell Proliferation; Endothelin-1; Humans; Immunosuppressive Agents; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Melanocytes; Phototherapy; Receptors, CXCR; Tacrolimus; Tumor Necrosis Factor-alpha; Vitiligo

Incidents of new-onset vitiligo attributed to infliximab therapy for rheumatoid arthritis and ulcerative colitis have been reported. Reported cases share a common theme in that symptoms manifested in close proximity to the initiation or significant dose increase of the medication. This case describes the presentation of infliximab-induced vitiligo in a patient using it for long-term treatment of stable pityriasis rubra pilaris. The patient was initiated and titrated to a stable dose of infliximab totaling 27 months' duration. He was able to achieve near-complete resolution of symptoms before developing depigmented patches consistent with vitiligo. Infliximab was discontinued. Tacrolimus 0.1% ointment and narrow-band ultraviolet B light successfully repigmented the patches. The association of discontinuing infliximab and resolution of vitiligo suggests infliximab had a role in this case. Though the mechanism of involvement is undetermined, infliximab may have induced an autoimmune process by paradoxically activating lymphocytes. Alternatively, infliximab antibodies may have led to the process by disrupting the normal balance of cytokines.

Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Rheumatoid; Diabetes Mellitus, Type 2; Gout; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Pityriasis Rubra Pilaris; Tacrolimus; Ultraviolet Therapy; Vitiligo

Topics: Blister; Combined Modality Therapy; Epidermis; Humans; Immunosuppressive Agents; Male; Middle Aged; Pigmentation Disorders; Suction; Tacrolimus; Ultraviolet Therapy; Vitiligo

Topical tacrolimus (FK506) has been considered as a treatment option for treating vitiligo, a dermatosis characterized by disappearance of melanocytes (MCs). Previous reports have shown that a significant portion of treated patients demonstrated follicular repigmentation, indicating that the activation of MC precursor cells residing in the outer root sheath of hair follicles played an important role during the tacrolimus-induced repigmentation process.. To investigate the mechanisms involved in follicular pigmentation induced by topical tacrolimus.. As stem cells of MC lineage are identified in the lower portion of mouse hair follicles throughout the hair cycle, immature mouse melanoblasts (MBs) derived from neural crest cells (NCCmelb4) were used for this study. Relevant maturation parameters were evaluated.. Our results revealed that FK506 stimulated the expressions of protein kinase A, protein kinase C and phosphorylated p38 mitogen-activated protein kinase. However, cell motility, a parameter associated with MB differentiation, was not enhanced by FK506 treatment. Endothelin (ET)-3, a prodifferentiation factor of MBs, also failed to promote NCCmelb4 cell locomotion. Combining ET-3 and FK506, however, stimulated cell mobility. ET B receptor, which was not present in NCCmelb4 cells, was induced after FK506 treatment.. In summary, we have shown that FK506 is an efficient differentiation-stimulating agent, especially for cells of neural origin. The clinical efficacy of topical tacrolimus on vitiligo may be enhanced by combination with ET-3.

Topics: Animals; Blotting, Western; Cell Movement; Cyclic AMP-Dependent Protein Kinases; Drug Therapy, Combination; Endothelins; Immunosuppressive Agents; Melanocytes; Mice; Neural Crest; p38 Mitogen-Activated Protein Kinases; Pigmentation; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Sunlight; Tacrolimus; Vitiligo

