Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo

Objective: To determine the efficacy of combined treatment with narrowband ultraviolet B phototherapy (NB-UVB) and topical tacrolimus in comparison with NB-UVB alone with placebo control in the treatment of vitiligo affecting face and neck. Methods: We included 60 patients with vitiligo affecting face and neck with or without involvement of the rest of body, in this randomized, double-blind, placebo-controlled trial. The patients were randomly allocated in two groups as A and B. Topical 0.1% tacrolimus ointment was given for vitiligo patches twice daily in group A, while placebo ointment was given to be applied in similar way for vitiligo patches in group B. Tri-weekly NB-UVB for depigmented areas with starting dose of 0.1J/cm2 with increment of 10% at every visit was given to the patients in both groups. Percentage of depigmented patches was calculated at the baseline, 1, 2 and 3 months. Results: All patients completed the treatment period of 3 months. The mean response at the end of the 3rd month revealed excellent response ( 75% repigmentation) in 16 (53.3%) patients in group A and 9 (30%) patients in group B. Good response (50-75% repigmentation) was seen in 11 (36.7%) in group A and 12 (40%) patients in group B. Moderate response (25-49% repigmentation) was shown by 3 (10%) patients in group A and 5 (16.7%) patients in group B. None of the patient showed poor response ( 25% repigmentation) in group A, however 4 (13.3%) patients showed poor response in group B. Comparison of efficacy in both groups show excellent and efficacious response in 16 (53.5%) of patients in group A and in only 9 (30%) of patients in group B (P 0.05). Conclusion: Combined treatment with NB-UVB and topical 0.1% tacrolimus ointment in comparison with NB-UVB with placebo control in the treatment of vitiligo affecting face and neck is more effective.