ABSTRACT
Vitiligo is an acquired depigmenting disorder that is characterized by loss of melanocytes from the epidermis. A large variety of therapeutic agents are being tried for the treatment of vitiligo, but an optimal treatment is not yet available. This study was conducted to estimate the efficacy of combination of topical calcipotriol and PUVA therapy in patients with vitiligo. Twenty-one patients with vitiligo were enrolled in this study, and were classified into three groups: group 1 [control group], nonlesional [normal] skin biopsies from all included patients in the study; group 2 [pretreated group], biopsies from lesional [vitiligo] skin from all included patients in the study; and group 3 [post-treated group], all included patients in the study, randomly divided into three subgroups: group 3a, included seven patients treated with topical calcipotriol cream [0.005%] twice daily for six months; group 3b, included seven patients treated with PUVA for six months; and group 3c, seven included patients treated with combined topical calcipotriol cream and PUVA twice daily for 6 months. Skin biopsies were taken, fixed, processed, and stained to assess histological changes [H and E], melanin pigment distribution [Masson-Fontana stain], and intercellular adhesion molecule 1 [ICAM-1] expression in the dermis and epidermis [immunohistochemical techniques]. Moreover, for statistical analysis, the mean area percentage of melanin pigment distribution in the epidermis, optical density of ICAM-1 expression in the epidermis and dermis of the immunostained sections, and number of melanosomes [using electron microscope] in the basal and spinous keratinocytes were measured and counted, respectively, in each of the studied groups. Vitiligo biopsies treated with combination of topical calcipotriol and PUVA showed disappearance of mononuclear cell infiltration, highly significant increase in the amount of melanin pigment concentration, highly significant decrease in ICAM-1 expression in the epidermis and dermis, and significant increase in the number of melanosomes when compared with the vitiligo group. Moreover, reappearance of melanocytes and regeneration of keratinocytes ultrastructure were observed. Combined topical calcipotriol and PUVA therapy showed complete repigmentation in vitiligo skin associated with regeneration of keratinocytes and reappearance of melanocytes in a shorter duration when compared with topical calcipotriol or PUVA therapy alone