Topical calcipotriol as monotherapy and in combination with psoralen plus ultraviolet A in the treatment of vitiligo

Abstract

Background Recent advances in the pathophysiology of vitiligo have demonstrated defective calcium homeostasis in depigmented skin. 1,25-Dihydroxyvitamin D3 may be involved in the regulation of melanin synthesis, and receptors for 1,25-dihydroxyvitamin D3 have been demonstrated on melanocytes. Objectives We conducted an open study to determine the efficacy and tolerability of calcipotriol cream as monotherapy and in conjunction with psoralen plus ultraviolet A (PUVA) in the treatment of vitiligo. Methods Twenty-six patients with vitiligo affecting 5–40% of their skin were recruited. Twenty-two were treated with twice-daily topical calcipotriol monotherapy (50 µg g−1) and four were placed on combination treatment with twice-daily topical calcipotriol 50 µg g−1 in conjunction with topical or oral 8-methoxypsoralen PUVA three times weekly. Results Treatment was well tolerated at all sites and no adverse effects were reported. After a therapy time of 3–9 months (mean 6 months), 77% (17 of 22) of those treated with monotherapy showed 30–100% improvement, and three of the four patients on combination treatment showed good response. Conclusions Topical calcipotriol appears to be an effective and well-tolerated treatment for vitiligo and can be safely used in conjunction with PUVA, but controlled studies are necessary to exclude the possibility of spontaneous repigmentation.