Vitiligo vulgaris is a chronic autoimmune depigmenting disorder affecting individuals of all skin colors. Lesions are commonly noted in the periorificial face and over the upper and lower extremities in areas of friction. Although there have been many published reports of successful therapies for vitiligo, few have assessed differential response based on skin color.. To determine if topical tacrolimus is more effective at treating vitiligo in individuals of color.. An IRB-approved chart review of patients with a diagnosis of vitiligo was conducted including patients seen between May 2001 and April 2006. Patients with vitiligo were treated with tacrolimus 0.03% for children ages 2-15 years of age and tacrolimus 0.1% ointment for individuals 16 years of age or older, applied twice-daily to all hypopigmented or depigmented lesions. A review of clinical features, Fitzpatrick skin type and response to topical tacrolimus were recorded.. Topical tacrolimus was effective in all Fitzpatrick skin types, with superior efficacy on body lesions in individuals of Fitzpatrick types 3-4 (Fisher exact test, P=0.03). Further, individuals with Fitzpatrick type 3-4 skin had shorter interval to greater than 75 percent improvement of lesions on the body (Kaplan-Meier Log-rank, P=0.03) and head and neck (P=0.016).. Topical tacrolimus is an effective treatment for vitiligo irrespective of skin tone, with greatest benefit in Fitzpatrick type 3-4 skin. Repigmentation of lesions on the head and neck is superior to repigmentation of the body and extremities in all racial subgroups.

Topics: Administration, Cutaneous; Adolescent; Adult; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Racial Groups; Retrospective Studies; Skin Pigmentation; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo; Young Adult

Topics: Adolescent; Child; Child, Preschool; Combined Modality Therapy; Humans; Immunosuppressive Agents; Lasers, Excimer; Low-Level Light Therapy; Phototherapy; Steroids; Tacrolimus; Treatment Outcome; Vitiligo

Although clinical trials for new drugs are often limited in children because of safety concerns or restrictions, new therapies or novel strategies with old drugs have recently expanded dermatologic armamentarium for pediatric patients. Oral propranolol is currently the first choice in the treatment of alarming infantile hemangiomas. In atopic dermatitis, proactive strategy with topical calcineurin inhibitors can safely prevent disease exacerbation. Tacrolimus, in particular, is also useful for the treatment of vitiligo occurring in sensitive areas such as the eyelids. Among biologic drugs, use of etanercept is safe and efficient in children and adolescents with moderate-to-severe plaque psoriasis. Engineered tissues with special antimicrobial properties (silver-coated fabrics or engineered silk) are now used to treat eczema and fungal diseases in children. In athlete's foot, the use of 5-finger socks can also be helpful.

Topics: Adolescent; Adrenal Cortex Hormones; Alopecia Areata; Autoimmune Diseases; Child; Child, Preschool; Dermatitis, Atopic; Eczema; Female; Hemangioma; Humans; Immunosuppressive Agents; Male; Propranolol; Psoriasis; Randomized Controlled Trials as Topic; Skin Diseases; Tacrolimus; Therapies, Investigational; Vitiligo

Topics: Adult; Dermatologic Agents; Face; Facial Dermatoses; Female; Humans; Male; Middle Aged; Prednisone; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo

Topics: Adolescent; Dermatology; Humans; Immunosuppressive Agents; Male; Photography; Tacrolimus; Vitiligo; Wales

Topics: Administration, Topical; Adult; Combined Modality Therapy; Female; Humans; Laser Therapy; Middle Aged; Risk Factors; Skin Neoplasms; Tacrolimus; Vitiligo

Topics: Administration, Cutaneous; Adult; Alcohol Drinking; Dermatologic Agents; Erythema; Female; Flushing; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Vitiligo

Vitiligo is an acquired, pigmentary skin disorder which is disfiguring and difficult to treat. Phototherapy and application of topical corticosteroids are most commonly prescribed. However, these therapies are often not effective and use of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia, and ocular complications.. We sought to assess the efficacy of topical tacrolimus ointment in the treatment of vitiligo.. A prospective pilot study was performed of 30 patients with vitiligo. Patients were treated with tacrolimus ointment for at least 4 months. Clinical responses were documented during clinic visits, and by pretacrolimus and post-tacrolimus photography.. Twenty-five (83.3%) patients showed some repigmentation at the end of 4 months. Patients with vitiligo for more than 5 years also responded well to tacrolimus ointment. Repigmentation in active vitiligo was superior to that in stable vitiligo. 80% of patients with segmental vitiligo of the head and neck showed some response to tacrolimus, but there was no statistical significance between segmental and vulgaris vitiligo. The mean percentage of repigmentation on the head and neck was greater than that on the trunk and extremities. Four patients initially experienced burning on application.. Topical tacrolimus ointment is an effective and well-tolerated alternative therapy for vitiligo especially involving the head and neck.

