Indian Journal of Dermatology, Venereology and Leprology | 2019
Cyclosporine in treatment of progressive vitiligo: An open-label, single-arm interventional study
Abstract
Sir, Vitiligo is a common disorder of pigmentation, affecting 1–4% of the world population. In the Indian context, the disease carries an enormous psychosocial burden.1 Cytotoxic T lymphocytes play a major role in destruction of melanocytes.2 Patients with an active, progressive vitiligo are treated with immunosuppressive therapies, such as, oral steroids. Oral steroids, in minipulse form, is a popular mode of therapy in India. Besides, oral levamisole and minocycline too have been used by clinicians, but these therapies carry their own risks.3 Topical calcineurin inhibitors, like tacrolimus, have also been used in vitiligo. However, cyclosporine, an oral calcineurin inhibitor with prominent immunomodulatory action has not been widely tried for progressive vitiligo. Cyclosporine interferes with the phosphorylation of nuclear factor of activated T cells (NFAT), a transcription factor, which is necessary for transcription of genes encoding interleukin‐2 (IL‐2). This interleukin is a master cytokine, necessary for full activation of the T‐cell pathway.4 We, therefore, decided to undertake this 12‐week open‐labeled, single‐center study on 18 patients with progressive vitiligo, using oral cyclosporine at a dose of 3 mg/kg/day. The study was approved by the institutional review board of RNT Medical College Udaipur. The study included patients with progressive vitiligo, which was defined as, development of new lesions or extension of preexisting lesions over the past 3 months. Patients with segmental vitiligo, those on any systemic or topical therapy for vitiligo for at least 6 months before enrolment and those with systemic diseases, were excluded from the study. Patients were prescribed oral cyclosporine (3 mg/kg/day), in two divided dosages and no additional therapy was allowed during the study period. Patients’ demographic and clinical details were recorded [Table 1]. Vitiligo activity was assessed using Vitiligo Area Scoring Index (VASI) and photographic documentation was done.5 Patients were evaluated at monthly interval. Statistical analysis was carried out, wherein quantitative variables were expressed using measures of central location (mean) and dispersion (standard deviation). Pre and post‐treatment VASI were compared using parametric (paired t‐test) and nonparametric tests (Wilcoxon signed rank test), with significance set at P < 0.05. In our study, progression of vitiligo was found to be halted in 11 out of 18 (61%) patients. It was interesting to note that of these 11 patients, 9 (81%) also showed repigmentation. The mean VASI score improved by 0.43 (P = 0.0016)‐ from 4.56 to