Narrow-band UVB therapy and topical calcineurin inhibitors for the treatment of paediatric vitiligo in real clinical practice

Abstract

Vitiligo is an acquired chronic skin disease, characterised by progressing, usually symmetric, depigmented areas in human skin. Vitiligo affects 0.5% of the human population, however, optimal treatment combination real clinical practice has yet to be found. The aim of the study was to assess whether combined therapy with ultraviolet B (UVB) therapy and calcineurin inhibitors (CNI) provides superior response in vitiligo patients, compared with phototherapy or topical CNI monotherapy. We performed a retrospective cohort study of children treated for vitiligo from January 2016 to December 2019. Primary outcome measures include clinical efficacy defined by area of repigmentation — good clinical efficacy (re-pigmentation of 50% of lesion surface area), positive clinical efficacy and poor clinical efficacy (re-pigmentation of < 15% of lesion surface area). Secondary outcome measures included reduction of lesion size and tolerability of therapy. A total of 114 patients were recruited in the study, 46 allocated to the topical CNI therapy group, 36 to the narrow band (Nb-UVB), and 32 to the combined therapy group. All treatments statistically significantly decreased lesion surface area compared to the baseline (mean, SD). Local therapy reduced lesions from 8.5 (5.7) to 5.3 (4.2) by 37.3% (p < 0.0001), phototherapy reduced lesions from 9.8 (5.4) to 5.7 (3.92) by 42.3% (p < 0.0001), and combined therapy reduced lesions from 14.2 (4.8) to 6.58 (3.5) by 53.6% (p < 0.0001), with combined therapy showing superior numerical efficacy. Clinical efficacy for CNI monotherapy was 67.4%, for phototherapy — 80.5%, and for combined therapy 93.7%. The safety profile of therapies was consistent with other studies. Our results support the use of combined therapy in vitiligo patients.