Topics: Administration, Topical; Adolescent; Adult; Analysis of Variance; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Emollients; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Pilot Projects; Prospective Studies; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Adolescent; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Male; Ointments; Silymarin; Tacrolimus; Trioxsalen; Vitiligo

Vitiligo is an acquired dermatological condition that is characterized by depigmentation of patches of skin. It is relatively common, occuring in about 0.38-0.50% of the general population, and can engender significant cosmetic disfigurement and psychological sequelae in the affected individual. Recent studies demonstrate that topical tacrolimus (Protopic; Astellas, Markham, ON, Canada) is efficacious in the treatment of vitiligo. We propose that the successful treatment of vitiligo with topical tacrolimus involves the unique immunosuppressive actions of the T lymphocyte T-helper (Th) 2 cytokine, interleukin (IL)-10.. We aimed to monitor clinical changes in lesions of vitiligo treated with topical tacrolimus 0.1% ointment and quantify IL-10 cytokine levels in nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy.. Clinical evaluation of lesions of vitiligo on the basis of surface area and follicular repigmentation under Wood's lamp was performed in 20 enrolled adult patients. Biopsy specimens were obtained from nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Specimens were processed and analysed for expression of IL-10 using the method of enzyme-linked immunosorbent assay.. A statistically significant mean +/- SEM decrease in vitiligo lesion size of 41.0 +/- 5.2% was observed following 3 months of treatment. A pattern of follicular repigmentation was noted by the third month of treatment for all patients completing the study. In addition, there was a statistically significant difference between IL-10 expression in vitiligo lesions following treatment for 3 months with topical tacrolimus compared with untreated vitiligo lesions (P = 0.017) and normal skin (P = 0.004).. These results confirm that topical tacrolimus is an effective treatment for vitiligo. We propose that topical tacrolimus increases IL-10 expression in vitiligo lesions, and thereby inhibits melanocyte destruction triggered by unchecked Th1 pathways in vitiligo.

Topics: Administration, Topical; Adolescent; Adult; Aged; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunosuppressive Agents; Interleukin-10; Male; Middle Aged; Ointments; Tacrolimus; Vitiligo; Young Adult

Current treatments for vitiligo are largely unsatisfactory. Topical corticosteroids and phototherapy (narrow-band UVB and psoralen+UVA) are the most prescribed, however, these therapies are often not effective and have important side-effect, especially when used for a long time. Many studies have reported the efficacy and safety of tacrolimus ointment in adults and children with vitiligo, particularly when located on the head and neck. Successful treatment is possible when it is combined with other therapies, such as narrow-band UVB, microphototherapy, helium-neon laser, or narrow-band excimer laser.

Topics: Adrenal Cortex Hormones; Combined Modality Therapy; Humans; Immunosuppressive Agents; Ointments; Phototherapy; Tacrolimus; Vitiligo

Topics: Acne Vulgaris; Adolescent; Dermatologic Agents; Drug Eruptions; Humans; Male; Tacrolimus; Vitiligo

Topics: Adolescent; Calcitriol; Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

