An open randomized study to compare narrow band UVB, topical pimecrolimus and topical tacrolimus in the treatment of vitiligo

Abstract

Vitiligo is an acquired loss of pigmentation and its treatment remains very difficult up to date. Narrow band ultraviolet B (NB-UVB) and topical immunomodulators are included among the most innovative approaches to vitiligo. We evaluated the efficacy and tolerability of NB-UVB, topical pimecrolimus and tacrolimus in the treatment of vitiligo. Adult patients with chronic and stable vitiligo refractory to conventional therapies were enrolled in an open parallel groups study. The patients were scheduled on the basis of a computer-generated randomization into three groups: 13 patients received NB-UVB phototherapy 3 times a week, 15 patients were treated with pimecrolimus 1% cream b.i.d. and 16 patients applied tacrolimus 0.1% ointment b.i.d. All three treatment regimens were performed for 24 weeks. At baseline and every three weeks for the whole period of therapy the patients were examined through digital photographs and, at the end of the study, based on the percentage of repigmentation, treatment outcome was classified as "absent" (0), "slight" (< 25%), mild (25-49%), "moderate" (50-74%), and "excellent" (> 75%). During the whole period of the study, possible side effects were recorded. The response to treatments varied according to the anatomical location of the lesions. No statistically significant differences in repigmentation for any anatomical site were recorded with the three treatments. The best results were obtained for lesions of the face with pimecrolimus cream and tacrolimus ointment and of the neck with NB-UVB. Statistically significant differences in repigmentation between photo-exposed and covered skin areas were recorded although the patients were asked to avoid direct UV exposition and to apply a very high protection sun screen on vitiligo lesions. All three treatments should be considered as a good option in the treatment of vitiligo. NB-UVB irradiation may represent the optimal choice in generalized vitiligo with topical immunomodulators in localized vitiligo.