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
| Autor: | Gianpaolo Tessari, Giampiero Girolomoni, Liliane Chatenoud, Luigi Naldi, A. Reseghetti, L. Marchesi, Fabrizia Sassi, Simone Cazzaniga |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Randomization Adolescent Hydrocortisone medicine.drug_class hydrocortisone 17 butyrate Administration Topical Vitiligo LASER CRYSTALS Dermatology Hydrocortisone 17-butyrate law.invention Young Adult chemistry.chemical_compound Randomized controlled trial law Humans Medicine Aged business.industry Middle Aged medicine.disease Combined Modality Therapy Confidence interval Clinical trial Exact test Treatment Outcome chemistry Quality of Life Corticosteroid Female Lasers Excimer Dermatologic Agents business Facial Dermatoses Neck |
| Popis: | Summary 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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