The current treatment of vitiligo is not satisfactory according to the opinions of both the patient population and the dermatologists. Recently, combination therapies have been introduced, which are both systemic and targeted (microphototherapy). To evaluate the effects of topical treatments given alone or in combination with 311-nm narrow-band microphototherapy. We evaluated the efficacy and safety of: (1) 311-nm narrow-band microphototherapy;(2) tacrolimus 0.1% ointment twice a day; (3) pimecrolimus 1% cream twice a day; (4) betamethasone dipropionate 0.05% cream twice a day; (5) calcipotriol ointment 50 microg/g twice a day; and (6) 10%l-phenylalanine cream twice a day, for the treatment of exclusively vitiligo patches. A 311-nm narrow-band microphototherapy (Bioskin) was given alone or in combination with the above-mentioned popular local treatments. Four hundred and seventy patients suffering from vitiligo that affected less than 10% of the skin surface were evaluated. The patients were divided into 11 groups according to the selected treatment modalities. Four hundred and fifty-eight patients completed the study period of 6 months. Excellent repigmentation (> 75%) was achieved by 72% of the patients in group 1, 76.5% in group 2, 76.1% in group 3, 90.2% in group 4, 75.6% in group 5, 74.8% in group 6, 61% in group 7, 54.6% in group 8, 71.2% in group 9, 59.1% in group 10, and 29.3% in group 11. Marked repigmentation (50-75%) was evident in 19.8% of the patients in group 1, 18.2% in group 2, 20.1% in group 3, 6.7% in group 4, 14.1% in group 5, 11.3% in group 6, 16.1% in group 7, 18.4% in group 8, 25% in group 9, 10.6% in group 10, and 8.1% in group 11. Moderate results (25-50% repigmentation) were seen in 4.6% of the patients in group 1, 3.3% in group 2, 2.7% in group 3, 2.2% in group 4, 7.4% in group 5, 10.1% in group 6, 18.4% in group 7, 21.7% in group 8, 2.1% in group 9, 27.1% in group 10, and 55% in group 11. Finally, minimal (< 25%) or no response was achieved in 3.6% of the patients in group 1, 2% in group 2, 1.1% in group 3, 0.9% in group 4, 2.9% in group 5, 3.8% in group 6, 4.5% in group 7, 5.3% in group 8, 1.75% in group 9, 3.2% in group 10, and 7.6% in group 11. Side effects were skin atrophy (76% in group 4 and 81% in group 9), stinging and burning (groups 2, 3, 7, and 8). Targeted combination therapies in vitiligo are remarkably more effective than single treatments. When single treatments are considered alone, 311-nm narrow-band UVB microfo

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Betamethasone; Calcitriol; Dermatologic Agents; Glucocorticoids; Humans; Immunosuppressive Agents; Middle Aged; Phenylalanine; Photochemotherapy; Severity of Illness Index; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo; Young Adult

Vitiligo is a common, acquired, depigmenting disease of the skin. Although the pathogenesis of vitiligo is still unclear, it is postulated that topical immunomodulators exert therapeutic effects on treatment of vitiligo. We reviewed the treatment of vitiligo with topical immunomodulators and topical steroids to evaluate the efficacy of immunomodulators in treatment of vitiligo. We reviewed 52 patients treated with topical immunomodulators and 27 patients with topical steroids. To evaluate the efficacy, repigmentation of vitiligo was reviewed. Between the two treatments, the duration from the start of treatment to onset of repigmentation was significantly shorter in the topical immunomodulator group (P = 0.002). However, no statistically significant differences were found in sex, age, mean disease duration, sites of vitiligo lesion and ratio of patients who showed response. We may suggest topical immunomodulator as an alternative to topical steroids for treatment of vitiligo.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Glucocorticoids; Humans; Immunologic Factors; Male; Middle Aged; Ointments; Retrospective Studies; Tacrolimus; Treatment Outcome; Vitiligo

Treatment of vitiligo is a challenge, especially in children. Recently, topical calcineurin inhibitors have been introduced in the management of vitiligo, but significant repigmentation is not achieved except on the face. Large pretibial lesions of a 15-year-old female with progressive vitiligo were treated twice daily over six months with 0.1% tacrolimus ointment on the right and 1% pimecrolimus cream on the left side without effect. Additional overnight occlusion with polyurethane and hydrocolloid foils during the following 18 months led to substantial repigmentation on both sides (tacrolimus-treated side, 88% repigmented area; pimecrolimus-treated side, 73%). Tacrolimus serum levels measured at four different time points did not exceed 1.8 ng/ml. This case report on a direct comparison of topical tacrolimus and pimecrolimus in vitiligo shows that on the shins considerable improvement could be induced with both agents only by additional long-term occlusion and that tacrolimus was somewhat more effective than pimecrolimus.

