Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Destressing the skin - are topical antioxidants effective in vitiligo treatment? (#118)

Samuel Morriss 1 , Mason Crossman 2 , Sue Liu 3 , Yali Deng 4 , Lawrence Lin 5 , Zhao Feng Liu 6 7 , Christopher Chew 6 8
  1. Department of Dermatology, The Royal Melbourne Hospital, Melbourne, VICTORIA, Australia
  2. Royal Adelaide Hospital, Adelaide, South Australia, Australia
  3. Department of Medicine, Monash University, Clayton, Victoria, Australia
  4. The University of Melbourne, Melbourne, Victoria, Australia
  5. Faculty of Medicine, Monash University, Clayton, Victoria, Australia
  6. Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
  7. Faculty of Medicine, Monash University, Clayton, Victoria, Australia
  8. Victorian Melanoma Service, Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia

Introduction:

Vitiligo is a pigmentary disorder characterized by the loss of melanocytes and pigmentation. The exact etiology of vitiligo remains unclear, but it is thought to involve genetic predisposition, autoimmune processes, and oxidative stress. Abating oxidative stress may be beneficial in the treatment of vitiligo.

This review aims to systematically summarise the literature regarding the efficacy of topical antioxidant therapies in vitiligo.

 

Methods:

A comprehensive literature search was conducted to identify human studies until April 2024 that evaluated the use of topical antioxidants in vitiligo using search terms "vitiligo," "antioxidants," “oxidative stress,” "treatment," and "therapy”. Studies that investigated the use of topical antioxidants in the treatment of vitiligo were included. The primary outcome measure was the extent of repigmentation.  Secondary outcomes included safety and tolerability of the topical agents.

 

Results:

12 studies were included in this review, including 6 randomised controlled trials (RCTs), 2 cohort studies, and 4 case series. 4 studies assessed the use of topical pseudocatalase/catalase on vitiligo lesions, with one case series of topical narrowband ultraviolet B (NB-UVB)-activated pseudocatalase cream resulting in complete cessation of disease activity in 70/71 children and significant repigmentation in other skin areas. Topical catalase and superoxide dismutase, when used with NB-UVB, resulted in more than 50% overall repigmentation in 11 of 19 patients (57.9%). An RCT of topical pseudocatalase/superoxide dismutase combined with topical tacrolimus compared to tacrolimus alone (no NB-UVB) demonstrated no significant difference in repigmentation. Topical piper nigrum extract, turmeric, antioxidant hydrogels, carboxytherapy and cold atmospheric plasma treatment have antioxidant benefits and have shown variable benefit in repigmentation.

 

Conclusion:

This systematic review provides a summary of topical antioxidant therapies which may improve repigmentation in vitiligo patients as monotherapy or more likely in combination with conventional treatments. Further studies are needed to further elucidate the utility of topical antioxidant therapy in vitiligo.