Guideline for the Diagnosis and Management of Vitiligo

D.J. Gawkrodger; A.D. Ormerod; L. Shaw; I. Mauri-Sole; M.E. Whitton; M.J. Watts; A.V. Anstey; J. Ingham; K. Young

Disclosures

The British Journal of Dermatology. 2008;159(5):1051-1076. 

In This Article

In All Patients With Vitiligo, What is the Efficacy of a Course of Narrowband UVB With a Vitamin D Analogue Compared With Narrowband UVB With Placebo in Terms of Condition Progression, Area Reduction and Quality of Life Score?

The use of combination treatments has been commonplace in the treatment of vitiligo.

Authors have attempted to assess whether the combination of a topical vitamin D analogue with NB-UVB is more effective than NB-UVB alone.

For calcipotriol, there are two studies with directly contradictory results. In a small single-blinded RCT with 20 patients, there was no additional benefit from adding calcipotriol to NB-UVB when compared with UVB alone.[82] In contrast, a slightly larger open study with 24 patients showed that the combination of calcipotriol with NB-UVB was more effective than UVB alone.[83] In a similar randomized but open-label study with 32 patients, the combination of tacalcitol with NB-UVB was more effective at inducing repigmentation in vitiligo than UVB alone.[84] Another open, bilateral comparison study with 20 subjects compared NB-UVB with NB-UVB and calcipotriene; results suggested a better response to the combination but the results were inconclusive.[85]

Two studies attempted to assess the response of vitiligo to the Excimer laser with and without topical tacrolimus. A double-blind study in eight patients whose vitiligo was treated with the Excimer laser with tacrolimus ointment 0·1% or placebo showed better results for the tacrolimus-treated group.[47] This study failed to include a tacrolimus-only limb or a Excimer laser-only limb so the results are hard to interpret. A second study compared Excimer monotherapy with Excimer and tacrolimus ointment and reported a superior response to the combination but also failed to include a tacrolimus-only limb or an ointment placebo with the Excimer.[46]

A combination study of 27 patients found no benefit of combining NB-UVB with vitamin B12 and folate vs. NB-UVB as monotherapy.[86] In addition, mention is made of the treatment of vitiligo using topical application of pseudocatalase and calcium in combination with UVB therapy or Dead Sea climatotherapy reported by Schallreuter etal.[87,88] In an open study of 33 patients, complete repigmentation on the face and hands was reported in 90% of the group starting within 2-4months.[87] This treatment cannot be considered further as it was not a controlled study and the work has not been reproduced.

There is no convincing evidence to suggest that topical vitamin D analogues in combination with NB-UVB phototherapy are superior to NB-UVB alone.

  1. Topical vitamin D analogues in combination with NB-UVB therapy should not be used in the treatment of vitiligo.

    Grade of recommendation C
    Level of evidence 3

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