Combined With NB-UVB Therapy, Topical Vitamin D May Enhance Therapeutic Outcomes of Vitiligo

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When used in combination with narrowband ultraviolet phototherapy (NB-UVB), topical formulations of vitamin D and analogues such as calcipotriol and tacalcitol have the potential to enhance therapeutic outcomes in patients with vitiligo, according to a study published in Cells.

Investigators sought to explore the efficacy of topical vitamin D formulations and analogs, particularly tacalcitol and calcipotrol, in combination treatment with NB-UVB, psoralens long wave ultraviolet radiation (PUVA), and monochromatic excimer light (MEL) therapy for vitiligo. They noted that data regarding vitamin D efficacy in combination with PUVA and MEL therapies are extremely limited.

Previous studies, they noted, have demonstrated the efficacy of synthetic vitamin D analogues in combination with NB-UVB for patients with stable plaque psoriasis. In this review, study authors explored the efficacy and safety of various synthetic vitamin D analogues in treating patients with vitiligo.

Using related search terms such as “vitiligo," “vitamin D,” “calciferol,” “cholecalciferol,” “ergocalciferol,” “tacalcitol,” “maxacalcitol,” and “calcipotriol,” among others, investigators combed through databases PubMed and Scopus. All searches included relevant papers, studies, and trials published between 2003 and 2023.

Preliminary searches tracked down 515 records across both databases. After eliminating duplicate publications and screening records for eligibility, investigators were left with 27 relevant publications.

In publications pulled from Scopus, the highest proportion of publications could be attributed to calcipotriol, tacalcitol, and cholecalciferol, respectively. In those pulled from PubMed, the highest proportion of publications were related to cholecalciferol, calcipotriol, and tacalcitol.

Ointment formulations proved to be the most common, followed by creams and other formulations such as gels, solutions, and suspensions.

Approximately 26% of patients achieved excellent responses, 40% achieved good responses, 18% achieved moderate responses, and 26% achieved poor responses to treatment.

Studies included in the review found that combination therapy employing the application of calcipotriol and use of PUVA may be a promising therapeutic option for patients with vitiligo. While NB-UVB treatment, for example, possesses efficacy as a monotherapy for vitiligo, the use of calcipotriol in combination with NB-UVB may lead to varying results, study authors noted.

Furthermore, the review demonstrated that topical vitamin D analogues used in combination with topical corticosteroids led to superior efficacy and outcomes than the use of topical corticosteroids alone. This, study authors wrote, may also reduce the potential for corticosteroid-related adverse effects.

"When used in conjunction with NB-UVB therapy, the addition of these derivatives has the potential to enhance the therapeutic outcomes for vitiligo. Tacalcitol has been shown to have stronger efficacy compared to calcipotriol in this regard. However, there is limited evidence supporting the use of vitamin D analogues to enhance the effectiveness of PUVA and MEL treatments for vitiligo, although some positive effects have been observed with the use of calcipotriol in a few studies," study authors wrote. "Additional research is needed to explore the optimal methods of topically administering vitamin D analogues as an anti-vitiligo agent. Further studies are necessary to investigate the specific protocols, dosages, and treatment durations to maximize the therapeutic benefits of vitamin D analogues in the management of vitiligo."

Reference

Al-Smadi K, Ali M, Alavi SE, et al. Using a topical formulation of vitamin D for the treatment of vitiligo: a systematic review. Cells. 2023;12(19):2387. Published 2023 Sep 30. doi:10.3390/cells12192387