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The Effect of Fractional Co2 Laser Either With Tacrolimus, Calcipotriol or NB-UVB in Stable Generalized Vitiligo

NCT03234673 — Phase 1, Unknown, 30 participants, Assiut University

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The Effect of Preceding Fractional Co2 Laser Either With Tacrolimus, Calcipotriol or With NB-UVB in the Treatment of Stable Generalized Vitiligo

RegistryNCT03234673
StatusUnknown
PhasePhase 1
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment30 (Estimated)
SponsorAssiut University (Other)
ConditionsVitiligo Vulgaris
InterventionsTacrolimus ointment, calcipotriol ointment, NB-UVB (Drug)
Datesstart 2017-08-01 (estimated), primary completion 2018-08-01 (estimated), completion 2019-01-01 (estimated), first posted 2017-07-31, last updated 2017-08-01

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-Summary

Vitiligo is an acquired disorder of the skin and mucous membranes characterized by well circumscribed depigmented macules and patches that occur secondary to selective destruction of melanocytes (Zhang et al., 2009).

Generalized vitiligo is the most common clinical presentation and often involves the face and acral regions (Alikhan et al., 2011).

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+Detailed description

Combined vitiligo treatments have been found to be superior to monotherapies regarding efficacy, early response and safety (Kandaswamy et al., 2013).

Fractionated lasers represent a new modality for skin resurfacing based on the theory of fractional photothermolysis introduced by Manstein et al (2004). These lasers were shown to be efficient in treating facial photo aging changes as well as scars, and have an improved safety and recovery profile compared with traditional CO2 laser resurfacing. Fractionated lasers do not ablate the entire epidermis and thereafter leave intact skin between coagulated necrotic columns. This characteristic facilitates the skin healing process (Bogdan et al., 2010)

+Arms and interventions

ArmTypeInterventionsDescription
Group A (Tacrolimus group):ExperimentalDrug: Tacrolimus ointmentfractional CO2 laser therapy and Tacrolimus ointment 1
Group B (Calcipotriol group):ExperimentalDrug: calcipotriol ointmentfractional CO2 laser therapy and Calcipotriol ointment
Group C (NB-UVB group):ExperimentalDrug: NB-UVBfractional CO2 laser therapy and NB-UVB twice weekly
  • Tacrolimus ointment (Drug), also known as tarolimus ointment: 3 sessions of fractional CO2 laser one month apart Patients will start treatment Tarolimus ointment twice daily for 3 months.
  • calcipotriol ointment (Drug), also known as calcipoheal: 3 sessions of fractional CO2 laser one month apart Patients will start treatment Calcipotriol ointment twice daily for 3 months.
  • NB-UVB (Drug), also known as narrow band ultraviolet rays B: 3 sessions of fractional CO2 laser one month apart Patients will start treatment NB-UVB phototherapy twice weekly for 3 months

+Outcome measures

Primary outcomes

  • 1- Re-pigmentation : that will be subjectively rated with a previously reported scoring system (Ghiya et al., 2016). [up to 3 months]: G0, < 25% repigmentation (poor) * G1, 25-50% repigmentation (fair) * G2, 50-75% repigmentation (good) * G3 > 75% repigmentation (excellent).

Secondary outcomes

  • The VASI percent change [every month for 3 months]: The VASI percent change will be calculated by subtracting the pre- procedure VASI score from the post-procedure VASI score and dividing by the pre-procedure VASI score.

Other outcomes

  • - Frequency and types of side effects. [3 months]: pain, scarring, hyperpigmentation
  • - Patient satisfaction. The patient overall satisfaction will be assessed after 6 months according to Wong and Vasconez (2011). Overall satisfaction: [3 months]: 1. dissatisfied 2. neutral 3. somewhat satisfied 4. moderately satisfied 5. very satisfied

+Eligibility

Sex: All, ages: 12 Years to 60 Years

Inclusion Criteria:

* patients with stable vitiligo
* nonsegmental vitiligo will be recruited
* A patient reporting no new lesions, no progression of existing lesions, and absence of Koebner phenomenon during the previous year

Exclusion Criteria:

1. Patients with active infection.
2. Reported histories of koebnerization.
3. History of keloid formation or hypertrophic scars.
4. Pregnant or lactating females.
5. Bleeding tendency.

+Publications

  • Results publication: Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015 Jul 4;386(9988):74-84. doi: 10.1016/S0140-6736(14)60763-7. Epub 2015 Jan 15. PMID 25596811
  • Results publication: Kandaswamy S, Akhtar N, Ravindran S, Prabhu S, Shenoi SD. Phototherapy in Vitiligo: Assessing the Compliance, Response and Patient's Perception about Disease and Treatment. Indian J Dermatol. 2013 Jul;58(4):325. doi: 10.4103/0019-5154.113944. PMID 23919018
  • Results publication: Bogdan Allemann I, Kaufman J. Fractional photothermolysis--an update. Lasers Med Sci. 2010 Jan;25(1):137-44. doi: 10.1007/s10103-009-0734-8. PMID 19787413
  • Results publication: Wong L, Vasconez HC. Patient satisfaction after Nd:YAG laser-assisted lipolysis. Ann Plast Surg. 2011 May;66(5):561-3. doi: 10.1097/SAP.0b013e31820b3d1e. PMID 21451378

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