Author(s) : Ichiro KATAYAMA Miwa ASHIDA, Aki MAEDA, Kumiko EISHI, Hiroyuki MUROTA, Sang Jae BAE , Department of Dermatology, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, Japan .
Summary : Vitiligo vulgaris is a common skin disease, however some cases show poor clinical responses to topical steroid ointment or PUVA therapy. Such regimens are generally avoided in the treatment of facial lesions or in pediatric cases because of the undesirable side effects. To confirm the excellent response to combination therapy with topical vitamin D3 ointment and solar irradiation for vitiligo achieved in the initial patients, we conducted an open trial on other patients, most of whom had poor clinical responses to the prior therapies. Fifteen patients (9 men and 6 women) with vitiligo vulgaris were enrolled in this study. Each patient was instructed to sunbathe for 30 minutes within 1 hour after topical application of the tacalcitol [1α24(OH)2
D3] ointment or cream to the skin lesions every day. Six of 15 patients showed a fair and excellent clinical response to the combination therapy (more than 30% clearance of the vitiligo). The clinical effect was more apparent in patients with a history of less than 5 years of vitiligo (4 of 6 cases) in contrast to those with a history of more than 5 years (2 of 9 cases).
In vitro experiments revealed that tacalcitol upregulated the expression of c-Kit mRNA by melanocytes irradiated with linear polarized infrared, UVA or short period solar irradiation. These results suggest that combination therapy with topical vitamin D
3 ointment and solar irradiation can be used as an alternate therapy for vitiligo vulgaris.
Figure 1. Clinical result in our initial case
after combination therapy with topical tacalcitol and solar
irradiation.
Within one month of initiating combination therapy regimen, most
of the vitiliginous lesions had been covered with repigmented skin
except for the margin of the eyelid that did not receive solar
irradiation.
Figure 2. Clinical results of combination
therapy.
Fair and excellent clinical responses were achieved in 6 of
15 cases.
Figure 3. Relationship between the duration of
vitiligo and clinical response to combination therapy.
Fair and excellent clinical responses were obtained in the
patients with the history of vitiligo for less than 5 years.
Figure 4. Clinical effect of combination therapy
in patient 15.
Five of 6 patients including patient 15 with poor
clinical response to topical corticosteroid/PUVA showed good
response to combination therapy.
Figure 5. Effect of vitamin D3 and various UV and
solar irradiation on c-Kit expression by cultured melanocytes.
The results of the in vitro study revealed that
tacalcitol[1α24(OH)2D3] clearly upregulated
the c-Kit mRNA expression by cultured human melanocyte under linear
polarized infrared, UVA and solar irradiation, but not under UVB
irradiation at the concentration of 10-10 M. UVB itself
showed rather strong c-Kit mRNA expression and
tacalcitol[1α24(OH)2D3] downregulated its
expression at the same concentration. Combination of tacalcitol and
UV irradiation did not affect NGF mRNA expression by melanocytes.
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