Vitiligo: Off Label Topical Calcineurin Inhibitors Help Some Patients

MedicalResearch.com Interview with:

Dr-Jung Min Bae

Dr. Jung Min Bae

Jung Min Bae, MD, PhD
Associate Professor, Department of Dermatology
St. Vincent’s Hospital
College of Medicine, The Catholic University of Korea 

MedicalResearch.com: What is the background for this study?

Response: Vitiligo is a common chronic skin disease affecting 1% of the population, and it causes low self-esteem and social stigma. To date, there are no approved drugs for the treatment of vitiligo, even though growing evidence indicates favorable therapeutic responses of topical calcineurin inhibitors (TCIs) including tacrolimus and pimecrolimus.

In this study, we conducted a systematic review and meta-analysis of all relevant prospective studies (n = 46) and identified remarkable therapeutic responses of TCI monotherapy and TCI plus phototherapy for vitiligo. Continue reading

Immunotherapy Ruxolitinib Cream Improves Facial Vitiligo

MedicalResearch.com Interview with:

David Rosmarin, MD Dermatologist; Assistant Professor Tufts University School of Medicine

Dr. Rosmarin

David Rosmarin, MD
Dermatologist; Assistant Professor
Tufts University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vitiligo is a disease where the immune system causes depigmentation of the skin. We performed a pilot study to evaluate the use of a new class of medication for the treatment of vitiligo.


MedicalResearch.com: What should readers take away from your report?

Response: After applying topical ruxolitinib cream twice a day, patients had significant repigmentation, particularly those with facial vitiligo.

This treatment holds promise as a potential new treatment for vitiligo. Because it is a topical, it spares many side effects of taking a medication orally.

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Citation:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Vitiligo Susceptibility Genes Associated With Immune Regulation Identified

MedicalResearch.com Interview with:

Richard Spritz, Director of the Human Medical Genetics and Genomics Program at the University of Colorado School Medicine, led a recent study that explored the genetic links between eye color and serious skin conditions like vitiligo and melanoma. (Marla R. Keown/Aurora Sentinel)

Dr. Richard Spritz,

Richard A. Spritz, M.D.
Professor and Director,
Human Medical Genetics and Genomics Program
University of Colorado School of Medicine.
Aurora, CO 80045 USA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vitiligo is an autoimmune disease in which depigmented skin results from destruction of skin melanocytes, with strong epidemiologic association with several other autoimmune diseases that include autoimmune thyroid disease, type 1 diabetes, rheumatoid arthritis, pernicious anemia, systemic lupus erythematosus, and Addison’s disease.

In previous genetic linkage and genome-wide association studies (GWAS) of vitiligo patients of European-derived white ancestry (EUR), we identified 27 vitiligo susceptibility loci. In the present study, we carried out a third GWAS of vitiligo in EUR subjects. The combined analysis, with almost 5,000 vitiligo cases and 40,000 non-vitiligo controls, identified a total 23 new confirmed vitiligo loci, as well as seven with suggestive significance.

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Vitiligo: Combination therapy with excimer laser and topical agents improves outcomes

More on Dermatology on MedicalResearch.com

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

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.

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JAK Inhibitors Offer Hope For Vitiligo

Brett King, M.D., Ph.D. Assistant Professor of Dermatology Yale University School of Medicine MedicalResearch.com Interview with:
Brett King, M.D., Ph.D.
Assistant Professor of Dermatology
Yale University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. King: Treatment options for vitiligo are limited and often ineffective. This report highlights the possibility of targeted therapy of vitiligo using a relatively new class of medicines called Janus kinase (JAK) inhibitors. Based upon our understanding of vitiligo, JAK inhibition interrupts interferon gamma signaling, which perpetuates depigmentation.

Medical Research: What should clinicians and patients take away from your report?

Dr. King: There is hope that effective treatments will soon be available for vitiligo.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. King: Clinical trials using different JAK inhibitors, both topically and orally, are needed. Also, we need to better understand how important JAK 1/2 vs JAK 1/3 inhibition is to repigmentation.

Citation:

Craiglow BG, King BA. Tofacitinib Citrate for the Treatment of Vitiligo: A Pathogenesis-Directed Therapy. JAMA Dermatol. Published online June 24, 2015. doi:10.1001/jamadermatol.2015.1520.

Brett King, M.D., Ph.D., Assistant Professor of Dermatology, & Yale University School of Medicine (2015). JAK Inhibitors Offer Hope For Vitiligo 

Study Examines Risk of Alopecia Areata and Vitiligo in Stem Cell Recipients

MedicalResearch.com Interview with:
Rena Zuo, BA
MD Candidate at Duke University School of Medicine and

Edward W. Cowen, MD, MHSc
Senior Clinician
Head, Dermatology Consultation Service
Dermatology Branch
Center for Cancer Research National Cancer Institute
National Institutes of Health

MedicalResearch: What are the main findings of the study?


Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood.

Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed.

Several particularly interesting results were found:

  1. Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
  2. Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
  3. Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.

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