An alternative pathway of vitamin D3 activation is the biologically active metabolites produced by the action of cytochrome P450 family 11 subfamily A member 1 (CYP11A1) (34-37). The side effects were upper respiratory infections, weight gain, arthralgia and mild elevation of lipid levels (61). Autoreactive cytotoxic CD8+ T cells engage melanocytes and promote disease progression through the local production of IFN-, and IFN- . The patients could use topical tacrolimus on the exposed parts of the body. Bhatnagar et al (113) compared treatment for induction of stability with nb-UVB or PUVA; vitiligo was arrested in 80% of patients using nb-UVB and only 40% of patients with PUVA. JOC, DEKL, NAZS, SLSF, CNSD, MASS, HGMR, OTVM, UW and TL critically revised the manuscript for important intellectual content. New lesions developed during treatment in 23% of patients in the MTX group and 28% of patients in the corticosteroid group (92). Rodrguez-Martn M, Garca Bustnduy M, Sez Rodrguez M, Noda Cabrera A. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. The feasibility of local vitiligo treatment, however, depends on the vitiligo disease extent. Cyclosporine in treatment of progressive vitiligo: An open-label, single-arm interventional study. Aranow C. Vitamin D and the immune system. In addition, inhibition of IFN- production decreases the expression of major histocompatibility complex II and inhibition of activated T cell (83-86). Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: The Vitiligo Area Scoring Index. Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast-spreading disease. Taieb A, Alomar A, Bhm M, Dell'anna ML, De Pase A, Eleftheriadou V, Ezzedine K, Gauthier Y, Gawkrodger DJ, Jouary T, et al. A pilot study was performed by Mutalik et al (97) in patients with localized stable vitiligo treated with autologous nonculture melanocyte-keratinocyte cell transplant (NCMKT). Treatment of vitiligo aims to prevent the spread of disease and facilitate repigmentation of affected lesions. The site is secure. Other treatment options are 4-methoxyphenol, 88% phenol solution, laser and cryotherapy (121). When beneficial effects are observed, treatment can be prolonged according to results (18). Another hypothesis is the melanocytorrhagy theory, which proposes that defective cell adhesion leads to detachment and transepidermal loss of melanocytes with exposure of autoantigens and activation of the immune system leading to melanocyte injury (3). The dosage of MTX varied from 7.5-25.0 mg weekly, along with folic acid supplementation. Order by 10pm (subject to change during promotions), available 7 days a week for 4.95. There was a lot of excitement around this approach when we published our paper about a year and a half ago in the summer of 2018 (read about it here ), especially from me! The disorder affects approximately 0.5-2% of adults and children globally and presents with amelanotic, milky white, and well-demarcated macules or patches surrounded by normal skin ( 2 ). Jos Eleuterio Gonzlez, Universidad Autnoma de Nuevo Len, Monterrey, Nuevo Len 64460, Mxico, 3Department of Research, Faculty of Medicine Saltillo Unit, Universidad Autnoma de Coahuila, Saltillo 25000, Mxico, 4Department of Dermatology and Allergology and Skin Cancer Center, Stdtisches Klinikum Dresden, D-01067 Dresden, Germany, 5Department of Dermatology and Venereology, University of Rome G. Marconi, I-00193 Rome, Italy, 6Department of Dermatology and Communicable Diseases, First Medical State University of Moscow I. M. Sechenev Ministry of Health, Moscow 119991, Russia. Topical corticosteroids (TCS), either potent (betamethasone valerate) or very potent (clobetasol propionate), are considered first-line therapy for vitiligo (19,20). The side effects of JAK inhibitors include erythema, pruritus, hyperpigmentation and transient acne (63,64). Both groups applied tacrolimus daily, but the combination group also received microneedling and tacrolimus application every 2 weeks for up to 12 sessions. Oral prednisolone was given the first 2 months at 0.3 mg/kg of body weight, the third month at half of the initial dose, and the fourth month at half of the previous dose. The UK is the first country to allow OTC access to Sanofi's tadalafil-based erectile dysfunction drug Cialis following a successful switch. bFGF effect in vitiligo is through melanocyte migration (59). First, microneedling