Safety of 0.1% topical tacrolimus in the treatment of vitiligo.

Cure rates for vitiligo are significantly lower because of problems to different studies have reported different response rate and different adverse effect for the treatment of vitiligo. This study was conducted to evaluate the response rate and adverse effect of topical tacrolimus 0.1% ointment in the treatment of vitiligo patients in the department of Dermatology and venereology, Bangladesh Medical college (BMC), Dhaka from January 2010 to July 2010. In this clinical trial, 30 newly diagnosed vitiligo (focal and segmental) patients, aged between 10 to 50 years were assigned for therapy and to observe the response and adverse effect. Each individual lesion was treated with topical tacrolimus 0.1% ointment twice daily for three months. All the patients completed three months treatment and available for statistical analysis. The highest percentage 13(43.3%) was in the age of 11-20 years. Sex ratio revealed higher in case of female 18(60%), with a male-female ratio 1:1.5 and 5(16.67%) patients had vitiligo among their families. Repigmentation was observed in 8 (26.7%) subjects at the end of 4th week, 15 (50.1%) subjects at 8th week and 25 (83.3%) subjects after 12 weeks of therapy. 25 (83.33%) subjects did not complain any adverse effect (like pruritus, burning etc.) and 5 (16.67%) subjects were suffered from different adverse effect of drug, like pruritus observed in 2 (6.7%) subjects and burning in 6 (20%) subjects. This study found that tacrolimus 0.1% ointment to be safe in the treatment of vitiligo, with reduction in the number of vitiliginous spots by increased repigmentation significantly.

Review of Treatment of Reflex Sympathetic Dystrophy.

A review study was done by searching literature through PubMed. Reflex sympathetic dystrophy is a life altering disease pathogenesis of which are not yet clearly known likewise its management protocol has not been established. Treatment of longstanding Reflex sympathetic dystrophy is empirical and of limited efficacy. This disease may lead to dreadful squeal which may need amputation for their management and few of these patients may even develop suicidal tendency. Patient with Reflex sympathetic dystrophy usually present late. It was found that the clinical presentation of RSD are too much variable, although different modalities of treatment are used either alone or in combination, the outcomes are often unpredictable and of variable efficacy. Understanding of the treatment modalities and proper selection of treatment option are essential for best outcome. Preventive measure does play a role in management of these patients. Option of treatment includes pharmacological method, sympathetic nervous system interruption, use of calcitonin and bisphosphonate. More study is required to find out the mechanism that triggers the pain and other clinical manifestation so that a standardized protocol for its management can be developed.