Topical Therapy of Vitiligo Using Sunlight Exposure with Lactic Acid Cream (10%) Versus Methoxsalene Solution


Topical Therapy of Vitiligo Using Sunlight Exposure with Lactic Acid Cream (10%) Versus Methoxsalene Solution


1Khalifa E. Sharquie, 2Wesal K. Aljanabi, 3Tamara Qais Al-Mohammedi

1Professor, MD; PhD., Department of Dermatology, College of Medicine, University of Baghdad. Iraqi and Arab Board for Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq. 2MD; FIBMS. Dermatology Center; Medical City, Baghdad, Iraq. 3MBChB, Dermatology Center; Medical City, Baghdad, Iraq.


Background Vitiligo is a common autoimmune disease to which multiple therapies have been used. Lactic acid in different modes of preparation like 15% topical solution and 1% intralesional injection has been tried effectively in treatment of vitiligo.

Objectives to test the efficacy of lactic acid cream10% with sunlight exposure in treatment of vitiligo, and to be compared with topical methoxsalene solution with sunlight exposure.

Materials and Methods This is an interventional, therapeutic, single blinded, comparative study that was conducted in the Center of Dermatology, Medical City, Baghdad, Iraq, between April 2018 and June 2019. Patients with generalized and localized vitiligo were included. The diagnosis of vitiligo was based on clinical characteristic loss of skin pigmentation and supported by woods light examination. The demographic features were recorded. Physical examination was done to determine the site and number of patches per patient. The patients were divided into two groups: group A patients, were treated with lactic acid 10% cream followed by sunlight exposure. While in group B, the patients were treated with topical methoxsalene solution followed by sunlight exposure. All patients were assessed, and the surface area of each patch was measured before starting the treatment and every month for 3 months of treatment. The side effects were also recorded. A follow up visit after 3 months was done. A reduction rate in the surface area of vitiliginous patch was calculated.

Results sixty patients, 41 (68.3%) females and 19 (31. 7%) males with a female to male ratio was 2.15:1. Their ages ranged between 3 – 42 years with mean± SD of 23.36±11.95 years. The disease duration ranged between 12-120 months. Total number of the lesions was 78 patches with a mean of 1.3 lesions per patient. No statistically significant differences were found between the two groups regarding demographic nor clinical features (P ≥ 0.05). In group A (lactic acid), 32 patients with 45 patches. The reduction rate in surfaces area of patches was increased at each visit. In the second visit, the reduction rate was (6.63%), the third visit, it was (17.45%). While in fourth and follow up visits the reduction rate was (30.22%) and (32.66%) respectively. The mean surface area of the lesions was decreased from 1.98±0.2cm2 to 1.23±0.1cm2 from the baseline visit to the last follow-up visit with  P value<0.001 which was highly significant and the mean±SD of reduction rate was 32.66 ± 3.4 from the base line to the last follow-up visit. Group B(methoxsalene): 28 patients with 33 patches. The reduction rate was 13.12% in second visit while (16.32%) in the 3rd visit. In fourth and follow up visits, the reduction rate was (21.33%) and (20.78%) respectively. The mean surface area of the lesions was decreased from 4.63±0.9 cm 2 to 4.22±1.1 cm2 from the baseline visit to the last follow-up visit with P value 0.13 was not statistically significant.

Conclusion this study showed that lactic acid 10% cream in combination with sunlight exposure was statistically effective in treatment for vitiligo. Topical methoxsalene with sun light exposure was less effective than lactic acid and with more side effects.


Keywords: Vitiligo, Lactic acid, methoxsalene, sun light, Sharquie, Iraq

Free Full-text PDF


How to cite this article:
Khalifa E. Sharquie, Wesal K. Aljanabi, Tamara Qais Al-Mohammedi.Topical Therapy of Vitiligo Using Sunlight Exposure with Lactic Acid Cream (10%) Versus Methoxsalene Solution. American Journal of Dermatological Research and Reviews, 2020, 3:29. DOI: 10.28933/ajodrr-2020-04-2305


References:

1. Lapeere H, Boone B, Schepper SD, Verhaeghe E, Geel MV, Ongenae K, et al. Hypomelanoses and hypermelanoses. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: The McGraw-Hill Companies; 2012: 804-826.
2. Sandoval-Cruz M, García-Carrasco M, Sánchez-Porras R, Mendoza-Pinto C, Jiménez-Hernández M, Munguía-Realpozo P, et al. Immunopathogenesis of vitiligo. Autoimmun Rev 2011; 10(12):762-5.3. Kadir NO, Al-Mashhadan SA, Al-Waiz MM. Treatment of patchy alopecia areata using topical 15% lactic acid solution. Iraqi J Community Med 2006; 19(4):361-4.
3. Garg BJ, Saraswat A, Bhatia A, Katare OP. Topical treatment in vitiligo and the potential uses of new drug delivery systems. Indian J Dermatol Venereol Leprol 2010; 76(3):231-8.
4. Dhiab NK. Intralesional therapy of striae distensae singly by insulin (isophane NPH), lactic Acid 0.25% and Isotonic saline (single, blinded, therapeutic, comparative study). [Doctorate thesis]. Baghdad: Submitted to the Scientific Council of the Arab board of Medical Specializations in Dermatology and Venereology; 2016.
5. Sharquie KE, Al‐Tikreety MM, Al‐Mashhadani SA. Lactic acid as a new therapeutic peeling agent in melasma. Dermatol Surg 2005; 31(2):149-54.
6. Sharquie KE, Abdulla MS. Treatment of vitiligo with topical 15% lactic acid solution in combination with ultraviolet-A. Saudi Med J 2005; 26(6):1013-5.
7. Sharquie KE, Al Hashimy S, Al-Niddawi A. Intralesional therapy of vitiligo by 1% Lactic acid [thesis]. Baghdad: Submitted to the Arab Board of Health Specializations in Dermatology and Venereology; 2018.
8. Sharquie KE, AL-Hammamy HR, Ameen WA. Treatment of localized vitiligo with infrared radiation [thesis]. Baghdad: Submitted to the Arab Board of Health Specializations in Dermatology and Venereology; 2006.
9. Passeron T, Ortonne J. Vitiligo and other disorders of hypopigmentations. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Elsevier; 2018: 1087-1112.
10. Sharquie KE, Noaimi AA, Al-Ekabee A. Treatment of vitiligo with calcipotriol ointment in comparison with calcipotriol+betamethasone ointment [thesis]. Baghdad: Submitted to the Iraqi Commission for Medical Specialization in Dermatology and Venereology; 2007.
11. Sharquie KE, Al-Hammamy HR, Noaimi AA, Al-Obeidy MH. Treatment of Vitiligo with Topical 5% Tincture Iodine and UVA Light. Am J Dermatol Venereol 2014; 3(4):75-9.
12. Grimes PE, Billips MA. Childhood Vitiligo. In: Nordlund JJ, Hann S, eds. Vitiligo: A Monograph on the Basic and Clinical Science. Wiley-Blackwell; 2000: 61-8.
13. Pasricha JS, Khera V. Effect of prolonged treatment with levamisole on vitiligo with limited and slow‐spreading disease. Int J Dermatol 1994;33(8):584-7.
14. Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral
dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol 2001; 44(5):814-7.
15. Al-Hilo MM, Ahmed WK, Sharquie KE, Hamadi SA. Antioxidants use of vitamin C and vitamin E in patients with vitiligo. Iraqi Journal of Community medicine 2006;19(2):118-25.
16. Sharquie KE, Noaimi AA, Al-Mudaris HA. Melanocytes transplantation in patients with vitiligo using needling micrografting technique. J Drugs Dermatol 2013;12(5): e74-8.
17. Schallreuter KU, Beazley WD, Wood JM. Biochemical theory of vitiligo: a role of Pteridines in pigmentation. In: Nordlund JJ, Hann S, eds. Vitiligo: a monograph on the basic and clinical science. Wiley-Blackwell; 2000:18-151.
18. Wang E, Koo J, Levy E. Intralesional corticosteroid injections for vitiligo: a new therapeutic option. J Am Acad Dermatol 2014;71(2):391-3.