Topical Tacrolimus Is More Effective for Treatment of Vitiligo in Patients of Skin of Color
May 2011 | Volume 10 | Issue 5 | Original Article | 507 | Copyright © May 2011
Jonathan I. Silverberg MD PhD MPH and Nanette B. Silverberg MD
Background: Vitiligo vulgaris is a chronic autoimmune depigmenting disorder affecting individuals of all skin colors. Lesions are commonly noted in the periorificial face and over the upper and lower extremities in areas of friction. Although there have been many published reports of successful therapies for vitiligo, few have assessed differential response based on skin color.
Objective: To determine if topical tacrolimus is more effective at treating vitiligo in individuals of color.
Methods: An IRB-approved chart review of patients with a diagnosis of vitiligo was conducted including patients seen between May 2001 and April 2006. Patients with vitiligo were treated with tacrolimus 0.03% for children ages 2-15 years of age and tacrolimus 0.1% ointment for individuals 16 years of age or older, applied twice-daily to all hypopigmented or depigmented lesions. A review of clinical features, Fitzpatrick skin type and response to topical tacrolimus were recorded.
Results: Topical tacrolimus was effective in all Fitzpatrick skin types, with superior efficacy on body lesions in individuals of Fitzpatrick
types 3-4 (Fisher exact test, P=0.03). Further, individuals with Fitzpatrick type 3-4 skin had shorter interval to >75 percent improvement of lesions on the body (Kaplan-Meier Log-rank, P=0.03) and head and neck (P=0.016).
Conclusion: Topical tacrolimus is an effective treatment for vitiligo irrespective of skin tone, with greatest benefit in Fitzpatrick type 3-4 skin. Repigmentation of lesions on the head and neck is superior to repigmentation of the body and extremities in all racial subgroups.
J Drugs Dermatol. 2011;10(5):507-510.
Vitiligo vulgaris affects 0.4-1 percent of the world population.
1 Pockets of areas of high incidence (as high as 8%) have been reported in India.2 While vitiligo vulgaris affects all races and ethnicities, lesions are more noticeable in individuals of color, due to the greater differential in skin tone between normally
pigmented skin and hypo- or depigmented skin.1 Effective skin therapy in all races and Fitzpatrick skin types is needed. If untreated vitiligo may become progressively more cosmetically disfiguring; it may interfere with work or personal relationships and may become less amenable to therapy.1,3
The comparative study of response to agents by race or skin tone has been noted in some past clinical reports of therapies for vitiligo vulgaris. Cockayne et al. reviewed the fact that their pediatric population demonstrated better results with topical corticosteroids than their adults with vitiligo, but noted that the children were primarily of color.4 Published data on efficacy of ultraviolet light therapies has demonstrated that narrowband UVB and excimer laser are more effective on the head and neck in individuals of color.5,6
A number of the original reports of topical tacrolimus for adults and children have documented good repigmentation in patients of color,1,7 including patients from India8 and Asia.9 Differential repigmentation by skin tone or ethnicity has not been previously explored for topical tacrolimus. The aim of this report is to provide comparative data on response of individuals of all colors to therapy for vitiligo using tacrolimus ointment topically.
An IRB-approved review of charts of individuals with the diagnosis of vitiligo vulgaris (international classification of diseases version 9 code 709.01) was conducted at the Department of Dermatology of the St. Luke's-Roosevelt Hospital Center, New York, NY. Individuals included in this review are those individuals who had used prescribed topical tacrolimus for at least a three month trial for vitiligo vulgaris. Clinical data reviewed included demographic data (age, sex, ethnicity), Fitzpatrick skin type, medical and family history, site of usage of tacrolimus, time at which first response was noted, length of medication usage to achieve maximum repigmentation and percentage of repigmentation (reflected as none, 100% or quartiles: 1-24%, 25-49%, 50-74% and 75-99%) as determined by a dermatologist (NS) during clinical visits. A standard prescribing protocol was followed for vitiligo. Tacrolimus was prescribed using 0.03% ointment for children ages 2-15 years and 0.1% ointment for patients ages 16 years and older.
Age and BSA were not normally distributed and were analyzed as ordinal variables. All categorical variables were examined by