Vitiligo: What’s old, what’s new
https://doi.org/10.4081/dr.2021.9142
Submitted: 18 March 2021
Accepted: 25 April 2021
Published: 15 September 2021
Accepted: 25 April 2021
Abstract Views: 2302
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Vitiligo is an acquired pigmentary disorder afflicting 0.5-2% of the world population for both sexes and all races with a capricious and unpredictable course. It has a complex etiology and varies in its manifestation, progression and response to treatment. Even if the precise aetiology and pathobiology of the disease are complex and still debated, recent evidence supports that vitiligo is a T CD8+ cell-mediated autoimmune disease triggered by oxidative stress. To date no clinical, biological and histological criteria allow us to establish the prognosis with certainty. The choice of the best therapy for adult and childhood vitiligo is based on various factors, such as the patient’s age, psychological condition and expectations, distribution and extension of skin lesions, type of vitiligo (stable or not) and availability and cost of therapeutic options. Since vitiligo has a deep psychological impact on patients and their quality of life, treating the disease is very important. As dermatologists, we have important goals in the treatment of vitiligo patients: stabilization of the disease progression, repigmentation of the lesions and especially the persistence of the aforementioned repigmentation. Although several medical and surgical therapeutic options have been proposed, no definite cure has yet been developed and the long-term persistence of repigmentation is unpredictable. We review the different therapeutic options with particular attention on the recurrence rate.
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2. Bishnoi A and Parsad D. Clinical and molecular aspects of vitiligo treatments. Int J Mol Sci 2018;19:1509.
3. Gianfaldoni S, Tchernev G, Wollina U et al. Micro-focused phototherapy associated to janus kinase inhibitor: a promising valid therapeutic option for patients with localized vitiligo. Maced J Med Sci 2018; 25:46-48.
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6. Pajvani U, Ahmad N, Wiley A, et al. The relationship between family medical history and childhood vitiligo. J Am Acad Dermatol. 2006;55(2):238–244
7. Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res. 2003;16(3):208–214
8. Ezzedine K, Diallo A, Léauté-Labrèze C, et al. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in prepubertal onset vitiligo. Br J Dermatol. 2012;167(3):490–495
9. Silverberg JI, Silverberg NB. Association between vitiligo and atopic disorders: a pilot study. JAMA Dermatol. 2013;149(8):983–986
10. Silverberg JI, Silverberg NB. Clinical features of vitiligo associated with comorbid autoimmune disease: a prospective survey. J Am Acad Dermatol. 2013;69(5):824–826
11. Michelsen D. The Double Strike Hypothesis of the vitiligo pathomechanism: new approaches to vitiligo and melanoma. Med Hypotheses. 2010 Jan;74(1):67-70
12. Sandoval-Cruz M, García-Carrasco M, Sánchez-Porras R, Mendoza-Pinto C, Jiménez-Hernández M, Munguía-Realpozo P, Ruiz-Argüelles A. Immunopathogenesis of vitiligo. Autoimmun Rev. 2011 Oct;10(12):762-5.
13. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017 Jul;77(1):1-13.
14. Jin Y, Andersen G, Yorgov D, et al. Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants. Nat Genet. 2016;48:1418-1424.
15. Abdel-Malek ZA, Jordan C, Ho T et al. The enigma and challenges of Vitiligo pathophysiology and treatment. Pigment Cell Melanoma Res 2020;33:778-87.
16. Ezzedine K, Whitton M, Pinart M. Interventions for Vitiligo. JAMA 2016; 316:1708.
17. Zubair R, Hamzavi IH. Phototherapy for Vitiligo. Dermatol Clin. 2020;38:55-62.
18. Vidolin AP, Aurizi C and Leone G. ‘ Phototherapy for vitiligo, what’s new ? G Ital Dermatol 2017; 152:474-88.
19. Whitton M, Pinart M, Batchelor JM, et al. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol. 2016;174:962-9.
20. Nicolaidou E, Antoniou C, Stratigos AJ, et al. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274-8.
21. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891-6.
