Vitiligo medical therapy: Difference between revisions
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(/* Topical calcinurin inhibitors 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=Guidelin...) |
(/* Phototherapy 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 the manage...) |
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:* Treatment should be prolonged up to a period of 1 year if proven efficient during the first 6 months. | :* Treatment should be prolonged up to a period of 1 year if proven efficient during the first 6 months. | ||
===Phototherapy <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>=== | ===Phototherapy=== | ||
====Photochemotherapy <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>==== | |||
* PUVA: Use of long-wave UVA radiation in combination with psoralens (administered orally or topically). | |||
:* Partial repigmentation can be achieved in 70% to 80%, but complete repigmentation is only achieved in 20% of the patients. | |||
:* The rate of relapse is as high as 75% over a 1 to 2 year period. | |||
:* Recommended psoralen oral dosages: 8-methoxypsoralen 0.6-0.8 mg/kg, 5-methoxypsoralen 1.2-1.8 mg/kg or trimethylpsoralen 0.6 mg/kg. Psoralen should be administered 3 hours previous to exposure. Treatment should be administered for a period of 6 months, if the response is positive the treatment should be prolonged to 1 to 2 years to achieve maximum repigmentation. | |||
:* Recommended regimen for topical PUVA: 8-methoxypsoralen 0.001% 30 minutes before exposure. Fewer applications and therefore fewer UVA cummulative concentrations needed are the main advantage of this regimen. | |||
* KUVA: Use of long-wave UVA radiation in combination with khellin. | |||
====Targeted phototherapies <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>==== | |||
==References== | ==References== | ||
Revision as of 16:49, 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.
- 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.
- TCI show less side effects than potent topical corticosteroids.
- Recommendations of the European Dermatology Forum consensus for the treatment of vitiligo are the following:
- TCI treatment is recommended for adults and children for patients with lesion in the face and neck and other selected areas.
- Twice daily applications over a period of 6 months, associated with moderate daily sunlight exposure.
- Treatment should be prolonged up to a period of 1 year if proven efficient during the first 6 months.
Phototherapy
Photochemotherapy Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus[1]
- PUVA: Use of long-wave UVA radiation in combination with psoralens (administered orally or topically).
- Partial repigmentation can be achieved in 70% to 80%, but complete repigmentation is only achieved in 20% of the patients.
- The rate of relapse is as high as 75% over a 1 to 2 year period.
- Recommended psoralen oral dosages: 8-methoxypsoralen 0.6-0.8 mg/kg, 5-methoxypsoralen 1.2-1.8 mg/kg or trimethylpsoralen 0.6 mg/kg. Psoralen should be administered 3 hours previous to exposure. Treatment should be administered for a period of 6 months, if the response is positive the treatment should be prolonged to 1 to 2 years to achieve maximum repigmentation.
- Recommended regimen for topical PUVA: 8-methoxypsoralen 0.001% 30 minutes before exposure. Fewer applications and therefore fewer UVA cummulative concentrations needed are the main advantage of this regimen.
- KUVA: Use of long-wave UVA radiation in combination with khellin.
Targeted phototherapies Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus[1]
References
- ↑ 1.0 1.1 1.2 1.3 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.