14139
The Effect of Narrow Band Ultra Violet B Rays Alone Versus its Combination with Intra lesional Injection of Latanoprost in the Treatment of Vitiligo
Heba Gamal Ibrahim1,Al_Mokadem S2, and Abdulla Esawy3
1Dermatology resident at Al-Ahrar hospital-Zagazig
2Professor of Dermatology, Venereology & Andrology, Faculty of MedicineZagazigUniversity.
3Assistant Professor of Dermatology, Venereology & Andrology,Faculty of Medicine Zagazig University.
Correspondingauthor:Heba Gamal Ibrahim Email :[email protected]
Abstract
Background: Vitiligo depigmentation is considered to be a consequence of melanocyte disappearance mediated by the immune system, toxic materials oroxidative stress.The pigmentary effect of three analogues of prostaglandin F2α (PGF2α) (latanoprost, bimatoprost, and travoprost) on normal skin of guinea pigs was found to be effective and promising interactive treatment. The gold standard for treatment of diffuse vitiligo is now known to be NBUVB (310-315) radiation.
Aim of the study: The aim of this study wasto compare the effect of NBUVB rays alone and combined with intra lesional injection of latanoprost in the treatment of vitiligo to evaluate the role of latanoprost in treatment of vitiligo.
Patients and methods:A total number of 40 patients with vitiligo were included in the study.
They were collected from out-patient clinic of Dermatology, Venereology and Andrology department, Faculty of Medicine, Zagazig University, in the period from November 2019 to November 2020 after obtaining the approval of the institutional review board (IRB) of Zagazig University. They were divided into 2 groups each of 20 patients. The first group received 2 sessions of NBUVB rays per week as a single treatment and the second group received also 2 sessions of NBUVB rays in addition to intra lesional injection of latanoprost once weekly both for 6 months duration.
Results:Regarding differences in each group pre & post treatment there was a decrease in score in group I by 16.82% after treatment but without statistical significance while in group II there was a statistically significant decrease in disease score after treatment by 53.86%. The degree of repigmentation with NBUV+latanoprost ranged from 0 – 95%, while with the NB-UVB treated patients, the degree of repigmentation ranged from 0 – 60%. There was a statistically significant increase in degree of repigmentation in group II compared to group I.During follow up, there was an increase in the disease score among group I compared to group II after 3 months from the end of treatment sessions but without statistical significance.
Conclusion:This study demonstrated that intradermal injection of PG F2α enhanced the outcome of NB-UVB as regard rate and degree of repigmentation of lesions in vitiligo.
Keywords:Vitiligo, Latanoprost, Narrow Band Ultra Violet B Rays (NBUV).
1.Introduction:
Vitiligo is an acquired, idiopathic, depigmenting disorder of the skin and mucous membranes.
Vitiligo depigmentation is considered to be a consequence of melanocyte disappearance mediated
by the immune system, toxic materials oroxidative stress (1).
Other theories include non-immunological pathogenetic mechanisms in vitiligo, functional impairment of epidermal cells, environmental factors and genotype. Various therapeutic options are currently used in vitiligo treatment although often without complete satisfactory therapeutic outcome (2).
Bleuel and Eberlein (3) had reported three approachesfor current therapeutic options;Regulation of the autoimmune response using topical and systemic immunomodulatory agents (corticosteroids and calcineurin inhibitors), decrease in oxidative stress in melanocytes by means of topical and systemic antioxidants, activation of melanocyte regeneration using phototherapy and photochemotherapy and transplantation of pigment cells. They also stated that combination therapies of aforementioned approaches are generally considered to be more successful than monotherapies. Early initiation of treatment is associated with a more favorable prognosis.
The narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality in vitiligo treatment since its first use in 1997. It was proved to be of higher efficacy, better tolerated, and superior to the other lines of treatment (4). Nevertheless, it is an office-based treatment that may require more than 1 year for its completion. Although successful in many cases, some patients may find this long duration of therapy inconvenient due to social and financial reasons (5).
Kapoor et al., (6) have documented efficacy of topical prostaglandin E 2 (PGE2) in the treatment of vitiligo with encouraging results presenting it as a promising therapy for localized vitiligo. On the other hand, Anbar et al., (7) have evaluated the pigmentary effect of three analogues of prostaglandin F2α (PGF2α) (latanoprost, bimatoprost, and travoprost) on normal skin of guinea pigs. They observed that all had a positive effect on skin pigmentation with latanoprost expressing a more significant increase in pigmentation than the other two analogues.
