COMPARISON OF EFFICACY OF TCI MONOTHERAPY WITH TCI AND NARROW BAND UVB IN VITILIGO: A HOSPITAL BASED STUDY.
DOI:
https://doi.org/10.53555/eijmhs.v9i2.152Keywords:
vitiligo, topical Calcineurin inhibitor, Narrow band UVB, phototherapyAbstract
Background:
A skin condition known as vitiligo is an advanced depigmentation of the skin that is characterized by the development of depigmented macules that cause significant social and psychological distress. Although there are various therapy options available, vitiligo management is still a therapeutic challenge for many dermatologists. Topical calcineurin inhibitors, ultraviolet B phototherapy, and topical steroids are examples of conservative treatments.
Objective: This study aims to compare the effectiveness of tacrolimus monotherapy and narrowband ultraviolet B phototherapy (NB-UVB) for treating vitiligo.
Materials and Methods: :For a period of two years, 100 vitiligo patients who presented to the dermatology outpatient department of the first Dali university associated hospital underwent a prospective and comparative study (from 2018-1-1 to 2019-12-31). All of the participants in this study met the inclusion and exclusion criteria after receiving the necessary ethical approval. According to the vitiligo data Proforma, demographic information was checked during the initial appointment.
All individuals with vitiligo underwent a complete clinical and dermatological examination of their condition. The associated laboratory tests were all finished. It was assessed how much of the body's surface area is affected by vitiligo. On the basis of their course of therapy, patients were divided into two groups at random. Tacrolimus ointment was applied topically to 50 patients in group A twice daily. 50 patients in group B received topical medication three times per week in addition to NB-UVB phototherapy.
The VASI (Vitiligo Area Severity Index) was used to compare the effectiveness of the two groups from the beginning of the trial to its conclusion. Global ratings from both patients and physicians were calculated as part of the study's secondary efficacy measure. Software called SPSS 23.0 was used to do the statistical analysis. At p 0.05, the difference was statistically significant.
Results: After 12 months of treatment, topical treatment alone outperformed Narrow Band UVB in terms of overall effectiveness. Patients treated with narrow band UVB plus topical treatment have earlier repigmentation response to lesions in the face, trunk, upper limbs, and lower limbs than those treated with topical treatment alone. When comparing the trunk, face, upper, and lower limbs for both types of therapies, lesions in the hands and feet require a lengthier course of treatment.
Conclusion:
Narrow band UVB along with TCI is of higher efficacy, better tolerated and superior to TCI monotherapy in the treatment of vitiligo. There was a statistically significant reduction in percentage of VASI p= with Narrow Band UVB along with TCI group when compared to TCI mono therapy alone.
References
. Koronne RV, Sachdeva KG. Vitiligo. Int J Dermatol 1998;27:676-81
. Nair BKH. Vitiligo: A retrospect. Int J Dermatol 1978;17:755-7
. Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in vitiligo: prevalence and correlates in India. J Eur Acad Dermatol Venereol. 2002;16: 573-8
. Mehta NR, Shah KC, Theodore C, Vyas VP, Patel AB. Epidemiological study of vitiligo in Surat area, South Gujarat. Indian J Med Res 1973;61:145–154
. Das SK, Majumder PP, Chakraborty R, Majumdar TK, Haldar B. Studies on vitiligo. I. Epidemiological profile in Calcutta, India. Genet Epidemiol 1985;2:71–78
. Howitz J, Brodthagen H, Schwartz M, Thomsen K. Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark. Arch Dermatol 1977;113:47–52
. Boisseau-Garsaud AM, Saint-Cyr I, Quist D, Arveiler B, Garsaud P. Familial aggregation of vitiligo in the French West Indies (Isle of Martinique). Eur J Dermatol 2001;11:554–556
. Lu T, Gao T, Wang A, Jin Y, Li Q, Li C. Vitiligo prevalence study in Shaanxi Province, China. Int J Dermatol;46:47–51
. Sehgal VN, Srivastava G. Vitiligo: Compendium of clinico-epidemiological features. Indian J Dermatol Venereol Leprol 2007;73:149-56
. Castanet J, Ortonne JP. Pathophysiology of vitiligo. Clin Dermatol, 15:845-851, 199
. Moretti, S., Spallanzani, A., Amato, L., Hautmann, G., Gallerani, I., Fabbri, P. 2002. Vitiligo and epidermal microenvironment: Possibile involvement of keratinocyte-derived cytokines. Arch. Dermatol. 138:274.
. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index. Archives of Dermatology. 2004 Jun 1;140(6):677-83.
. Tkachenko E, Lin JY, Hartman RI. Regional vitiligo induced by imiquimod treatment for in-transit melanoma metastases. JAAD Case Reports. 2019 May;5(5):427.
. Kawakami T, Hashimoto T. Disease severity indexes and treatment evaluation criteria in vitiligo. Dermatology Research and Practice. 2011 Jan 1;2011.
. Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Archives of dermatology. 1997 Dec 1;133(12):1525-8.
. Lan CCE, Chen GS, Chiou MH, Wu CS, Chang CH, Yu HS. FK506 promotes melanocyte and melanoblast growth and creates a favourable milieu for cell migration via keratinocytes: possible mechanisms of how tacrolimus ointment induces repigmentation in patients with vitiligo. Br J Dermatol. 2005;153(3):498-505. doi:10.1111/j.1365-2133.2005.06739.x
. Barikbin, Behrooz, et al. "Does Pimecrolimus Cream Enhance the Effect of Excimer Laser on Eyelid Vitiligo?." (2011): 26-29.
. Liu JB, Li M, Yang S, Gui JP, Wang HY, Du WH, Zhao XY, Ren YQ, Zhu YG, Zhang XJ. Clinical profiles of vitiligo in China: an analysis of 3742 patients. Clinical and experimental dermatology. 2005 Jul 1;30(4):327-31.
. Hartmane I, Mikažāns I, Ivdra I, Mirzajanova I, Dērveniece A, Bondare-Ansberga V. Narrow-band UVB therapy and topical calcineurin inhibitors for the treatment of paediatric vitiligo in real clinical practice. InProceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 2021 Jun 1.
. Njoo MD, Spuls PI, Bos JT, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo: meta-analysis of the literature. Archives of dermatology. 1998 Dec 1;134(12):1532-40.
. Kanwar AJ, Dogra S, Parsad D, Kumar B (2005) Narrow-band UVB for the treatment of vitiligo: an emerging effective and well-tolerated therapy. Int J Dermatol 44: 57-60.
. Brazzelli V, Prestinari F, Castello M, Bellani E, Roveda E, et al. (2005)Useful treatment of vitiligo in 10 children with UV-B narrowband(311 nm). Pediatr Dermatol 22: 257-261.
. Dertlioğlu SB. Comparison of the Efficacy of Topical Tacrolimus, Pimecrolimus, Methylprednisolone Aceponate and Narrow Band UVB in the Treatment of Vitiligo. J Clin Cosmet Dermatol. 2018;2(3).
. Fai D, Cassano N, Vena GA. Narrow‐band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. Journal of the European Academy of Dermatology and Venereology. 2007 Aug;21(7):916-20.
. Stinco G, Piccirillo F, Forcione M, Valent F, Patrone P. An open randomized study to compare narrow band UVB, topical pimecrolimus and topical tacrolimus in the treatment of vitiligo. European Journal of Dermatology. 2009 Nov 1;19(6):588-93.
. Esfandiarpour I, Ekhlasi A, Farajzadeh S, Shamsadini S. The efficacy of pimecrolimus 1% cream plus narrow-band ultraviolet B in the treatment of vitiligo: a double-blind, placebo-controlled clinical trial. Journal of dermatological treatment. 2009 Jan 1;20(1):14-8.
. Bilal A, Shiakh ZI, Khan S, Iftikhar N, Anwar I, Sadiq S. Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo. Journal of Pakistan Association of Dermatologists. 2014;24(4):327-31.3.
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