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Phototherapy combined with topical antioxidants showed the highest efficacy for vitiligo repigmentation, outperforming other combinations in a meta-analysis.

Phototherapy combined with topical antioxidants, corticosteroids, or calcineurin inhibitors are promising therapeutic options for patients with vitiligo, according to a network meta-analysis published in the Journal of Dermatological Treatment.

“Phototherapy coupled with topical antioxidants outperformed other therapies in achieving both ≥50% and 75% repigmentation. This may be attributed to the critical role of oxidative stress in the pathogenesis of vitiligo,” wrote corresponding author Ling Jiang, MD, and colleagues.

The network meta-analysis included 27 randomized controlled trials (RCTs) that investigated combination therapies with phototherapy and topical therapies. The trials included a total 1,027 patients with 2,417 lesions or patches. Regarding phototherapy types, narrowband ultraviolet B (NB-UVB) was used in 16 trials, 308-nm excimer laser was used in seven trials, and 308-nm excimer light was used in four trials.

The researchers used surface under the cumulative ranking (SUCRA) curves to assess the best combinations for clinically significant responses (defined as ≥50% repigmentation) and excellent responses (defined as ≥75% repigmentation). Higher SUCRA scores indicated higher efficacy.

For achieving ≥50% repigmentation, the top combination therapies were phototherapy combined with antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5), according to the study. Next were phototherapy combined with vitamin D analogs (SUCRA 45.5) and fractional CO₂ laser (SUCRA 41.7). Phototherapy alone had a SUCRA of just 3.1.

For achieving an excellent response of ≥75% repigmentation, the top therapies were phototherapy combined with antioxidants (SUCRA 89.0), calcineurin inhibitors (SUCRA 70.3), and fractional CO₂ laser (SUCRA 63.6). Next was phototherapy combined with corticosteroids, which achieved a SUCRA of 49.8. Phototherapy combined with vitamin D analogs had a SUCRA of 14.3, and the phototherapy alone had a SUCRA of 12.7.

In a subgroup analysis of patients with stable vitiligo, SUCRAs for ≥50% repigmentation were 94.7 for phototherapy combined with antioxidants, 68.3 for phototherapy combined with fractional CO₂ laser, and 61.4 for phototherapy combined with vitamin D analogs. SUCRAs for ≥75% repigmentation were 85.4 for phototherapy combined with antioxidants, and 74.5 for phototherapy combined with fractional CO₂ laser.

“In patients with stable vitiligo, phototherapy combined with antioxidants or fractional CO2 lasers may enhance treatment efficacy,” the researchers wrote. “Nevertheless, further high-quality RCTs are necessary to validate these findings.”