with a Dermapen at the lowest speed and a depth of 0.25-0.50 mm according to the area was performed, then one patch was treated with a solution of 5-FU (50 mg/ml) and the other with tacrolimus 0.03% ointment. Lotti T, Wollina U, Tchernev G, Valle Y, Lotti J, Frana K, Satolli F, Rovesti M, Tirant M, Lozev I, et al. Given the contrast between the white patches and areas of normal skin, the . Mohamed HA, Mohammed GF, Gomaa AH, Eyada MM. This treatment, considered a second-line therapy, requires topical application or ingestion of psoralen and exposure to UVA (18). Huff SB, Gottwald LD. Notably, patients were allowed concomitant use of TCS, TCI, supplements, or phototherapy during the study. Depigmentation tends to be permanent and can take more than a year to complete. The side effects of TCI include burning sensation, pruritus and increased susceptibility to infection (herpes simplex and molluscum contagiosum) (24). The response to treatment should be assessed after 18-36 sessions and because of the existence of slow responders, at least 72 sessions are recommended before discontinuing therapy (103). It can also affect the eyes, the. Azathioprine is an immunosuppressant that inhibits DNA synthesis in immune effector cells (47). Statins also exert antioxidant properties by upregulating the transcription factor nuclear erythroid 2-related factor, resulting in a reduction of reactive oxygen species and activation of the antioxidant response in melanocytes (83). Patients were classified into four different groups of ruxolitinib: 1.5% twice daily, 1.5% once daily, 0.5% once daily and 0.15% once daily. Immediately after obtaining columnar areas of epidermal ablation, they applied latanoprost 0.005% solution onto each skin lesion. Iraji F, Banihashemi SH, Faghihi G, Shahmoradi Z, Tajmirriahi N, Jazi SB. Shi Q, Li K, Fu J, Wang Y, Ma C, Li Q, Li C, Gao T. Comparison of the 308-nm excimer laser with the 308-nm excimer lamp in the treatment of vitiligo-a randomized bilateral comparison study. To increase the probability of a therapeutic response when TCS is used as monotherapy, very potent TCS may be preferred (17). Bakis-Petsoglou S, Le Guay JL, Wittal R. A randomized, double-blinded, placebo-controlled trial of pseudocatalase cream and narrowband ultraviolet B in the treatment of vitiligo. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE, Group VW. Photoprotective properties of Vitamin D and lumisterol hydroxyderivatives. Monobenzyl ether of hydroquinone (MBEH) 10% is applied topically daily the first month, then MBEH 20% is applied daily for 1 month, and after that twice daily. 1 The peak occurrence is between 1st and 3rd decade of life; however, it can appear anytime . To evaluate this, Parsad and Kanwar (79) performed a study on 32 patients with gradually progressive vitiligo. Methylprednisolone was intravenously administered for 3 consecutive days at a dose of 8 mg/kg of body weight. Liu LY, Strassner JP, Refat MA, Harris JE, King BA. Cyclosporine is a calcineurin inhibitor with immunomodulatory action. Microneedling in combination with topical treatment was repeated every 2 weeks for a maximum of 12 sessions. After 24 h, the skin lesions were irradiated with a UVA1 laser (355 nm) for 20 min. Finally, the convergence theory states that a combination of several pathways is necessary for the development of vitiligo, such as genetic background, susceptibility to environmental changes, altered epidermal microenvironment, an intrinsic melanocyte defect and an autoimmune response (13,14). Bae JM, Hong BY, Lee JH, Lee JH, Kim GM. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Imamura and Tagami (68) performed a study on 17 patients with generalized vitiligo and five patients with localized vitiligo. Latanoprost 0.005% gel was applied twice daily for 12 weeks and was compared with placebo. Apremilast is approved for the treatment of moderate to severe plaque psoriasis (73). Topical PUVA uses the psoralen as a cream or ointment (8-methoxypsoralen 0.001%) and is applied 30 min before UVA radiation. Inclusion in an NLM database does not imply endorsement of, or agreement with, The combination group achieved moderate to excellent response (50% repigmentation) in 65.7% of lesions compared with monotherapy with tacrolimus in 25.8% of lesions (31). 