(Table 2). However, these differences were not statistically different (P=0.37). Gender, age, family history of vitiligo and history of autoimmunity were not statistically significant for both head and neck or body lesions (Tables 1 and 2).
Rapidity of repigmentation, as judged by the interval until achievement of 75 percent repigmentation, was fastest for subjects with Fitzpatrick types 3-4, when compared with types 1-2 and 5-6 (Kaplan-Meier survival analysis). This was true for both body (Log-rank P=0.03; Figure 1A) and head and neck lesions (Log-rank P=0.02; Figure 1B). By 6 months, 75 percent or more repigmentation of body lesions was achieved in 49.3 percent, 64.1 percent and 37.5 percent of subjects with Fitzpatrick types 1-2, 3-4 and 5-6, respectively (Figure 1a). For head and neck lesions, 82.7 percent, 88.1 percent and 74.6 percent of lesions achieved 75 percent or more repigmentation, respectively (Figure 1b).
Vitiligo vulgaris is an autoimmune condition in which pigmentation is lost from the skin and mucous membranes. Patients of all colors can be affected by vitiligo.1,3One of the clinical difficulties in vitiligo therapy is identifying the best initial therapy for any one patient, as there is fair evidence in favor of a number of agents One of the clinical difficulties in vitiligo therapy is identifying the best initial therapy for any one patient, as there is fair evidence in favor of a number of agents.10 Our findings here suggest that topical tacrolimus is a beneficial therapy in all Fitzpatrick skin types, but may be especially effective for individuals of intermediate color (types 3-4). Studies looking comparatively at individual response to topical agents in vitiligo based on skin tone are lacking in the literature. This is the first study to demonstrate superior response in individuals of color and specifically individuals of intermediate pigmentation. Although our data suggests that the darkest skin types may not be as responsive to topical tacrolimus in atopic dermatitis, we found responses of individuals with Fitzpatrick types 5-6 (mostly African American and Indian individuals) to be non-inferior to that of Fitzpatrick types 1-2 (mostly Cacasian individuals), but inferior to responses in individuals in the Fitzpatrick 3-4 range (mostly Hispanic individuals).
Topical tacrolimus was initially developed as a topical agent for atopic dermatitis in Asia. Studies have suggested that individuals of African American descent may require higher concentrations than 0.03% tacrolimus topically for atopic dermatitis.11 Factors that could affect response include genetic variations in ability to absorb products through the intact skin barrier, vitamin levels (e.g., vitamin D levels, which are lowest in individuals of Fitzpatrick types 5-6),12 and immunological differences between racial groups. Furthermore, genetic studies have demonstrated that vitiligo is heterogeneous.13-15 There may be different pathological bases for disease in different ethnic groups that could account for variations in response to topical agents.
In conclusion, our data demonstrates differences in clinical response to topical agents that support biological differences in individuals of different skin tones and ethnicities. Further research into comparative responses by skin tone and ethnicity are needed
to aid in development of ideal therapeutic protocols for vitiligo in individuals of all skin types and ethnicities.
The authors have no conflict of interest to disclose.
- Silverberg NB. Update on childhood vitiligo. Curr Opin Pediatr. 2010;22:445-452.
- Shah S AA, Silverberg N. Treatment of Vitiligo in Children of Color. Asian Pigment Bulletin. January 2007.
- Grimes PE. New insights and new therapies in vitiligo. JAMA. 2005;293:730-735.
- Cockayne SE, Messenger AG, Gawkrodger DJ. Vitiligo treated with topical corticosteroids: Children with head and neck involvement respond
well. J Am Acad Dermatol. 2002;46:964-965.
- Hadi SM, Spencer JM, Lebwohl M. The use of the 308-nm excimer laser for the treatment of vitiligo. Dermatol Surg. 2004;30:983-986.
- Nicolaidou E, Antoniou C, Stratigos AJ, Stefanaki C, Katsambas AD. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274-278.
- Hossani-Madani AR, Halder RM. Topical treatment and combination approaches
for vitiligo: New insights, new developments. G Ital Dermatol Venereol. 2010;145:57-78.
- Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for treatment of childhood vitiligo in Asians. Clin Exp Dermatol. 2004;29:589-592.
- Lo YH, Cheng GS, Huang CC, Chang WY, Wu CS. Efficacy and safety of topical tacrolimus for the treatment of face and neck vitiligo. J Dermatol. 2010;37:125-129.
- Gawkrodger DJ, Ormerod AD, Shaw L, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159:1051-1076.
- Hanifin JM, Ling MR, Langley R, Breneman D, Rafal E. Tacrolimus ointment
for the treatment of atopic dermatitis in adult patients: Part I, efficacy. J Am Acad Dermatol. 2001;44(suppl 1):28-38.
- Silverberg J, Silverberg A, Malka E, Silverberg N. A pilot study assessing
the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010;62:937-941.
- Jin Y, Mailloux CM, Gowan K, et al. NALP1 in vitiligo-associated multiple autoimmune disease. N Engl J Med. 2007;356:1216-1225.
- Jin Y, Birlea SA, Fain PR, et al. Common variants in FOXP1 are associated with generalized vitiligo. Nat Genet. 2010;42:576-578.
- Jin Y, Birlea SA, Fain PR, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med. 2010;362:1686-1697.
Address for Correspondence
Nanette Silverberg, MDSt. Luke's-Roosevelt Hospital Center1090 Amsterdam Avenue, Suite 11DNew York, NY 10025Phone: (212) 523-3888Fax: (212) email@example.com