Treatment of Generalised Vitiligo with Tacrolimus 0.1% Ointment vs. UVB Intense Pulsed Light Phototherapy: A Pilot Study

Thus far, several small studies and case reports on the use of topical immunomodulators in vitiligo have been published. We undertook a comprehensive literature review, searching for studies evaluating clinical response to tacrolimus topical therapy for vitiligo. A search was performed on PubMed/Medline using the term “vitiligo”, combined with “topical” and “ointment”. Our inclusion criteria were: use of tacrolimus ointment as monotherapy to treat vitiligo. We found 29 studies from 2002 to 2014. Overall, 709 patients were treated in 29 studies. Pooling the lesions, 50% repigmentation of vitiligo patches was never achieved before 2 months of treatment, with a peak after 6 months of therapy. The best results were obtained on lesions of the cephalic region, especially the face, with tacrolimus 0.1% ointment two times daily. The percentage of non-responsive patients ranged from 0% to 14%. Treatment was generally well-tolerated; only localized adverse effects were reported. Our objective was to verify the effectiveness and safety of tacrolimus ointment monotherapy. It has good efficacy and tolerability. At present, only small trials and case series are available in the literature. Further, standardized investigations on a larger number of patients are needed.

show abstract

“…The best results were obtained on lesions in the cephalic regions, especially the face, applying tacrolimus ointment twice daily. 14 - 16 …”

Section: Resultsmentioning

confidence: 99%

“…Only Kathuria et al reported unsatisfactory results and limitations to the drug, with 50% repigmentation after 6 months of therapy in 5.3% of patients. 17 …”

Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of topical tacrolimus monotherapy for repigmentation in vitiligo: a comprehensive literature review

Sisti

Oranges

2016

An. Bras. Dermatol.

View full text Add to dashboard Cite

show abstract

“…FK506 is known to have clinical effects in patients with hypopigmentation disorders, such as vitiligo (Grimes et al., ). However, a single FK506 treatment is not sufficient to confer melanogenic effects; thus, patients with vitiligo are often treated with FK506 in combination with phototherapy (Hartmann et al., ). Accordingly, we investigated the effect of UVB irradiation on FK506‐treated melanocytes.…”

Section: Resultsmentioning

confidence: 99%

“…UV irradiation is known to: enhance the formation of dendrites from melanocytes (Cardinali et al., ); increase the transfer of melanosomes to keratinocytes by upregulating PAR‐2 in the skin epidermis (Scott et al., ); and stimulate melanocytes, thereby enhancing the secretion of cytokines from keratinocytes (Yoshizumi et al., ). Meanwhile, FK506‐induced repigmentation in patients with vitiligo tends to be more successful for the face/neck region than the trunk (Hartmann et al., ), and more rapid/effective when combined with phototherapy (Passeron et al., ). Thus, we speculated that FK506 treatment and UV irradiation might have synergistic effects.…”

Section: Discussionmentioning

confidence: 99%

FK506 regulates pigmentation by maturing the melanosome and facilitating their transfer to keratinocytes

Jung

Chung

Chang

et al. 2016

Pigment Cell Melanoma Res

View full text Add to dashboard Cite

Summary Despite the clinical ability of topical tacrolimus (FK506) to effectively promote repigmentation in vitiligo, the underlying mechanism through which FK506 regulates melanogenesis was previously unclear. We found that FK506 treatment increased the melanin contents (especially that of eumelanin) in both melanocytes and melanoma cells. This treatment did not affect the transcription levels of tyrosinase, suggesting that FK506 increases melanin synthesis by regulating cellular levels of tyrosinase. Interestingly, FK506 promoted melanosome maturation by increasing melanosomal pH (a marker of melanosome maturation), thereby enhancing the stability of melanosome‐localized tyrosinase. In addition, FK506 enhanced UVB‐mediated melanosome secretion, the uptake of melanosomes by HaCaT cells, and the transfer of melanosomes to keratinocytes co‐cultured with melanocytes. Together, these findings suggest that FK506 contributes to melanin synthesis by regulating the maturation of melanosomes and their transfer to keratinocytes. This offers a novel regulatory mechanism through which FK506 and UVB can have a combined effect on melanogenesis.

show abstract

“…However, the long-term safety of these steroid-sparing agents is unknown. Topical tacrolimus is commonly used to help with repigmentation in vitiligo [2][3][4][5]. The mechanism of how calcineurin inhibitors encourage pigmentation is not well understood.…”

Section: Introductionmentioning

confidence: 99%

Multiple labial melanotic macules occurring after topical application of calcineurin inhibitors

Shi

Joo²,

Sharon

2014

Dermatology Online Journal

View full text Add to dashboard Cite

Topical calcineurin inhibitors are widely used to treat inflammatory dermatoses for their steroid-sparing advantage. Herein, we report a patient with chronic lip dermatitis who developed multiple labial melanotic macules after application of tacrolimus 0.1% ointment and pimecrolimus 1% cream. Prior and current reports raise concerns for potential development of pigmented lesions associated with topical calcineurin inhibitor use. These reports highlight the need for careful risk-benefit assessment when prescribing topical calcineurin inhibitors for inflammatory dermatoses, especially when used on sun-exposed sites.

show abstract

Treatment of Generalised Vitiligo with Tacrolimus 0.1% Ointment vs. UVB Intense Pulsed Light Phototherapy: A Pilot Study

Cited by 9 publications

References 13 publications

Effectiveness and safety of topical tacrolimus monotherapy for repigmentation in vitiligo: a comprehensive literature review

Effectiveness and safety of topical tacrolimus monotherapy for repigmentation in vitiligo: a comprehensive literature review

FK506 regulates pigmentation by maturing the melanosome and facilitating their transfer to keratinocytes

Multiple labial melanotic macules occurring after topical application of calcineurin inhibitors

Contact Info

Product

Resources

About