22. Kishan Kumar YH, Rao GR, Gopal KV, et al. Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo. Indian J Dermatol Venereol Leprol. 2009;75:162-6.
23. Silpa-Archa N, Weerasubpong P, Junsuwan N, et al. Y Treatment outcome and persistence of repigmentation from narrow-band ultraviolet B phototherapy in vitiligo. J Dermatolog Treat. 2019;30:691-6.
24. Lotti T, Wollina U, Tchernev G, et al. An Innovative Therapeutic Protocol for Vitiligo: Experience with the Use of Fraxel Herbium Laser, Topical Latanoprost and Successive Irradiation with UVA - 1 Laser. Open Access Maced J Med Sci. 2018;6:49-51.
25. Silpa-Archa N, Lim HW, Wongpraparut C. Excimer laser in vitiligo: where there is light, there is hope. Br J Dermatol. 2019 Jul;181(1):21-22
26. Paro Vidolin A, Aurizi C, Leone G. Phototherapy for vitiligo, what’s new? G Ital Dermatol Venereol 2017;152:474-88.
27. Spencer JM, Nossa R, Ajmeri J. Treatment of vitiligo with the 308 nm excimer laser: a pilot study. J Am Acad Dermatol 2002;46:727-31.
28. Taneja A, Trehan M, Taylor CR. 308 nm excimer laser for the treatment of localized vitiligo. Int J Dermatol 2003;42:658-62.
29. Passeron T, Ortonne JP. Use of the 308 nm excimer laser for psoriasis and vitiligo. Clin Dermatol 2006;24:33-42.
30. Wu Y, Sun Y, Qiu L et al. A multicentre, randomized, split face and/or neck comparison of 308-nm excimer laser and 0.1% tacrolimus ointment for stable vitiligo plus intramuscular slow-releasing betamethasone for active vitiligo. Br J Dermatol 2019; 181:210–1.
31. Zhang B, Li T, Tang Y, et al. The effects of 308-nm excimer laser on the infiltration of CD4+, CD8+ T-cells, and regulatory T cells in the lesional skin of patients at active and stable stages of nonsegmental vitiligo. J Dermatolog Treat. 2019;11:1-5
32. Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2015; 56:85–92.
33. Taieb A, Alomar A, Böhm M, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013; 168:5
34. Khurrum H, AlGhamdi KM, Osman E. Screening of glaucoma or cataract prevalence in vitiligo patients and its relationship with periorbital steroid use. J. Cutan. Med. Surg 2016; 20:146–9.
35. Pasricha J, Khaitan BK. Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast-spreading disease. Int J Dermatol 1993; 32: 753–7.
36. Kanwar AJ, Mahajan R, Parsad D. Low-dose oral mini- pulse dexamethasone therapy. J Cutan Med Surg 2013; 17: 259–68.
37. Bishnoi A, Parsad D. Clinical and Molecular Aspects of Vitiligo Treatments. Int J Mol Sci 2018; 19:1509.
38. Agarwal K, Podder I, Kassir M, et al. Therapeutic options in vitiligo with special emphasis on immunomodulators: A comprehensive update with review of literature. Dermatol Ther 2020;33:e13215.
39. Rothstein B, Joshipura D, Saraiya A, et al. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib. J Am Acad Dermatol 2017; 76: 1054–60.
40. Harris JE, Rashighi M, Nguyen N et al. Rapid skin repigmentation on oral ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J Am Acad Dermatol 2016; 74: 370–1.
41. Joshipura D, Plotnikova N, Goldminz A et al. Importance of light in the treatment of vitiligo with JAK-inhibitors. J Dermatol Treat 2018; 29: 98–9.
42. Lan CC, Chen GS, Chiou MH, et al. FK506 promotes melanocyte and melanoblast growth and creates a favourable milieu for cell migration via keratinocytes: Possible mechanisms of how tacrolimus ointment induces repigmentation in patients with vitiligo. Br J Dermatol 2005; 153: 498–505.
