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Top 10 treatments for vitiligo.

EXPERT ANALYSIS AT PDA 2015

PARK CITY, UTAH -- At the annual meeting of the Pacific Dermatologic Association, Dr. Sancy A. Leachman offered a top 10 list of new agents and technologies for vitiligo.

No. 10: Ultraviolet A1 (UVA1) phototherapy

Dr. Harvey Lui at the University of British Columbia in Vancouver is leading a phase II trial to evaluate the potential for UVAl to induce repigmentation within vitiligo patches. "I think it might work," said Dr. Leachman, professor and chair of dermatology at Oregon Health & Science University, Portland.

No. 9: Gingko biloba

Gingko biloba 40-60 mg 2-3 times per day, 10 minutes before a meal, was mentioned in a Cochrane Review of vitiligo treatments published on Feb. 24, 2015. "I think I'm going to give this a try in people who have failed other treatments and see if I can get some response," Dr. Leachman said.

No. 8: Red light

Dr. Lui also is leading a randomized phase II trial of low-intensity and high-intensity red light versus no treatment for vitiligo patches. Treatments will be given twice weekly for 10 weeks, with follow-up assessments at 4, 8, and 12 weeks post treatment.

No. 7: Micrografting

A novel suction blister device known as the CelluTome epidermal harvesting system uses heat and slight vacuum pressure to harvest healthy epidermal skin tissue without damaging the donor site. Dr. Leachman characterized the technology as "semiautomating the process of suction graft transplantation."

No. 6: The ReCell device

Manufactured by Avita Medical, this investigational autologous cell harvesting device is used after C[O.sub.2] abrasion and enables clinicians to create regenerative epithelial suspension with a small sample of the patient's skin. A phase IV trial in the Netherlands is assessing the efficacy and safety of autologous epidermal cell suspension grafting with the ReCell device after C[O.sub.2] laser abrasion, compared with C[O.sub.2] laser abrasion alone and no treatment, in patients with piebaldism and stable vitiligo.

No. 5: Topical Photocil

In a pilot study sponsored by Applied Biology, researchers are enrolling patients with vitiligo to assess the safety and efficacy of Photocil. The primary outcome measure is the Vitiligo Area Severity Index (VASI). "When this cream is activated by sunlight, it degrades into narrow-band and UVB light, so you can put a topical cream on that will administer narrow-band UVB only in that spot," said Dr. Leachman, who is also director of OHSU's Knight Melanoma Research Program. "That's amazing to me."

No. 4: Afamelanotide

This is an analogue of a melanocyte-stimulating hormone. A randomized study conducted at two academic medical centers found that the combination of afamelanotide implant and narrow-band UVB phototherapy resulted in superior and faster repigmentation, compared with narrow-band UVB alone (JAMA Dermatol. 2015 Jan;151[1]:42-50).

No. 3: Abatacept (Orencia)

This is a soluble fusion protein consisting of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA4), which prevents T-cell activation. A phase I trial is underway at Brigham and Women's Hospital in Boston to determine if weekly self-injections of the agent lead to improvements of vitiligo lesions. The primary outcome measure is change in repigmentation with abatacept therapy based on the VASI score.

No. 2. Simvastatin

The notion of its use is based on STAT1 inhibition reducing interferon-gamma-dependent activation of CD8-positive T cells, according to Dr. Leachman. The concept has been successful in a mouse model, and a study in humans was recently completed by Dr. John Harris at the University of Massachusetts, Worcester. "What we have is the ability to apply an existing drug (Simvastatin) to the process and see if it works," she said. "Wouldn't it be cool if we could give a statin and improve vitiligo?"

No 1: Tofacitinib

This Janus kinase inhibitor is used for rheumatoid arthritis. A case report demonstrating its efficacy in a 53-year-old patient was published in JAMA Dermatology by Dr. Brett A. King and Dr. Brittany Craiglow, of Yale School of Medicine, New Haven, Conn. "I'm hopeful this [agent] will be made into a topical cream because these drugs do have substantial side effects," Dr. Leachman said.

Dr. Leachman disclosed that she is on the advisory board for Myriad Genetics Laboratory. She has also participated in an advisory board meeting for Castle Biosciences and has participated in the DecisionDx registry. dbrunk@frontlinemedcom.com

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Title Annotation:MEDICAL DERMATOLOGY
Author:Brunk, Doug
Publication:Dermatology News
Article Type:Report
Geographic Code:1USA
Date:Oct 1, 2015
Words:722
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