tretinoin and Vitiligo

If vitiligo involves most of the body, it might be easier to depigment the normal remaining skin rather than to attempt repigmentation. We reviewed the literature to date regarding available therapies for depigmenting the normal skin in vitiligo universalis. Our review revealed that the threshold regarding what percentage of body surface area qualifies as depigmentation is variable among practitioners. Monobenzyl ether of hydroquinone (MBEH) is the most widely used depigmenting agent and has few side-effects. Tretinoin in combination with MBEH is able to speed depigmentation of the skin. Monomethylether of hydroquinone has also been used successfully for depigmentation. Eighty-eight per cent phenol is also effective in depigmenting the skin but its application on large areas is toxic for liver and kidney. Different types of lasers are also available to destruct the melanocytes selectively, but this technique can be painful and expensive. Cryotherapy is a cheap depigmenting therapy but, because of scarring risk, it should only be used by experienced dermatologists. No trials have compared the efficacy of the above-mentioned well-established depigmentation agents/techniques. Certain drugs such as imatinib, imiquimod and diphencyprone, which are used to treat other diseases, caused depigmentation as a side-effect. Some depigmentation agents used for branding cattle can also serve as topical depigmentation agents. In conclusion, comparative clinical trials are needed to compare the efficacy of various depigmentation agents/techniques. In particular, topical imatinib, imiquimod and diphencyprone may be considered as potential depigmenting agents, which require further investigation. This review revealed that MBEH is safe and effective depigmenting agent.

Topics: Cryotherapy; Dermatologic Agents; Humans; Hydroquinones; Laser Therapy; Skin Pigmentation; Tretinoin; Vitiligo

The future of a drug depends upon what it can do in the hands of the practitioner. Medicine is practiced on the basis of probabilities, and treatment must be selected which has the best chance of helping the patient, with the least amount of harm. There are many new drugs available for dermatologic therapy in other developed countries which are not available in this country, due to peculiarities of federal drug regulations.

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Antifungal Agents; Antineoplastic Agents; Carotenoids; Dermatologic Agents; Fluorouracil; Herpesviridae Infections; Humans; Keratolytic Agents; Photosensitivity Disorders; Psoriasis; Skin Diseases; Tretinoin; United States; United States Food and Drug Administration; Vitamin E; Vitiligo

Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders.. To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy.. A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed.. Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: -0.5% in the tretinoin group and -8.7% in the control group at 12 weeks (. Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response.. ClinicalTrials.gov NCT03933774.

Topics: Adult; Humans; Hyperpigmentation; Phototherapy; Treatment Outcome; Tretinoin; Ultraviolet Therapy; Vitiligo

Topical all-trans-retinoic acid (tretinoin) prevents skin atrophy induced by long-term use of topical corticosteroids, without abrogating their anti-inflammatory effects.. The goal of this study was to determine the efficacy of tretinoin plus topical corticosteroids (tretinoin plus) for repigmentation in patients with vitiligo.. A placebo-controlled, paired-comparison, left-right study was conducted for a period of 6 months on tretinoin plus and the vehicle plus the same topical corticosteroid (vehicle plus) treatment in 50 patients diagnosed with generalized vitiligo. Clinical responses were assessed using the computerized analysis, and the results were compared with the visual analysis.. The percentage agreement between the 2 analyses was 91.8%. Among 49 participants who successfully completed this study, 27 (55%) showed a better response to tretinoin plus than to vehicle plus. The improved response was noted at an early stage of treatment, during the first 3 months in 60% of patients.. Combined therapy with tretinoin plus topical corticosteroids is safe and effective and provides another option for treatment of patients with vitiligo.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Child; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Keratolytic Agents; Male; Middle Aged; Skin Pigmentation; Time Factors; Treatment Outcome; Tretinoin; Vitiligo; Young Adult

A 65-year-old women presented with sharply demarcated macules and small nodules on her face and neck for 2.5 years. They first appeared on her left face and gradually spread to her whole face and neck. The lesions were slightly pruritic. Her history was remarkable only for a high dose of topical tretinoin cream 0.025% dosage. On the basis of distribution and history, we made the diagnosis of contact dermatitis for the macules. A biopsy of a red papule from her neck revealed characteristics of pyogenic granuloma. However, white patches appear on his face at the third month follow-up after suspension of the tretinoin cream; Wood's lamp examination was consistent with vitiligo. It is the first report of a dose-response variant of this adverse reaction (Contact dermatitis combined with Pyogenic granulomas).

