Left-right comparison study of the combination of fluticasone propionate and UV-A vs either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo

Objective: To compare the efficacy and safety of using a combination of flu ticasone propionate (FP) and UV-A with that of either drug used alone in th e long-term treatment of vitiligo. Design: Prospective, randomized, controlled, left-right comparison study;. Repigmentation was judged by a single dermatologist (L.N.-K.) and skin thic kness was scored by a pathologist (using biopsy samples), a dermatologist ( L.N.-K.) (visually), and patients (using a standard questionnaire). Setting: Netherlands Institute for Pigmentary Disorders, Amsterdam. Patients: Patients with lesions on arms, legs, and trunk were treated on 2 symmetrical lesions for 9 months with FP alone and a combination of FP and UV-A (FP group) or with UV-A alone and a combination of FP and UV-A (UV-A g roup). Fluticasone propionate cream was applied once daily at about bedtime , and UV-A (10 J/cm(2)) exposure was twice a week. Patients attended the cl inic at 3-month intervals. Results: One hundred thirty-five patients were included. 96 of whom were ev aluable after 9 months. Patients not reaching the end point withdrew becaus e of insufficient repigmentation (n = 23), decreased motivation (n = 11), o r protocol violations (n = 5). No patient (irrespective of whether they wit hdrew) experienced any adverse effects. The FP and UV-A groups were compara ble with respect to sex, age, and location of lesions. On average, combinat ion treatment was 3 times more effective than either UV-A or FP treatment a lone. In the FP group, no atrophy was seen after 9 months with either treat ment. In the UV-A group, a little atrophy was detected twice: as well durin g UV-A treatment alone as during combination treatment. Conclusions: Combination treatment with FP and W-A is much more effective i n reaching complete repigmentation than are FP and UV-A used alone, but lar ge interindividual differences occur. Fluticasone propionate, UV-X, and a c ombination of FP and UV-A seem to be safe for long-term treatment. of vitil igo.