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Ecuadorian Congress of Medicine. About physicians from all parts of the country and several foreign physicians, who had been especially invited, attended the congress. The congress met in two great sections, a clinical and a surgical section, for study of 'official topics' of the congress. Each of the two sections was subdivided in three branches for the study of more than papers on 'free subjects. Armando Pareja Coronel, and clinical aspects of allergy, which was presented by Dr. Plutarco Naranjo Vargas. The surgical topics discussed were prostatic surgery, presented by Dr. Maldonado Carbo, and surgery of the biliary tract, presented by Dr. Dionisio Espinoza Vega. The topic that was considered. X Facebook LinkedIn. This Issue. April 4, Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. Purchase access. Rent article Rent this article from DeepDyve. Sign in to access free PDF. Save your search. Customize your interests. Create a personal account or sign in to:. Privacy Policy. Make a comment.

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Official websites use. Share sensitive information only on official, secure websites. E-mail: asisti6 gmail. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited. Thus far, several small studies and case reports on the use of topical immunomodulators in vitiligo have been published. We undertook a comprehensive literature review, searching for studies evaluating clinical response to tacrolimus topical therapy for vitiligo. Our inclusion criteria were: use of tacrolimus ointment as monotherapy to treat vitiligo. We found 29 studies from to Overall, patients were treated in 29 studies. The best results were obtained on lesions of the cephalic region, especially the face, with tacrolimus 0. Treatment was generally well-tolerated; only localized adverse effects were reported. Our objective was to verify the effectiveness and safety of tacrolimus ointment monotherapy. It has good efficacy and tolerability. At present, only small trials and case series are available in the literature. Further, standardized investigations on a larger number of patients are needed. The etiology of vitiligo is unknown. The autoimmune theory remains the most widely accepted. Vitiligo has frequently been reported in association with autoimmune disorders such as thyroid disease, diabetes mellitus and alopecia areata. The disease affects both genders equally. It can appear at any age and the average age of onset is somewhat variable in different geographic regions. The mean onset age is reportedly 22 in the U. Vitiligo treatment remains a challenge. Topical corticosteroids are most commonly used drug to treat vitiligo but there are concerns over side effects due to long-term use. Steroid application causes skin atrophy, telangiectasia, hypertrichosis and acne. Tacrolimus and pimecrolimus are used as topical immunomodulators. They inhibit calcineurin action, thus preventing T-cell activation and the production of various inflammatory cytokines. Both have been used to treat other inflammatory and immunologic skin disorders, including vitiligo, with encouraging results. Tacrolimus is a macrolide antibiotic produced by Streptomyces tsukubaensis with strong T-specific, immunosuppressant activity. The biological activity of tacrolimus takes effect after binding to the cytosolic 12kd macrophilin FK binding protein FK-BP. Hence, the expression of several inflammatory T-cell cytokines is inhibited. Lan et al. Further, they noted that the concentration of stem-cell factor and matrix metallopeptidase-9 activity in tacrolimus-treated keratinocyte supernatant increased significantly. They suggested that their results provided in vitro evidence demonstrating the positive effect of tacrolimus on melanocyte growth and migration. To verify the effectiveness of tacrolimus alone, we selected studies that discussed tacrolimus ointment as monotherapy for vitiligo treatment. Inclusion criteria were: 1 case study, review of literature, case report, clinical trial, open-label prospective study 2 tacrolimus used as monotherapy. The exclusion criterion was tacrolimus as a combination therapy. The entire PubMed database was explored, without time restrictions. Each article was tabulated as follows: authors, year of study, type of study, number of patients, age in years and sex of patients, localization of disease, treatment protocol, adverse effects, outcome. Studies discussing children and adults were included, along with studies describing topical treatment with both tacrolimus ointment 0. English and non-English-language papers were included. The publications were screened manually and reviewed to identify reports on tacrolimus monotherapy. Three investigators independently reviewed and extracted data from the papers according to the predetermined criteria. We identified full-text articles; 88 did not meet the inclusion criteria, leaving 29 studies available from to Nineteen were open-label trials, 3 were retrospective cohorts, 6 were case reports and 1 was a case series Chart 1. Overall, the treatments of patients were described in 29 studies. The main treatment choice was tacrolimus ointment 0. Six studies examined treatment with tacrolimus 0. Treatment length was variable, with a mean duration of 5. All patients were advised to use sunscreen regularly and avoid intentional sun exposure during the day. Response rates also varied. The best results were obtained on lesions in the cephalic regions, especially the face, applying tacrolimus ointment twice daily. Only Kathuria et al. Treatment was generally well-tolerated; no adverse systemic effects were reported. The most frequent adverse effects were burning sensation and pruritus, local erythema or irritation, acne or folliculitis-like manifestations, dysesthesia, stinging, pickling, formication and soreness. Our review aimed to critically assess the studies evaluating monotherapy with tacrolimus ointment to treat vitiligo. Selection bias and a lack of common outcome measures were among the issues that prevented a proper meta-analysis. Although this review is not a meta-analysis, we critically assessed the literature and tried to identify high-quality studies. The main limits of this analysis are the low number of patients included in most studies and the high heterogeneity of the study populations. Nevertheless, the studies analyzed as a whole seem to show that tacrolimus