308 nm准分子激光联合他克莫司软膏治疗白癜风的临床疗效Meta分析

目的:系统评价308 nm准分子激光联合他克莫司软膏对比窄谱中波紫外线(NB-UVB)联合他克莫司软膏治疗白癜风的临床疗效。方法:计算机检索中文科技期刊数据库(VIP)、中国知网(CNKI)、万方数据库,百度学术、谷歌学术等搜索引擎,搜索308nm准分子激光联合他克莫司软膏、NB-UVB联合他克莫司软膏治疗白癜风的随机对照试验(RCT),按制定的纳入及排除标准进行文献筛选、数据提取,采用Revman 5.3软件分析统计,以有效率作为疗效指标进行分析,计算比值比(OR)及95%可信区间(CI)。结果:纳入14篇RCT,共计2223例患者。亚组间OR值比较结果显示:308 nm准分子激光联合他克莫司软膏对比单用他克莫司软膏治疗白癜风的有效率OR值[OR=7.53,95%CI(4.52,12.53)]大于NB-UVB联合他克莫司软膏对比单用他克莫司软膏治疗白癜风的OR值[OR=3.48,95%CI(2.81,4.30)],差异有统计学意义(P<0.05)。结论:308nm准分子激光联合他克莫司软膏治疗白癜风的临床疗效优于NB-UVB联合他克莫司软膏。     

308nm准分子激光联合他克莫司软膏治疗面颈部白癜风疗效观察

目的:观察308 nm准分子激光和他克莫司软膏外用治疗面颈部白癜风的临床疗效.方法:将91例白癜风患者随机分为3组:治疗组采用308 nm准分子激光照射联合他克莫司软膏外用;对照1组采用308 nm准分子激光照射,2次/w;对照2组采用他克莫司软膏外涂患处,2次/d.结果:治疗2、4、6个月疗效分别进行比较.治疗6个月后3组有效率分别为93.54%、73.33%和56.67%.3组间疗效比较有统计学差异(P<0.05).结论:308 nm准分子激光照射治疗面颈部白癜风起效较快,如联合他克莫司软膏外用,则能进一步提高疗效.     

308nm准分子激光治疗白癜风随机对照试验的系统评价

目的评价308nm准分子激光治疗白癜风的疗效和安全性。方法用计算机检索Medline(1966-2010),Embase(1984-2010)、中国生物医学文献数据库(CBM 1978-2010)。手工检索相关会议文献,文种限于中文和英文。根据纳入和排除标准筛选文献,收集所有相关随机对照试验(RCT),提取资料进行质量评价,采用RevMan5.1软件对数据进行Meta分析。结果共纳入10个RCT,包括411例患者。308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液治疗的无效率均小于单纯308nm准分子激光治疗[RR他合并=0.20,95%CI(0.08,0.51)],[RR胸合并=0.62,95%CI(0.41,0.93)];308nm准分子激光联合0.1%他克莫司软膏、他卡西醇软膏治疗的75%以上色素恢复率均优于单纯308nm准分子激光照射[RR=3.48,95%CI(1.39,8.70)],[OR=5.71,95%CI(1.13,28.75)];308nm准分子激光联合表皮移植治疗的75%以上色素恢复率优于单独表皮移植治疗[RR=0.14,95%CI(0.01,2.63)];308nm准分子激光治疗的75%以上色素恢复率优于NB-UVB照射[RR=6.00,95%CI(0.81,44.35)]。所有研究均未发现严重不良反应。结论 308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液能降低白斑消退的无效率,308nm准分子激光联合0.1%他克莫司软膏、卡泊三醇软膏能提高75%以上色素恢复率。     

308-nm准分子激光联合他克莫司软膏治疗面部白癜风656例疗效评价

目的：评价308nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效。方法：对656例面部白癜风患者照射308nm准分子激光联合外用他克莫司软膏。他克莫司软膏每日2次,308nm准分子激光每周治疗1-2次,共治疗30次。末次治疗后随访1年。结果：1630块白斑中,总有效率为47.12%,病程<2年皮损总有效率为58.10%高于病程≥2年皮损的16.60%,两组差异具有统计学意义(P<0.001)。眼周皮损疗效最佳,总有效率为54.96%,口周皮损疗效最差,总有效率为40.22%,差异有统计学意义（P<0.0001）。结论：308 nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效与病期和皮损部位有关。     

308 nm准分子光联合他克莫司软膏治疗儿童白癜风疗效观察

目的观察308 nm准分子光用于治疗儿童白癜风的疗效观察。方法选取我院2017年9月—2018年7月收治的128例白癜风患儿为本次研究对象,按照是否给予308 nm准分子光将所有患者分为对照组(64例:0.03%他克莫司软膏治疗)与试验组(64例:308 nm准分子光联合0.03%他克莫司软膏治疗),比较2组患儿临床疗效。结果试验组患儿治疗3个月后总有效率(74.33%)明显优于对照组,P0.05。试验组患儿治疗后不良反应发生率(4.69%)与对照组比较差异无统计学意义(P0.05)。结论 308 nm准分子光联合他克莫司软膏对白癜风患儿治疗效果明显优于单用他克莫司软膏。     

