Phototherapy with topical antioxidants, corticosteroids, or calcineurin inhibitors improve vitiligo symptoms: Study

A new study published in The Journal of Dermatological Treatment showed that for vitiligo patients, phototherapy combined with topical antioxidants, corticosteroids, or calcineurin inhibitors may provide better results.

About 0.5–2% of people worldwide suffer from vitiligo, a common acquired hypopigmentary condition marked by the formation of white macules. Dermatologists still have difficulties in stopping depigmentation, stabilizing depigmented lesions, and encouraging vitiligo repigmentation with current therapies. Common choices are 308-nm excimer laser/light (EL) and narrowband ultraviolet B (NB-UVB).

Antioxidants, calcineurin inhibitors, topical corticosteroids, and vitamin D analogs are frequently used in the treatment of vitiligo. However, prolonged topical use may result in negative side effects, including burning and skin atrophy, which should be carefully considered. The restricted ability of traditional meta-analyses and randomized controlled trials (RCTs) to do head-to-head comparisons makes evaluating the relative effectiveness of variable combinations difficult. Thus, to determine which common topical medication works best when paired with phototherapy, an NMA was used for the first time in this study. The results are intended to give medical professionals evidence-based knowledge to help them create individualized treatment plans for individuals with vitiligo.

This study examined phototherapy, which includes topical treatments in conjunction with narrowband ultraviolet B (NB-UVB) and excimer laser/light (EL) at 308 nm. The Cochrane Library, PubMed, and Embase were the sources of randomized controlled trials. A random-effects model served as the foundation for the data analysis, and surface under the cumulative ranking (SUCRA) curves were used to evaluate the treatments' effectiveness.

There were 27 trials in this NMA, totaling 2417 lesions (patches). The SUCRA results showed that the top three combination therapies for achieving ≥50% repigmentation were phototherapy plus antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5).

For ≥75% repigmentation, the top three combination therapies were fractional CO2 laser (SUCRA 63.6), phototherapy plus antioxidants (SUCRA 89.0), and calcineurin inhibitors (SUCRA 70.3).

Overall, when used in conjunction with phototherapy, topical antioxidants, corticosteroids, and calcineurin inhibitors offer potential treatment alternatives for vitiligo. Phototherapy in conjunction with antioxidants or fractional CO2 lasers may improve treatment outcomes for people with stable vitiligo. However, further high-quality RCTs are required to confirm these results.

Source:

Luo, L., Huang, J., Fu, C., Hu, Y., Chen, J., Jiang, L., & Zeng, Q. (2025). The efficacy of combined phototherapy with topical therapy in vitiligo: a network meta-analysis. The Journal of Dermatological Treatment, 36(1), 2483808. https://doi.org/10.1080/09546634.2025.2483808