Topics: Administration, Topical; Adolescent; Calcineurin Inhibitors; Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Leg Dermatoses; Occlusive Dressings; Remission Induction; Skin Pigmentation; Tacrolimus; Tibia; Treatment Outcome; Vitiligo

Topics: Administration, Topical; Biopsy; Child; Disease Progression; Female; Forearm; Humans; Immunosuppressive Agents; Melanoma; Skin; Skin Neoplasms; Tacrolimus; Vitiligo

Topics: Adolescent; Adult; Child; Female; Humans; Immunosuppressive Agents; Male; Skin Pigmentation; Tacrolimus; Treatment Outcome; Ultraviolet Rays; Vitiligo

Vitiligo is a chronic disease that mostly affects children and young adults. Nowadays many treatment options are available; however, most of them have limited efficacy and in most cases would result in undesirable complications.. To determine the extent of repigmentation according to the location of the lesions after applying topical cream pimecrolimus 1% in vitiligo patients.. Thirty consecutive patients with vitiligo lesions affecting less than 20% of body surface area without any previous history of spontaneous repigmentation were treated with pimecrolimus cream 1% twice daily for 12 weeks. The extent of repigmentation in vitiligo lesions was determined in each patient after 6 and 12 weeks.. Moderate to excellent response (repigmentation >26%) was observed in 6.6 and 25.9% of vitiligo lesions 6 and 12 weeks after treatment, respectively. More responsive lesions were located on the trunk, face and elbow (85.7, 75 and 70%).. Pimecrolimus cream 1% results in repigmentation in vitiligo in different extents according to the location of the lesion; however, to clearly prove its efficacy as monotherapy or in combination with other available treatment options, double-blind placebo-controlled studies are essential.

Topics: Adolescent; Adult; Child; Dermatologic Agents; Humans; Middle Aged; Ointments; Skin Pigmentation; Tacrolimus; Vitiligo

Narrow-band ultraviolet B (NB-UVB) phototherapy and topical tacrolimus are included among the most innovative approaches to vitiligo.. To evaluate the efficacy and tolerability of combined treatment with NB-UVB and topical tacrolimus in vitiligo.. After informed consent, adult patients with chronic (> 1-year duration) stable vitiligo refractory to conventional treatments were enrolled in an open-labelled prospective study. Treatment regimen consists of once-daily application, in the evening, of tacrolimus 0.03% ointment to the lesions of the face, or tacrolimus 0.1% ointment to the vitiligous patches located on other areas. Concomitant NB-UVB phototherapy was performed twice weekly for 16 weeks.. Study population included 110 patients (mean age, 42) with a total of 403 lesions. Within the treatment period, variable repigmentation was evident on more than 70% of lesions. Clinical response (repigmentation more than 50%) was observed in 42% of lesions. Response was strictly dependent on the site, being more frequent for face lesions (73%), followed by limbs (68%) and trunk (53.5%). The therapeutic effect on the extremities and genital areas was quite disappointing. Treatment was well tolerated.. Our preliminary data suggest that the combination of topical tacrolimus with NB-UVB phototherapy can represent an alternative highly effective approach to refractory vitiligo located on the face, trunk and limbs. Long-term safety data and randomized controlled trials on a large number of patients are required.

Topics: Adolescent; Adult; Aged; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Prospective Studies; Statistics, Nonparametric; Tacrolimus; Treatment Outcome; Ultraviolet Therapy; Vitiligo

To explore the effectiveness of pimecrolimus cream 1% used twice daily (BID) for the treatment of facial vitiligo.. Patients who had used pimecrolimus cream 1% monotherapy BID for at least 3 months and who had photographs taken at baseline and after initiation of therapy were analyzed in a retrospective study. The total affected surface area (cm2) of facial vitiligo in the baseline and follow-up photographs was compared. The extent of facial depigmentation was scored using a 7-point scale (0 = no disease to 6 = 100% involvement).. Eight patients met study entry criteria. Mean time from initiation of treatment to the final follow-up visit was 11 months (SD +/- 7.5 months). Mean affected surface area at baseline and follow-up were 79.40 cm2 and 17.96 cm2, respectively, (P = .012) with a mean percent improvement 72.5% (SD +/- 20.4%). Mean depigmentation score decreased from 2.8 at baseline to 1.4 at follow-up. No adverse events were reported.. Pimecrolimus cream 1% may be a viable alternative to current therapies for the treatment of facial vitiligo.