43. Taneja A, Kumari A, Vyas K, et al. Cyclosporine in treatment of progressive vitiligo: An open-label, single-arm interventional study. Indian J Dermatol Venereol Leprol 2019; 85: 528–31.
44. Nageswaramma S, Vani T, Indira N. Efficacy of methotrexate in Vitiligo. J Dent Med Sci 2018; 17:16–19.
45. Abdelmaksoud A, Dave DD, Lotti T, Vestita M. Topical methotrexate 1% gel for treatment of vitiligo: A case report and review of the literature. Dermatol Ther 2019; 32: e13013.
46. Passeron T. Indications and limitations of afamelanotide for treating vitiligo. JAMA Dermatol 2015; 151: 349–50.
47. Song X, Xu A, Pan W et al. Minocycline protects melanocytes against H2O2-induced cell death via JNK and p38 MAPK pathways. Int J Mol Med 2008; 22: 9– 16.
48. Parsad D, Kanwar A. Oral minocycline in the treatment of vitiligo—A preliminary study. Dermatol Ther 2010; 23: 305–307.
49. Nguyen S, Chuah SY, Fontas E, et al. Atorvastatin in combination with narrowband UVB in adult patients with active vitiligo: A randomized clinical trial. JAMA Dermatol 2018;154:725-26.
50. AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol 2013; 79:750
51. Ermis O, Alpsoy E, Cetin L, Yilmaz E. Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebo-controlled double-blind study. Br J Dermatol 2001; 145:472.
52. Khullar G, Kanwar AJ, Singh S, Parsad D. Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB-UVB vs. NB-UVB alone in the treatment of vitiligo: a 24-week prospective right-left comparative clinical trial. J Eur Acad Dermatol Venereol 2015; 29:925.
53. Rodríguez-Martín M, García Bustínduy M, Sáez Rodríguez M, Noda Cabrera A. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. Br J Dermatol 2009; 160:409
54. Tsuji T, Hamada T. Topically administered fluorouracil in vitiligo. Arch Dermatol 1983; 119:722–7.
55. Gianfaldoni S, Tchernev G, Lotti J, et al. Unconventional Treatments for Vitiligo: Are They (Un) Satisfactory? Open Access Maced J Med Sci. 2018;6:170-5.
56. Scheinfeld N, Rosenberg JD, Weinberg JM. Levamisole in dermatology. Am J Clin Dermatol 2004; 5:97–104.
57. https://www.edf.one/dam/jcr:beac4241-7a34-4906-b474-75a345f44616/Guideline-on-Vitiligo.pdf
58. Bishnoi A, Parsad D. Immunomodulators and immunosuppressives in vitiligo treatment. In S Gupta, MJ Olsson, D Parsad, HW Lim, N van Geel, AG Pandya, eds.Vitiligo: Medical and surgical management. Hoboken, NJ: Wiley-Blackwe; 2018. pp. 123–131.
59. Dell'Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol 2007; 32:631
60. Zhang S, Yi X, Su X, et al. Ginkgo biloba extract protects human melanocytes from H2O2-induced oxidative stress by activating Nrf2. J Cell Mol Med 2019; 23:5193.
61. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, et al. Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol 2007; 21:942.
62. Schallreuter KU, Krüger C, Würfel BA, et al. From basic research to the bedside: Efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo. Int J Dermatol 2008; 47: 743–753.
63. Gianfaldoni S, Wollina U, Tirant M, et al. Herbal Compounds for the Treatment of Vitiligo: A Review. Open Access Maced J Med Sci. 2018;6:203-7
64. Kapur R, Osmanovic S, Toyran S, Edward DP. Bimatoprost-induced periocular skin hyperpigmentation: histopathological study. Arch Ophthalmol 2005; 123:1541.
65. Anbar TS, El-Ammawi TS, Abdel-Rahman AT, Hanna MR. The effect of latanoprost on vitiligo: A preliminary comparative study. Int J Dermatol 2015; 54:587–93.
