Topical Calcineurin Inhibitors & Phototherapy for the Vitiligo Treatment

In a meta-analysis, Dang et al (2016) examined the effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment. These investigators searched the MEDLINE, Embase, and Cochrane central register of controlled trials databases for articles published prior to September 2014.  A total of 13 studies were included in the meta-analysis.  After pooling the trials, these researchers concluded that calcineurin inhibitors showed a better therapeutic effect on vitiligo than placebo, according to lesion report (risk ratio [RR] = 2.62, 95 % confidence interval [CI]: 1.39 to 4.93, p = 0.003) and patient report (RR = 1.42, 95 % CI: 0.87 to 2.31, p = 0.157).  Subgroup analysis was performed to examine if the combination with phototherapy was a source of heterogeneity.  The trial sequence analysis indicated that the results of combined therapy by lesion report were reliable and conclusive.  However, in the patient report trials, the frequency of lesions on the hand and foot was higher, and the effect of combined therapy was still non-significant.  The authors concluded that calcineurin inhibitors showed a better therapeutic effect than placebo in the treatment of vitiligo with phototherapy.  However, the typical UV-resistant sites (i.e., hand and foot) were still difficult to cure even with combined therapy.  Moreover, they stated that because of concerns about photo-carcinogenesis, the clinical application of combined therapy should be explored with caution.