NB-UVB Phototherapy Combined with Tacrolimus Ointment in Vitiligo Treatment

Ayesha Siddiqua *

Delta Medical College and Hospital, Bangladesh.

Md Mahabubur Rahaman

Aurora skin and Aesthetics, Bangladesh.

Mohammad Rahmat Ullah Siddique

Department of Dermatology, Banghabandhu Sheikh Mujib Medical University, Bangladesh.

Anzirun Nahar Asma

Popular Medical College and Hospital, Bangladesh.

Sabrina Akter

Aurora skin and Aesthetics, Bangladesh.

*Author to whom correspondence should be addressed.


Abstract

Background:  Vitiligo, often referred to as a common and  chronic disorder in which the skin loses its pigment or melanocyte-generating cells, causing hypopigmentation or depigmentation of affected area skin. Various treatment modalities such as topical, systemic and phototherapy are employed to treat this disease.

Objective: Vitiligo is often treated with phototherapy that utilizes narrowband ultraviolet B (NB–UVB). This study aims to investigate the effectiveness of combination therapy of NB–UVB phototherapy and tacrolimus in vitiligo treatment.

Methods: Minimal Erythema Dose (MED) was not calculated & an initial dose of 300 mj/cm2 was started in all adult patients & 150 mj/cm2 in children. Treatment was administered 2 times in a week on non-consecutive days. A retrospective questionnaire-based study was conducted for seven months (August 2019 to February 2020). About 95 patients with vitiligo in Dhaka were taken for observation. Microsoft Office Excel 2010 software was used to do the analysis.

Results: In this study, 34.37% of patients were male, and on the other side, about 65.63% of patients were female. And most of the patients were young aged (21-30). In this case, females are mostly conscious of their skin health. One hundred forty lesions were treated on the face, extremities, and trunk. Excellent results were achieved in 66.43% (93/140) lesions, while 20.71% (29/140) lesions exhibited a good response. The response was termed poor as the extent of pigmentation achieved was less than 12.86% (18/140).

Conclusion: In this study, we found that the combination of NB-UVB phototherapy and tacrolimus is potentially effective in vitiligo, with the face and extremities (proximal part) responding better than other body sites.

Keywords: Vitiligo, narrowband ultraviolet b, tacrolimus, Dhaka, Bangladesh, etc


How to Cite

Siddiqua, Ayesha, Md Mahabubur Rahaman, Mohammad Rahmat Ullah Siddique, Anzirun Nahar Asma, and Sabrina Akter. 2022. “NB-UVB Phototherapy Combined With Tacrolimus Ointment in Vitiligo Treatment”. Asian Journal of Research in Dermatological Science 5 (1):103-10. https://journalajrdes.com/index.php/AJRDES/article/view/71.

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References

The following references have been extracted and will be linked to the submission metadata.

Eleftheriadou V. Reliability and validity of the Vitiligo Signs of Activity Score. Br J Dermatol. 2020;183(5):801-802.

Islam, Tawhid. Vitiligo and the way to recovery. News Article, Dhaka, Bangladesh: The Daily Star; 2018.

Allam M, Riad H. Concise review of recent studies in vitiligo. Qatar Med J. 2013; 2013:1–19.

Le Poole IC, Das PK, van den Wijngaard RM, Bos JD, Westerhof W. Review of the etiopathomechanism of vitiligo: A convergence theory. Exp Dermatol. 1993; 2:145–153.

Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015;386: 74–84.

DOI: 10.1016/S0140-6736(14)60763-7.

Ghafourian A, Ghafourian S, Sadeghifard N, Mohebi R, Shokoohini Y, Nezamoleslami S, Hamat RA. Vitiligo: Symptoms, pathogenesis and treatment. Int J Immunopathol Pharmacol. 2014;27: 485–489.

Homan MW Linthorst, Spuls PI, Nieuweboer-Krobotova L, de Korte J, Sprangers MA, Bos JD, Wolkerstorfer A, van der Veen JP. A randomized comparison of excimer laser versus narrow-band ultraviolet B phototherapy after punch grafting in stable vitiligo patients. J Eur Acad Dermatol Venereol. 2012;26:690–695.

Henning SW, Jaishankar D, Barse LW, Dellacecca ER, Lancki N, Webb K, Janusek L, Mathews HL, Price RN, Le Poole IC. The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data. PLoS One. 2020;15(1):e0227909.

[PMC free article] [PubMed]

Cohen BE, Manga P, Lin K, Elbuluk N. Vitiligo and Melanoma-Associated Vitiligo: Understanding Their Similarities and Differences. Am J Clin Dermatol. 2020 Oct;21(5):669-680.

Whitton ME, Ashcroft DM, Barrett CW, Gonzalez U. Interventions for vitiligo. Cochrane Database Syst Rev. 2006;25: CD003263

Scherschun L, Kim JJ, Lim HW. Narrow-band ultraviolet-B is a useful and well-tolerated treatment for vitiligo. J Am Acad Dermatol. 2001;44:999–1003.