66. Ju HJ, Bae JM, Lee RW, et al. Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol. Published online February 17, 2021
1. Bae JM, Jung HM, Hong BY, et al. Phototherapy for Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol 2017;153:666-74.
2. Bishnoi A and Parsad D. Clinical and molecular aspects of vitiligo treatments. Int J Mol Sci 2018;19:1509.
3. Gianfaldoni S, Tchernev G, Wollina U et al. Micro-focused phototherapy associated to janus kinase inhibitor: a promising valid therapeutic option for patients with localized vitiligo. Maced J Med Sci 2018; 25:46-48.
4. Ezzedine K, Silverberg N. A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children. Pediatrics. 2016 Jul;138(1):e20154126.
5. Ongenae K, Van Geel N, Naeyaert JM. Evidence for an autoimmune pathogenesis of vitiligo. Pigment Cell Res. 2003 Apr;16(2):90-100.
6. Pajvani U, Ahmad N, Wiley A, et al. The relationship between family medical history and childhood vitiligo. J Am Acad Dermatol. 2006;55(2):238–244
7. Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res. 2003;16(3):208–214
8. Ezzedine K, Diallo A, Léauté-Labrèze C, et al. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in prepubertal onset vitiligo. Br J Dermatol. 2012;167(3):490–495
9. Silverberg JI, Silverberg NB. Association between vitiligo and atopic disorders: a pilot study. JAMA Dermatol. 2013;149(8):983–986
10. Silverberg JI, Silverberg NB. Clinical features of vitiligo associated with comorbid autoimmune disease: a prospective survey. J Am Acad Dermatol. 2013;69(5):824–826
11. Michelsen D. The Double Strike Hypothesis of the vitiligo pathomechanism: new approaches to vitiligo and melanoma. Med Hypotheses. 2010 Jan;74(1):67-70
12. Sandoval-Cruz M, García-Carrasco M, Sánchez-Porras R, Mendoza-Pinto C, Jiménez-Hernández M, Munguía-Realpozo P, Ruiz-Argüelles A. Immunopathogenesis of vitiligo. Autoimmun Rev. 2011 Oct;10(12):762-5.
13. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol. 2017 Jul;77(1):1-13.
14. Jin Y, Andersen G, Yorgov D, et al. Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants. Nat Genet. 2016;48:1418-1424.
15. Abdel-Malek ZA, Jordan C, Ho T et al. The enigma and challenges of Vitiligo pathophysiology and treatment. Pigment Cell Melanoma Res 2020;33:778-87.
16. Ezzedine K, Whitton M, Pinart M. Interventions for Vitiligo. JAMA 2016; 316:1708.
17. Zubair R, Hamzavi IH. Phototherapy for Vitiligo. Dermatol Clin. 2020;38:55-62.
18. Vidolin AP, Aurizi C and Leone G. ‘ Phototherapy for vitiligo, what’s new ? G Ital Dermatol 2017; 152:474-88.
19. Whitton M, Pinart M, Batchelor JM, et al. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol. 2016;174:962-9.
20. Nicolaidou E, Antoniou C, Stratigos AJ, et al. Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy. J Am Acad Dermatol. 2007;56:274-8.
21. Sitek JC, Loeb M, Ronnevig JR. Narrowband UVB therapy for vitiligo: does the repigmentation last? J Eur Acad Dermatol Venereol. 2007;21:891-6.
22. Kishan Kumar YH, Rao GR, Gopal KV, et al. Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo. Indian J Dermatol Venereol Leprol. 2009;75:162-6.
23. Silpa-Archa N, Weerasubpong P, Junsuwan N, et al. Y Treatment outcome and persistence of repigmentation from narrow-band ultraviolet B phototherapy in vitiligo. J Dermatolog Treat. 2019;30:691-6.
