18 Jan Vitiligo: Combination therapy with excimer laser and topical agents improves outcomes
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Dr. Jung Min Bae
MedicalResearch.com Interview with:
Jung Min Bae, MD, PhD
Department of Dermatology, St. Vincent’s Hospital,
College of Medicine
The Catholic University of Korea,
Suwon Korea
Medical Research: What is the background for this study?
Response: Vitiligo is one of the major challenging skin diseases. Although a number of interventions have been done in the treatment of vitiligo, no definitive curative treatment exists. Narrowband ultraviolet B phototherapy is considered the mainstay of vitiligo treatment, and 308-nm excimer laser/light therapy has gained popularity for localized vitiligo. However, they are not effective in all patients with vitiligo, and the combination therapies with topical agents are widely applied to increase the response rates of these treatment modalities in clinical practice. We sought to compare the efficacy of excimer laser/light and topical agent combination therapy versus excimer laser/light monotherapy for vitiligo. We performed a systematic review and meta-analyses of randomized controlled trials in this subject.
Medical Research: What are the main findings?
Response: According to our study, the combination therapy of excimer laser/light and topical calcineurin inhibitors showed almost a two-fold increase in treatment success rate (≥75% repigmentation) compared to excimer laser/light monotherapy (relative risk 1.93). The combination therapy also reduced the treatment failure rate (<25% repigmentation) by almost half (relative risk 0.43). Addition of topical vitamin-D3 analogs or topical corticosteroids on excimer laser/light showed insufficient evidence to support their use in combination therapies yet. Considering the difficulites in complete recovery of vitiligo, the combination therapies enhancing the treatment response are promising.
Medical Research: What should clinicians and patients take away from your report?
Response: Actually, the combination therapies are already widely adopted for the treatment of vitiligo in clinical practice. However, the treatment adherence to the topical agents are not high enough to warrant the best outcome in all patients. Although the poor adherence to topical calcineurin inhibitors may be largely attributable to the sticky nature of the topical agents, the principle reason would be low confidence of clinicians in the true efficacy of the combination therapies.
Our systematic review revealed that excimer laser/light in combination with topical calcineurin inhibitors are more effective than excimer laser/light monotherapy with specific figures. Our study could have both clinicians and patients convinced of the combination therapies. The use of topical calcineurin inhibitors should be strongly encouraged to enhance the response to excimer laser/light treatment in patients with vitiligo.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: More clinical trials are needed to determine the efficacy of diverse combination with excimer laser/light. The mechanism of action for the combination therapies should be explored as well.
Citation:
Jung Min Bae, Bo Young Hong, Joo Hee Lee, Ji Hae Lee, Gyong Moon Kim
DOI: http://dx.doi.org/10.1016/j.jaad.2015.11.044
Published online: January 16 2016
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Jung Min Bae, MD, PhD (2016). Vitiligo: Combination Therapy including Laser/Light Improves Outcomes MedicalResearch.com
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Last Updated on January 19, 2016 by Marie Benz MD FAAD