308nm准分子光联合0．03％他克莫司软膏治疗面部白癜风疗效观察

目的：探讨308 nm准分子光联合0.03%他克莫司软膏治疗面部白癜风疗效及安全性。方法选取面部白癜风患者129例,按就诊顺序分为3组,A组为试验组,43例患者采用308 nm准分子光联合0.03%他克莫司软膏治疗;B组为对照1组,43例患者单用308 nm准分子光治疗;C组为对照2组,43例患者单用0.03%他克莫司软膏外用治疗,疗程均为12周或治疗至皮损完全复色。结果 A组、B组、C组的显效率分别为73.80%、47.61%、17.07%,A组与B组和C组显效率比较,差异有统计学意义（P＜0.05）。3组患者均未出现严重不良反应。结论308 nm准分子光联合0.03%他克莫司软膏治疗面部白癜风疗效好、不良反应少,显效率明显高于单独治疗。     

308nm准分子光联合他克莫司软膏治疗白癜风临床观察

目的观察308nm准分子光联合他克莫司治疗白癜风的临床疗效。方法 360例白癜风患者随机分为联合组和308单频光组,两组均采用准分子光系统进行308nm光疗,联合组同时外用他克莫司软膏。结果联合组和308单频光组的有效率分别为83.9%和70.1%,差异具有统计学意义(P<0.05)。两组临床有效率最高的部位均为颈部、面部和躯干,最低为手足部;稳定期疗效高于进展期,差异均具有统计学意义(P<0.05)。结论 308nm准分子光联合外用他克莫司软膏治疗白癜风临床疗效好。     

综合疗法治疗难治性白癜风临床观察

目的 观察CO2点阵激光联合NB-UVB及他克莫司软膏治疗难治性白癜风的疗效及安全性。方法 选取44例难治性白癜风患者,随机分为治疗组和对照组,各22例,治疗组CO2点阵激光配合NB-UVB照射及他克莫司软膏外用,对照组NBUVB照射和他克莫司软膏外用。结果 治疗20周后,治疗组、对照组有效率分别为90.91%和59.09%,治疗组明显优于对照组(P0.05)。两组患者均未出现严重不良反应。结论 CO2点阵激光联合NB-UVB及他克莫司软膏治疗难治性白癜风安全有效,值得临床应用。     

他克莫司软膏联合308nm高能准分子光治疗面颈部白癜风临床疗效观察

目的观察他克莫司软膏联合308nm高能准分子光治疗面颈部白癜风的临床疗效。方法白癜风患者134ff4,随机分为3组。联合治疗组采用他克莫司软膏联合308nm高能准分子光治疗,他克莫司治疗组仅用他克莫司软膏治疗,准分子光治疗组仅用308nm高能准分子光治疗。3个月为1个疗程,根据色素恢复的程度评价临床疗效。结果联合治疗组有效率为95．5％,他克莫司治疗组为58_3％,308nm高能准分子光治疗组为78．6％,组间差异均有统计学意义（P〈0．05,P〈O．01）。结论他克莫司软膏联合308nm高能准分子光治疗白癜风效果较好。     

308nm准分子激光治疗白癜风概述

白癜风治疗方法较多,308 nm准分子激光凭借起效快、疗效高及副作用小等优势而迅速应用于临床。其治疗白癜风的作用机制不清,可能通过诱导皮损处浸润的淋巴细胞凋亡而取得疗效。联合外用他克莫司软膏或吡美莫司乳膏治疗白癜风效果比单独应用308 nm准分子激光更为显著。     

The efficacy and safety of tacrolimus as mono- and adjunctive therapy for vitiligo: A systematic review of randomised clinical trials

There is currently no definitive treatment for vitiligo; various modalities include immune modulators phototherapy and skin camouflage. We investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo. Electronic systematic search of the literature was carried out using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo have been included in a systematic review and meta-analysis. Meta-analysis was conducted via RevMan, and risk of bias was assessed through the Cochrane quality assessment tool. The protocol was published through PROSPERO (CRD42018112430). A total of 19 studies including 814 patients were included in our systematic review. The random-effects-model meta-analysis of two studies revealed that the tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy rates is better than NB-UVB alone in inducing >75% repigmentation [RR 1.34 (95% CI: 01.05–1.71), P = 0.02]. Tacrolimus and steroids had similar potency in acheiving >75% repigmentation [RR 1.02 (95% CI: 0.19–5.51), P = 0.98]. Meta-analysis of two studies revealed that the fractional laser and tacrolimus combination therapy is no better than tacrolimus alone in causing >75% repigmentation [RR 2.11 (95% CI: 0.87–5.09), P = 0.10]. Further investigating tacrolimus as mono- or adjuvant therapy for vitiligo is highly recommended. Combining tacrolimus to other treatment options such as steroids, phototherapy and laser may be superior to using tacrolimus alone.     

Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy and topical tacrolimus are included among the most innovative approaches to vitiligo. OBJECTIVE: To evaluate the efficacy and tolerability of combined treatment with NB-UVB and topical tacrolimus in vitiligo. METHODS: After informed consent, adult patients with chronic (> 1-year duration) stable vitiligo refractory to conventional treatments were enrolled in an open-labelled prospective study. Treatment regimen consists of once-daily application, in the evening, of tacrolimus 0.03% ointment to the lesions of the face, or tacrolimus 0.1% ointment to the vitiligous patches located on other areas. Concomitant NB-UVB phototherapy was performed twice weekly for 16 weeks. RESULTS: Study population included 110 patients (mean age, 42) with a total of 403 lesions. Within the treatment period, variable repigmentation was evident on more than 70% of lesions. Clinical response (repigmentation more than 50%) was observed in 42% of lesions. Response was strictly dependent on the site, being more frequent for face lesions (73%), followed by limbs (68%) and trunk (53.5%). The therapeutic effect on the extremities and genital areas was quite disappointing. Treatment was well tolerated. CONCLUSIONS: Our preliminary data suggest that the combination of topical tacrolimus with NB-UVB phototherapy can represent an alternative highly effective approach to refractory vitiligo located on the face, trunk and limbs. Long-term safety data and randomized controlled trials on a large number of patients are required.     

Effectiveness of 0.1% topical tacrolimus in adult and children patients with vitiligo

Topical corticosteroids and phototherapy are the conventional treatments of vitiligo. However, the acrofacial and segmental types are often unresponsive to these treatments. Nowadays, a few studies have been conducted on efficacy of topical tacrolimus in treatment of vitiligo including vulgaris and segmental types. Nevertheless, the acrofacial type has never been investigated with this topical therapy. The aim of our study is to evaluate the effectiveness of 0.1% tacrolimus ointment in patients including all types of vitiligo. Forty-two patients with vitiligo (22 adults, 20 children) were enrolled in this study. They were treated with 0.1% tacrolimus ointment twice daily for 6 months. Of these 42 patients, 38 of them completed the treatment process. The mean age of the patients was 27.8 years. The response rate was 76.09%. The vulgaris and focalis had a maximum response rate of 94.12%. The response rates for segmentalis and acrofacialis were 76.92% and 56.25% respectively. Concerning the response, age groups, types and location of vitiligo, there was significant difference in all variables (P = 0.001, P = 0.001, P = 0.025, respectively). Children had approximately nine times higher odds (95% CI = 1.09, 81.88) of having better response to the treatment than adults. The disease duration of 5 years or less also showed a better response. In conclusion, topical tacrolimus can be used for the treatment of patients with vitiligo. We recommend that, other than in the vulgaris type, topical tacrolimus may be considered as a treatment for two difficult to treat types of vitiligo, acrofacialis and segmentalis, before considering other modalities.     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的评价0.1%他克莫司软膏联合308nm准分子激光治疗白癜风疗效。方法将50例患者分为2组。A组外用0.1%他克莫司软膏联合308nm准分子激光照射,B组单独外用0.1%他克莫司软膏。于12,16周观察疗效。结果治疗12周后A组有效率为68.4%,B组有效率为41.8%,两组间疗效差异有统计学意义(P<0.01)。16周后A组有效率为75.4%,B组有效率为69.1%,两组间疗效差异无统计学意义(P>0.05)。A,B两组不同分期皮损的有效率比较,差异均有统计学意义(P<0.05),进展期疗效均优于稳定期。结论 A,B两组疗法均有效,进展期疗效优于稳定期,A组皮损较B组起效早且复色时间提前。     

Analysis of interleukin-10 levels in lesions of vitiligo following treatment with topical tacrolimus