24. Lotti T, Wollina U, Tchernev G, et al. An Innovative Therapeutic Protocol for Vitiligo: Experience with the Use of Fraxel Herbium Laser, Topical Latanoprost and Successive Irradiation with UVA - 1 Laser. Open Access Maced J Med Sci. 2018;6:49-51.
25. Silpa-Archa N, Lim HW, Wongpraparut C. Excimer laser in vitiligo: where there is light, there is hope. Br J Dermatol. 2019 Jul;181(1):21-22
26. Paro Vidolin A, Aurizi C, Leone G. Phototherapy for vitiligo, what’s new? G Ital Dermatol Venereol 2017;152:474-88.
27. Spencer JM, Nossa R, Ajmeri J. Treatment of vitiligo with the 308 nm excimer laser: a pilot study. J Am Acad Dermatol 2002;46:727-31.
28. Taneja A, Trehan M, Taylor CR. 308 nm excimer laser for the treatment of localized vitiligo. Int J Dermatol 2003;42:658-62.
29. Passeron T, Ortonne JP. Use of the 308 nm excimer laser for psoriasis and vitiligo. Clin Dermatol 2006;24:33-42.
30. Wu Y, Sun Y, Qiu L et al. A multicentre, randomized, split face and/or neck comparison of 308-nm excimer laser and 0.1% tacrolimus ointment for stable vitiligo plus intramuscular slow-releasing betamethasone for active vitiligo. Br J Dermatol 2019; 181:210–1.
31. Zhang B, Li T, Tang Y, et al. The effects of 308-nm excimer laser on the infiltration of CD4+, CD8+ T-cells, and regulatory T cells in the lesional skin of patients at active and stable stages of nonsegmental vitiligo. J Dermatolog Treat. 2019;11:1-5
32. Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2015; 56:85–92.
33. Taieb A, Alomar A, Böhm M, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013; 168:5
34. Khurrum H, AlGhamdi KM, Osman E. Screening of glaucoma or cataract prevalence in vitiligo patients and its relationship with periorbital steroid use. J. Cutan. Med. Surg 2016; 20:146–9.
35. Pasricha J, Khaitan BK. Oral mini-pulse therapy with betamethasone in vitiligo patients having extensive or fast-spreading disease. Int J Dermatol 1993; 32: 753–7.
36. Kanwar AJ, Mahajan R, Parsad D. Low-dose oral mini- pulse dexamethasone therapy. J Cutan Med Surg 2013; 17: 259–68.
37. Bishnoi A, Parsad D. Clinical and Molecular Aspects of Vitiligo Treatments. Int J Mol Sci 2018; 19:1509.
38. Agarwal K, Podder I, Kassir M, et al. Therapeutic options in vitiligo with special emphasis on immunomodulators: A comprehensive update with review of literature. Dermatol Ther 2020;33:e13215.
39. Rothstein B, Joshipura D, Saraiya A, et al. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib. J Am Acad Dermatol 2017; 76: 1054–60.
40. Harris JE, Rashighi M, Nguyen N et al. Rapid skin repigmentation on oral ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J Am Acad Dermatol 2016; 74: 370–1.
41. Joshipura D, Plotnikova N, Goldminz A et al. Importance of light in the treatment of vitiligo with JAK-inhibitors. J Dermatol Treat 2018; 29: 98–9.
42. Lan CC, Chen GS, Chiou MH, et al. FK506 promotes melanocyte and melanoblast growth and creates a favourable milieu for cell migration via keratinocytes: Possible mechanisms of how tacrolimus ointment induces repigmentation in patients with vitiligo. Br J Dermatol 2005; 153: 498–505.
43. Taneja A, Kumari A, Vyas K, et al. Cyclosporine in treatment of progressive vitiligo: An open-label, single-arm interventional study. Indian J Dermatol Venereol Leprol 2019; 85: 528–31.