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. However, due to the promising preliminary results, these are also mentioned in the present review. All therapies for vitiligo are limited, no known treatment can consistently produce repigmentation in all patients. The most frequent local side effect is atrophy, which depends on diverse factors, including age, site of application, the potency of the TCS and the presence of occlusion. The bFGF group reported >75% repigmentation in 45% of patients, 50-75% repigmentation in 35 and <50% repigmentation in 20%, compared with 0, 7 and 13%, respectively, in the betamethasone group. HHS Vulnerability Disclosure, Help In each patient, three lesions of similar size were chosen. The extent of repigmentation was 76-99% in 15.0% of patients, 51-75% in 7.5% of patients, 26-50% in 25.0% of patients, 10-25% in 17.5% of patients and <10% in 35.0% of patients (70). Using the same scheme, Banerjee et al (69) observed arrest in 90% of patients and repigmentation in 76% of patients with active vitiligo. JOC, DEKL, NAZS, SLSF, CNSD, MASS, HGMR and OTVM drafted the initial manuscript. Liu et al (61) reported a case series of 10 patients treated with tofacitinib 5-10 mg, once or twice daily for at least 3 months. No side effects were reported. During the study, suction blister sampling was performed on responding and nonresponding areas, revealing an inhibition of the autoimmune response in both. In an uncontrolled pilot study by Alghamdi and Khurrum (89), no clinical improvement was observed with MTX 25 mg weekly for 6 months. Both groups applied their respective drug daily for 16 weeks. Vitiligo treatment can sometimes be frustrating due to the inconsistency in clinical improvement and its relapsing feature. Nguyen S, Chuah SY, Fontas E, Khemis A, Jhingan A, Thng STG, Passeron T. Atorvastatin in combination with narrowband UV-B in adult patients with active vitiligo: A randomized clinical trial. The first group received azathioprine calculated at 0.60-0.75 mg/kg per day (maximum dosage 50 mg) combined with twice-weekly oral psoralen (methoxypsoralen 0.3-0.4 mg/kg) plus UVA. Kamala Subhashini P, Sankar K, Chandrakala K, Venkataramana V. Comparative study of efficacy and safety of topical active fragment of basic fibroblast growth factor (B FGF) 0.1% solution V/S betamethasone valerate 0.1% ointment in the treatment of vitiligo patients. The latter is considered the most important positive regulator (5,9,10). Bhatnagar A, Kanwar AJ, Parsad D, De D. Psoralen and ultraviolet A and narrow-band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score: An open prospective comparative study. Chang HC, Hsu YP, Huang YC. The range of repigmentation in the combined treatment was 0-70%, with <25% repigmentation in 73.3 and 50-75% repigmentation in 10% of patients; the range of repigmentation in the monotherapy group was 0-5% (49). Progression of vitiligo was arrested in 61% of the patients and repigmentation was observed in 81% of the patients (96). Corticosteroid holidays which are weeks without TCS, along with tapering from high to mild potency can be used to minimize side effects (24). Bishnoi A, Vinay K, Kumaran MS, Parsad D. Slominski AT, Zmijewski MA, Plonka PM, Szaflarski JP, Paus R. How UV light touches the brain and endocrine system through skin, and Why. Effect of narrow band ultraviolet B phototherapy as monotherapy or combination therapy for vitiligo: A Meta-analysis. Innervation of melanocytes in human skin. The results were halt in active disease in 89% of patients with 5 mg dose after 1-3 months and repigmentation was observed in 80% of patients after 2-4 months of treatment. Radakovic-Fijan S, Frnsinn-Friedl AM, Hnigsmann H, Tanew A. Before Calcineurin inhibitors are immunomodulators and an off-label treatment for vitiligo (24). The results demonstrated that cortisol levels were abnormal in 29% of patients, and the potential risks associated were lesions located in the head and neck (25). The most common side effects in the MM group were nausea and diarrhea. Addition of oral minipulse dexamethasone to narrowband ultraviolet B phototherapy and topical steroids helps arrest disease activity in patients with vitiligo. Ebrahim et al (30) performed a study comparing the application of tacrolimus 0.1% alone or in combination with microneedling (fine needles to create micro-holes in the skin) in patients with localized stable vitiligo. Tsuji T, Hamada T. Topically administered fluorouracil in vitiligo. Nageswaramma S, Vani T, Indira N. Efficacy of methotrexate in vitiligo. TCIs, such as tacrolimus (0.03 or 0.1%) and pimecrolimus (1%) are recommended for the head and neck areas as they have less side effects, mainly the lack of atrophy risk (18,21). Pasricha JS, Khaitan BK. Passeron T. Medical and maintenance treatments for vitiligo. Vitiligo is an acquired chronic disease of depigmented white macules and patches that result from destruction of melanocytes in the affected skin. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Kobner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Oral minocycline in the treatment of vitiligo-a preliminary study. Madarkar M, Ankad B, Manjula R. Comparative study of safety and efficacy of oral betamethasone pulse therapy and azathioprine in vitiligo. In vitiligo, sometimes long treatments are required (24). Melanocytes are found in several tissues in the skin, hair follicles, eyes, inner ear, bones, heart and brain (4). Findings In this systematic review and meta-analysis that included 117 unique studies and 8776 unique patients, the rates of repigmentation above 90% and above 50% after a single session of all surgical interventions were 52.69% and 81.01%, respectively. A recent phase 2 study by Rosmarin et al (64) evaluated the efficacy and safety of ruxolitinib cream at three different concentrations (0.15, 0.5 and 1.5%) compared with placebo, for up to 52 weeks. Several schemes for SCS have been reported. Chiavrini C, Passeron T, Ortonne JP. Nol M, Gagn C, Bergeron J, Jobin J, Poirier P. Positive pleiotropic effects of HMG-CoA reductase inhibitor on vitiligo. Faria AR, Tarl RG, Dellatorre G, Mira MT, Castro CC. In the latter group, most patients (52%) achieved 25-50% repigmentation. MTX is commonly used for multiple inflammatory and autoimmune diseases (89). Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation. Endogenously produced nonclassical vitamin D hydroxy-metabolites act as biased agonists on VDR and inverse agonists on ROR and ROR. Naini FF, Shooshtari AV, Ebrahimi B, Molaei R. The effect of pseudocatalase/superoxide dismutase in the treatment of vitiligo: A pilot study. Depigmentation may occur on the face, neck, and scalp, and around body openings such as the mouth and genitals, as well. Both groups were followed for 4 months. Singh A, Kanwar AJ, Parsad D, Mahajan R. Randomized controlled study to evaluate the effectiveness of dexamethasone oral minipulse therapy versus oral minocycline in patients with active vitiligo vulgaris. Lim et al (109) performed a randomized control trial of nb-UVB alone compared to afamelanotide 16 mg subcutaneously applied monthly for 4 months along with nb-UVB. Psoralen photochemotherapy for vitiligo. One lesion was treated with tacrolimus 0.03% daily, another with a combination of monthly microdermabrasion (light abrasion of the skin) and daily tacrolimus 0.03%, and the last was treated with placebo. They function by inhibiting calcineurin, a pro-inflammatory protein in lymphocytes and dendritic cells that induces the transcription of interleukin (IL)-2 and tumor necrosis factor- (TNF-) (27). The results were moderate repigmentation in 70% of patients and arrest in progression in 90% of patients. The side effects of EL are pruritus, burning sensation and dryness (118). A comparison of betamethasone valerate 0.1% cream twice daily plus oral simvastatin versus betamethasone valerate 0.1% Cream alone in the treatment of vitiligo patients. SCS is administrated to treat rapidly progressive active vitiligo (18). Repigmentation was observed in 60 and 50% of the patients in the bimatoprost and tacrolimus groups, respectively. Is melanocyte loss a melanocytorrhagy? In a meta-analysis, Njoo et al (20) reported the effectiveness of TCS in localized vitiligo, measured as the percentage achieving 75% repigmentation, which was comparable with potent (56%) and very potent (55%) TCS. The efficacy of TCI as monotherapy in a systemic review and meta-analysis by Lee et al (28), demonstrated 25% repigmentation in 55%, 50% repigmentation in 38.5%, and 75% repigmentation in 18.1% of patients. Marked repigmentation (50-75%) was achieved in 6.7% of patients in the calcipotriol, 13.3% in the betamethasone and 26.7% in the combination groups, respectively. People who have the condition can now request Opzelura from a board-certified dermatologist. Tofacitinib citrate for the treatment of vitiligo: A pathogenesis-directed therapy. 