Topics: Adolescent; Adult; Dermatologic Agents; Facial Dermatoses; Female; Humans; Male; Middle Aged; Ointments; Retrospective Studies; Skin; Tacrolimus; Vitiligo

Vitiligo is characterized by the selective destruction of melanocytes resulting in patches of skin depigmentation. Vitiligo is a therapeutic challenge. Eyebrows, eyelids and genital vitiligo are a therapeutic dilemma, especially in children. The possible side effects of topical corticosteroids and the difficulties for choosing any other adequate treatment option are a major concern. We present two children, one with vitiligo of the eyelids and the other with genital vitiligo, both treated with pimecrolimus 1% cream with almost full repigmentation of the lesions, showing pimecrolimus could be an adequate option for the treatment of vitiligo for these special vitiligo areas in children.

Topics: Administration, Topical; Child; Eyelids; Humans; Immunosuppressive Agents; Male; Penis; Remission Induction; Skin; Tacrolimus; Vitiligo

Topics: Acne Vulgaris; Adolescent; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

Topics: Follow-Up Studies; Humans; Immunosuppressive Agents; Prospective Studies; Tacrolimus; Treatment Outcome; Ultraviolet Rays; Vitiligo

Topics: Administration, Topical; Alopecia; Child; Female; Humans; Immunosuppressive Agents; Male; Ointments; Tacrolimus; Vitiligo; Warts

Topics: Child; Female; Humans; Immunosuppressive Agents; Molluscum Contagiosum; Ointments; Tacrolimus; Vitiligo

Vitiligo is an acquired pigmentary disorder characterized by depigmentation of skin and hair. As the pathogenesis of this disease is still obscure, the treatment of vitiligo has generally been unsatisfactory and often disappointing. Topical tacrolimus (FK506) ointment has recently been added to the armamentarium against this pigmentary disorder. Despite its clinical efficacy, the underlying mechanisms of how topical tacrolimus induces repigmentation in vitiligo have rarely been investigated. As tacrolimus ointment is applied directly to the skin, its impact on keratinocytes (KCs) requires thorough investigation.. To investigate the effects of FK506 on melanocyte (MC) and melanoblast (MB) growth via KCs.. Cultured MCs and MBs were treated with supernatant of KC cultures conditioned with various concentrations of FK506. The impact of supernatant on MCs and MBs was assessed in terms of its effect on MC/MB proliferation, melanin formation and cell migration. The activities of matrix metalloproteinase (MMP)-2 and MMP-9, known for their influence on cell migration, were evaluated. The concentrations of MC/MB growth factors in the KC supernatant were also determined.. Results demonstrated that proliferation of both MCs and MBs was significantly enhanced by FK506-treated KC supernatant. In addition, the concentration of stem cell factor in KC supernatant increased dose-dependently with FK506 treatment. The supernatant from FK506-treated KC culture showed a significant increase in MMP-9 activity.. Our study provides in vitro evidence demonstrating that direct interaction between FK506 and KCs creates a favourable milieu for MC growth and migration. Furthermore, our findings provide a possible mechanism explaining how tacrolimus ointment induces repigmentation in patients with vitiligo.

