|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 1 | Page : 36-37
Combination of 308 nm excimer light with topical tacalcitol ointment for vitiligo treatment
Kiran Godse1, Gauri Godse2
1 D Y Patil Hospital, Nerul, Navi Mumbai, Maharashtra, India
2 Shree Skin Centre, Nerul, Navi Mumbai, Maharashtra, India
|Date of Web Publication||10-Jul-2018|
Prof. Kiran Godse
D Y Patil Hospital, Nerul, Navi Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Godse K, Godse G. Combination of 308 nm excimer light with topical tacalcitol ointment for vitiligo treatment. Indian J Drugs Dermatol 2018;4:36-7
|How to cite this URL:|
Godse K, Godse G. Combination of 308 nm excimer light with topical tacalcitol ointment for vitiligo treatment. Indian J Drugs Dermatol [serial online] 2018 [cited 2019 Feb 23];4:36-7. Available from: http://www.ijdd.in/text.asp?2018/4/1/36/236280
Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact the quality of life. The disease affects approximately 1% of the population worldwide. Studies have demonstrated that the disfiguring nature of vitiligo causes high psychosocial morbidity.,
The 308 nm excimer laser is a newer treatment option that can yield impressive results in an abbreviated timeframe. We tried excimer light therapy with a combination of tacalcitol ointment in 33 adult patients (18 females and 12 males mean age 31.1, age group 21–65-year duration of disease, and mean 3.1 years with a range of 2.1–5 years) with stable vitiligo. In 20 patients, lesions were located on the face while 4 patients had lesions on the neck, and in 9 cases, they were located on arms and legs. Exclusion criteria were lesions involving >20% of body surface area and unstable vitiligo.
We used GSD 308 nm excimer light machine by Schenzen GSD technology Ltd.,® at wavelength of 308 nm and frequency of 50/60 Hz with a maximum irradiated area of 18.9 cm 2. Before starting treatment, minimal erythema dose (MED) was calculated. Patients were asked to apply tacalcitol ointment at night and received 308 nm excimer light therapy twice a week. Initial dose of excimer light was determined based on MED with 72 h interval between two treatments. Light therapy was performed twice weekly until patients developed significant repigmentation. This was increased by 10% per visit until patients get repigmentation. Treatment dosages were then maintained or decreased by 10% depending on the severity of the side effects. None of the patients stopped treatment due to side effects of the laser therapy.
After 12 weeks of excimer light treatment, three patients were lost to follow-up. Repigmentation was graded according to the percentage of repigmentation in the treated area: 75%–100% repigmentation, excellent (Score 3); 50%–74%, good (Score 2); 25%–49%, moderate (Score 1); and 1%–24%, poor and 0 (Score 0). Out of thirty patients receiving this light therapy, 12 showed excellent repigmentation, 8 showed a good response, 5 showed moderate repigmentation, and 5 showed poor repigmentation.
There were no major side effects noted. 1,24-Dihydroxyvitamin D3 (tacalcitol), a Vitamin D3 compound, has been used to treat T cell-mediated inflammatory skin diseases such as psoriasis, prurigo, and vitiligo. Sahu et al. found that topical tacalcitol potentiates the efficacy of Narrow Band ultraviolet B (UVB) as it enhances the extent of pigmentation, decreases time for repigmentation, and lowers the cumulative doses of narrow-band UVB. In another study, combination of tacalcitol with sun exposure showed no additional advantages compared with sun exposure alone. Concurrent topical tacalcitol application was shown to potentiate the efficacy of 308 nm monochromatic excimer light in the treatment of vitiligo, and that this combination achieved earlier pigmentation with a lower total dosage.
One open trial showed that topical tacalcitol (1,24-dihydroxyvitamin D3), a Vitamin D3 analog with a structure similar to that of calcipotriol (1,25-dihydroxyvitamin D3), combined with sunlight exposure can induce repigmentation. Limitation of this study is a small number of patients and uncontrolled study.
We found this therapy useful in practice. However, double-blind randomized controlled studies with a larger sample are needed to confirm the encouraging small study results.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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