Background Vitiligo is an acquired dermatological condition that is characterized by depigmentation of patches of skin. It is relatively common, occuring in about 0·38–0·50% of the general population, and can engender significant cosmetic disfigurement and psychological sequelae in the affected individual. Recent studies demonstrate that topical tacrolimus (Protopic^®; Astellas, Markham, ON, Canada) is efficacious in the treatment of vitiligo. We propose that the successful treatment of vitiligo with topical tacrolimus involves the unique immunosuppressive actions of the T lymphocyte T‐helper (Th) 2 cytokine, interleukin (IL)‐10. Objectives We aimed to monitor clinical changes in lesions of vitiligo treated with topical tacrolimus 0·1% ointment and quantify IL‐10 cytokine levels in nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Methods Clinical evaluation of lesions of vitiligo on the basis of surface area and follicular repigmentation under Wood’s lamp was performed in 20 enrolled adult patients. Biopsy specimens were obtained from nonvitiliginous skin, as well as lesions of vitiligo before and following topical tacrolimus therapy. Specimens were processed and analysed for expression of IL‐10 using the method of enzyme‐linked immunosorbent assay. Results A statistically significant mean ± SEM decrease in vitiligo lesion size of 41·0 ± 5·2% was observed following 3 months of treatment. A pattern of follicular repigmentation was noted by the third month of treatment for all patients completing the study. In addition, there was a statistically significant difference between IL‐10 expression in vitiligo lesions following treatment for 3 months with topical tacrolimus compared with untreated vitiligo lesions (P = 0·017) and normal skin (P = 0·004). Conclusions These results confirm that topical tacrolimus is an effective treatment for vitiligo. We propose that topical tacrolimus increases IL‐10 expression in vitiligo lesions, and thereby inhibits melanocyte destruction triggered by unchecked Th1 pathways in vitiligo.     

Efficacy and safety of topical tacrolimus for the treatment of face and neck vitiligo

Vitiligo is a common acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. The conventional treatments are limited by their inconsistent and incomplete responses, relapse rate, inconvenience to apply, side-effects and especially long-term effects. The aim of the present study was to determine the efficacy and safety of topical tacrolimus as monotherapy for the treatment of face/neck vitiligo in Taiwan. This was a multicenter, open-label, non-comparative study. Patients were at least 16 years old and had vitiligo lesions with Vitiligo Index of Disease Activity score +1 or more on face or neck. Patients received a monotherapy with 0.1% of tacrolimus ointment twice daily for 12 weeks. The efficacy was measured by the percentage of repigmentation of target lesion, which was graded as minimal (1–25%), mild (26–50%), moderate (51–75%) or excellent (76–100%). Patients who had at least mild repigmentation were defined as responders. A total of 61 patients were enrolled in this investigation. Most of the patients showed repigmentation at week 4. At the end of treatment, all patients showed repigmentation and 45.9% of patients were responders. During the study, 15 adverse events related to the ointment were reported. All the reported adverse events were mild and similar to the well-known adverse effect of tacrolimus in the treatment of atopic dermatitis. Tacrolimus ointment is effective and well tolerated for the treatment of patients with vitiligo in Taiwan. It will be another drug of choice for persons with vitiligo who are unable to receive regular phototherapy and fear the side-effects of topical steroid in long-term use.     

A comparative study on the use of fractional CO2 laser with tacrolimus or calcipotriol or narrow band ultraviolet‐B in treatment of stable nonsegmental vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO₂) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO₂ laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO₂ laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO₂ laser and NB‐UVB was found to be more effective.     

Efficacy and safety of tarcrolimus cream 0.1% in the treatment of vitiligo

Background  Vitiligo is an acquired, pigmentary skin disorder which is disfiguring and difficult to treat. Phototherapy and application of topical corticosteroids are most commonly prescribed. However, these therapies are often not effective and use of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia, and ocular complications.
Objective  We sought to assess the efficacy of topical tacrolimus ointment in the treatment of vitiligo.
Methods  A prospective pilot study was performed of 30 patients with vitiligo. Patients were treated with tacrolimus ointment for at least 4 months. Clinical responses were documented during clinic visits, and by pretacrolimus and post-tacrolimus photography.
Results  Twenty-five (83.3%) patients showed some repigmentation at the end of 4 months. Patients with vitiligo for more than 5 years also responded well to tacrolimus ointment. Repigmentation in active vitiligo was superior to that in stable vitiligo. 80% of patients with segmental vitiligo of the head and neck showed some response to tacrolimus, but there was no statistical significance between segmental and vulgaris vitiligo. The mean percentage of repigmentation on the head and neck was greater than that on the trunk and extremities. Four patients initially experienced burning on application.
Conclusions  Topical tacrolimus ointment is an effective and well-tolerated alternative therapy for vitiligo especially involving the head and neck.     

Tacrolimus ointment 0.1% produces repigmentation in patients with vitiligo: results of a prospective patient series

The cause of the selective melanocyte destruction in vitiligo may be due to an autoimmune disorder. A series of 15 patients with vitiligo were treated with a topical immunomodulator, tacrolimus ointment 0.1%, twice daily for a minimum of 45 days. Thirteen patients (87%) experienced at least partial repigmentation, and 3 of those patients had greater than 75% repigmentation. Patients with the greatest treatment response likely benefited from concomitant natural sunlight exposure. Further studies investigating the safety and efficacy of tacrolimus ointment either as monotherapy or in combination with other therapeutic measures are warranted.