Tacrolimus combination superior to monotherapy for vitiligo treatment

Australia: Tacrolimus in combination with steroids, phototherapy and laser is superior to tacrolimus alone for vitiligo treatment, according to a recent study published in the Australasian Journal of Dermatology.

Vitiligo is a disease that causes the loss of skin colour in blotches. It affects about 0.5% to 1% of the population and is associated with low self-esteem and social stigma. The medical approach to vitiligo patients is a complex process. Topical medications (corticosteroids and calcineurin inhibitors) and phototherapy are the mainstays of treatment.

There are also other treatment options such as skin surgery and laser, but none of them has been able to provide consistent and satisfactory results in all patients.

Topical calcineurin inhibitors (TCIs) including tacrolimus and pimecrolimus possess a dual mechanism of action for the treatment of vitiligo: immunosuppression and melanocyte induction. TCIs are recommended as first-line treatments for limited forms of vitiligo, however, the efficacy of TCI monotherapy is often underestimated.

Charan Jeet Arora, Miranda Medical Centre, Miranda, New South Wales, Australia, and colleagues investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo.

The researchers carried out the electronic systematic search of the literature using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo were included in a systematic review and meta‐analysis. A total of 19 studies including 814 patients were included in our systematic review.

Also Read: Topical calcineurin inhibitors show favorable therapeutic response in Vitiligo

Key Findings of the study include:

• In the random-effects-model meta-analysis tacrolimus plus narrowband ultraviolet B (NB-UVB) was better in achieving >75% repigmentation than NB-UVB alone.


• Tacrolimus vs steroids did not differ in achieving: >25%, >50%, and >75% repigmentation.


• No significant difference was observed between fractional laser plus tacrolimus in achieving >25% and >75% repigmentation.


• Excimer laser plus tacrolimus vs excimer laser alone did not differ in achieving >25%, >50%, and >75% repigmentation.

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"Further investigating tacrolimus as mono‐ or adjuvant therapy for vitiligo is highly recommended," concluded the authors.

To read the complete study log on to https://doi.org/10.1111/ajd.13096