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

Abstract

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.

Trends in Regenerative Medicine: Repigmentation in Vitiligo Through Melanocyte Stem Cell Mobilization

“…These findings suggest that UV‐induced erythema is necessary to further stimulate melanocyte proliferation. This may explain the higher efficacy of NBUVB in inducing repigmentation versus PUVA (UVA requires 1000‐fold higher dose than UVB to induce erythema) or topical compounds (e.g., calcineurin inhibitors and vitamin D derivatives, which induce modest inflammation and have been shown to suppress melanocyte growth) …”

The Clonal Growth Behavior of Melanocytes Derived From Melanocyte Stem Cells in Glabrous Skin

“…These results suggest that MSCs and/or their immediate progenies, such as AMMCs, exist not only in the bulge region of HFs but also within the epidermis or dermis of glabrous skin [17][18][19][20]. These MSCs provide a new basis to understand the pathological changes caused by defects or dysfunction in stem cells, such as hair graying, vitiligo and melanoma [10,15,19].…”

“…That evidence comes from clinical studies of patients with vitiligo, who were given a series of treatments to stimulate re-pigmentation of the skin [18]. After those treatments, some tyrosinase-positive MCs were detected along the basement membrane in the previously de-pigmented palm skin.…”

Assessment of Dietary Supplementation in the Treatment of Vitiligo

“…These include topical medications such as corticosteroids or immunomodulators, phototherapy, oral medications, autologous melanocyte or epidermal transplant, surgery, and depigmentation [7]. While these therapies are important components in the treatment of vitiligo, the role of dietary modification and supplementation is often overlooked [1,8].…”