Gambichler T, Breuckmann F, Boms S et al. Narrow-band UVB phototherapy in skin conditions beyond psoriasis. J Am Acad Dermatol. 2005;52:660–670.

Kanwar AJ, Dogra S. Narrow-band UVB for the treatment of generalized vitiligo in children. Clin Exp Dermatol. 2005;30: 332–336.

Parsad D, Kanwar AJ, Kumar B. Psoralen-ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo. J Eur Acad Dermatol Venereol. 2006;20: 175–177.

El Mofty M, Mostafa W, Esmat S et al. Narrow-band Ultraviolet B 311 nm in the treatment of vitiligo: two right–left comparison studies. Photodermatol Photoimmunol Photomed. 2006;22:6–11.

Grimes PE, Soriano T, Dytoc MT. Topical tacrolimus for repigmentation of vitiligo. J Am Acad Dermatol 2002;47:789–791.

Tanghetti EA. Tacrolimus ointment 0.1% produces repigmentation in patients with vitiligo: results of a prospective patient series. Cutis. 2003;71:158–162.

Lepe V, Moncada B, Castanedo-Cazares JP et al. A double-blind randomized trial of 0.1% tacrolimus vs. 0.05% clobetasol for the treatment of childhood vitiligo. Arch Dermatol. 2003;139:581–585.

Silverberg NB, Lin P, Travis L et al. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004;51:760–766.

Kostovic K, Pasic A. New treatment modalities for vitiligo: focus on topical immunomodulators. Drugs. 2005;65: 447– 459.

Castanedo-Cazares JP, Lepe V, Moncada B. Repigmentation of chronic vitiligo lesions by following tacrolimus plus ultraviolet-B-narrow-band. Photodermatol Photoimmunol Photomed. 2003;19:35–36.

Kawalek AZ, Spencer JM, Phelps RG. Combined excimer laser and topical tacrolimus for the treatment of vitiligo: a pilot study. Dermatol Surg. 2004;30: 130–135.

Passeron T, Ostovari N, Zakaria W et al. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004;140:1065–1069.

Ujihara J.E., Ferreira F.R., Mandelbaum S.H. Phototherapy: experience from a reference service. An Bras Dermatol. 2017;92:745–746.

Barros NM, Sbroglio LL, Buffara MO, Baka JLCES, Pessoa AS, Azulay-Abulafia L. Phototherapy. An Bras Dermatol. 2021;96 (4):397-407.

Birlea SA, Spritz RA. Norris DA. Fitzpatric's Dermatology in General Medicine. Edited by 8th. New York, USA: McGraw-Hill; 2014.

Kyriakis KP, Palamaras I, Tsele E, Michailides C, Terzoudi S. Case detection rates of vitiligo by gender and age. Int J Dermatol. 2009:328 –329.

Alkhateeb A, Fain PR, Thody A, Bennett DC,Spritz RA. Epidemiology of vitiligo and associatedautoimmune diseases in Caucasian probands andtheir relatives. Pigment Cell Res., 2003:208 – 214.

Ali khan A, Felsten LM, Daly M, Petronic-Rosic V. "Vitiligo: A comprehensive overview Part 1. J Am Acad Dermatol. 2011:473–491.

Hann S-K, Nordlund J. Vitiligo."Oxford: Blackwell Science; 2000.

Akar A, Tunca M, Koc E, Kurumlu Z. Broadband targeted UVB phototherapy for localized vitiligo: A retrospective study. Photodermatol Photoimmunol Photomed. 2009:161-163.

Park KK, Liao W, Murase JE. A review of monochromatic excimer light in vitiligo." Br J Dermatol. 2012:468-478.

Asawanonda P, Kijluakiat J, Korkij W, Sindhupak W. Targeted broadband ultraviolet B phototherapy produces similar responses to targeted narrowband ultraviolet B phototherapy for vitiligo: A randomized, double-blind study. Acta Derm Venereol. 2008:376-381.

Asawanonda P, Charoenlap M, Korkij W. Treatment of localized vitiligo with targeted broadband UVB phototherapy: A pilot study. Photodermatol Photoimmunol Photomed. 2006: 133-136.

Le Duff F, Fontas E, Giacchero D, Sillard L, Lacour JP, Ortonne JP. 308-nm excimer lamp vs 308-nm excimer laser for treating vitiligo: A randomized study. Br J Dermatol. 2012:188-192.

Passeron T, Ostovari N, Zakaria W, Fontas E, Larrouy JC, Lacour JP. Topical tacrolimus and the 308-nm excimer laser: A synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004:1065- 1069.

Njoo MD, Westerhof W, Bos JD, Bossuyt PM. The development of guidelines for the treatment of vitiligo. Clinical Epidemiology Unit of the Istituto Dermopatico dell'Immacolata-Istituto di Recovero e Cura a Carattere Scientifico (IDI-IRCCS) and the Archives of Dermatology. Arch Dermatol. 1999;135:1514–1521.