Combination Treatment to Repigment Vitiligo

Dr Christophe HSU – dermatologist. Geneva, Switzerland

• Medical Repigmentation treatments consist of:

1. medical: topical (tacrolimus, pimecrolimus, topical corticosteroids…(calcipotriène, pseudocatalase, piperine)), systemic (pulse steroids…)

-UV (Ultraviolet)-based therapy: Narrow Band UVB (NBUVB) is the mainstay of treatment. PUVA (Psoralen + UVA is also used but is more complicated (and less effective).

Let us consider the following combination treatment: Combination of afamelanotide* with NBUVB:

• -it has been shown to be more effective than with NBUVB alone for non segmental vitiligo patients (study following patients for a duration of one year). So far (presentation in Manila) the results compare 5 patients treated with the combination vs the NBUVB group.

1. It takes 2 times fewer phototherapy treatments
2. the VASI (Vitligo Analog Severity index) goes from 24 to 18 in the combination group, but only 26 to 25 in the NBUVB group only.
3. no mole changes in the afamelanotide treated group were observed. Unfortunately, in the end (presentation in Verona) ,half of the 12 patients in the combination treatment dropped out of the study.

* It is an alpha- MSH Melanocyte Stimulating Hormone) agonist used in photodermatoses: solar urticaria (injection og 16mg s.c.once) and erythropoietic propoporphyria ( 2 injection of 20mg s.c. spaced by 60 days)

Other combination treatments have been tried with: topical calcipotriol and tacrolimus, oral P.Leucotomus.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information:

Lim H. White Patches: What’s New in Vitiligo ? 2012 (02) – 20th Regional Conference of Dermatology (RCD) – Manila, Phillipines

SY 22. Lim H.W. Therapeutic challenges in vitiligo. 2012 (06) – 9th Spring Symposium of the EADV (European Academy of Dermatology and Venerology) – Verona, Italiy (Italia)