Methotrexate Gel Either Alone or Combined with Narrow Band Ultraviolet B or Excimer Light for the Treatment of Vitiligo.

BACKGROUND: Methotrexate has been used successfully in the treatment of vitiligo. It leads to decrease in the number of TNF-α secreting T cells in association with increase in the number of interleukin (IL)-10 producing T cells. Topical forms of methotrexate do not have significant hematologic or hepatotoxic side effects unlike the systemic forms of the drug.

OBJECTIVE: We sought to evaluate the efficacy and safety of methotrexate gel for the treatment of vitiligo, either alone or combined with narrowband (NB) ultraviolet B (UVB) or with excimer light.

METHODS: Forty-eight patients with vitiligo were randomized into three treatment groups. Group I was treated with methotrexate gel twice daily. Group II was treated with methotrexate gel twice daily plus NB-UVB twice weekly. Group III was treated with methotrexate gel twice daily combined with excimer light twice weekly. Treatment was continued for three months followed by a one-month follow-up period.

RESULTS: There was a statistically significant difference between groups regarding the therapeutic response. The highest response was recorded in the group treated with methotrexate gel and NB-UVB. More patients in Group II showed good or excellent response than in the other groups.

CONCLUSION: Methotrexate gel could increase the therapeutic effect of NB-UVB and excimer laser and shorten the treatment period of vitiligo. However, it was not effective enough to induce repigmentation when used alone.