Topics: Adult; Cell Movement; Cell Proliferation; Coculture Techniques; Culture Media, Conditioned; Dose-Response Relationship, Drug; Growth Substances; Humans; Immunosuppressive Agents; Keratinocytes; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Melanins; Melanocytes; Ointments; Stem Cell Factor; Stimulation, Chemical; Tacrolimus; Vitiligo

Vitiligo is a frequent dyschromia, characterized by achromic macules that reflect the absence of melanocytes. The cause of this selective destruction seems to be due to an autoimmune phenomenon. Tacrolimus is an immunomodulator produced by Streptomyces tsukubaensis, whose topical use has been approved for atopic dermatitis. It has been tested in other dermatoses where immunological phenomena are involved.. During the period from September 1, 2003 to April 30, 2004, an open study was carried out on 12 cases of vitiligo treated with topical tacrolimus 0.1 % twice a day. The degree of repigmentation was analyzed using digital photography at the initial visit, and at three and six months. The response in each case was taken into consideration, as well as the response by treated area. Possible adverse effects during the treatment period were also noted.. 50 % of the patients treated showed repigmentation with good (50 %-75 %) or excellent (> 75 %) improvement after 6 months. All of the patients with facial involvement achieved repigmentation of over 50 % in this location. Repigmentation in all cases took place homogeneously and centripetally, rather than in a perifollicular pattern. Repigmentation began before three months of treatment had elapsed in 10 patients, and after three months in the remaining two. We did not find any evidence of adverse effects except pruritus in the eyelid area in two patients during the first week of treatment.. We believe that tacrolimus 0.1 % applied topically for a minimum of six months may be a valid alternative in the treatment of vitiligo in the facial area, especially the eyelids, where other therapeutic modes are not recommended because of the possible side effects.

Topics: Administration, Topical; Adult; Aged; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Vitiligo

Vitiligo is an autoimmune disorder characterized by loss of pigmentation. Phototherapy and application of topical corticosteroids are most commonly prescribed. However, these therapies are often not effective and use of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia, and ocular complications.. We sought to assess the efficacy of topical tacrolimus ointment in the treatment of pediatric vitiligo.. A retrospective review was performed of 57 pediatric patients with vitiligo at two clinical sites. Patients were treated with tacrolimus ointment for at least 3 months. Clinical responses were documented during clinic visits, and by pretacrolimus and posttacrolimus photography.. At least partial response was noted to tacrolimus ointment on the head and neck in 89%, and on the trunk and extremities in 63% of patients. Facial vitiligo of the segmental type showed the best response rate. Two patients initially experienced burning on application.. Topical tacrolimus ointment is an effective alternative therapy for childhood vitiligo, particularly involving the head and neck.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Ointments; Recurrence; Retrospective Studies; Skin Pigmentation; Tacrolimus; Vitiligo

The cause of the selective melanocyte destruction in vitiligo may be due to an autoimmune disorder. A series of 15 patients with vitiligo were treated with a topical immunomodulator, tacrolimus ointment 0.1%, twice daily for a minimum of 45 days. Thirteen patients (87%) experienced at least partial repigmentation, and 3 of those patients had greater than 75% repigmentation. Patients with the greatest treatment response likely benefited from concomitant natural sunlight exposure. Further studies investigating the safety and efficacy of tacrolimus ointment either as monotherapy or in combination with other therapeutic measures are warranted.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Prospective Studies; Skin Pigmentation; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Adult; Chronic Disease; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Severity of Illness Index; Tacrolimus; Ultraviolet Rays; Vitiligo

Topics: Administration, Topical; Adult; Child; Female; Humans; Immunosuppressive Agents; Male; Ointments; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Adjuvants, Immunologic; Age Factors; Autoimmune Diseases; Child; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

Topics: Administration, Cutaneous; Adult; Facial Dermatoses; Female; Follow-Up Studies; Humans; Ointments; Pigmentation; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Dermatitis, Atopic; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Vitiligo

We describe 6 patients with generalized vitiligo who responded to treatment with tacrolimus ointment. Moderate to excellent repigmentation was achieved in 5 patients. Although the number of cases in this noncontrolled, nonblinded series is small, tacrolimus ointment may be an efficacious and safe treatment option for vitiligo.

Topics: Adolescent; Adult; Child; Female; Humans; Immunosuppressive Agents; Male; Ointments; Skin Pigmentation; Tacrolimus; Vitiligo