title: A combination of excimer laser treatment and topical tacrolimus is more effective in treating vitiligo than either therapy alone for the initial 6 months, but not thereafter.
abstract: BACKGROUND
  There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus.
  
  
  OBJECTIVE
  To evaluate the clinical efficacy according to the duration of treatment and in vitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo.
  
  
  METHODS
  In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser.
  
  
  RESULTS
  After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P < 0.001 and P < 0.01, respectively) for the first 6 months. However, this superiority was not observed after the initial 6 months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone.
  
  
  CONCLUSIONS
  A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6 months, but continuation of this therapy for > 6 months might not provide a better final outcome than monotherapy.
authors: Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: O J
authors: OJ
authors: Park
authors: Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
authors: G-H
authors: GH
authors: Park
authors: Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea.
authors: J R
authors: JR
authors: Choi
authors: Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea.
authors: H J
authors: HJ
authors: Jung
authors: Department of Life Sciences, Division of Life and Pharmaceutical Sciences, Center for Cell Signaling and Drug Discovery Research, Ewha Womans University, Seoul, Korea.
authors: E S
authors: ES
authors: Oh
authors: Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: J H
authors: JH
authors: Choi
authors: Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: M W
authors: MW
authors: Lee
authors: Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: S E
authors: SE
authors: Chang
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015153:Blotting, Western; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D019746:Intramolecular Oxidoreductases / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008543:Melanins / Q000378:metabolism; D008544:Melanocytes / Q000378:metabolism; D008875:Middle Aged; D014442:Monophenol Monooxygenase / Q000378:metabolism; D010789:Phototherapy / Q000379:methods*; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D014357:Trypsin / Q000378:metabolism; D014820:Vitiligo / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D008543:Melanins; D014442:Monophenol Monooxygenase; C489303:PRSS1 protein, human; D014357:Trypsin; D019746:Intramolecular Oxidoreductases; C042501:dopachrome isomerase; D016559:Tacrolimus