Prostaglandin F2α commonly used in the treatment of ocular hypertension was tried in vitiligo based on the presence of irreversible iris pigmentation and reversible peri-ocular hyperpigmentation observed in glaucoma patients (8).
Prostaglandin F2α however exerts its effect indirectly through induction of cyclooxygenase 2 enzyme (COX-2) and PGE 2 and has been reported to be a promising therapeutic option for vitiligo in both animal and human studies with increased efficacy (7).
We aimed in this study to compare the effect of NBUVB rays alone and combined with intra lesional injection of latanoprost in the treatment of vitiligo to evaluate the role of latanoprost in treatment of vitiligo.
2. Patients and Methods:
2.1. The current study was conducted as interventional study; Randomized clinical comparative trial.A total number of 40 patients with vitiligo were included in the study. They were collected from out-patient clinic of Dermatology, Venereology and Andrology department, Faculty of Medicine, Zagazig University, in the period from November 2019 to November 2020 after obtaining the approval of the institutional review board (IRB) of Zagazig University.
2.2. A consent form approved by the committee of human rights in research in Zagazig University was obtained from each participant before the study initiation.
2.3. Patients who were included in this study of any age and both sexes who had the will to contribute in our study, sign informed consent and did not receive other modalities of treatment
14141 for the last three months.
2.4. All patients who were on other treatment modalities of vitiligo, had systemic diseases as renal, hepatic and auto immune diseases, any pregnant or lactating personnel were excluded from the study.
2.5. The patients who met the inclusion criteria and were suitable candidates for the study have been subjected to:
Complete personal history: name, age, sex, occupation, marital status and residence.
History of present illness: including onset, course, duration, site, and history of previous treatment for the disease.
History of other dermatological diseases.
History of systemic diseases.
History of drug intake.
History of surgical operations.
Family history.General Examination;
General examination of body systems has been performed to discover associated medical conditions.
Dermatological examination;
Examination of vitiligo lesions including site, size, shape using Wood´s light.Any associated dermatologic diseases.
Methodology:
The patients were divided into two groups each group included 20 patients of different ages and both sexes.Duratin of treatment 6 month.
Group I:Each patient has been treated with NBUV B alone twice weekly.
Group II:Each patient has been treated with two sessions of NBUVB in addition to intra dermal injection of latanoprost every week. The injection of latanoprost has been done once weekly in the next day of NBUVB sessions.
NB-UVB therapy (7):
All patients received NB-UVB sessions twice per week until satisfying repigmentation was achieved or for a maximum of 6 months. The NB-UVB source was eight NB fluorescent tubes (Philips TL 100 W/01; Philips BV, Eindhoven, the Netherlands) with a spectrum of 310–315 nm and a maximum wavelength of 311 nm, in a WaldmannUV-1000 unit (Waldmann GmbH, Schwenningen, Germany).
The sessions started with a dose of 0.21 J/cm2 independent of skin type and increased by 20%
every session until we reach the minimal erythema dose. The minimal erythema dose is the dosage which induces mild erythema that disappears the next day of the session.
The patient’s erythema has been evaluated with every clinic visit. No NB-UVB exposure has been allowed if erythema was still present before the session. During the NB-UVB sessions, the affected parts have been exposed with the eyes protected
by UV-blocking goggles. If the eyelids were the areas to be treated, patients have been instructed to keep their eyes closed during exposure without wearing goggles.
Prostaglandin F2 α:
A Prostaglandin F2α analogue; latanoprost 0.005%, has been used for intradermal injection in the next day of NB-UVB sessions. We used Ioprost solution from Alexandria/ Orchidia Pharmaceutical Industries. It is stored in 2-8 °C but once it has been opened it can be stored in room temperature. The vitilignous lesions were cleaned and sterilized with 70% alcohol. The injection was done using insulin syringe at a depth of 3-4 mm with 1 cm distance between each point of injection. We used lidocaine 2 % added to ioprost in the same syringe to decrease the burning sensation accompanying the injection. The procedure was repeated once weekly for each patient until improvement occurred or for maximum 6 months (24 sessions).
2.6. Evaluation of the treatment:
The patients were examined at the first visit and were reviewed weekly for the progress of therapy and the presence of any side effects. Patients were photographed before and at the end of treatment. The assessment of clinical improvement was made by dermatologists according to their estimation of the degree of repigmentation, a 5-grade scale ranging from G0 to G4 according to (9) has been shown in Table 1.
