Efficacy and safety of topical tacrolimus for the treatment of face and neck vitiligo

Abstract

Vitiligo is a common acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. The conventional treatments are limited by their inconsistent and incomplete responses, relapse rate, inconvenience to apply, side-effects and especially long-term effects. The aim of the present study was to determine the efficacy and safety of topical tacrolimus as monotherapy for the treatment of face/neck vitiligo in Taiwan. This was a multicenter, open-label, non-comparative study. Patients were at least 16 years old and had vitiligo lesions with Vitiligo Index of Disease Activity score +1 or more on face or neck. Patients received a monotherapy with 0.1% of tacrolimus ointment twice daily for 12 weeks. The efficacy was measured by the percentage of repigmentation of target lesion, which was graded as minimal (1-25%), mild (26-50%), moderate (51-75%) or excellent (76-100%). Patients who had at least mild repigmentation were defined as responders. A total of 61 patients were enrolled in this investigation. Most of the patients showed repigmentation at week 4. At the end of treatment, all patients showed repigmentation and 45.9% of patients were responders. During the study, 15 adverse events related to the ointment were reported. All the reported adverse events were mild and similar to the well-known adverse effect of tacrolimus in the treatment of atopic dermatitis. Tacrolimus ointment is effective and well tolerated for the treatment of patients with vitiligo in Taiwan. It will be another drug of choice for persons with vitiligo who are unable to receive regular phototherapy and fear the side-effects of topical steroid in long-term use.

Vitamin D status and the effects of oral vitamin D treatment in children with vitiligo: A prospective study

“…There are several medical options available for the treatment of vitiligo and their levels of success are variable. Topical tacrolimus, which is a calcineurin inhibitor, inhibits T lymphocyte activation and recommended as a treatment before considering other modalities, since tacrolimus ointment does not cause the atrophy, telangiectasia, or adverse potential ocular effects of topical corticosteroids [12,13].…”

Hyperpigmentation in photo exposed patches of vitiligo following tacrolimus therapy

“…[2] Tacrolimus is an immunomodulator which has the ability to interfere with multiple immune as well as inflammatory pathways, and this may explain its effect on vitiligo. [3] Tacrolimus exerts its biological activity after binding to the cytosolic 12-kd macrophilin FK506 binding protein (FK-BP). The tacrolimus/FK-BP complex inhibits calcineurin-mediated phosphorylation of the transcription factor, that is, nuclear factor of activated T cells (NFAT); and thereby the expression of several inflammatory T-cell cytokines.…”

“…This makes it an excellent alternative for persons with vitiligo, who have poor compliance to phototherapy or have a fear of side effects of long term topical steroid use. [3] The common adverse effects include pruritus and burning sensation at application site, which are mild and transient. [6] There are few reports of tacrolimus-induced localized hyperpigmentation in the literature.…”

Efeitos da aplicação do L.A.S.E.R. HeNe e do ultravioleta B no vitiligo

“…A etiologia e patogenia exata da doença são desconhecidas. Existem teorias como as hipóteses neural, imune e autodestrutiva (6)(7)(8)(9)(10). A caracterização do vitiligo sugere que fatores predisponentes (genéticos) e precipitantes (ambientais) tornam uma pessoa mais suscetível à doença.…”

“…A caracterização do vitiligo sugere que fatores predisponentes (genéticos) e precipitantes (ambientais) tornam uma pessoa mais suscetível à doença. Dentre os possíveis mecanismos que levam ao desaparecimento dos melanócitos funcionais, estão os imunomediados e os tóxicos como os mais prováveis (7). Evidências sugerem a ocorrência de um estresse oxidativo, levando à degeneração dos melanócitos (3,11,12).…”