Excimer Laser & topical calcineurin inhibitors for the effective management of vitiligo

Vitiligo is a quite common disease that mainly affects the skin, leading to loss of skin colour through the development of fewer or more patches of lighter colour. Although it is a non-infectious and non-life-threatening condition, it can change a patient’s life as it affects the appearance. Moreover, as this condition usually lasts throughout the course of a person’s life, it is particularly important to develop effective treatments and coping strategies.

In a recent systematic literature review that was published in the Journal of the American Academy of Dermatology, the researchers conclude that combination therapy with the excimer laser and topical calcineurin inhibitors is more effective for the treatment of vitiligo in comparison to monotherapy with the excimer laser only.

Today, combination therapies with the excimer laser (308 nm) and various topical agents are widely used for the management of vitiligo. In this review, eight randomised, controlled trials were included, in which a total number of 276 patients with vitiligo had participated. Patients followed either a regimen of combination therapy (excimer and local agent) or a monotherapy treatment regimen with the excimer laser only.

Treatment success was determined as repigmentation of more than 75%, while treatment failure was determined as repigmentation of less than ≤ 25% repigmentation. According to the results of this review, it was concluded that combination therapy with the excimer laser and topical calcineurin inhibitors constitutes a more effective method for the treatment of vitiligo as compared to monotherapy.

Calcineurin inhibitors selectively inhibit the intracellular protein calcineurin and subsequently suppress tumour necrosis factor-a (TNF-α) and interferon-g expression, which is involved in the pathogenesis of vitiligo. Furthermore, the researchers highlight that the evidence regarding the beneficial effects of treatments with topical vitamin-D3 analogues and corticosteroids is insufficient based on the available research studies.

Taking into account both the difficulties related to the complete recovery of vitiligo and the possible negative psychological impact for the patients, combination therapies with the excimer laser and topical agents that improve response to treatment are really promising.

Bae JM, Hong ΒΥ, Lee JH, Lee JH, Kim GM. The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs). J Am Acad Dermatol. 2016, in press.
Grimes PE, Morris R, Avaniss-Aghajani E, Soriano T, Meraz M, Metzger A. Topical tacrolimus therapy for vitiligo: therapeutic responses and skin messenger RNA expression of proinflammatory cytokines.J Am Acad Dermatol. 2004;51:52-61.