Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial.
BACKGROUND
Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment.


OBJECTIVE
To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP).


METHODS
Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial.


RESULTS
In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation.


CONCLUSIONS
Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.
Dell'Anna
M L
ML
San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
Mastrofrancesco
A
A
Sala
R
R
Venturini
M
M
Ottaviani
M
M
Vidolin
A P
AP
Leone
G
G
Calzavara
P G
PG
Westerhof
W
W
Picardo
M
M
D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010084:Oxidation-Reduction / Q000187:drug effects / Q000528:radiation effects; D012720:Severity of Illness Index; D012880:Skin Pigmentation / Q000187:drug effects / Q000528:radiation effects; D008063:Thioctic Acid / Q000627:therapeutic use; D016896:Treatment Outcome; D014467:Ultraviolet Therapy; D014807:Vitamin D / Q000627:therapeutic use; D014820:Vitiligo / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D000975:Antioxidants; D004338:Drug Combinations; D014807:Vitamin D; D008063:Thioctic Acid; D001205:Ascorbic Acid