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.
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
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
