Corticosteroid Injections and UV Light Effective in Vitiligo Management

Moetaz El-Domyati, MD

Investigators in Egypt found that intralesional corticosteroid injections (ILS) combined with narrow-band ultraviolet B (NB-UVB) light therapy presented as a well-tolerated therapeutic option for vitiligo.

The investigative team, led by Moetaz El-Domyati, MD, Minia University, Al-Minya, noted that concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest treatment options, with fewer side effects and complications.

Despite an ever-growing collection of data on vitiligo, it remains one of the most difficult dermatological challenges for medical professionals.

Treatments such as phototherapy, topical and systemic immunosuppressants, and surgical options have aided in halting and stabilizing the disease, and the use of steroids have been proven to decrease melanocyte destruction and induce pigment production.

Narrowband ultraviolet phototherapy has been considered a “very important modality” in the treatment of the disease, with promising data available in young populations as well as pregnant women.

As such, El-Domyati and colleagues explored the efficacy and safety of different concentrations of ILS combined with NB-UVB phototherapy in the treatment of patients with non-segmental vitiligo.

The Study

A total of 20 patients with non-segmental vitiligo were enrolled in the study, all of whom were recruited from the dermatology outpatient clinic at Minia University Hospital.

The age of patients in the study ranged from 15 to 56 years old, with the duration of the disease ranging from 2 to 7 years.

A total of 5 patches were selected and classified in each patient: patch 1 (control) was injected with normal saline, patch 2 was injected with triamcinolone acetonide, patch 3 with a concentration of 1.25 mg/ml (1:32), patch 4 with a concentration of 2.5 mg/ml (1:16), and patch 5 with triamcinolone acetonide at a concentration of 5 mg/ml (1.8).

All patients received NB-UVB phototherapy twice per week for 6 months, starting with a dose of 0.21 J/cm2 and then increasing by 20% every session till minimal erythema dose (MED) was achieved.

Skin biopsies and a morphometric measurement of epidermal thickness were also conducted on each patient.

The Findings

Investigators reported that there were significant differences between all groups in their repigmentation responses.

In patch 1 (control), 60% of cases showed no changes while 20% showed fair response, 5% showed moderate response, and 15% revealed excellent response. In patch 2 (0.625 mg/ml), 20% showed no changes, 10% revealed fair response, 5% showed moderate response, 20% showed good response, and 45% revealed excellent response.

In patch 3 (1.25 mg/ml), 20% showed no changes, 20% showed good response, and 60% revealed excellent response, and in patch 4 (2.5 mg/ml), 20% showed no changes, 5% showed moderate response, 10% showed good response and 65% revealed excellent response.

Finally, in patch 5 (5 mg/ml), 15% showed no changes, 5% showed fair response, 10% showed good response, and 70% revealed excellent response.

The team also reported that higher concentrations of 2.5 and 5 mg/ml were more effective in the treatment of vitiligo patches, yet more side effects were recorded.

Overall, the responses to ILS injections with NB-UVB were positive, with investigators calling it an “effective, simple, and relatively safe treatment when used with caution”.

“Therefore, we recommend starting with a lower concentration (0.625 mg/ml) to avoid TA side effects, however, in some cases, higher concentrations may be needed to achieve the required improvement,” the team wrote.

The study, “The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: clinical, histopatholigic, and histometric evaluation,” was published online in the International Journal of Dermatology.