Safety of the current drug treatments for vitiligo

ABSTRACT

Introduction: Vitiligo is an acquired depigmenting skin disorder adversely affecting the patient’s quality of life. Despite the presence of several treatment modalities, ranging from medical to physical to surgical options, none is curative. Each modality has its own drawbacks and side effects. Thus, the treatment modality needs to be tailored for each individual patient taking into consideration the disease characteristics and also its efficacy and safety to obtain a favorable risk–benefit ratio.

Areas covered: This review highlights the different treatment modalities utilized in vitiligo up until 4 November 2019 along with their adverse effects and contraindications, if any.

Expert opinion: All the medications have their own adverse effects and contraindications. We have included the most commonly used topical corticosteroids, which may result in striae, cutaneous atrophy, and tachyphylaxis, to the recently introduced biologics, which may induce hypersensitivity reactions, systemic toxicities, and even malignancies. However, more long-term studies are needed to assess the safety of these medications, especially the newer ones, to provide a safe and effective treatment for this disorder.

KEYWORDS:

• Vitiligo
• treatment
• safety
• contraindications

Article highlights

• Vitiligo is an acquired de-pigmenting cutaneous disorder with a grave psychosocial impact on the patient’s quality of life.

• Several treatment modalities exist for this disorder ranging from topical corticosteroids to the recent biologics with varying rates of efficacy, each having its own share of adverse effects and contraindications.

• Most of the topical modalities, psoralen and NBUVB show maximum level of evidence, while immunomodulators including biologics have limited evidence till the review was completed.

• Most of the newer immunomodulators and biologics including PUVA are better avoided during pregnancy, lactation, and childhood, while some immunomodulators like methotrexate are teratogenic.

• This article describes the various adverse effects and contraindications of the important therapeutic strategies along with relevant review of literature. The authors hope this review would enable treating physicians to select the most appropriate therapy for their vitiligo patients, thereby minimizing the burden of adverse effects.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.