SEOUL, SOUTH KOREA – Topical bimatoprost ophthalmic solution shows promise as a novel treatment for localized, stable vitiligo, a small pilot study suggests.
Patients with recalcitrant sequential or focal vitiligo, especially on the face, responded particularly well to the topical prostaglandin F2-alpha analogue in this small prospective trial with blinded outcome assessment, Dr. Tarun Narang said at the World Congress of Dermatology.
Topical bimatoprost may hold promise as a treatment for vitiligo.
Advantages of this off-label treatment include its low cost, the fact that patients can self-apply it with no requirement for photoexposure, and the minimal side effects, added Dr. Narang of Gian Sagar Medical College in Banur, India.
He reported on 10 patients with localized vitiligo who applied bimatoprost 0.03% ophthalmic solution at a dose of 1 drop per 2 cm2 of affected skin twice daily for 4 months.
Seven of 10 patients showed pronounced repigmentation beginning on average after 2 months of treatment: 3 patients had 100% repigmentation, 3 others had 75%-99% repigmentation, and 1 patient showed 50%-75% repigmentation.
Patients with a disease duration of 6 months or less had the best results. Lesions on the face and scalp regimented fastest, after just 4-6 weeks of treatment. Facial lesions responded best, as all three patients who had 100% clearing had vitiligo on the face.
During 6 months of follow-up, three patients with lesions on the trunk or extremities that initially responded to treatment relapsed, typically 2-3 months after conclusion of the 4-month treatment period. Interestingly, all five patients with focal or segmental vitiligo had either 100% repigmentation or 75%-99% improvement, and none relapsed off therapy, Dr. Narang noted.
The only treatment side effect was a transient burning sensation, mainly on the lips, reported by two patients.
Dr. Narang said that although vitiligo involves the disappearance of dermal melanocytes, the mechanisms involved are not completely understood. However, it is known that prostaglandins in the skin help regulate melanocytes.
The topical prostaglandin analogues prescribed for treatment of glaucoma cause increased melanogenesis as evidenced by their common side effects: periocular skin hyperpigmentation, hypertrichosis, and iris hyperpigmentation.
Ophthalmologic colleagues say these side effects are more pronounced with bimatoprost than other topical prostaglandin analogues, which is why Dr. Narang said he decided to conduct this first-ever study of the drug as a treatment for vitiligo. The long-term effects of daily bimatoprost for vitiligo will require further study, he stressed.
Dr. Narang declared having no relevant financial disclosures.