Topical tacrolimus therapy for vitiligio: Therapeutic responses and skin messenger RNA expression of proinflammatory cytokines

Background: Previous studies have documented humoral and cell-mediated immunologic defects in patients with vitiligo. Objective: This 24-week study assessed the efficacy and safety of tacrolimus 0.1% ointment in patients with generalized vitiligo as well as the pretreatment and post-treatment expression of cytokines in the depigmented and normal skin of patients compared with controls. Methods: Twenty-three patients were enrolled in this investigation, and 19 patients completed the study; 8 were male and 11 were female. Fifteen age-, race-, and sex-matched control subjects were also included. Patients were treated with tacrolimus 0.1% ointment applied twice daily. Repeat evaluations were performed at 4, 8, 12, 16, 20, and 24 weeks. Three-millimeter punch biopsy specimens were taken from the depigmented, non-sun-exposed skin and adjacent normal skin of patients at baseline and 24 weeks, and from normal, non-sun-exposed skin of controls. Cellular messenger RNA expression for interleukin 2 (IL-2), IL-4, IL-10, tumor necrosis factor alfa (TFN-alpha), and interferon gamma (IFN-gamma) were determined by real-time quantitative polymerase chain reaction. Results: At 24 weeks, 17 of 19 patients (89%) achieved varying levels of repignientation. There was a statistically significant decrease in overall disease severity scores at 24 weeks. Thirteen patients (68%) had grejter than 75% repignientation of face and/or neck lesions. Signs and symptoms of irritation were minimal. At baseline, compared with healthy control,,;, vitiligo patients demonstrated a statistically significant increase in the expression of IFN-gamma in involved and adjacent uninvolved skin (P =.05 and P =.02, respectively); significantly increased TNF-alpha expression in involved and uninvolved skin (P =.01 and P = 0.02, respectively): and significantly increased IL-10 expression in involved and uninvolved skin (P =.01 and P =.04, respectively). Posttreatment, TNF-alpha expression decreased in the depigmented and adjacent uninvolved skin (P <.001). There was no statistically significant change in IL-10 or TFN-gamma posttreatment. These data suggest that tacrolimus 0.1% ointment is a safe and effective therapy for patients with vitiligo. it further Suggests that an imbalance in local cytokine expression triay play a role in the pathogenesis of vitiligo. Suppression of TNF-alpha after topical tacrolimus application may be associated with repignientation of vitiligo.