ointment provides effective treatment. Treatment with topical tacrolimus is generally safe and free of major local side effects. No serious adverse events occurred that required treatment to be stopped. In a single study, erythema and folliculitis-like manifestations on the treated area led 2 patients to discontinue therapy with tacrolimus ointment 0. In the open, randomized trial conducted by Stinco et al. One female patient related the appearance of soreness; another female patient reported pruritus on the eyelids associated with formication of the lips, while one female patient presented erythema of the bulbar conjunctiva. Five patients described redflushing on their faces after consuming small amounts of alcohol a glass of beer or wine. All local side effects resolved within weeks after the topical treatment regimen was reduced from two daily applications to one daily application. Tacrolimus 0. Although tacrolimus monotherapy seems to have good efficacy and tolerability, only small trials and case series are available in the literature. As a library, NLM provides access to scientific literature. An Bras Dermatol. Find articles by Andrea Sisti. Find articles by Giovanni Sisti. Find articles by Carlo Maria Oranges. Overview of clinical studies on vitiligo treatment with tacrolimus ointment monotherapy. Author s , year Type of study No. Grimes P. E et al. The medication was applied to all the lesions twice daily. Burning and stinging sensations occurred at the treated sites, which resolved after 1 to 2 weeks. One of our patients developed localized tinea corporis in an area adjacent to vitiligo patches treated with tacrolimus ointment. Lepe V. Travis L. Depigmentation of the forehead, forearms, chest, back, and calves. Completely repigmented after 2 months Complete repigmentation after 2 months. Tanghetti E. Two of the patients had no response to treatment. Kanwar A. Nineteen Of these 19 children, repigmentation was marked to complete in 11 All patients applied tacrolimus 0. Signs and symptoms of irritation were minimal. Silverberg N. Prats Caelles I. Slow but evident focal repigmentation in all locations. Areas of vitiligo showed frank repigmentation with no other secondary findings. Almeida P. Topical tacrolimus 0. Hartmann A. In 20 patients with widespread depigmentation on the right arm and leg, tacrolimus ointment was combined with overnight occlusive dressings in previously defined areas. Overall repigmentation was Lotti et al. After 2 months of therapy, all the lesions repigmented completely with excellent color matching except those in the infraorbital area. Choi C. Among them, 10 lesions were on the cheek, 7 lesions were on the forehead, 2 lesions were on the eyebrow, 5 lesions were on the eyelid, 3 lesions were on the prenarse, 3 lesions were perioral, 5 lesions were on the neck, 4 lesions were on the trunk, and 1 lesion was on the back of the hand. Taher Z. Radakovic S. Stinco G. One female patient related soreness; 1 female patient reported pruritus on the eyelids associated with formication of the lips, and 1 female patient presented erythema of the bulbar conjunctiva. Five patients described the appearance of redflushing on their face after consuming a small amount of alcohol a glass of beer or wine. All side effects resolved within weeks. We noted that although Udompataikul M. These included burning sensation and erythema. The overall response rate, defined as at least some repigmentation, was Silverberg J. Bhuvana K. In 32 patients, single region was affected; 20 patients had lesions on the face, especially the lips, eyelids, and ears. Tacrolimus ointment 0. Tamler C. Kathuria S. Sahni K. There was some perifollicular repigmentation in most of the other vitiligo lesions. Four patients showed moderate to excellent repigmentation. Baldo A. Open in a new tab. Conflict of Interest: None. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Smith D. Topical tacrolimus ointment twice daily 18 months. After 2 months of treatment, areas of repigmentation were noted in the patches of vitiligo on his face and scalp. In general, side effects were mild in all patients. Repigmentation was Complete repigmentation in 4 months. Face, neck, forehead,left knee,ankle,hands,elbows,chest. Side effects were minimal, including pruritus and burning, noted in only three patients. Anatomic sites included face, neck, trunk, upper extremities, and lower extremities. Patients were treated with tacrolimus 0. Symmetrically involving the extensor surfaces of her arms, thighs, and knees. Two months after starting therapy and without previous injuries, the patient noticed hair growth over her right knee focal hypertrichosis. Face, hands, arms, legs, foot, trunk, genitals. Pruritus in the eyelid area in two patients during the first week of treatment 2 patients. Bakos L. Left side of her chin and neck and on both sides of the dorsum. At the end of 3 months, the cervical and chin spots showed an extensive eruption of inflammatory and noninflammatory lesions of acne, with papules, pustules, and closed comedones. Depigmented lesions of the face and neck 21 out of 31 patients as well as of the right upper and lower extremity 31 patients. Infraorbital area, arms, thighs, and around the knees and ankles. Brownish hyperpigmentation in the previous patch of vitiligo in infraorbital area hyperpigmentation. In all, 40 target lesions were treated. Twenty-five Qualitatively, all patients completing the study demonstrated improvements in lesion size following treatment, with follicular repigmentation in all cases. Once or twice-daily application of 0. Nine patients, 7 female and 2 male, described a heat sensation on the face during the first days of application; in one case the application of the ointment was reduced to once a day for two weeks, leading to disappearance of the symptoms. Adverse events were observed in Sixty-six patients had vitiligo lesions on the body, 65 patients on the face. Topical 0. Repigmentation was good in all patients. Of the 55 patients, 36 showed response to treatment and 19 showed no response after 3 months. Only 5. Scalp, periorbital regions, elbows, thighs, legs, and feet. Hyperpigmentation over the periorbital macules. Depigmented lesions on the face, trunk, and extremities of the right side, on the shins. Erythema and folliculitis-like manifestations 2 patients discontinued the therapy because of side effects.

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