Therapeutic options in vitiligo with special emphasis on immunomodulators: A comprehensive update with review of literature

Abstract

Vitiligo is a relatively common disorder characterized by areas of depigmented skin. It may be associated with social stigma and adversely affects the quality of life. Although many treatment options are available, none is curable. The search continues for an effective therapeutic option. New targeted options include biologics and other immunomodulatory agents, with varying degrees of evidence. We have discussed briefly the therapeutic options with special emphasis on the newer immunomodulatory agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords (alone and in combination) and MeSH items such as “vitiligo,” “treatment,” “recent,” and “immunomodulators” to obtain several relevant articles, priority being given to prospective randomized controlled trials. We scanned all the relevant articles and summarized them to obtain the latest information about the treatment of this condition to prepare the current article.

Updates and new medical treatments for vitiligo (Review)

“…The 5-FU group also presented a faster response to repigmentation (53). The side effects of 5-FU are hyperpigmentation, scarring, infection, ulceration and delayed wound healing (47,53).…”

“…A study performed by Alshiyab et al (46), comparing the efficacy of tacrolimus 0.1% ointment to tacrolimus 0.1% ointment plus topical pseudocatalase/superoxide dismutase gel in the treatment of children with localized vitiligo, demonstrated that there was no significant difference in repigmentation percentages between the two groups. However, information on side effects and safety of pseudocatalase is lacking (47). Current data are not in favor of an additional effect of topical catalase compared with UVB alone (45).…”

“…Azathioprine. Azathioprine is an immunosuppressant that inhibits DNA synthesis in immune effector cells (47). There is a study of its use in vitiligo performed by Madarkar et al (94), comparing azathioprine 50 mg twice daily to betamethasone 5 mg on 2 consecutive days every week for 6 months.…”

“…In a meta-analysis, Chang et al (110) evaluated the efficacy of combining nb-UVB with fractional CO 2 laser, but no additional benefit in repigmentation was observed. The adverse reactions of nb-UVB include burning, erythema, pruritus, xerosis, photoaging and photodamage (47).…”

Therapeutic options and hot topics in vitiligo with special focus on pediatrics' vitiligo: A comprehensive review study

“…TCIs are also used in the first line for treatment and are generally applied twice daily 3 . Tacrolimus (0.3% or 0.1%) and pimecrolimus (1%) are used as off‐label drugs for vitiligo 5 . A study was performed on 30 patients aged 7 to 16 years to find out whether there is a connection between vitiligo and decreased levels of 25‐hydroxyvitaminD 14 .…”