Vitiligo medical therapy: Difference between revisions
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(/* Topical corticosteroids Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus{{cite journal| author=Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V et al.| title=Guidelines for...) |
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==Medical Therapy== | ==Medical Therapy== | ||
===Topical corticosteroids <small><small><small>Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus<ref name="pmid22860621">{{cite journal| author=Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V et al.| title=Guidelines for the management of vitiligo: the European Dermatology Forum consensus. | journal=Br J Dermatol | year= 2013 | volume= 168 | issue= 1 | pages= 5-19 | pmid=22860621 | doi=10.1111/j.1365-2133.2012.11197.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22860621 }} </ref></small></small></small>=== | ===Topical corticosteroids <small><small><small>Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus<ref name="pmid22860621">{{cite journal| author=Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V et al.| title=Guidelines for the management of vitiligo: the European Dermatology Forum consensus. | journal=Br J Dermatol | year= 2013 | volume= 168 | issue= 1 | pages= 5-19 | pmid=22860621 | doi=10.1111/j.1365-2133.2012.11197.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22860621 }} </ref></small></small></small>=== | ||
* Topical corticosteroids along, with topical calcineurin inhibitors (such as [[tacrolimus]]), are considered the first line treatment for limited lesions. | * Topical corticosteroids along, with topical calcineurin inhibitors (such as [[tacrolimus]] and [[pimecrolimus]]), are considered the first line treatment for limited lesions. | ||
* Topical corticosteroids have shown repigmentation rates of up to 75%. | * Topical corticosteroids have shown repigmentation rates of up to 75%. | ||
* Best results have been observed in areas exposed to sunlight ([[neck]] and [[face]]), dark skin and new lesions. | * Best results have been observed in areas exposed to sunlight ([[neck]] and [[face]]), dark skin and new lesions. | ||
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* Both schemes are recommended for children and adults. | * Both schemes are recommended for children and adults. | ||
* If large areas are affected and risk of systemic absorption is a concern (specially in children), then [[mometasone furoate]] or methylprednisolone aceponate are the preferred options as this drugs present less systemic side effects. | * If large areas are affected and risk of systemic absorption is a concern (specially in children), then [[mometasone furoate]] or methylprednisolone aceponate are the preferred options as this drugs present less systemic side effects. | ||
===Topical calcinurin inhibitors <small><small><small>Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus<ref name="pmid22860621">{{cite journal| author=Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V et al.| title=Guidelines for the management of vitiligo: the European Dermatology Forum consensus. | journal=Br J Dermatol | year= 2013 | volume= 168 | issue= 1 | pages= 5-19 | pmid=22860621 | doi=10.1111/j.1365-2133.2012.11197.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22860621 }} </ref></small></small></small>=== | |||
* Topical calcinuerin inhibitors (TCI) are recommended for patients in which prolonged use of topical corticosteroids is contraindicated. | |||
* TCI inhibit the destruction of melanocytes by the immune system and enhance melanocyte migration and differentiation in the lesion site. | |||
* TCIs have shown efficacy for the treatment of vitiligo lesion in the face and neck. | |||
* A synergistic interaction has been proven between UV light exposure and TCI treatment. No trials are available for long-term safety for this interaction. | |||
* Data from randomized clinical trials (RCT) shows similar efficacy between [[tacrolimus]], [[pimecrolimus]] and topical corticosteroids ([[Clobetasol propionate|clobetasol]]). | |||
* One open label RCT showed that [[tacrolimus]] could be effective for the treatment of segmental vitiligo. | |||
* No available data about the most effective administration scheme is available. It has been proven that twice-daily applications are more effective than daily applications. | |||
* Treatment usually Data about the best treatment period or about the effectiveness of intermittent long-term treatment in not available. | |||
==References== | ==References== | ||
Revision as of 15:38, 25 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Topical corticosteroids Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus[1]
- Topical corticosteroids along, with topical calcineurin inhibitors (such as tacrolimus and pimecrolimus), are considered the first line treatment for limited lesions.
- Topical corticosteroids have shown repigmentation rates of up to 75%.
- Best results have been observed in areas exposed to sunlight (neck and face), dark skin and new lesions.
- No difference has been observed between the efficacy of potent (mometasone) versus superpotent (clobetasol) topical corticosteroids, then potent corticosteroids should be the first option.
- Two schemes are recommended by the European Dermatology Forum consensus for the treatment of facial and extrafacial lesions:
- Discontinuous scheme (preferred scheme): Daily application of a potent topical corticosteroid during 15 days a month for a total of 6 months.
- Continuous scheme: Daily application of a potent topical corticosteroid during 3 months.
- Photographs should be taken to evaluate the response to the treatment.
- Both schemes are recommended for children and adults.
- If large areas are affected and risk of systemic absorption is a concern (specially in children), then mometasone furoate or methylprednisolone aceponate are the preferred options as this drugs present less systemic side effects.
Topical calcinurin inhibitors Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus[1]
- Topical calcinuerin inhibitors (TCI) are recommended for patients in which prolonged use of topical corticosteroids is contraindicated.
- TCI inhibit the destruction of melanocytes by the immune system and enhance melanocyte migration and differentiation in the lesion site.
- TCIs have shown efficacy for the treatment of vitiligo lesion in the face and neck.
- A synergistic interaction has been proven between UV light exposure and TCI treatment. No trials are available for long-term safety for this interaction.
- Data from randomized clinical trials (RCT) shows similar efficacy between tacrolimus, pimecrolimus and topical corticosteroids (clobetasol).
- One open label RCT showed that tacrolimus could be effective for the treatment of segmental vitiligo.
- No available data about the most effective administration scheme is available. It has been proven that twice-daily applications are more effective than daily applications.
- Treatment usually Data about the best treatment period or about the effectiveness of intermittent long-term treatment in not available.
References
- ↑ 1.0 1.1 Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V; et al. (2013). "Guidelines for the management of vitiligo: the European Dermatology Forum consensus". Br J Dermatol. 168 (1): 5–19. doi:10.1111/j.1365-2133.2012.11197.x. PMID 22860621.