Early systemic intervention for vitiligo: A prospective bicentric interventional study

BACKGROUND: Vitiligo is a complex autoimmune skin disease characterized by loss of melanocytes resulting in the appearance of white skin patches. Recent advances in treatment have improved patient outcomes, but the process of repigmentation is prolonged and often incomplete. OBJECTIVES: To evaluate the effects of early systemic intervention in newly diagnosed vitiligo patients compared to those with a longer disease duration, including both long-standing and recently developed depigmented lesions, on clinical outcome, melanocytes and melanocyte precursor reservoir at lesional sites across groups. METHODS: Prospective bicentric interventional study. Fifty-one eligible patients were enrolled in three groups depending on duration and activity of their vitiligo (G1: long-lasting disease (more than 2 years) with no active lesions; G2: long-lasting disease with recent lesions; G3: newly diagnosed, less than 6 months, with active lesions). All subjects received Nb-UVB and oral mini pulse of corticosteroids twice a week for 6 months. Clinical scores were used to assess extent (VES) and disease activity (V-SAS). Primary objective was to compare efficacy of treatment at 6 months between the groups. Secondary objectives include the analysis of melanocyte and melanocyte precursor reservoir using skin immunohistofluorescence of lesional vitiligo skin. RESULTS: Of 51 randomized patients, 44 (86%) completed the 6-month assessment. Mean disease duration was 13.4 years in G1, 8.3 years in G2 and 4.8 months in G3. VES75 (75% improvement from baseline extent of vitiligo) at 6 months after treatment was achieved in 0% in G1, 16% in G2 and 46% in G3 (p = 0.01). Epidermal mature melanocytes persisted in 50% of G3 patients, 20% of G2 and none of the G1 patients. All patients had remaining melanocyte precursors in the lesional skin. CONCLUSIONS: Early systemic therapeutic approach allows a significantly better response in recently diagnosed patients, highlighting the importance of an early window of opportunity in vitiligo.