Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study.

BACKGROUND: Only a few, small double-blind clinical trials have been reported for the treatment of vitiligo. Narrowband-ultraviolet B (NB-UVB) is an established form of treatment for this condition. Tacrolimus ointment is assumed to have an effect in some patients. OBJECTIVES: To assess the additive effect of tacrolimus ointment (0.1%) once daily in vitiligo patients treated with NB-UVB. METHODS: In a randomized double-blind trial, patients with stable symmetrical vitiligo were treated half-side with tacrolimus ointment (0.1%) and half-side with placebo ointment. Whole body NB-UVB was given twice or thrice weekly for at least 3 months. As a morphometric device, Visitrak(TM) was used to measure the area of the vitiligo target lesions. RESULTS: Of 40 patients, 27 had a better effect on the tacrolimus side. The degree of improvement was significantly better on the tacrolimus side (P = 0.005). The median reduction in the target lesion areas was 42.1% on the tacrolimus side and 29% on the placebo side. There was a correlation between the effect and the number of topical tacrolimus applications (P = 0.044), but there was no correlation with the number of UV treatments given; neither any significance of gender, age, skin type, duration of disease, familial occurrence of vitiligo nor presence of other autoimmune disease or atopy was observed. We found a significant reduction in the patients' subjective disease impact during the treatment period (P < 0.001). CONCLUSION: According to this study, the combination of NB-UVB and tacrolimus ointment (0.1%) is more effective than UV treatment alone in patients with vitiligo. The effect is tacrolimus total dose-dependent.

Narrowband UVB therapy for vitiligo: does the repigmentation last?

BACKGROUND: Since 1997, a number of trials have shown promising results in treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults and children. However, there is little knowledge concerning the duration and permanency of the treatment-induced repigmentation. OBJECTIVE: Our main objective was to perform a follow-up trial of successfully treated patients receiving narrowband UVB for generalized vitiligo. METHODS: We have investigated to what degree the treatment-induced repigmentation remains stable for up to 2 years post-treatment. We performed an initial open trial including 31 patients with generalized vitiligo. They received narrowband UVB thrice weekly for up to 12 months. Patients experiencing > 75% repigmentation were defined responders and were included in the follow-up trial. Responders were followed every 6 months for up to 2 years after cessation of treatment. We observed the pigmentation status and registered any changes indicating loss of pigmentation and relapse. RESULTS: Eleven of the 31 treated patients were included in the follow-up trial. Six patients had relapse and five patients had stable response 24 months after cessation of treatment. Four out of six relapses were within 6 months post-treatment. CONCLUSION: In our study population of 31 patients with generalized vitiligo, five patients (16%) experienced > 75% stable repigmentation 2 years after cessation of a treatment programme of up to 1 years narrowband UVB therapy.

Chemotherapy for giardiasis: randomized clinical trial of bacitracin, bacitracin zinc, and a combination of bacitracin zinc with neomycin.

This study describes a prospective, randomized, clinical trial in patients infected with the protozoa Giardia lamblia. Patients received a 10-day treatment with twice a day doses of either 120,000 U (USP) of bacitracin zinc, 120,000 U (USP) of bacitracin, 120,000 U (USP) of neomycin, or 60,000 U (USP) of bacitracin zinc and 60,000 U (USP) of neomycin. At the first assessment (day 11), all 21 subjects (100%) treated with bacitracin zinc had ceased to show Giardia parasites in their stools compared with 19 (95%) of 20 receiving bacitracin, 20 (90.9%) of 22 subjects receiving neomycin, and 17 (89.5%) of 19 subjects receiving bacitracin zinc plus neomycin. During the two-week follow up period, one (5.3%) of the 19 subjects examined who received bacitracin zinc experienced a recurrence compared with one (6.7%) of 15 receiving bacitracin, one (5.0%) of 20 receiving neomycin, and 0 (0%) of 14 receiving the combination treatment. Final cure rates of 94.7% for bacitracin zinc, 87.5% for bacitracin, 86.4% for neomycin, and 87.5% for bacitracin zinc plus neomycin were obtained. No synergistic activity was noted between bacitracin zinc and neomycin. Side effects were generally limited to nausea, abdominal discomfort, and diarrhea in a small number of patients.

Natural and Chang liver cell cytotoxic studies of methotrexate-treated psoriatic patients with liver cirrhosis.

Forty patients with psoriasis were investigated for unspecific and specific lymphocyte cytotoxicity in order to evaluate the significance for liver cell damage in methotrexate-treated (MTX) patients. We found no difference between psoriasis patients with regard to cytotoxicity. We also observed a normal proliferation of lymphocytes after stimulation with tuberculin and phytohemagglutinin.