Table (1): Grades of Repigmentation
>75% repigmentation G4
Excellent
50-75%repigmentation G3
Very good
25-50%repigmentation G2
Good
up to 25% repigmentation G1
Satisfactory
No repigmentation G0
Poor
Quantitative evaluation of the response was also performed in a numerical percentage for precise statistical evaluation using Vitiligo Area Scoring Index (VASI) score before and after the treatment (10).
Vitiligo Area Scoring Index:In this assessment, the patient’s body is separated into five regions: the hands, upper extremities (including axilliary regions), trunk, lower extremities (including inguinal regions and buttocks) and the feet. Subsequent studies have added a sixth site: the head/neck area. The percentage of vitiligo involvement for each body region is calculated by using the palmar method. The palmar method uses the palmar surface area of the patient’s hand as an estimation guide and defines the surface of the patient’s hand including fingers to be 1% of the total body surface area.
Each site is then clinically evaluated by visual assessment for the pattern of skin depigmentation using a visual scale and the extent of residual depigmentation is expressed by the following percentages: 0, 10%, 25%, 50%, 75%, 90% or 100%. At 100% depigmentation, no pigment is present; at 90 %, specks of pigment are present; at 75%, the depigmented area exceeds the pigmented area; at 50%, the depigmented and pigmented areas are equal; at 25%, the pigmented area exceeds the depigmented area; at 10%, only specks of depigmentation are present. Then, the VASI is derived by multiplying the values assessed for the vitiligo involvement by the percentage of affected skin for each body site and summing the values of all body sites together.
VASI = Σ (all body size) (hand units) × (residual depigmentation).
14143 2.7. Safety assessment:
The patients were examined every visit for detection of any complications as; erythema, pain, ulceration, burning sensation, ecchymosis, infection, post inflammatory hyperpigmentation, or any allergic manifestations.
2.8. Follow-up:
The patients were followed-up monthly for 3 months after the end of the treatment sessions to detect any recurrence, complications or worsening of the lesions.
2.9. Statistical analysis:
The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 24.0.Qualitative data were represented as frequencies and relative percentages. Chi square test was used to calculate difference between qualitative variables.Mann Whitney test was used to calculate difference between quantitative variables in not normally distributed data in two groups.Paired Wilcoxon test was used to calculate difference between not normally distributed data quantitative variables in the same group pre & post treatment.Spearman’s correlation coefficient was used to calculate correlation between quantitative variables.The threshold of significance is fixed at 5% level (P-value):*P value of
>0.05 indicates non-significant results.P value of <0.05 indicates significant results.
3. Results:
In group I the age of the patients ranged from 8-55 years with a mean of 24.15 ± 15.58 and median of 19 years. Sixty five percent of the patients were females and 35% were males.
In group II the age of the patients ranged from 9-50 years with a mean of 25.9 ±12.45 and median of 22 years. Seventy five percent of the patients were females and 25 % were males. There was no statistically significant difference between the two groups in age or sex. The clinical data of the patients are illustrated in (table 2).
In group Ithe most common site for vitiligo was trunk and lower limb (50%) followed by upper limb (45%) then feet (40%), and in hands the percentage of patients affected was (25%) and the least percentage was the face and neck with (20%) and (10%) respectively.
In group II the most common site for vitiligo was trunk (50%), followed by lower limb (40%) then feet (35%). The percentage of patients affected in upper limb and hands was (25%), (20%) respectively, while the face and neck had the least percentage (10%). There was no statistically significant difference between the two groups in site of lesions as illustrated in figure (1).
Regarding differences in each group pre & post treatment there was a decrease in score in group I by 16.82% after treatment but without statistical significance while in group II there was a statistically significant decrease in disease score after treatment by 53.86% as illustrated in (table 2).The percentage of improvement with NBUVB+ latanoprost ranged from 0 – 95% with a mean of 41.8 ±30.06 and a median of 51.5%. With the NB-UVB only treated patients, the percentage of improvement ranged from 0 – 60% with a mean of 18.3 ± 21.37 and a median of 10%. There was a statistically significant increase in percentage of improvement and grade of repigmentation among group II compared to group I,P<0.05, as illustrated in (table 3).
There was no statistically significant relation between grade of repigmentation and family history, P>0.05, but there was a statistically significant increase in degree of repigmentation among males
compared to females. There was also a statistically significant decrease in degree of repigmentation in face & hand, P<0.05, as illustrated in (table 4).
