Topical tacrolimus therapy for vitiligo: therapeutic responses and skin messenger RNA expression of proinflammatory cytokines - 24/08/11
Los Angeles, California
Abstract |
Background |
Previous studies have documented humoral and cell-mediated immunologic defects in patients with vitiligo.
Objective |
This 24-week study assessed the efficacy and safety of tacrolimus 0.1% ointment in patients with generalized vitiligo as well as the pretreatment and post-treatment expression of cytokines in the depigmented and normal skin of patients compared with controls.
Methods |
Twenty-three patients were enrolled in this investigation, and 19 patients completed the study; 8 were male and 11 were female. Fifteen age-, race-, and sex-matched control subjects were also included. Patients were treated with tacrolimus 0.1% ointment applied twice daily. Repeat evaluations were performed at 4, 8, 12, 16, 20, and 24 weeks. Three-millimeter punch biopsy specimens were taken from the depigmented, non-sun-exposed skin and adjacent normal skin of patients at baseline and 24 weeks, and from normal, non-sun-exposed skin of controls. Cellular messenger RNA expression for interleukin 2 (IL-2), IL-4, IL-10, tumor necrosis factor alfa (TFN-⍺), and interferon gamma (IFN-γ) were determined by real-time quantitative polymerase chain reaction.
Results |
At 24 weeks, 17 of 19 patients (89%) achieved varying levels of repigmentation. There was a statistically significant decrease in overall disease severity scores at 24 weeks. Thirteen patients (68%) had greater than 75% repigmentation of face and/or neck lesions. Signs and symptoms of irritation were minimal. At baseline, compared with healthy controls, vitiligo patients demonstrated a statistically significant increase in the expression of IFN-γ in involved and adjacent uninvolved skin (P=.05 and P=.02, respectively); significantly increased TNF-⍺ expression in involved and uninvolved skin (P=.01 and P=0.02, respectively); and significantly increased IL-10 expression in involved and uninvolved skin (P=.01 and P=.04, respectively). Posttreatment, TNF-⍺ expression decreased in the depigmented and adjacent uninvolved skin (P < .001). There was no statistically significant change in IL-10 or IFN-γ posttreatment. These data suggest that tacrolimus 0.1% ointment is a safe and effective therapy for patients with vitiligo. It further suggests that an imbalance in local cytokine expression may play a role in the pathogenesis of vitiligo. Suppression of TNF-⍺ after topical tacrolimus application may be associated with repigmentation of vitiligo.
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This study was funded by a research grant from Fujisawa Healthcare. Conflicts of interest: None identified. The data were presented as a poster exhibit and oral presentation for the Society of Investigative Dermatology, Los Angeles, California, May 18, 2002. |
Vol 51 - N° 1
P. 52-61 - juillet 2004 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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