Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04

    • atpase inhibitor br Introduction Vitiligo is an acquired dep

    2018-11-15


    Introduction Vitiligo is an acquired depigmentation disorder with challenging management. Usually, it takes several months or years for noticeable repigmentation. The therapeutic options depend on vitiligo type and disease severity. For localized vitiligo, topical corticosteroids remain the standard treatment. However, cutaneous side effects from long-term applications of corticosteroids, which included skin atrophy and telangiectasia, are of major concern. The use of topical tacrolimus, a topical calcineurin inhibitor, in vitiligo was first reported in 2002. It is an immunomodulator that affects activation and maturation of T cells, including enhancement of melanocyte atpase inhibitor and differentiation, which explain its effect on repigmentation of vitiligo. In the past 13 years, the efficacy of topical tacrolimus in the treatment of childhood and adult vitiligo has been reported. Mometasone furoate is a nonfluorinated Class IV corticosteroid with a good safety profile. It has a much greater vasoconstriction property than hydrocortisones, but similar adverse effects. Mometasone furoate 0.1% demonstrated excellent efficacy in the treatment of childhood vitiligo. For adult vitiligo, mometasone is generally prescribed by physicians; however, the data of its efficacy in vitiligo are still lacking. Herein, the authors reported the outcome of a comparison study using 0.1% tacrolimus ointment and 0.1% mometasone furoate cream for adult vitiligo vulgaris in terms of their efficacy and safety profiles.
    Methods This study was approved by the Ethical Committee on Research Involving Human Subjects of Siriraj Hospital, Mahidol University, Bangkok, Thailand. The ClinicalTrials.gov identifier is NCT01333410. Repigmentation outcome was assessed by two independent dermatologists, using blinded comparative photographs taken at baseline and 6 months. The improvement was graded as follows: no change, and 1–25%, 26–50%, 51–75%, and 76–100% repigmentation. Repigmentation above 50% is indicated as successful repigmentation.
    Results Eighteen participants completed the study. Two dropped out because of inconveniences in the follow-up schedule. Demographic data including those of age, gender, duration of vitiligo, treated location, underlying diseases, and repigmentation outcome are given in Table 1. In the tacrolimus group, successful repigmentation (> 50%) was demonstrated in 22%, with 11% achieving > 75% repigmentation, while ∼50% of cases showed 1–25% repigmentation. In the mometasone group, 33% of cases gained successful repigmentation, with 11% achieving > 75% repigmentation, while 33% of cases had 1–25% repigmentation. There was no statistically significant difference in the grading of repigmentation in both groups (p = 0.13); however, repigmentation of lesions on the mometasone-treated side was achieved earlier. At 2 months, repigmentation was seen in eight cases on the mometasone-treated side and in three cases on the tacrolimus-treated side (Figure 1). There was an agreement of grading improvement evaluated by two independent dermatologists using inter-rated reliability assessment. With respect to the location, a higher percentage of repigmentation in both groups was achieved on the neck, followed by on the trunk and extremities. At the end of the study, telangiectasia was found in six cases on the mometasone-treated sites, while no case of telangiectasia was observed on the tacrolimus-treated side (p = 0.03). No striae or skin atrophy was detected in both groups. Eight (44.4%) cases and five (27.7%) cases reported slight burning and stinging sensation on the tacrolimus- and mometasone-treated sides, respectively. However, both agents were well tolerated by these patients.
    Discussion Long-term treatment is usually required based upon the clinical course of vitiligo; the ideal topical agent should have good clinical efficacy with a better safety profile. Topical tacrolimus is a topical calcineurin inhibitor derived from the bacteria Streptomyces tsukubaensis. Since 2002, several studies have shown this agent to have promising results in vitiligo. The response rates vary between 63% and 89% depending on the type and location of vitiligo, with good results for face and neck lesions.