44. Nageswaramma S, Vani T, Indira N. Efficacy of methotrexate in Vitiligo. J Dent Med Sci 2018; 17:16–19.
45. Abdelmaksoud A, Dave DD, Lotti T, Vestita M. Topical methotrexate 1% gel for treatment of vitiligo: A case report and review of the literature. Dermatol Ther 2019; 32: e13013.
46. Passeron T. Indications and limitations of afamelanotide for treating vitiligo. JAMA Dermatol 2015; 151: 349–50.
47. Song X, Xu A, Pan W et al. Minocycline protects melanocytes against H2O2-induced cell death via JNK and p38 MAPK pathways. Int J Mol Med 2008; 22: 9– 16.
48. Parsad D, Kanwar A. Oral minocycline in the treatment of vitiligo—A preliminary study. Dermatol Ther 2010; 23: 305–307.
49. Nguyen S, Chuah SY, Fontas E, et al. Atorvastatin in combination with narrowband UVB in adult patients with active vitiligo: A randomized clinical trial. JAMA Dermatol 2018;154:725-26.
50. AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol 2013; 79:750
51. Ermis O, Alpsoy E, Cetin L, Yilmaz E. Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebo-controlled double-blind study. Br J Dermatol 2001; 145:472.
52. Khullar G, Kanwar AJ, Singh S, Parsad D. Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB-UVB vs. NB-UVB alone in the treatment of vitiligo: a 24-week prospective right-left comparative clinical trial. J Eur Acad Dermatol Venereol 2015; 29:925.
53. Rodríguez-Martín M, García Bustínduy M, Sáez Rodríguez M, Noda Cabrera A. Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo. Br J Dermatol 2009; 160:409
54. Tsuji T, Hamada T. Topically administered fluorouracil in vitiligo. Arch Dermatol 1983; 119:722–7.
55. Gianfaldoni S, Tchernev G, Lotti J, et al. Unconventional Treatments for Vitiligo: Are They (Un) Satisfactory? Open Access Maced J Med Sci. 2018;6:170-5.
56. Scheinfeld N, Rosenberg JD, Weinberg JM. Levamisole in dermatology. Am J Clin Dermatol 2004; 5:97–104.
57. https://www.edf.one/dam/jcr:beac4241-7a34-4906-b474-75a345f44616/Guideline-on-Vitiligo.pdf
58. Bishnoi A, Parsad D. Immunomodulators and immunosuppressives in vitiligo treatment. In S Gupta, MJ Olsson, D Parsad, HW Lim, N van Geel, AG Pandya, eds.Vitiligo: Medical and surgical management. Hoboken, NJ: Wiley-Blackwe; 2018. pp. 123–131.
59. Dell'Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol 2007; 32:631
60. Zhang S, Yi X, Su X, et al. Ginkgo biloba extract protects human melanocytes from H2O2-induced oxidative stress by activating Nrf2. J Cell Mol Med 2019; 23:5193.
61. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, et al. Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol 2007; 21:942.
62. Schallreuter KU, Krüger C, Würfel BA, et al. From basic research to the bedside: Efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo. Int J Dermatol 2008; 47: 743–753.
63. Gianfaldoni S, Wollina U, Tirant M, et al. Herbal Compounds for the Treatment of Vitiligo: A Review. Open Access Maced J Med Sci. 2018;6:203-7
64. Kapur R, Osmanovic S, Toyran S, Edward DP. Bimatoprost-induced periocular skin hyperpigmentation: histopathological study. Arch Ophthalmol 2005; 123:1541.
65. Anbar TS, El-Ammawi TS, Abdel-Rahman AT, Hanna MR. The effect of latanoprost on vitiligo: A preliminary comparative study. Int J Dermatol 2015; 54:587–93.
66. Ju HJ, Bae JM, Lee RW, et al. Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol. Published online February 17, 2021
Bertolani, M., Rodighiero, E., de Felici del Giudice, M. B., Lotti, T., Feliciani, C., & Satolli, F. (2021). Vitiligo: What’s old, what’s new. Dermatology Reports, 13(2). https://doi.org/10.4081/dr.2021.9142
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