1 INTRODUCTION. Data sharing is not applicable. The side effects of MTX are hepatotoxicity, idiosyncratic pulmonary toxicity, pancytopenia, nausea, vomiting and diarrhea (24). Slominski A, Tobin DJ, Shibahara S, Wortsman J. Melanin pigmentation in mammalian skin and its hormonal regulation. The side effects of PF2A are minimal and periorbital hyperpigmentation is infrequent (24). The primary objective of this trial is to determine the efficacy of interleukin-15 (IL-15) inhibition with AMG 714 at inducing facial repigmentation in vitiligo. The results demonstrated a significant decrease in disease extension in group C compared with the other groups (93). This causes your skin to appear lighter than your natural skin tone or turn white. Abdelwahab et al (49) performed a study to assess the effect of 5-FU in monotherapy compared with its combination with ablative erbium: YAG (2,940 nm) laser in non-segmental vitiligo. Treatment of ocular hypertension with prostaglandin F2 alpha analogs (PF2A) is common (55). Question What are the treatment outcomes and adverse effects of surgical interventions for patients with vitiligo?. Treatment of vitiligo by topical calcipotriol. Efficacy of PUVA phototherapy reported by Bae et al (104) in a systematic review and meta-analysis was 25% repigmentation in 51.4% of patients at 6 months and 61.6% of patients at 12 months; 75% repigmentation in 8.5% of patients at 6 months and 13.6% of patients at 1 year (104). Another prospective comparative trial by Siadat et al (82) compared minocycline 100 mg daily to nb-UVB phototherapy in patients with unstable vitiligo during 3 months of treatment. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. The side effects of azathioprine include myelosuppression, hepatotoxicity, gastric irritation, increased susceptibility to infections (herpes simplex and human papillomavirus) and hypersensitivity syndrome (24). However, information on side effects and safety of pseudocatalase is lacking (47). Vanderweil SG, Amano S, Ko WC, Richmond JM, Kelley M, Senna MM, Pearson A, Chowdary S, Hartigan C, Barton B, Harris JE. Lotti T, Agarwal K, Podder I, Satolli F, Kassir M, Schwartz RA, Wollina U, Grabbe S, Navarini AA, Mueller SM, Goldust M. Safety of the current drug treatments for vitiligo. The treatment was repeated every 21 days, for 9 months. Shah B, Godse K, Mahajan S, Grandhi S, Shendkar S, Sharma A, Teli C, Pathak R, Parsad D. Efficacy and safety of basic fibroblast growth factor (bFGF) related decapeptide solution plus Tacrolimus 0.1% ointment versus Tacrolimus 0.1% ointment in the treatment of stable vitiligo. Symptoms of ED include. Radmanesh M, Saedi K. The efficacy of combined PUVA and low-dose azathioprine for early and enhanced repigmentation in vitiligo patients. Both treatments were applied daily. Ultraviolet radiation, more markedly UVB (wavelength of 280-320 nm) than UVA (wavelength of 320-400 nm), has several systemic effects, such as activation of the central hypothalamic-pituitary-adrenal axis, activation of the proopiomelanocortin pathway in the arcuate nucleus of the hypothalamus, immunosuppressor and opioidogenic effects (99-101). Both groups had a similar reduction in the VIDA score at the end of the study. TCI can be applied twice daily for a minimum of 6 months. The .gov means its official. JAK inhibitors are not only topically used. Ruxolitinib 1.5% cream was applied twice daily for 20 weeks in up to 10% of the body surface area or 3.75 g per application. Topical immunosuppressants may be an alternative to steroids in localized vitiligo. The side effects of minocycline are nausea, gastrointestinal complaint, headache, and hyperpigmentation of the nails, oral mucosa or skin (80,82). Vitiligo is an autoimmune disease of the skin that targets pigment-producing melanocytes and results in patches of depigmentation that are visible as white spots. The etiology of vitiligo is unknown but there are different theories to explain its pathogenesis. Excimer light (wavelength of 308 nm) in excimer lamps and EL are useful for targeted phototherapy (116). 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. Skobowiat C, Postlethwaite AE, Slominski AT. ED is often a symptom of another health problem or health-related factor. The disease has no prominent sex predilection. Wu CS, Lan CC, Wang LF, Chen GS, Yu HS. 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