title: Does topical tacrolimus ointment enhance the efficacy of narrowband ultraviolet B therapy in vitiligo? A left-right comparison study.
abstract: BACKGROUND
  Narrowband ultraviolet B (NB-UVB) therapy has emerged as one of the most favored treatment options in patients with generalized vitiligo. The aim of combining topical agents is to improve the efficacy of NB-UVB in causing repigmentation in vitiligo.
  
  
  OBJECTIVE
  The present study aims to study the effect of combining topical tacrolimus to NB-UVB therapy in causing repigmentation in vitiligo lesions.
  
  
  METHODS
  This prospective single-blind study was performed on 80 patients of generalized vitiligo above 12 years of age who had symmetrically distributed vitiligo lesions on the face, trunk or limbs. The patients applied topical tacrolimus 0.1% ointment twice daily on selected symmetrically distributed lesions on the left side of the body. No topical agent was applied on the corresponding lesions on the right side. The patients also received whole-body NB-UVB exposure three times every week on non-consecutive days according to a set protocol. Lesions selected for the comparison analysis were photographed serially and assessed by a single-blinded observer for the extent or repigmentation achieved. The extent of repigmentation achieved was calculated on the basis of VASI scoring. The time taken for the initial repigmentation to start, the overall repigmentation achieved as well as any adverse effects were noted down and compared between the selected lesions on the two sides.
  
  
  RESULTS
  Seventy-four patients with 234 symmetrical vitiligo lesions were available for comparison analysis at the end of study period. The mean repigmentation achieved on the left-sided study lesions was approximately 71% (VASI score of approximately 4.0) as compared with 60.5% on the symmetrically distributed right-sided lesions (VASI score of 3.4). Moreover, the repigmentation started earlier on the study lesions on left side than on the right-sided ones. No significant adverse events were reported with the combination treatment.
  
  
  CONCLUSIONS
  Addition of topical tacrolimus increases the extent of overall repigmentation achieved with NB-UVB therapy in vitiligo and also reduces the cumulative NB-UVB dose needed to achieve a therapeutic benefit in affected patients.
authors.affiliation: Department of Dermatology and STD, Government Medical College, Srinagar, Jammu & Kashmir, India. imran54@yahoo.com
authors.forename: Imran
authors.initials: I
authors.lastname: Majid
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009824:Ointments / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000009:adverse effects; D014820:Vitiligo / Q000188:drug therapy* / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus