Apremilast and narrowband ultraviolet B combination therapy suppresses Th17 axis and promotes melanogenesis in vitiligo skin: a randomized, split-body, pilot study in skin types IV-VI

Arch Dermatol Res. 2023 Mar;315(2):215-221. doi: 10.1007/s00403-022-02343-1. Epub 2022 Mar 13.

Abstract

Improved repigmentation of generalized vitiligo in skin types IV-VI has been reported in clinical response to combined therapy with apremilast and narrowband (NB)-UVB; however, tissue responses to combined therapy versus NB-UVB monotherapy have not been elucidated. We compared the change from baseline in cellular and molecular markers in vitiligo skin after combined therapy versus NB-UVB monotherapy. We assessed lesional and nonlesional skin samples from enrolled subjects and evaluated for immune infiltrates, inflammatory, and melanogenesis-related markers which were compared across different treatment groups. Combined therapy resulted in significant reduction of CD8+T cells and CD11c+ dendritic cells, downregulation of PDE4B and Th17-related markers, and upregulation of melanogenesis markers. This study was limited to small sample size, skin types IV-VI, and high dropout rate. Our molecular findings support the clinical analysis that apremilast may potentiate NB-UVB in repigmentation of generalized vitiligo in skin types IV-VI.

Keywords: Anti-inflammatory; Apremilast; IFNγ pathway; Innate immune system; Narrowband UVB; Phosphodiesterase-4 inhibitor; Split-body study; Th17 axis; Vitiligo.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Combined Modality Therapy
  • Humans
  • Pilot Projects
  • Skin
  • Treatment Outcome
  • Ultraviolet Therapy* / methods
  • Vitiligo* / drug therapy
  • Vitiligo* / radiotherapy

Substances

  • apremilast