Combined Excimer Laser and Topical Tacrolimus for the Treatment of Vitiligo: A Pilot Study

Abstract

Background. 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. Objective. 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. Methods. 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. 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. Conclusion. Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease.

Vitiligo: A comprehensive overview

“…Common side effects include erythema, pruritis, burning, and irritation 6,14,22,24,31 ; hyperpigmentation and acne are less frequent. [35][36][37] As a precautionary measure, the product label revisions approved by the US Food and Drug Administration (FDA) for topical CIs in January 2006 were based on a theoretical risk arising from the systemic use of CIs in transplant recipients and animal studies. This is a controversial issue, and data have yet to support the link between topical CIs and cancer.…”

Pimecrolimus Cream in Repigmentation of Vitiligo

“…During the last few years, there are many reports that show the effectiveness of topical immunomodulatory agents as monotherapy or in combination with other modalities both in children [11,12,13,14,15,16] and adults [2,17,18,19,20,21]. Based on these reports, we decided to evaluate the effectiveness of topical pimecrolimus 1% among a group of selected patients affected with vitiligo.…”

Vitiligo Management- An Update

“…In a randomized right-left comparison study with 14 patients, Excimer light monotherapy was compared with a combination of Excimer laser with topical tacrolimus. While 20% of lesions treated with Excimer laser alone achieved >75% repigmentation, the same degree of repigmentation was obtained in 70% lesions with the combination treatment 22 . Topical methoxsalen has also been used in combination with Excimer laser phototherapy and this has been claimed to have worked better than laser therapy alone 23 .…”

“…The laser system has been used with increasing frequency over the last few years for targeted treatment of individual vitiligo lesions 21 . The laser is used either alone or in combination with topical immunomodulator or PUVA-sol therapy 22,23 . Treatment with this laser is claimed to give extremely good and early results in both localized and segmental vitiligo.…”