There was an increase in the disease score among group I compared to group II after 3 months from the end of treatment sessions but without statistical significance. This was noticed in 5 patients (25 %) in group I and 2 patients (10%) in group II, as illustrated in (table 5), figure (2).
hIn group I the duration of the disease ranged from 1-20 years with a mean of 4.53 ± 3.98 and a median of 3.75 years. The family history was positive in 15 % of the patients in this group and negative in 85%.
In group II the duration of the disease ranged from 0.42 – 7 years with a mean of 3.67 ± 2.05 and a median of 3.5 years. The family history was positive in 25 % of the patients in this group and negative in 75%. There was no statistically significant difference between the two groups in duration or family history as shown in(Table 6).
In group Ithe most common site for vitiligo was trunk and lower limb (50%) followed by upper limb (45%) then feet (40%) , and in hands the percentage of patients affected was (25%) and the least percentage was the face and neck with (20%) and (10%) respectively.
In group II the most common site for vitiligo was trunk (50%), followed by lower limb (40%) then feet (35%). The percentage of patients affected in upper limb and hands was (25%), (20%) respectively, while the face and neck had the least percentage (10%). There was no statistically significant difference between the two groups in site of lesions as illustrated in(Table 7).
Table (2): Age & sex of the two groups.
Variable
Group I (NBUVB)
(n=20)
Group II (NBUVB+
Latanoprost) (n=20)
MW P
Age: (year)
Mean ± SD Median
Range
24.15 ± 15.58 19 8 - 55
25.9 ±12.45 22 9 - 50
0.70 0.48
Variable No % No % χ2 P
Sex: Male
Female
7 13
35 65
5 15
25
75 0.48 0.49 Table (3): Disease score pre and post treatment in both groups.
Variable
Group I (NBUVB)
(n=20)
Group II (NBUVB+
Latanoprost) (n=20)
MW P
Pre
Mean ± SD Median Range
4.74 ± 3.50 4.5 0.45 – 12.3
3.93 ± 2.84 3 0.6 – 9
0.53 0.60
Post
Mean ± SD Median Range
4.04 ± 3.17 3.12 0.4 – 11.4
1.84 ± 1.37 1.54 0.3 – 4.35
2.16 0.03*
(S)
Paired W 1.87 3.62
P 0.06 <0.001**(S)
14145
% of reduction 16.82% 53.86%
Table (4): Comparison of grades of repigmentation in both groups.
Variable
Group I (NBUVB)
(n=20)
Group II (NBUVB+
Latanoprost) (n=20)
MW P
Improvement:
(%)
Mean ± SD Median
Range
18.3 ± 21.37 10 0 - 60
41.8 ±30.06 51.5 0 - 95
2.82 0.005 *
Variable No % No % χ2 P
Grade:
G0 G1 G2 G3 G4
6 9 2 3 0
30 45 10 15 0
1 6 2 8 3
5 30 10 40 15
9.44 0.04*
Table (5): Follow up results in both groups.
Variable
Group I (NBUVB)
(n=20)
Group II
(NBUVB+ Latanoprost) (n=20) χ2 P
No % No %
Follow up: No Yes
15 5
75 25
18 2
90
10 1.56 0.21
Table (6): Family history and duration of disease in both groups.
Variable
Group I (NBUVB)
(n=20)
Group II (NBUVB+
Latanoprost) (n=20)
MW P
Duration:
(years)
Mean ± SD Median Range
4.53 ± 3.98 3.75 1 - 20
3.67 ± 2.05 3.5
0.42 - 7 0.38 0.70
Variable No % No % χ2 P
Family history:
-ve +ve
17 3
85 15
15 5
75
25 0.63 0.43
Table (7): Site of lesions in both groups.
Variable
Group I (NBUVB)
(n=20)
Group II
(NBUVB+ Latanoprost)
(n=20) χ2 P
No % No %
Site:
Face Neck Upper limb Hand Trunk Lower limb Feet
4 2 9 5 10 10 8
20 10 45 25 50 50 40
2 2 5 4 10
8 7
10 10 25 20 50 40 35
0.78 0 1.78 0.14 0 0.40 0.11
0.38 1 0.19 0.71 1 0.5 0.74
14147 4. Discussion:
Treatment of vitiligo is a challenge for dermatologists. The multifactorial and polygenic nature of the pathomechanism of the disease paves the way to combination therapy that showed better repigmentation response than monotherapy (11).
