Table 1.
Medical treatments (Randomized and prospective controlled trials for medical treatments for vitiligo from January 2010 to July 2015. Case reports, case series, retrospective studies, pilot studies, preclinical studies, and uncontrolled trials were excluded from this table)
| AUTHOR | YEAR | INTERVENTION | PATIENTS (N) | TREATMENT PERIOD (MONTHS) | PRIMARY OUTCOMES | ADVERSE EFFECTS |
|---|---|---|---|---|---|---|
| Topical therapies | ||||||
| Ho et al | 2011 | Tacrolimus vs. clobetasol vs. placebo | 100 | 6 | Successful response defined as repigmentation >50%; tacrolimus was successful in 58% of patients (n=55) with facial vitiligo and 23% (n=45) with non-facial vitiligo; clobetasol yielded comparable results | None reported |
| Kose et al | 2010 | Mometasone vs. pimecrolimus | 40 | 3 | 65% repigmentation rate with mometasone, 42% repigmentation rate with pimecrolimus | Mometasone: atrophy, telangiectasia, and/or erythema (10%); pimecrolimus: burning sensation and/or pruritis (10%) |
| Systemic therapies | ||||||
| Singh et al | 2015 | Methotrexate vs. oral minipulse dexamethasone | 52 | 6 | 6 of 25 patients in the methotrexate group developed new lesions, while 7 of 25 in the steroid group developed new lesions. Methotrexate was found to be equally effective as oral minipulse steroids in controlling unstable vitiligo | Methotrexate: 20% developed nausea, Oral minipulse steroids: 20% developed weight gain and acneiform eruption |
| Singh et al | 2014 | Minocycline vs. mini pulse dexamethasone | 50 | 6 | Minocycline was found comparably effective to oral mini pulse corticosteroids in halting actively-spreading disease | Minocycline: facial hyperpigmentation (8%), oral mucosal hyperpigmentation (12%), nausea, and vomitting (12%); Dexamethasone: weight gain, headache, and/or weakness (28%) |
| Ultraviolet (UV) light therapy | ||||||
| Bansal et al | 2013 | Psoralen + NB-UVB vs. NB-UVB | 45 | 5 | Psoralen + NB-UVB hastens repigmentation rates and yields greater repigmentation and decreased VASI scores vs. NB-UVB alone (29.2 vs. 21.7% at 5 months, p=0.043) | P-NBUVB: nausea (45%), hyperpigmentation (25%); both arms: phototoxicity (5%), depigmented macuoles (10%) |
| El Mofty et al | 2013 | PUVA vs. BB-UVA | 45 | 5 | Mean repigmentation with PUVA comparable to BB-UVA suggesting the latter might be useful when oral psoralens are contraindicated | PUVA: phototoxicity (61.5%), thickening (23.1%); BB-UVA: phototoxicity (21.4%) |
| El Mofty et al | 2013 | NB-UVB vs. BB-UVA | 45 | 5 | NB-UVB yield significantly greater repigmentation rates than BB-UVA (64% ± 27.4 vs 44% ± 29.8 at 4 months, p=0.047) | NB-UVB: burning sensation and/or erythema (15%) |
| El Zawahry et al | 2012 | NB-UVB vs. UVA1 | 40 | 3 | NB-UVB superior to UVA1 based on percentage change in VASI score (median: -6.7% vs. 0%, P<0.001) and change in VETF area score (-4.4% vs. 0%, P=0.001) | NB-UVB: phototoxicity (5%), koebnerization (5%) |
| Sapam et al | 2012 | NB-UVB vs. PUVA | 56 | 6 | No significant difference in mean degree of repigmentation between the NB-UVB group and PUVA group (45% vs. 40%, respectively) | NB-UVB: pruritis (7.1%); PUVA: pruritus (19.2%), thickening (15.4%), hyperpigmentation (7.7%), giddiness (7.7%), erythema (7.7%), nausea (7.7%) |
| Siadat et al | 2014 | NB-UVB vs. oral minocycline | 42 | 3 | NB-UVB therapy reduced disease activity by 76.2% vs. 33.9% with minocycline (p<0.05), and was better able to reduce lesion diameters (p=0.031) | NB-UVB: pruritus, erythema (% not reported); minocycline: oral mucosal hyperpigmentation, GI complaints, and/or headache (14.2%) |
| Singh et al | 2013 | PUVA-Sol vs. PUVA | 35 | 9 | PUVA-Sol fell short of PUVA in repigmentation and quality of life (QOL) improvement outcomes (26% vs. 46% repigmentation at 9 months, respectively, p=0.06; mean QOL metric post-PUVA-sol treatment was a third of that post-PUVA at the same time point, p=0.04) | PUVA-Sol: phototoxicity (64.7%); PUVA: phototoxicity (100%) |
