Successful Treatment of Refractory Vitiligo with a Combination of Khellin and 308-nm Excimer Lamp: An Open-Label, 1-Year Prospective Study

Abstract

IntroductionPhototherapy is the cornerstone of treatment of vitiligo. The 308-nm excimer lamp (EL) induces T cell apoptosis and the stimulation of melanocyte proliferation. Khellin is a furanochromone with a chemical structure close to psoralens. The objective of the study was to evaluate the safety and efficacy of 1-year treatment of recalcitrant vitiligo with a combination of 308-nm EL and khellin.MethodsTwenty patients with resistant vitiligo were included. Khellin was applied 45 min before irradiation with EL, twice a week, at a dose of 250 mJ/cm2. The repigmentation was assessed in four categories: excellent repigmentation (ER) (> 75% repigmentation), good repigmentation (GR) (50–75% repigmentation), moderate repigmentation (MR) (25–50% repigmentation), and poor repigmentation (PR) (< 25% repigmentation).ResultsAn ER was observed in 45% of patients (9/20), 5/20 (25%) achieved a GR, 3/20 (15%) an MR, and 3/20 (15%) a PR. Better response was observed on the face, neck, upper limb, hands, and abdomen. The mean number of procedures was 54.1 and the mean cumulative dose was 2967.5 mJ/cm2. Six months after the last session no recurrences were observed.ConclusionThe combination of 308-nm EL and khellin is a safe and effective treatment and represents a new alternative therapy for vitiligo. Further comparative controlled randomized investigations are needed to confirm these promising results with the appropriate therapeutic protocols.

Treatment of vitiligo with 308‐nm light emitting diode: Our experience from a two‐year follow‐up of Chinese patients

“…The irradiation dose range is 50 mW/cm 2 –5 W/cm 2 , and these doses do not cause thermal effects or photoablation, making the 308‐nm LED lamp safe during treatment 5 . The maximal irradiation dose of the 308‐nm LED in our study was 1938 mJ/cm 2 for the face, 2950 mJ/cm 2 for the body, and 5000 mJ/cm 2 for the hands and feet, comparable to the excimer lamp 13 . The main purpose of this study was to explore the therapeutic scheme, efficacy, and safety of 308‐nm LED phototherapy for the treatment of vitiligo.…”

“…5 The maximal irradiation dose of the 308-nm LED in our study was 1938 mJ/ cm 2 for the face, 2950 mJ/cm 2 for the body, and 5000 mJ/cm 2 for the hands and feet, comparable to the excimer lamp. 13 The main purpose of this study was to explore the therapeutic scheme, efficacy, and safety of 308-nm LED phototherapy for the treatment of vitiligo.…”

Vitiligo: boa resposta � combina��o do extrato de Brosimum gaudichaudii tr�cul com khellin, associados � helioterapia. Relato de caso

“…Khellin é uma furanocromona extraída das sementes de Ammi visnaga (khella), uma planta comum na região do Mediterrâneo Oriental, e tem uma estrutura química próxima a dos psoralenos com propriedades fototerapêuticas semelhantes, mas com menos efeitos fototóxicos e carcinogênicos 7 . Provou anteriormente sua eficácia no tratamento do vitiligo em associação com o UVA 8 .…”

Comparison between 308‐nm excimer light alone versus 308‐nm excimer light and platelet‐rich plasma in the treatment for localized vitiligo

“…According to the review by Park et al, 2 the safety and efficacy of MEL (delivered by excimer laser or lamp, alone or in combination with other modalities) in the treatment for localized stable vitiligo has been established in many studies. Proposed mechanisms of actions of MEL in the treatment for vitiligo include induction of T cell apoptosis, stimulation of proliferation of follicular melanocytes and their migration into the epidermis, and stimulation of keratinocytes to secrete melanocyte‐activating cytokines such as stem cell factor (SCF) 4 …”

“…Proposed mechanisms of actions of MEL in the treatment for vitiligo include induction of T cell apoptosis, stimulation of proliferation of follicular melanocytes and their migration into the epidermis, and stimulation of keratinocytes to secrete melanocyte-activating cytokines such as stem cell factor (SCF). 4 Moreover, MEL activates the Wnt/β-catenin signaling pathway with subsequent activation of microphthalmia-associated transcription factor (MITF) and tyrosinase transcription. This resulted in the enhancement of melanin synthesis.…”