Enhanced repigmentation of vitiligo by topical minoxidil and excimer lamp treatment

Vangelis George Kanellis; Monisha Gupta

doi:10.4103/Pigmentinternational.Pigmentinternational_

Enhanced repigmentation of vitiligo by topical minoxidil and excimer lamp treatment

Vangelis George Kanellis¹, Monisha Gupta²
¹ The Canberra Hospital, Canberra, ACT, Australia
² The Skin Hospital, Sydney, NSW, Australia

Correspondence Address:
Vangelis George Kanellis
The Canberra Hospital, Canberra, ACT, 2605
Australia

Sir,

We present the effectiveness of topical 5% minoxidil and excimer lamp therapy in a patient of segmental vitiligo affecting the face and neck. Previously, combined use of excimer lamp with topical calcipotriene^[1] and topical tacrolimus has been reported to be successful in treating vitiligo.^[2] However, to our knowledge, this is the first report on encouraging results with the use of excimer lamp phototherapy combined with topical 5% minoxidil for vitiligo.

Vitiligo is an acquired skin depigmentation disorder of melanocytes. It has no race or gender bias and has a global prevalence of 0.5% to 2%. Vitiligo is thought to arise from multiple factors including autoimmunity, genetics, melanocyte defects, trauma, dysregulation of cytokines, and growth factor deficiencies. Typically, lesions are well-defined, nonscaly, and pale macules or patches that affect skin, hair, and mucosa. Although the cornerstone treatment of vitiligo has been narrow-band ultraviolet B in combination with other agents, there has been increasing use of other combination therapies that use modalities such as the excimer lamp, steroids, calcineurin inhibitors, vitamin D analogs, psoralens, and prostaglandin E2 and F2 alpha analogs.

We present a 30-year-old Caucasian man who presented with a history of a vitiligo patch on his right neck and chin that was progressively enlarging over the preceding month as shown in [Figure 1]A. The patch was asymptomatic, well-defined, and displayed some hair depigmentation; 52 sessions of excimer lamp therapy (308 nm) was given three times weekly in combination with alternating weeks of tacrolimus ointment 0.1% twice daily and clobetasol propionate ointment 0.1% once daily over 4 months. This combination therapy was switched to latanoprost 50 mcg twice daily alone, without excimer lamp therapy, for 10 months to stimulate hair repigmentation. At this time, only minimal benefit with disease stabilization was observed.

Figure 1 Improvement in vitiligo patches before (A) and after (B) combination treatment of 36 excimer lamp therapy sessions and minoxidil 5% twice daily over a 5-month period. The patient had already received 52 excimer lamp sessions prior (A) in combination with tacrolimus ointment 0.1% twice daily and clobetasol propionate ointment 0.1% once daily.

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Subsequently, 36 sessions of excimer lamp given three times weekly combined with minoxidil 5% twice daily over 5 months produced evidence of repigmentation of hair in the beard area and perifollicular migration of pigment as shown in [Figure 1]B.

Topical 5% minoxidil was able to initiate repigmentation in vitiligo patches of our patient by maintaining hair follicles in the anagen phase,^[3] stimulating T-cell blastogenesis and increasing local cutaneous blood flow.^[4] At the same time, the active melanocytes from the outer root sheath of anagen hair follicles can be stimulated by excimer lamp phototherapy to achieve perifollicular migration of melanocyte into the surrounding depigmented skin to encourage repigmentation.

The combined use of narrow-band ultraviolet B and 2% minoxidil has been documented for over 2 decades to be a safe treatment modality with only minor side effects.^[5] In our experience, topical 5% minoxidil is cheap, safe, and effective when treating vitiligo in areas of hair-bearing skin when combined with other agents and with the excimer lamp phototherapy in appropriate patients. Furthermore, larger studies replicating our results could establish this combination as a useful adjunct in the armamentarium of vitiligo treatments.

Prior publication

This study was presented as poster at a meeting organized by the Australasian College of Dermatology, Annual Scientific Meeting in Melbourne, Australia, May 18–21, 2019.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Mouzakis JA, Liu S, Cohen G. Rapid response of facial vitiligo to 308 nm excimer laser and topical calcipotriene. J Clin Aesthet Dermatol 2011;4:41-4.
2.	Passeron T, Ostovari N, Zakaria W, Fontas E, Larrouy JC, Lacour JP et al. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol 2004;140:1065-9.
3.	Faghihi G, Mozafarpoor S, Asilian A, Mokhtari F, Esfahani AA, Bafandeh B et al. The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia. Indian J Dermatol Venereol Leprol 2018;84:547-53. [PUBMED] [Full text]
4.	Fiedler-Weiss VC, Buys CM. Response to minoxidil in severe alopecia areata correlates with T lymphocyte stimulation. Br J Dermatol 1987;117:759-63.
5.	Rebora A, Guarrera M. Hair discoloration caused by minoxidil lotion. J Am Acad Dermatol 1989;21:1314.

Figures

[Figure 1]