Correspondence
Vitiligo
N Engl J Med 2009; 360:1788April 23, 2009
- Article
To the Editor:
In their Clinical Practice article on vitiligo, Taïeb and Picardo (Jan. 8 issue)1 do not include data to provide support for the use of some combination therapies. Recent evidence suggests that the combination of erbium:yttrium–aluminum–garnet (YAG) laser skin ablation with fluorouracil application before narrow-band ultraviolet B (UVB) phototherapy confers a benefit as compared with phototherapy alone.2 In addition, the authors state that it is unclear whether topical corticosteroid treatment with UVB radiation is superior to UVB radiation alone. However, we have reported a significant benefit of the combination of excimer laser UVB phototherapy and topical hydrocortisone 17-butyrate cream (applied twice daily in 3-week cycles, with a corticosteroid-free interval of 1 week), as compared with excimer laser therapy alone, in a randomized, parallel-group trial. This trial involved 84 consecutive patients with vitiligo who had lesions on the face, neck, or both that were unresponsive to previous conventional UVB phototherapy. At 12 weeks, the rates of the primary outcome — at least a 75% reduction from baseline in overall lesional areas, based on an automated analysis of reflected ultraviolet photographs — were 43% with the combination of corticosteroid treatment and UVB phototherapy versus 17% with phototherapy alone (P=0.01).3 No skin atrophy or hypertrichosis was reported in patients who received corticosteroid therapy. Combination treatments for vitiligo warrant further investigation in randomized trials.
3 ReferencesLuigi Naldi, M.D.
Fabrizia Sassi, M.D.
Ospedali Riuniti, 24100 Bergamo, Italy
luigi.naldi@gised. it 1
Taieb A ,Picardo M . Vitiligo. N Engl J Med 2009;360:160-169
Full Text | Web of Science | Medline2
Anbar TS ,Westerhof W ,Abdel-Rahman AT ,Ewis AA ,El-Khayyat MA . Effect of one session of ER:YAG laser ablation plus topical 5Fluorouracil on the outcome of short-term NB-UVB phototherapy in the treatment of non-segmental vitiligo: a left-right comparative study. Photodermatol Photoimmunol Photomed 2008;24:322-329
CrossRef | Web of Science | Medline3
Sassi F ,Cazzaniga S ,Tessari G , et al. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol 2008;159:1186-1191
Web of Science | Medline
Author/Editor Response
We did not cite the recent articles by Anbar et al.1 and Sassi et al.2 in our review article because they were published after our article was accepted for publication. In the study reported by Sassi et al.,2 the excimer laser was used as a source of UVB radiation; treatment with this device is more potent than conventional narrow-band UVB treatment. Indeed, their patients were selected because they did not have a response to conventional ultraviolet treatment, topical corticosteroids, or both. The results suggest that this new combination may be a valuable addition to possible treatments for vitiligo in patients with limited disease, although more data are needed to better inform its role.
The report by Anbar et al.1 raises promise for the treatment of vitiligo in difficult-to-treat areas such as the dorsum of the hands. However, experience with the use of fluorouracil in vitiligo is limited, and its use cannot be considered to be conventional. Its mechanism of action in vitiligo has not been clarified, although a photosensitizing capacity of the drug has been reported, as well as repigmentation after systemic administration in isolated cases.
2 ReferencesAlain Taïeb, M.D.
Centre Hospitalier Universitaire de Bordeaux, 33075 Bordeaux, France
alain.taieb@chu-bordeaux. fr Mauro Picardo, M.D.
San Gallicano Dermatological Institute, 00144 Rome, Italy1
Anbar TS ,Westerhof W ,Abdel-Rahman AT ,Ewis AA ,El-Khayyat MA . Effect of one session of ER:YAG laser ablation plus topical 5Fluorouracil on the outcome of short-term NB-UVB phototherapy in the treatment of non-segmental vitiligo: a left-right comparative study. Photodermatol Photoimmunol Photomed 2008;24:322-329
CrossRef | Web of Science | Medline2
Sassi F ,Cazzaniga S ,Tessari G , et al. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol 2008;159:1186-1191
Web of Science | Medline
