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 Applying Calcipotriol or Tacalcitol vs. Placebo or an Active Treatment in Terms of Condition Progression, Area Reduction and Quality of Life Score?

Introduction

The vitamin D analogues, calcipotriol and tacalcitol, may have a place in the treatment of vitiligo.

Methods

Nine papers met the criteria for inclusion as used for topical corticosteroids. In all trials but one (Chiaverini etal.,[39] in which localized forms of vitiligo were included), only patients with generalized (symmetrical) types of vitiligo were studied.

Evidence Statements

The best study of calcipotriol is the randomized open left-vs.-right study of Chiaverini etal.,[39] in which the effect over a 3-6-month period of the once daily application of calcipotriol is compared in symmetrical target lesions in 24 patients (15 females, nine males; age range 5-59years) with localized and generalized vitiligo. No repigmentation was noted in 21 of 23 patients after 3-6months. One patient had 5% repigmentation with calcipotriol; two had repigmentation with and without calcipotriol (P>0·5). An unpublished clinical trial of the efficacy of topical calcipotriol vs. vehicle for vitiligo showed no beneficial effect for the calcipotriol over the vehicle placebo (A. Bibby, LEO Pharma A/S, personal communication, 2008).

A study of topical betamethasone vs. calcipotriol vs. a combination of the two over 5-10weeks in 15, 16 and 18 adults, respectively, showed >50% repigmentation in two, one and four each out of 15 evaluable cases.[37] The conclusion was that the results favoured the combination of topical betamethasone and calcipotriol over betamethasone alone. However, the numbers here are too small for a definitive conclusion and there has been no other study of this sort. An open study of twice daily topical calcipotriol (with PUVA in four patients) in 26 patients (16 females, 10 males; age range 5-61years; 22 Asians) for 3-9months showed that 17 of 22 receiving monotherapy with calcipotriol had 30-100% repigmentation which was >50% in 12.[40]

There have been studies of the effect of combining topical calcipotriol with phototherapy (see below).[19,41,42,43,44]

Evidence to Recommendations

For generalized symmetrical or localized types of vitiligo, topical calcipotriol by itself has no effect in vitiligo and is not recommended. For generalized symmetrical types of vitiligo, the addition of topical calcipotriol to narrowband (NB) UVB does not add any benefit and is not recommended. The use of topical calcipotriol with PUVA may produce earlier repigmentation but it is not clear whether the final degree of repigmentation is enhanced. There is insufficient evidence to make a comment about the use of tacalcitol.

Recommendation

  1. The use of topical calcipotriol as a monotherapy is not recommended.

    Grade of recommendation B
    Level of evidence 2++

     

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