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More Evidence That Combined Tacrolimus and Narrowband UVB Are Useful for Vitiligo
Combined treatment was better than ultraviolet treatment alone, and the effects were tacrolimus dose-dependent.
With few therapeutic options, vitiligo can be frustrating for both patients and physicians. Narrowband ultraviolet B (UVB) phototherapy and tacrolimus ointment have each been shown effective in some patients. These investigators evaluated a combination of both treatments in a double-blind trial in 46 patients with stable, symmetrical vitiligo. All subjects received total-body narrowband UVB two or three times per week (mean number of phototherapy treatments, 46; range, 17–68). Subjects were instructed to apply a formulation containing tacrolimus ointment 0.1% once daily to lesions on one side of the body and a formulation containing vehicle alone to the other side (average number of topical treatments, 148; range, 33–221).
The target lesion area was reduced a median of 42.1% on the tacrolimus side and 29.0% on the vehicle side, a statistically significant difference (P=0.005). Nine of the 40 patients who completed the trial were considered to be high responders, 19 were low responders, and 12 were nonresponders to the combined regimen. The reduction in target lesion area correlated with the number of tacrolimus applications but not with the number of narrowband UVB treatments. Treatment response did not correlate with Fitzpatrick sun-reactive skin type. Participants were followed for 3 months after therapy completion. No major relapses were observed in this period, and no phototoxic reactions occurred.
Comment: This large, systematic trial supports previous findings of efficacy with combined narrowband ultraviolet B and calcineurin inhibitors for vitiligo. Theoretical concerns about the long-term effects of this treatment and the possibility of increased skin cancer incidence may be somewhat allayed by observations that vitiligo patients seem to be resistant to nonmelanoma skin cancers. No evidence to date has demonstrated increased susceptibility to skin cancer in calcineurin inhibitor recipients. Nevertheless, this combination should probably be reserved for patients with vitiligo who fail to benefit from other forms of therapy.
Dr. Elmets has served on a Data Safety Monitoring Board for a manufacturer of topical tacrolimus regarding its safety in patients with atopic dermatitis.
Published in Journal Watch Dermatology January 6, 2012
Citation(s):
Nordal EJ et al. Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study. J Eur Acad Dermatol Venereol 2011 Dec; 25:1440.
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