Topics: Aged; Dermatitis, Contact; Female; Granuloma, Pyogenic; Humans; Irritants; Tretinoin; Vitiligo

Topics: Administration, Topical; Animals; Cell Proliferation; Drug Combinations; Guinea Pigs; Humans; Indicators and Reagents; Keratinocytes; Male; Skin Pigmentation; Tretinoin; Vitamin E; Vitiligo

Chronic skin disorders that require long-term treatment with corticosteroids, such as vitiligo, may use a combination of topical corticosteroids and topical all-trans-retinoic acid (ATRA) to prevent corticosteroid-induced skin atrophy. Besides protecting against the side effects of corticosteroids, ATRA produces a better clinical outcome in some patients. This study examined whether ATRA influences the expression of mRNAs responsible for the clinical correlation. Differential display was performed using kits incorporating an annealing control primer. Epidermis from suction blisters taken from six patients diagnosed with a generalized type of vitiligo, who were included in a placebo-controlled paired-comparison left-right study using ATRA and vehicle for 3-6 months, were used. Ten differentially expressed mRNAs were identified in those six patients. Expression levels were restored to normal particularly in four types of mRNAs, which were matched with sequences encoding eukaryotic translation initiation factor 4A1 (eIF4A1), ribosomal protein L13, mediator of RNA polymerase to transcription (MRT) and ribosomal phosphoprotein PO. Of those mRNAs, the level of eIF4A1 mRNA showed a clinical correlation; The expression of eIF4A1 mRNA, examined by real-time PCR, was elevated in four patients who showed a favorable clinical response to ATRA, whereas no change or a decrease occurred in three patients whose clinical responses did not differ between ATRA and vehicle treatment. The eIF4A1 protein expression from the other two patients, one of them with a favorable response to ATRA, also showed a clinical correlation. Therefore, eIF4A1 mRNA may be an important gene related to ATRA effects, although further studies are required.

Topics: Adult; Aged; Base Sequence; Biomarkers; DNA, Complementary; Drug Resistance; Epidermis; Eukaryotic Initiation Factor-4A; Female; Gene Expression Profiling; Humans; Male; Molecular Sequence Data; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Tretinoin; Vitiligo

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

Mice homozygous for the vitiligo mutation of the microphthalmia (Mitf) gene have a retinal degeneration characterized by slow loss of photoreceptor cells and compromised retinal pigment epithelial (RPE) structure and function. The levels of retinyl esters, which are essential for generation of 11-cis-retinaldehyde for the formation of rhodopsin, were reported previously to be elevated by 6 weeks postnatally in the RPE of vitiligo mutant mice. The purpose of the present study was to determine whether this elevation was due to increased activity of lecithin:retinol acyl transferase (LRAT) the enzyme that converts all-trans-retinol to retinyl esters.. Retinoids extracted from the RPE and neural retina of mutant and normal mice ages 2, 4, 6 and 8 weeks were analyzed by reversed-phase HPLC. The esterification capacity of the RPE to convert 3H-retinol to 3H-retinyl ester was determined by HPLC in mutant and normal mice at 3 and 9 weeks.. Retinyl ester levels were elevated significantly in the mutant RPE as early as postnatal week 2 and were four-fold greater by 8 weeks. The esterification assay indicated no significant differences between mutants and controls at 3 weeks. At 9 weeks, the esterification activity of the mutant RPE was significantly reduced compared to controls rather than elevated.. The data suggest that the accumulation of retinyl esters is not due to increased LRAT activity. Alternative explanations for the retinyl ester accumulation are discussed.

Topics: Acyltransferases; Aging; Animals; Chromatography, High Pressure Liquid; Diterpenes; DNA-Binding Proteins; Esterification; Mice; Mice, Inbred C57BL; Mice, Mutant Strains; Microphthalmia-Associated Transcription Factor; Microscopy, Electron, Scanning; Microsomes, Liver; Mutation; Pigment Epithelium of Eye; Retinyl Esters; Time Factors; Transcription Factors; Tretinoin; Vitamin A; Vitiligo