title: Response of vitiligo to once- vs. twice-daily topical tacrolimus: a controlled prospective, randomized, observer-blinded trial.
abstract: BACKGROUND
  A few studies on the treatment of vitiligo with topical tacrolimus have been published and showed promising results. However, most of these trials were uncontrolled.
  
  
  OBJECTIVE
  This study aims to assess the response of vitiligo to once- or twice-daily treatment with 0.1% tacrolimus in a controlled, randomized, observer-blinded study.
  
  
  METHODS
  Seventeen patients with generalized vitiligo were enrolled in this study. In each patient, two lesions were selected and randomized to treatment with either once- or twice-daily application of 0.1% tacrolimus for a total period of 6 months. In 10 patients, a third patch was left untreated to serve as a control.
  
  
  RESULTS
  Fifteen patients with 40 target lesions completed the study. Twice-daily treatment induced excellent (> 75%) repigmentation in two lesions, moderate (> 25-50%) and poor (1-25%) repigmentation in four lesions each, and no response in five lesions. Once-daily treatment resulted in moderate repigmentation in two lesions and poor repigmentation in five lesions, whereas no effect was observed in the remaining eight lesions. One out of 10 control lesions developed moderate spontaneous repigmentation, the other nine remained unchanged. Besides the frequency of tacrolimus application, the treatment outcome was determined by the localization of the affected areas with the facial region showing the best response.
  
  
  CONCLUSIONS
  Tacrolimus ointment appears to be an effective treatment option for facial vitiligo. A guarded prognosis is advisable for vitiliginous lesions on other localizations. Treatment must be applied twice daily for optimum response.
authors.affiliation: Division of Special and Environmental Dermatology, Medical University of Vienna, Vienna, Austria. sonja.radakovic@meduniwien.ac.at
authors.forename: S
authors.initials: S
authors.lastname: Radakovic
authors.forename: J
authors.initials: J
authors.lastname: Breier-Maly
authors.forename: R
authors.initials: R
authors.lastname: Konschitzky
authors.forename: H
authors.initials: H
authors.lastname: Kittler
authors.forename: P
authors.initials: P
authors.lastname: Sator
authors.forename: H
authors.initials: H
authors.lastname: Hoenigsmann
authors.forename: A
authors.initials: A
authors.lastname: Tanew
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D011446:Prospective Studies; D016037:Single-Blind Method; D012880:Skin Pigmentation; D016559:Tacrolimus / Q000008:administration & dosage* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014820:Vitiligo / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus