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- Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo
- Mometasone cream for vitiligo
Its ability to enhance the protective and anti-destructive mechanism of melanocytes and locally suppress immune changes, enabling melanocytes to repigment, has been demonstrated.
Therefore, mometasone is a good therapeutic option to treat vitiligo either alone or in combination. It is well documented that it is possible to associate surgical methods with other therapeutic modalities, such as laser, heliotherapy, NB-UVB and PUVA therapy, to stimulate melanocyte migration from the follicle and thus promote the occurrence of pigmented halo around the implanted graft. We found that the largest halos occurred in the patients 9 and 10, who had sun exposure more often, which confirms the importance of light stimulation for repigmentation.
In five out of the 11 patients there was satellite repigmentation. In one patient number 2 , the mean areas of the treated and untreated halos were similar, which may have been caused by the proximity of the grafts. Both findings may be due to the hypothesis of stimulation of donor melanocytes and keratinocytes or action of growth factors on inactive melanocytes. It is important to highlight that the measure of round halos was more difficult to calculate using fotofinder, as the line drawn on the outer edge of the halos was manually done with the computer mouse, which often makes it difficult to perform short and round movements.
Therefore, there might have been a measurement bias, which is inherent to all cases, since there was only one observer. We could not find studies in the literature using the combination of autologous punch grafting and subsequent use of mometasone to evaluate the real impact of this topical corticoid on repigmentation after grafting.
A randomized study was conducted in by Barman et al evaluating 42 patients divided into two groups. The first group underwent punch grafting and PUVA, and the second group received punch grafting and topical fluocinolone. However, there was no statistically significant difference between the groups. Conversely, in the present study, we were able to analyze the positive association between mometasone and punch grafting in patients with clinically stable vitiligo, showing a statistical significance, which might serve as a basis for further studies with larger samples.
In spite of the small size of our sample which, from a statistical point of view, is not sufficient to draw definite conclusions, our results suggest a positive impact of mometasone on the progression of pigmented halos. Further studies with larger samples are needed to reach an accurate conclusion about the true effect of topical mometasone on repigmentation after grafting, which may become a new treatment option for patients with clinically stable vitiligo.
Conflict of interest: I deny any conflict of interest. The objective was the use of mometasone. This laboratory just made the samples available in a bigger quantity, therefore enough for the study. Financial Support: Mometasone creams Dermotil supplied by Glenmark pharmaceutical industry to myself main author who would distribute them to all study patients. Open menu Brazil. Anais Brasileiros de Dermatologia.
Open menu. Abstract Resumo English Resumo Portuguese. Text EN Text English. Glucocorticoids; Transplantation; Vitiligo. An Bras Dermatol. Epidemiological profile of patients with vitiligo and its association with thyroid disease. Falabella R, Barona MI.
Update on skin repigmentation therapies in vitiligo. Pigment Cell Melanoma Res. Mometasone cream versus pimecrolimus cream for the treatment of childhood localizated vitiligo.
J Dermatol Treat. Kostovic K, Pasic A. New treatment modalities for vitiligo: focus on topical immunomodulators. The efficacy of low dose oral corticosteroids in the treatment of vitiligo patients. Int J Dermatol. Vitiligo in children: a review of classification, hypothesis of pathogenesis and treatment.
Guideline for the diagnosis and management of vitiligo. Br J Dermatol. A clinical trial of clobetasol propionate in Filipino vitiligo patients. Clin Ther. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of literature. Arch Dermatol. Topical mometasone fuorate for the treatment of childhood vitiligo. Indian J Dermatol Venerol Leprol. Mutalik S, Ginzburg A. Surgical Management of stable vitiligo: A review with personal experience. Dermatol Surg.
Czajkowski R. Comparision of melanocytes transplantation methods for treatment of vitiligo. Lahiri K, Sengupta SR. Treatment of stable and recalcitrant depigment skin conditions by autologous punch grafting. News amp Views. Observation Letter. Observation Letters. Original Article. Original Contributions. Pattern of Skin Diseases. Pediatric Dermatology.
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Systematic Review and Meta Analysis. Systematic Reviews and Meta analyses. Systematic Reviews and Meta analysis. Therapeutic Guidelines. Therapy Letter. View Point. What s new in Dermatology. Translate this page into: English. Buy Reprints PDF. Topical mometasone furoate for the treatment of childhood vitiligo. FDA Resources. Arms and Interventions. Outcome Measures. Primary Outcome Measures : percent of repigmentation [ Time Frame: 6 months ] Percent of patients who get repigmentation of the lesion after 0.
Secondary Outcome Measures : side effect [ Time Frame: 6 months ] Possible side effect from topical 0. Eligibility Criteria. Inclusion Criteria: Patients must be above 18 years old Patients must have symmetrical vitiligo lesion on both sides of the body. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials. Faculty of Medicine Siriraj Hospital. More Information. National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Drug: tacrolimus ointment Drug: Mometasone furoate. Phase 4.
Study Type :. Interventional Clinical Trial. Estimated Enrollment :. Comparison the Efficacy and Safety of 0.
❾-50%}Mometasone cream for vitiligo
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Resident page. Resident s Page. Residents Corner. Residents Page. Review Article. Review Articles. This study purpose is to evaluate the efficacy and safety of 0. At first visit, patients will be randomized to receive 0.
The lesion on the other side of the body will be treated with 0. Patients are instructed to apply 0. Patients will be follow up at 2, 4 and 6 months for clinical improvement, side effects and photographs. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. We're building a better ClinicalTrials. Check it out and tell us what you think! Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information.
Search for terms. Save this study. Warning You have reached the maximum number of saved studies Comparison of Efficacy and Safety of 0. Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Recruitment status was: Active, not recruiting First Posted : April 12, Last Update Posted : October 10, Study Description. This event has been poorly studied so far and it occurs after punch grafting.
It consists on the appearance of melanin pigmentation in peripheral areas that did not receive grafting. This could be caused by the action of donor keratinocytes that might act as a source of growth factors, which stimulate melanocyte donors to proliferate and migrate to the vitiligo patches or, alternatively, by the action of growth factors spread in the achromic patches and responsible for stimulating "dormant" melanocytes.
Conversely, topical corticosteroids are one of the oldest and most widely used methods to treat vitiligo. Studies have reported that corticosteroids enhance the protective and anti-destructive mechanism of melanocytes, inhibit immune changes, blocking T-cells and allowing melanocytes to reactivate.
Its ability to enhance the protective and anti-destructive mechanism of melanocytes and locally suppress immune changes, enabling melanocytes to repigment, has been demonstrated.
Therefore, mometasone is a good therapeutic option to treat vitiligo either alone or in combination. It is well documented that it is possible to associate surgical methods with other therapeutic modalities, such as laser, heliotherapy, NB-UVB and PUVA therapy, to stimulate melanocyte migration from the follicle and thus promote the occurrence of pigmented halo around the implanted graft.
We found that the largest halos occurred in the patients 9 and 10, who had sun exposure more often, which confirms the importance of light stimulation for repigmentation. In five out of the 11 patients there was satellite repigmentation.
In one patient number 2 , the mean areas of the treated and untreated halos were similar, which may have been caused by the proximity of the grafts. Both findings may be due to the hypothesis of stimulation of donor melanocytes and keratinocytes or action of growth factors on inactive melanocytes. It is important to highlight that the measure of round halos was more difficult to calculate using fotofinder, as the line drawn on the outer edge of the halos was manually done with the computer mouse, which often makes it difficult to perform short and round movements.
Therefore, there might have been a measurement bias, which is inherent to all cases, since there was only one observer.
We could not find studies in the literature using the combination of autologous punch grafting and subsequent use of mometasone to evaluate the real impact of this topical corticoid on repigmentation after grafting. A randomized study was conducted in by Barman et al evaluating 42 patients divided into two groups. The first group underwent punch grafting and PUVA, and the second group received punch grafting and topical fluocinolone.
However, there was no statistically significant difference between the groups. Conversely, in the present study, we were able to analyze the positive association between mometasone and punch grafting in patients with clinically stable vitiligo, showing a statistical significance, which might serve as a basis for further studies with larger samples. In spite of the small size of our sample which, from a statistical point of view, is not sufficient to draw definite conclusions, our results suggest a positive impact of mometasone on the progression of pigmented halos.
Further studies with larger samples are needed to reach an accurate conclusion about the true effect of topical mometasone on repigmentation after grafting, which may become a new treatment option for patients with clinically stable vitiligo. Conflict of interest: I deny any conflict of interest.
The objective was the use of mometasone. This laboratory just made the samples available in a bigger quantity, therefore enough for the study. Financial Support: Mometasone creams Dermotil supplied by Glenmark pharmaceutical industry to myself main author who would distribute them to all study patients.
Open menu Brazil. Anais Brasileiros de Dermatologia. Open menu. Abstract Resumo English Resumo Portuguese. Text EN Text English. Glucocorticoids; Transplantation; Vitiligo. An Bras Dermatol. Epidemiological profile of patients with vitiligo and its association with thyroid disease. Falabella R, Barona MI. Update on skin repigmentation therapies in vitiligo. Pigment Cell Melanoma Res. Mometasone cream versus pimecrolimus cream for the treatment of childhood localizated vitiligo.
J Dermatol Treat. Kostovic K, Pasic A. New treatment modalities for vitiligo: focus on topical immunomodulators. The efficacy of low dose oral corticosteroids in the treatment of vitiligo patients. Int J Dermatol. Vitiligo in children: a review of classification, hypothesis of pathogenesis and treatment.
Guideline for the diagnosis and management of vitiligo. Br J Dermatol. A clinical trial of clobetasol propionate in Filipino vitiligo patients. Clin Ther. Nonsurgical repigmentation therapies in vitiligo.
Meta-analysis of literature. Arch Dermatol. Topical mometasone fuorate for the treatment of childhood vitiligo. Indian J Dermatol Venerol Leprol. Mutalik S, Ginzburg A. Surgical Management of stable vitiligo: A review with personal experience.
The treatments available still offer limited results to some patients. For patients with clinically stable vitiligo, melanocyte transplantation is an appropriate treatment option, and the technique of autologous punch grafting shows good repigmentation.
METHODS: Between and11 patients with clinically stable vitiligo 7 generalized, 2 focal and 2 segmental underwent autologous punch grafting in the achromic patches. According to the clinical type of vitiligo, patients were instructed to use the corticosteroid ointment during 6 months, only on a few grafted lesions. In the first month, the mometasone ointment was used twice a day and after that just once. They were reassessed 1, 3 and 6 months after the procedure.
Grafted halos were photographed and recorded using the software fotofinder. After 6 months, all the treated and untreated areas of the repigmentation halos were measured and analyzed comparatively.
However, this should be further investigated in larger samples in order to validate this positive action in the treatment of stable vitiligo. Seu tratamento ainda oferece resultados limitados em alguns pacientes. It is a pigmentation disorder characterized by achromic patches that, depending on the body region affected, can be classified as localized focal, segmental or generalized totalis, universal. Vitiligo results from disrupted epidermal melanization and its etiology has not been defined.
Because of its unknown etiology, the treatment of vitiligo is still unsatisfactory for some patients, in spite of the advances achieved in recent decades. Several types of treatment, such as UVB phototherapy, UVA associated with oral or topical psoralens and local steroids are commonly used in unstable vitiligo and result in incomplete repigmentation.
Abnormalities of both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators such as tacrolimus and pimecrolimus, in the treatment of vitiligo. Topical corticosteroids have been widely used in the treatment of vitiligo, but their use is impractical in generalized vitiligo because of associated adverse effects, such as skin atrophy, telangiectasia, and striae distensae.
In actively spreading vitiligo, systemic corticosteroids can be used to suppress immunity and may arrest the progression of vitiligo and lead to repigmentation. Corticosteroids are a well established treatment of vitiligo and they have been used for a long time. InTsukada used corticosteroids intradermally and Bleehen reported that this treatment was effective in repigmentation when used topically. In a meta-analysis involving randomized controlled trials on the non-surgical treatment of localized and generalized vitiligo, Njoo et al.
From all class 3 corticosteroids, mometasone is a non fluorinated topical one with safety profile and effective in all areas of the human body, mainly in the head, because of its higher melanocyte density.
Many vitiligo patients respond to standard therapeutic options. However, some patients remain recalcitrant, or only improve partially. There are many treatment possibilities for vitiligo, resulting in varying degrees of success. Some attempts are unsuccessful and sometimes frustrating, indicating the absence of melanocyte reserve in the achromic areas. The first reports about the use of surgery in leukoderma date back to the 19th century when Baronio demonstrated good results with experimental skin grafts in sheep.
InLewin and Peck performed grafts in pigs with good results. InNorman Orentriech was the first to report repigmentation with autografts in humans. Later, this same author reported several cases of successful repigmentation of chemical leukoderma or post-dermabrasion and focal and segmental vitiligo. The surgical treatments have greatly evolved in the past four decades and brought hope to patients with clinically stable vitiligo. Additionally, it is less aggressive and less expensive. Surgery candidates must have clinically stable vitiligo for at least 1 year, be resistant to other treatments, do not have koebnerization, do not use immunosuppressants, do not have a history of unsightly scars, and not be pregnant.
The objective of the present study was to assess whether mometasone enhances repigmentation of grafts performed in patients with clinically stable vitiligo. We conducted an open non randomized paired controlled clinical trial with an intentional sample, which was obtained from a group of patients treated at the outpatient clinic of vitiligo, Skin Institute, Faculdade de Medicina do ABC.
The patients included in the study must have had clinically stable vitiligo for at least 1 year a less frequent condition in this disease.
The inclusion criteria were: have been previously treated clinically and showing no satisfactory improvement and being over 12 years Chart 1. The exclusion criteria were: use of immunosuppressants, unsightly scars or achromic patches in the sacral region donor area chosen not to be exposed. The study was. The stability of the disease was clinically established and defined as either absence of new lesions or lesions with progressive depigmentation, as well as absence of koebnerization, characterized by the appearance of vitiligo lesions induced by physical trauma to the healthy skin.
The patients underwent the minigrafting test to confirm this stability. The test consists of collecting two 3-mm fragments of healthy skin using punch from the donor area sacral region.
These fragments were placed in saline solution. Next, a 2-mm skin fragment was collected using punch from each of the two achromic patches recipient areaswhich were selected in advance to receive the graft. After placing these fragments, such recipient areas were occluded with medical tape. Seven days later, the patients returned for a follow-up visit to have the tape removed and to receive counseling. After two months, the patients were reassessed to confirm the absence of koebnerization in the donor and recipient areas, as well as to check for the presence of repigmentation in the recipient area pigmented halo approximately 1 to 2 mm around the graft.
If both these data were confirmed, the patients were selected and invited to participate in the protocol. They were also asked to sign a written consent form. Only eleven patients agreed to participate in the study and continued until the end of the protocol. They were photographed and underwent a new surgical session with the implantation of new grafts in each patch the number of grafts depended on the size of the lesion area.
Thereafter, the patients were asked to avoid using medications that stimulate pigmentation, like oral corticosteroids, psoralens or others complementary treatments. The donor area was sutured for better healing. Next, we conducted asepsis, antisepsis, and local anesthesia of two recipient achromic patches of similar size, from which 2-mm fragments were removed using punch to accommodate the grafts. The fragments of the donor area were degreased and implanted into these holes on the donor patches.
The patients received a number of grafts required to partially cover these patches, allowing 1-cm spaces between them. During this first visit after the procedure, the dressing was removed and the grafts were examined.
The recipient patches were photographed using a digital camera attached to the software fotofinder, which was used to file the images. All patients were instructed to use mometasone furoate cream 0. In the second follow-up visit 1 month after the procedureimages of the pigmented halos were recorded using fotofinder and the patients were instructed to use mometasone cream once a day on the selected areas.
The third follow-up visit took place in the 3rd month of treatment. The lesions were photographed once more and the use of the cream once a day was recommended. The fourth follow-up visit was conducted six months after the grafting. The pigmented halos were photographed for the last time during this visit. Later, we measured each halo using an application of fotofinder that allowed drawing the outer edge of each halo and calculating the internal area in mm 2. Based on such data, we were able to compare the increase of the pigmented halos in each patch with and without the use of mometasone, for each patient.
Six months after the procedure, the patients continued to be followed up and treated at the outpatient clinic of dermatology.
The choice of measures of central tendency and dispersion of the values pertinent to the sample and statistical tests for comparison between them were based on the types of distribution.
The values of each continuous variable were organized and described by median and interquartile ranges. Absolute and relative frequencies were used for categorical variables. To compare the median areas of the halos with and without mometasone of each patient nonparametric dependent samples the Wilcoxon test was used. Of the 11 patients enrolled, 8 were female and 3 were male. Their ages ranged from 14 to 78 years median: 29, interquartile range: The disease duration varied from 3 to 30 years median: 7, interquartile range: As for the clinical type of vitiligo, 7 had generalized vitiligo, 2 had focal vitiligo, and 2 had segmental vitiligo.
Of the 11 patients studied, 5 had satellite repigmentation Table 1. Figures 1 and 2 show the photographic analysis of the areas of pigmented halos after 6 months of minigrafting to patient 10's cheeks. In cases of clinically stable vitiligo, grafting provides good results because it allows repopulation of achromic areas using functional cells derived from normally pigmented areas.
In some cases, there is a phenomenon called satellite repigmentation. This event has been poorly studied so far and it occurs after punch grafting. It consists on the appearance of melanin pigmentation in peripheral areas that did not receive grafting. This could be caused by the action of donor keratinocytes that might act as a source of growth factors, which stimulate melanocyte donors to proliferate and migrate to the vitiligo patches or, alternatively, by the action of growth factors spread in the achromic patches and responsible for stimulating "dormant" melanocytes.
Conversely, topical corticosteroids are one of the oldest and most widely used methods to treat vitiligo. Studies have reported that corticosteroids enhance the protective and anti-destructive mechanism of melanocytes, inhibit immune changes, blocking T-cells and allowing melanocytes to reactivate.
Its ability to enhance the protective and anti-destructive mechanism of melanocytes and locally suppress immune changes, enabling melanocytes to repigment, has been demonstrated. Therefore, mometasone is a good therapeutic option to treat vitiligo either alone or in combination. It is well documented that it is possible to associate surgical methods with other therapeutic modalities, such as laser, heliotherapy, NB-UVB and PUVA therapy, to stimulate melanocyte migration from the follicle and thus promote the occurrence of pigmented halo around the implanted graft.
We found that the largest halos occurred in the patients 9 and 10, who had sun exposure more often, which confirms the importance of light stimulation for repigmentation. In five out of the 11 patients there was satellite repigmentation. In one patient number 2the mean areas of the treated and untreated halos were similar, which may have been caused by the proximity of the grafts. Both findings may be due to the hypothesis of stimulation of donor melanocytes and keratinocytes or action of growth factors on inactive melanocytes.
It is important to highlight that the measure of round halos was more difficult to calculate using fotofinder, as the line drawn on the outer edge of the halos was manually done with the computer mouse, which often makes it difficult to perform short and round movements.
Therefore, there might have been a measurement bias, which is inherent to all cases, since there was only one observer. We could not find studies in the literature using the combination of autologous punch grafting and subsequent use of mometasone to evaluate the real impact of this topical corticoid on repigmentation after grafting. A randomized study was conducted in by Barman et al evaluating 42 patients divided into two groups.
The first group underwent punch grafting and PUVA, and the second group received punch grafting and topical fluocinolone. However, there was no statistically significant difference between the groups. Conversely, in the present study, we were able to analyze the positive association between mometasone and punch grafting in patients with clinically stable vitiligo, showing a statistical significance, which might serve as a basis for further studies with larger samples.
In spite of the small size of our sample which, from a statistical point of view, is not sufficient to draw definite conclusions, our results suggest a positive impact of mometasone on the progression of pigmented halos.
Further studies with larger samples are needed to reach an accurate conclusion about the true effect of topical mometasone on repigmentation after grafting, which may become a new treatment option for patients with clinically stable vitiligo.
In conclusion, % tacrolimus ointment and % mometasone furoate cream are effective in the treatment of adult nonacral vitiligo; however, topical tacrolimus. Forty-five children with vitiligo were treated with topical applications of mometasone furoate for 2 to 6 months. The best results occurred in the facial. The underlying mechanism was shown in an in vitro study that topical tacrolimus promoted proliferation of melanocytes and melanoblasts. This study purpose is to. Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body. In conclusion, % tacrolimus ointment and % mometasone furoate cream are effective in the treatment of adult nonacral vitiligo; however, topical tacrolimus. Symposium Aesthetic Surgery. Vitiligo surgery: its evolution as a definite treatment in the stable vitiligo. Contacts and Locations.Exact matches only. Search in title. Search in content. Search in excerpt. Abstracts from current literature. Art amp Psychiatry. Association Activities. Association Notes. Award Article. Book Review. Brief Report. Case Analysis. Case Letter. Case Letters. Case Notes. Case Report. Case Reports. Clinical and Laboratory Investigations. Clinical Article. Clinical Studies. Clinical Study. Conference Oration. Conference Summary. Continuing Medical Education.
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