Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck

F. Sassi, S. Cazzaniga, G. Tessari, L. Chatenoud, A. Reseghetti, L. Marchesi, G. Girolomoni, L. Naldi

Research output: Contribution to journalArticle

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Abstract

Background: Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge. Objectives: We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy. Methods: Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75% of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores. Results: A total of 76 (90%) patients completed the study. In an intention-to-treat analysis, seven [16.6%; 95% confidence interval (CI) 5.3-27.8%] patients in the excimer monotherapy arm and 18 (42.8%; 95% CI 27.8-57.8%) in the combination arm showed ≥ 75% reduction of vitiligo lesions at 12 weeks (χ2 test 6.89, P = 0.0087). Clearance was observed in two (4.7%; 95% CI 1.6-11.2%) and nine (21.4%; 95% CI 9.0-33.8%) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29. Conclusions: Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.

Original languageEnglish
Pages (from-to)1186-1191
Number of pages6
JournalBritish Journal of Dermatology
Volume159
Issue number5
DOIs
Publication statusPublished - Nov 2008

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Excimer Lasers
Vitiligo
Neck
Randomized Controlled Trials
Confidence Intervals
Arm
Therapeutics
Steroids
Physicians
Intention to Treat Analysis
Phototherapy
hydrocortisone-17-butyrate

Keywords

  • Excimer laser
  • Phototherapy
  • Randomized controlled trial
  • Topical corticosteroids
  • Vitiligo

ASJC Scopus subject areas

  • Dermatology

Cite this

Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. / Sassi, F.; Cazzaniga, S.; Tessari, G.; Chatenoud, L.; Reseghetti, A.; Marchesi, L.; Girolomoni, G.; Naldi, L.

In: British Journal of Dermatology, Vol. 159, No. 5, 11.2008, p. 1186-1191.

Research output: Contribution to journalArticle

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abstract = "Background: Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge. Objectives: We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy. Methods: Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75{\%} of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores. Results: A total of 76 (90{\%}) patients completed the study. In an intention-to-treat analysis, seven [16.6{\%}; 95{\%} confidence interval (CI) 5.3-27.8{\%}] patients in the excimer monotherapy arm and 18 (42.8{\%}; 95{\%} CI 27.8-57.8{\%}) in the combination arm showed ≥ 75{\%} reduction of vitiligo lesions at 12 weeks (χ2 test 6.89, P = 0.0087). Clearance was observed in two (4.7{\%}; 95{\%} CI 1.6-11.2{\%}) and nine (21.4{\%}; 95{\%} CI 9.0-33.8{\%}) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29. Conclusions: Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.",
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AU - Sassi, F.

AU - Cazzaniga, S.

AU - Tessari, G.

AU - Chatenoud, L.

AU - Reseghetti, A.

AU - Marchesi, L.

AU - Girolomoni, G.

AU - Naldi, L.

PY - 2008/11

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N2 - Background: Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge. Objectives: We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy. Methods: Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75% of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores. Results: A total of 76 (90%) patients completed the study. In an intention-to-treat analysis, seven [16.6%; 95% confidence interval (CI) 5.3-27.8%] patients in the excimer monotherapy arm and 18 (42.8%; 95% CI 27.8-57.8%) in the combination arm showed ≥ 75% reduction of vitiligo lesions at 12 weeks (χ2 test 6.89, P = 0.0087). Clearance was observed in two (4.7%; 95% CI 1.6-11.2%) and nine (21.4%; 95% CI 9.0-33.8%) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29. Conclusions: Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.

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