Immunomodulators, Other Emerging Therapies Show Promise for Vitiligo

The efficacy of immunomodulators for the treatment of vitiligo is supported by results from a literature review published in Dermatologic Therapy. In a systematic review, investigators explored the current data for vitiligo therapy, concluding that immunomodulators and other emerging treatment modalities may become more prominent in coming years.

Investigators conducted a search of the PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane databases for English-language publications describing vitiligo treatment. Special emphasis was placed on identifying articles describing immunomodulators—a relatively new therapeutic option. Five treatment categories were explored: (1) medical treatment, including topical and systemic options; (2) phototherapy; (3) laser therapy; (4) surgical treatment, including depigmentation; and (5) immunomodulators and other emerging therapy options. In the literature of medical treatment, topical corticosteroids remain the first-line therapeutic option for vitiligo. Systemic options include oral corticosteroids, levamisole, and psoralen. Although corticosteroids were often associated with positive outcomes, long-term steroid use may result in significant side effects; use should be limited to 3 months or fewer, it was noted.

Phototherapy and laser therapy were also commonly described in the literature. Phototherapy is often used as the first-line treatment in patients with extensive vitiligo. Narrow-band ultraviolet B (NB-UVB) light was frequently cited as the “choice” therapy for vitiligo given its efficacy and mild safety profile. Regarding laser therapy, the 308-nm monochromatic excimer laser (MEL) has been approved by the Food and Drug Administration for vitiligo treatment. However, no official dosing guidelines exist. And although MEL has been associated with improvements in vitiligo, long-term exposure can age the skin and cause cancer. For surgical interventions, investigators tabulated 3 categories: (1) tissue grafts, in which the whole epidermis and dermis are transplanted; (2) cellular grafts, in which a particular cellular component is transplanted; and (3) nongrafting surgical techniques, including ablation, micropigmentation tattooing, and depigmentation. Of these, the most data were available for tissue and cellular grafts, which were generally efficacious but typically expensive and resource consuming. In addition, many surgical techniques require specialized facilities and/or a surgical expert, which may be prohibitive for many patients.

Regarding immunomodulators, afamelanotide, rituximab, minocycline, latanoprost, zinc, tofacitinib, cyclosporine, methotrexate, and sodium oxo-dihydro-acridinylacetate (ODHAA) each displayed some degree of efficacy in vitiligo treatment. In particular, afamelanotide combined with NB-UVB outperformed NB-UVB monotherapy for repigmentation in a randomized clinical trial of patients with vitiligo. In an open trial of 32 patients, minocycline was associated with an “arrest [in] disease progression.” A pilot study of sodium ODHAAA demonstrated stabilization of vitiligo in 73% of enrollees. Emerging therapies like stem cell regeneration and selective sunscreen application were also described in the literature, although data on their respective efficacies remain sparse.

Results from a literature review highlight the myriad treatment options available for vitiligo. However, no option offers promise of complete clearance. As such, investigators advocated for further research of immunomodulators and other emerging therapies, which have demonstrated promise in existing clinical trials. “We have [highlighted] the recent modalities…to create awareness about these newer therapeutic options and provide better care to our vitiligo patients,” investigators wrote.

Reference

Agarwal K, Podder I, Kassir M, et al. Therapeutic options in vitiligo with special emphasis on immunomodulators: a comprehensive update with review of literature [published online December 31, 2019]. Dermatol Ther. doi:10.1111/dth.13215