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Topical treatment and combination approaches for vitiligo: new insights, new developments.
G Ital Dermatol Venereol. 2010 Feb; 145(1):57-78.GI

Abstract

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.

Authors+Show Affiliations

Department of Dermatology, Howard University College of Medicine, Washington, DC 20060, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20197746

Citation

Hossani-Madani, A R., and R M. Halder. "Topical Treatment and Combination Approaches for Vitiligo: New Insights, New Developments." Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, vol. 145, no. 1, 2010, pp. 57-78.
Hossani-Madani AR, Halder RM. Topical treatment and combination approaches for vitiligo: new insights, new developments. G Ital Dermatol Venereol. 2010;145(1):57-78.
Hossani-Madani, A. R., & Halder, R. M. (2010). Topical treatment and combination approaches for vitiligo: new insights, new developments. Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, 145(1), 57-78.
Hossani-Madani AR, Halder RM. Topical Treatment and Combination Approaches for Vitiligo: New Insights, New Developments. G Ital Dermatol Venereol. 2010;145(1):57-78. PubMed PMID: 20197746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Topical treatment and combination approaches for vitiligo: new insights, new developments. AU - Hossani-Madani,A R, AU - Halder,R M, PY - 2010/3/4/entrez PY - 2010/3/4/pubmed PY - 2010/6/22/medline SP - 57 EP - 78 JF - Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia JO - G Ital Dermatol Venereol VL - 145 IS - 1 N2 - 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. SN - 0392-0488 UR - https://www.unboundmedicine.com/medline/citation/20197746/Topical_treatment_and_combination_approaches_for_vitiligo:_new_insights_new_developments_ L2 - http://www.minervamedica.it/index2.t?show=R23Y2010N01A0057 DB - PRIME DP - Unbound Medicine ER -