Guideline for the Diagnosis and Management of Vitiligo

D.J. Gawkrodger; A.D. Ormerod; L. Shaw; I. Mauri-Sole; M.E. Whitton; M.J. Watts; A.V. Anstey; J. Ingham; K. Young


The British Journal of Dermatology. 2008;159(5):1051-1076. 

In This Article

In All Patients With Vitiligo, What is the Efficacy of a Course of PUVA With a Vitamin D Analogue Compared With PUVA With Placebo in Terms of Condition Progression, Area Reduction and Quality of Life Score?

The use of combination therapies has been common in the treatment of vitiligo.

Studies were identified which have attempted to assess whether PUVA or PUVA-sol in combination with a vitamin D analogue was more effective than PUVA or PUVA-sol alone.

Five studies were identified - two used an RCT design. A study of 27 patients treated with PUVA monotherapy or PUVA with calcipotriol showed an earlier and better overall response for the combination than for PUVA monotherapy.[41] These findings were similar to the second RCT of 19 patients in which the combination of PUVA with calcipotriol was more effective and faster than PUVA alone.[43] In contrast, another study showed no improvement for the combination of PUVA with calcipotriol compared with PUVA alone.[42] Other open studies report the combination of calcipotriol with PUVA to be more effective than PUVA alone, especially at initiating repigmentation.[40,44]

Five small studies fail to provide convincing evidence for an additional therapeutic effect for PUVA combined with a vitamin D analogue compared with PUVA monotherapy.

  1. Topical vitamin D analogues in combination with PUVA therapy should not be used in the treatment of vitiligo.

    Grade of recommendation C
    Level of evidence 3


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