Prostaglandin F2α commonly used in the treatment of ocular hypertension was tried in vitiligo based on the presence of irreversible iris pigmentation and reversible peri-ocular hyperpigmentation observed in glaucoma patients (8).
Prostaglandin F2α however exerts its effect indirectly through induction of COX-2 and PGE2 and has been reported to be a promising therapeutic option for vitiligo in both animal and human studies with increased efficacy (7).
The study included 40 patients divided into 2 groups each of 20 patients. The first group received 2 sessions of NBUVB rays per week as a single treatment and the second group received also 2 sessions of NBUVB rays in addition to intrallesional injection of latanoprost once weekly both for 6 months duration.
In group I the age of the patients ranged from 8-55 years, 65 % of the patients were females and 35% were males. In group II the age of the patients ranged from 9-50 years, 75% of the patients were females and 25 % were males. There was no statistically significant difference between the two groups in age or sex.
Regarding differences in disease score (VASI) of each group pre & post treatment there was a decrease in score in group I by 16.82% after treatment but without statistical significance, while in group II there was a statistically significant decrease in disease score after treatment by 53.86%.
The percentage of improvement with NBUVB+ latanoprost in group II ranged from 0 – 95%, while in group I with the NB-UVB only, the percentage of improvement ranged from 0 – 60%.
There was a statistically significant increase in percentage of improvement and grade of repigmentation among group II compared to group I.
During follow up, there was an increase in the disease score among group I compared to group II after 3 months from the end of treatment sessions but without statistical significance. This was noticed in 5 patients (25 %) in group I and 2 patients (10%) in group II.
This came in agreement with Eldelee et al., (12); the study included 27 stable vitiligo patients with overall symmetrical lesions. For each patient one patch was treated with NBUVB alone (control side) while another symmetrical patch was treated with combined intralesional injection of PGF2α with NBUVB therapy, weekly for 3 months.
They found that there was statistically significant difference between the two treatment sides regarding the degree of repigmentation of vitilignous lesions. The percentage of improvement with PGF2α / NB-UVB treated side ranged from 0 – 96 %. While with the NB-UVB only treated patches, the percentage of improvement was 0-30%. However, their study design depended on half body comparison not two groups of patients and treatment was limited to only small patches which is not the case in our study.
Their study reported that there was recurrence for the disease in 3 patients (11.1%) after 3 months.
Similarly, there was an increase in disease score in 2 patients (10%) after 3 months from the end of treatment sessions.
Neinaaet al., (13) designed a study to assess the therapeutic efficacy of micro needling in combination with NB-UVB phototherapy versus their combination with latanoprost in vitiligo. It was conducted on 50 patients with stable bilateral localized nonsegmental vitiligo. In every patient; two bilateral, nearly symmetrical lesions were selected and treated by micro needling (12 sessions at 2-week interval) followed by topical application of latanoprost 0.005% solution on one side, and topical saline (as placebo) on the other side. In addition, all patients received concomitant NB-UVB phototherapy (three sessions /week) for 6 months.
The degree of improvement and repigmentation ranged from 0% to 98% with combined NB-UVB, microneedling and latanoprost, while the combined NB-UVB and microneedling treated side only resulted in percentage of repigmentation ranging from 0% to 65%. There was statistically significant difference in the percentage of repigmentation on both treatment sides.
The slight difference between their results and ours, in favour to their study, could be assigned to the small size of the vitiliginous patches they treated and the site of disease among the patients. In the current study we reported 12 patients with acral vitiligo which is known to have poor prognosis. On the other hand, their study included 7 patients with acral lesions.
Anbar et al., (7) demonstrated a study which involved 22 patients with bilateral and symmetrical vitiligo lesions, stable for the last three months, divided into three groups: group I, to evaluate latanoprost versus placebo, group II; to evaluate latanoprost versus NB-UVB and group III; to evaluate the effect of their combination. It was reported that that latanoprost showed good repigmentation rates, up to 100%, and its effect was additionally enhanced when combined with NBUVB. However, latanoprost was used topically as a sterile solution 0.005% twice daily on lesions with small surface area less than 5% of body surface for 3 months, unlike the current study.
Anbar et al., (7) found that three patients (25%) experienced disease activity after 6 months in the form of the appearance of new lesions and partial loss of gained pigmentation after latanoprost application in vitiligo, while the percentage in this study was 10% representing 2 patients. This could be explained by; 1) longer duration of treatment of the present study (6 months) compared to their relatively short duration (3months) which allows more stability to the activated melanocytes and accordingly the resulted repigmentation and 2) direct intralesional injection of latanoprost instead of local application which facilitates its direct action on the melanocytes.
