Comparison of the efficacy of 308‐nm excimer lamp monotherapy with topical tacrolimus or clobetasol 17‐propionate combination therapies in localized vitiligo

Erduran, Funda; Adışen, Esra

doi:10.1111/phpp.12266

Cited by 12 publications

(34 citation statements)

References 27 publications

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“…However, 5 of them were excluded because 2 used other topical agents rather than tacrolimus, two provided data that were unavailable for analysis, and one was a single-arm trial. Finally, 11 studies [14,[24][25][26][27][28][29][30][31][32][33] that met the inclusion criteria were included in this meta-analysis (Fig. 1).…”

Section: Selection Of Studiesmentioning

confidence: 99%

“…The baseline characteristics of the included studies are presented in Table 1. Among the included studies, 8 were performed with RCT design (including 5 intra-individual study) [24,25,27,[29][30][31][32][33], and 3 were comparative studies [14,26,28]. Three studies were conducted in India [26,29,31], two in Pakistan [24,25], and Italy [14,33], respectively, and each one in France [27], Turkey [28], and Thailand [30].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Among the included studies, 8 were performed with RCT design (including 5 intra-individual study) [24,25,27,[29][30][31][32][33], and 3 were comparative studies [14,26,28]. Three studies were conducted in India [26,29,31], two in Pakistan [24,25], and Italy [14,33], respectively, and each one in France [27], Turkey [28], and Thailand [30]. The sample size ranged greatly, which ranged from 8 to 159, with a total of 588 patients.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis

et al. 2020

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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.

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Section: Selection Of Studiesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis

et al. 2020

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“…also has propagated topical tacrolimus or topical clobetasol-17 propionate ointment enhance the efficacy of excimer laser [16]. As a summary, there is big gap for to discuss which topical choice has better results.…”

Section: Laser Treatments Approach In Vitiligo Patients 21 Excimer Lmentioning

confidence: 99%

Lasers in the Treatment of Vitiligo

Turan¹

2019

Depigmentation

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Vitiligo is an acquired cutaneous hypopigmentary disorder characterized by multiple depigmented macules and patches. There are numerous therapy modalities consist of topical corticosteroids and calcineurin inhibitors, phototherapy, surgical interventions and laser treatments are evaluated. Last 10 years, firstly excimer laser treatment has showed good results in repigmentation rates. "Excited dimers" produces a 308-nm ultraviolet (UV) monochromatic coherent wavelength, which lies within the UVB spectrum that absorb DNA as a chromophore to breakage DNA chain that causes a decrease in T-lymphocyte proliferation. Some articles have shown different responses depends on the type of vitiligo, number of sessions, interval periods and localisation. Researchers have also compared efficacy and also side effects of excimer laser between other methods. Combination therapies with excimer laser will be also treatment of choice via topical steroids or topical calcineurin inhibitors. Some of the patients developed delayed-onset permanent hypopigmentation need resurfacing methods such as CO 2 or Er:YAG laser which mainly aims to ablate the epidermis in specific coagulation columns to promote the penetration of externally applied agent. As an alternative treatment modality in vitiligo, lasers may help to raise patient compliance and reduce potential risk for skin cancer. Its convenience is limited by high cost and accessibility.

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“…It has previously proven its efficacy in vitiligo in association with UVA [ 6 ]. The combination therapy has become the first-line treatment of vitiligo and many reports have proved the efficacy of 308-nm excimer light in association with other kinds of drugs [ 7 – 10 ]. So, we evaluate in this study the safety and efficacy of 308-nm excimer lamp (EL) and topical khellin in the treatment of recalcitrant localized vitiligo.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Refractory Vitiligo with a Combination of Khellin and 308-nm Excimer Lamp: An Open-Label, 1-Year Prospective Study

Fenniche

Zaouak

Tanfous

et al. 2017

Dermatol Ther (Heidelb)

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IntroductionPhototherapy is the cornerstone of treatment of vitiligo. The 308-nm excimer lamp (EL) induces T cell apoptosis and the stimulation of melanocyte proliferation. Khellin is a furanochromone with a chemical structure close to psoralens. The objective of the study was to evaluate the safety and efficacy of 1-year treatment of recalcitrant vitiligo with a combination of 308-nm EL and khellin.MethodsTwenty patients with resistant vitiligo were included. Khellin was applied 45 min before irradiation with EL, twice a week, at a dose of 250 mJ/cm2. The repigmentation was assessed in four categories: excellent repigmentation (ER) (> 75% repigmentation), good repigmentation (GR) (50–75% repigmentation), moderate repigmentation (MR) (25–50% repigmentation), and poor repigmentation (PR) (< 25% repigmentation).ResultsAn ER was observed in 45% of patients (9/20), 5/20 (25%) achieved a GR, 3/20 (15%) an MR, and 3/20 (15%) a PR. Better response was observed on the face, neck, upper limb, hands, and abdomen. The mean number of procedures was 54.1 and the mean cumulative dose was 2967.5 mJ/cm2. Six months after the last session no recurrences were observed.ConclusionThe combination of 308-nm EL and khellin is a safe and effective treatment and represents a new alternative therapy for vitiligo. Further comparative controlled randomized investigations are needed to confirm these promising results with the appropriate therapeutic protocols.

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Comparison of the efficacy of 308‐nm excimer lamp monotherapy with topical tacrolimus or clobetasol 17‐propionate combination therapies in localized vitiligo

Abstract: We noted that 308-nm excimer lamp therapy was efficacious; adding topical tacrolimus or topical clobetasol-17 propionate could increase response to treatment.

Cited by 12 publications

References 27 publications

The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis

The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis

Lasers in the Treatment of Vitiligo

Successful Treatment of Refractory Vitiligo with a Combination of Khellin and 308-nm Excimer Lamp: An Open-Label, 1-Year Prospective Study

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