| Monochromatic excimer light laser (MEL) therapy | ||||||
| Le Duff et al | 2010 | MEL vs. excimer lamp | 20 | 3 | Both treatments showed similar efficacy with >50% mean repigmentation; the lamp induced more erythema than the laser | Both arms: erythema (“majority of patients”) |
| Shi et al | 2013 | MEL vs. excimer lamp | 14 | 2 | Both treatments exhibited similar efficacies in treating vitiligo; >50% in 79% of patches treated by laser and 87.5% of patches treated by lamp | MEL laser: erythema (92.9%); excimer lamp: erythema (85.7%) |
| Verhaeghe et al | 2011 | MEL vs. NB-UVB | 11 | 3 | No vitiliginous patches achieved >50% repigmentation after 3 months of MEL. 20% of lesions treated with NB-UVB achieved repigmentation scores >50% | MEL laser: erythema (82%), burning sensation (27%); NB-UVB: erythema (82%), burning sensation (18%) |
| Combination UV and topical or systemic therapies | ||||||
| Akdeniz et al | 2014 | Topical calcipotriol + NB-UVB + betamethasone vs. NB-UVB + topical calcipotriol vs. NB-UVB | 45 | 6 | Significantly greater repigmentation at 6 months observed with topical calcipotriol + NB-UVB + betamethasone therapy compared to NB-UVB alone (63.3 ± 7.6% vs 46.7 ± 8.0%, p = 0.0048). No other significant differences reported | None reported |
| Anbar et al | 2014 | Latanoprost + NB-UVB vs. Latanoprost vs. NB-UVB | 22 | 3 | At 6 month follow-up, latanoprost-induced repigmentation was comparable to that of the NB-UVB treatment. The latanoprost-NB-UVB combination was superior to other treatment arms, with 75% of patients retaining their repigmentation at 6 month follow-up | None reported |
| Baldo et al | 2014 | Topical tacrolimus + NB-UVB | 48 | 9 | NB-UVB therapy was deemed comparable to 0.1% topical tacrolimus, with at least partial repigmentation rates of ~70% | Erythema and/or folliculitis (16%) |
| Lim et al | 2015 | NB-UVB + percutaneous afamelanotide vs. NB-UVB | 55 | 6 | Afamelanotide + NB-UVB, vs. NB-UVB alone, yielded faster repigmentation of facial (41 vs. 61 days, p=0.001) and upper extremity lesions (46 vs. 69 days, p=0.003), and greater 6-month repigmentation rates (48.6% vs. 33.3%) | Combination: erythema (68%), nausea (18%), pruritis (7%), hyperpigmentation (7%) NB-UVB: erythema (82%), pruritis (7%), burning sensation (7%) |
| Nordal et al | 2011 | Topical tacrolimus + NB-UVB vs. NB-UVB | 40 | 3 | 42.1% repigmentation observed with tacrolimus + NB-UVB vs. 29% with NB-UVB monotherapy. A correlation between the number of topical tacrolimus applications and the repigmentation response was observed (p=0.044) | None reported |
| Combination MEL laser (MEL) and topical therapies | ||||||
| Hui-Lan et al | 2009 | Topical pimecrolimus + MEL laser treatment vs. MEL | 48 | 4 | Topical pimecrolimus + MEL laser treatment yielded significantly greater repigmentation at 7.5 months than MEL laser treatment alone (71% vs. 50% of subjects with >50% repigmentation, p=0.001) | Combination: burning sensation (16.7%), pruritis (14.6%) MEL laser: erythema (“common”), burning sensation (12.5%) |
| Nistico et al | 2012 | Topical tacrolimus + MEL laser treatment vs. MEL laser treatment | 52 | 3 | Repigmentation rates of the MEL laser treatment + tacrolimus (+vitamin E) vs. MEL laser treatment (+vitamin E) not statistically significant (p=0.36) at 4 months (70% vs. 55% with > 50% repigmentation) | Combination: erythema and/or burning sensation (25%) MEL laser: erythema and/or burning sensation (30%) |
PUVA=psoralen UVA; PUVA sol=psoralen UVA (sunlight as PUVA source); NB-UVB=narrowband UVB; MEL=meditec excimer light laser; QOL=quality of life; BB-UVB=broadband UVB; VASI=vitiligo area scoring index