The findings in the current study- proving the role of latanoprost in vitiligo repigmentation - were concordant with Parsad et al., (14) study in which 27 patients with vitiligo with a body surface area involvement of less than 5% were enrolled. Patients were instructed to apply a translucent gel containing 0.5 mg/3 g (166.6 µg/g) PGE2 in the evening to depigmented skin. The treatment period was 6 months. Of the 24 patients, marked to complete repigmentation was seen in 15, 3 patients showed moderate improvement at the end of 6 months, whereas the remaining 6 patients showed little or no improvement. Kapoor et al., (6) also used PGE2 gel for 6 months with similar methods and results.
Moreover, Korobko et al., (15) proved that PGF2α is superior to tacrolimus in the treatment of
14149 vitiligo. The study included patients aging from 18–65 years with vitiligo vulgaris stable for at least 3 months and with symmetrically located lesions not exceeding 15 cm2 in surface area.
Symmetrical lesions were treated with dermaroller device with 0.5 mm needle length, latanoprost 0.005% solution (further referred as experimental lesion) or tacrolimus (0.1% ointment, further referred as control lesion) followed by NBUVB. Repigmentation was seen in 58.3% of patients with PGF2α. This came in agreement with our study.
However, Stanimirovic et al., (16) had used combination of narrowband UVB and topical PGF2α with and without dermaroller 0.5 mm needle length-assisted microneedling on 25 patients with bilateral symmetrical vitiligo vulgaris and acrofacial vitiligo. Repigmentation was observed in 36% and 32% of lesions with and without microneedling, respectively.
The addition of microneedling did not improve the efficiency, as the depth of penetration was 0.5 mm which remains epidermal, while in the present study, repigmentation was observed in 95 % of cases probably because the intradermal injection of PGF2α facilitates its direct action on the melanocytes.
Lotti et al., (8), achieved superior results by using a Fraxel Erbium laser, the successive topical application of PG F2α, and by the irradiation with UVA - 1 laser on 30 patients. The difference with present study results is probably because of the combined use of multiple techniques (Fraxel Erbium and UVA -1 laser) and the longer duration of treatment as the treatment has been repeated every 21 days, for nine months, while in ours it was for maximum 6 months only.
Nowroozpoor et al., (17) have demonstrated a study of 31 patients with vitiligo vulgaris and focal vitiligo involving the eyelids. Patients were randomly divided into two groups; first group received topical latanoprost gel twice daily for 12 weeks, whereas the second group received placebo with the same protocol. The group treated with latanoprost showed significant reduction in the extent of the disease, whereas those treated with placebo did not show any alteration.
In the present study, there was no statistically significant relation between grade of improvement and site of lesion in group I, while there was a significant decrease in grade of improvement in face & hand in group II.
Anbar et al., (7) found that vitiligo of the face achieved the best results when treated with topical tacrolimus, topical PGE2 and NB-UVB, psoralen + UVA, respectively. Kapoor et al., (2009) also confirmed that head and neck lesions showed the best response, when he assessed using topical PG E2 Anbar et al., (7) found that the face has the best repigmentation response in comparison to other body sites using different treatment modalities,while in the contrary Lotti et al., (8) observed no difference in repigmentation for lesions with different localization. And regarding the efficacy of treatment on different body sites, PG F2α/NBUVB showed excellent to good response in the trunk and face, while extremities and acral parts showed moderate response, but there were no statistically significant relations between different parts of body.
Anbar et al., (7) found that three patients (25%) experienced disease activity after 6 months in the form of the appearance of new lesions and partial loss of gained pigmentation after latanoprost application in vitiligo, while the percentage in this study was 10% representing 2 patients. This
could be explained by; 1) longer duration of treatment of the present study (6 months) compared to their relatively short duration (3months) which allows more stability to the activated melanocytes and accordingly the resulted repigmentation and 2) direct intralesional injection of latanoprost instead of local application which facilitates its direct action on the melanocytes.
5. Conclusion:
This study demonstrated that intradermal injection of PG F2α enhanced the outcome of NB-UVB as regard rate and degree of repigmentation of lesions in vitiligo. This combination seems to be effective in different body sites, shortens the duration of NB-UVB therapy and does not require costly devices and well-equipped rooms.
6. ConflictofInterest: Noconflictofinterest.
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