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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 36-37

Combination of 308 nm excimer light with topical tacalcitol ointment for vitiligo treatment


1 D Y Patil Hospital, Nerul, Navi Mumbai, Maharashtra, India
2 Shree Skin Centre, Nerul, Navi Mumbai, Maharashtra, India

Date of Web Publication10-Jul-2018

Correspondence Address:
Prof. Kiran Godse
D Y Patil Hospital, Nerul, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdd.ijdd_15_18

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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 2018 Dec 11];4:36-7. Available from: http://www.ijdd.in/text.asp?2018/4/1/36/236280

Sir,

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.[1],[2]

The 308 nm excimer laser is a newer treatment option that can yield impressive results in an abbreviated timeframe.[3] 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.[4] In another study, combination of tacalcitol with sun exposure showed no additional advantages compared with sun exposure alone.[5] 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.[6]

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.[7] 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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Linthorst Homan MW, Spuls PI, de Korte J, Bos JD, Sprangers MA, van der Veen JP, et al. The burden of vitiligo: Patient characteristics associated with quality of life. J Am Acad Dermatol 2009;61:411-20.  Back to cited text no. 1
    
2.
Ongenae K, Beelaert L, van Geel N, Naeyaert JM. Psychosocial effects of vitiligo. J Eur Acad Dermatol Venereol 2006;20:1-8.  Back to cited text no. 2
    
3.
Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: a review. J Am Acad Dermatol 2009;60:470-7.  Back to cited text no. 3
    
4.
Sahu P, Jain VK, Aggarwal K, Kaur S, Dayal S. Tacalcitol: A useful adjunct to narrow-band ultraviolet-B phototherapy in vitiligo. Photodermatol Photoimmunol Photomed 2016;32:262-8.  Back to cited text no. 4
    
5.
Rodríguez-Martín M, García Bustínduy M, Sáez Rodríguez M, Noda Cabrera A. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. Br J Dermatol 2009;160:409-14.  Back to cited text no. 5
    
6.
Lu-Yan T, Wen-Wen F, Lei-Hong X, Yi J, Zhi-Zhong Z. Topical tacalcitol and 308-nm monochromatic excimer light: A synergistic combination for the treatment of vitiligo. Photodermatol Photoimmunol Photomed 2006;22:310-4.  Back to cited text no. 6
    
7.
Katayama I, Ashida M, Maeda A, Eishi K, Murota H, Bae SJ. Open trial of topical tacalcitol [1 alpha 24(OH) 2D3] and solar irradiation for vitiligo vulgaris: Upregulation of c-Kit mRNA by cultured melanocytes. Eur J Dermatol 2003;13:372-6.  Back to cited text no. 7
    




 

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