Comparative Evaluation of Efficacy and Safety of Tacrolimus and Dinoprostone Following Dermabrasion in Stable Vitiligo

May 2021 | Volume 20 | Issue 5 | Original Article | 519 | Copyright © May 2021


Published online April 30, 2021

doi:10.36849/JDD.5751

Jaskirat Kaur MD, Sumir Kumar MD, B.K Brar MD, Amarbir Singh Boparai MD

Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College and Hospital, Faridkot, India

Abstract
Background: Dinoprostone (DNP), a prostaglandin E2 (PGE2) analogue, has been found to cause repigmenation in vitiliginous lesions. Combined medical and surgical therapy might be more useful for successful treatment of vitiligo.
Objectives: In this study, we aimed to evaluate the efficacy and safety of dermabrasion followed by dinoprostone gel and to compare it with tacrolimus ointment following the same procedure in the treatment of localized stable vitiligo.
Methods: 40 patients of stable vitiligo were enrolled which were divided in two groups of 20 patients each. In group 1, dermabrasion followed by tacrolimus 0.1% ointment was done and in group 2, dermabrasion followed by dinoprostone gel was done.
Results: Group 1 patients showed slightly better response (P=0.039), whereas the side effect profile was better for group 2.
Conclusion: DNP and tacrolimus have immunomodulatory and melanocyte stimulating effect and are well tolerated when combined with dermabrasion. Their effect on skin pigmentation could be enhanced by dermabrasion.

J Drugs Dermatol. 2021;20(5):519-522. doi:10.36849/JDD.5751

INTRODUCTION

Vitiligo is a disorder of skin color characterized by defective melanocyte proliferation and melanosome transfer with an unpredictable course. With a dearth of therapeutic options, the present study assesses the use of novel molecule dinoprostone (DNP), which is having a favorable effect on the above mechanisms.

The conventional surgical management of stable vitiligo include skin grafting, non-cultured epidermal cell suspension, and hair follicle grafting. Dermabrasion is a commonly used surgical modality for treating dermatological conditions like acne scarring, striae, and is also a preliminary step in vitiligo surgery. This minimally invasive method can be used as a drug delivery method, hence, can be combined with several topical medications like 5-flourouracil, latanoprost, tacrolimus, pimecrolimus, and decapeptides. During the healing process, the inflammatory reactions and re-epithelialization phase stimulates the follicular and perilesional melanocytes.1 Tacrolimus is a few-decades-old molecule, having certified efficacy for the disease.2 There is expression of various PG receptors like PGE2 type 1 (EP1) and PGE2 type 3 (EP3) over the melanocytes.3 DNP, a PGE2 analogue, was prescribed first in 2002 for vitiligo, but since then, the molecule hibernated for years to come.4 We conducted this study to compare the efficacy and safety of dermabrasion followed by tacrolimus ointment versus dermabrasion followed by dinoprostone gel in localized stable vitiligo.

MATERIALS AND METHODS

Institutional ethical committee approval was obtained prior to start of the study. 40 patients with stable vitiligo were enrolled from the outpatient department of dermatology of a tertiary health care center from January 2018 to December 2019. They were randomly divided into two groups using random number tables – groups 1 and 2. Informed and written consent was taken from each patient. Detailed history including the duration of lesion and family history were recorded. In our study, we considered vitiligo to be stable if it had not shown any increase in the number or size of lesion for the last 1 year. This was in concordance with the previous studies.5,6

Patients included were 15–45 years of age. Subjects having generalized and unstable vitiligo, keloidal tendency, active local infection, known hypersensitivity to the agents, and pregnant and lactating women were excluded from the study.

A mechanical dermabrader unit of average speed of 1500 rpm and diamond fraises were used for the procedure. The relevant patch was cleaned with povidone iodine, anesthetized locally with 2% lignocaine and 1:10000 adrenaline injection after which the dermabrasion was done 4 times in each direction horizontally, vertically, and diagonally.

Hemostasis was achieved and the dressing was done as follows: In group 1, tacrolimus ointment (0.1%) was applied and in group 2, DNP (0.5g/3g) gel was applied and dressing was done. The