title: Combined excimer laser and topical tacrolimus for the treatment of vitiligo: a pilot study.
abstract: BACKGROUND
  Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease.
  
  
  OBJECTIVE
  To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder.
  
  
  METHODS
  Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board-approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results.
  
  
  RESULTS
  Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy.
  
  
  CONCLUSIONS
  Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease.
authors.affiliation: Department of Dermatology Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Adam Z
authors.initials: AZ
authors.lastname: Kawalek
authors.forename: James M
authors.initials: JM
authors.lastname: Spencer
authors.forename: Robert G
authors.initials: RG
authors.lastname: Phelps
mesh_terms: D000287:Administration, Topical; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014820:Vitiligo / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus