Clinical trial

The effect of latanoprost on vitiligo: a preliminary

comparative study
Tag S. Anbar, MD, Tarek S. El-Ammawi, MD, Amal T. Abdel-Rahman, MD, and
Michel R. Hanna, MSc

Department of Dermatology, Al-Minya Abstract

University, Al-Minya, Egypt
Correspondence
Tag Anbar, MD
Dermatology Department
Al-Minya University Hospital
AL-Minya, 61111 Egypt
E-mail: taganbar@yahoo.com
Funding Source: Personal.
Conflicts of interest: None.
doi: 10.1111/ijd.12631
Latanoprost (LT), a prostaglandin F 2alpha (PGF2a) analogue used in the treatment of
glaucoma, was found to induce skin pigmentation in guinea pigs in addition to its known
periocular and iridal pigmentation side effects. This study aims to evaluate the efficacy of
topical LT in the induction of skin repigmentation in patients with vitiligo and to compare its
potency with narrow band ultraviolet (UV) B (NB-UVB). The result of their combination was
also assessed. This study involved 22 patients with bilateral and symmetrical vitiligo
lesions, stable for the last three months, divided into three groups: group I, to evaluate LT
vs. placebo; group II, to evaluate LT vs. NB-UVB; and group III, to evaluate the effect of
their combination. The response to treatment was evaluated by taking photographic
records of the treated lesions with follow-up photography every two weeks. After three
months, assessment of the degree and extent of repigmentation was performed. Follow-up
assessment was done six months after termination of the trial for the persistence of
pigmentation, recurrence, or development of any side effects. LT was found to be better
than placebo and comparable with the NB-UVB in inducing skin repigmentation. This effect
was enhanced by the addition of NB-UVB. LT could be a promising treatment for vitiligo,
especially the periocular variant. Its effect on skin repigmentation could be enhanced by
NB-UVB exposure.

[LT], bimatoprost, and travoprost) on normal skin of gui-

Introduction
Vitiligo is an acquired hypomelanotic disorder character-
ized by circumscribed depigmented macules in the skin
resulting from loss of functioning melanocytes and mela-
nin from cutaneous epidermis.1
Epidermal melanocytes synthesize melanin in response
to ultraviolet rays (UVR). The mechanisms mediating the
UVR-induced activation of melanogenesis are not definitely
settled. As UVR induces the turnover of membrane phos-
pholipids generating prostaglandins, such as PGE2 and
PGF2a and other products, it is possible that one or more
of them might provide the activating signal. The melano-
cytes express several receptors for prostaglandins, including
PGE2 i.e., PGE2 type 1 (EP1) and PGE2 type 3 (EP3), and
PGF2a (FP).2
Several therapeutic options are available for the treatment
of vitiligo, but none is uniformly effective. Parsad et al.3
and Kapoor et al.4 have documented efficacy of topical
PGE2 in the treatment of vitiligo with encouraging results
presenting it as a promising therapy for localized stable viti-
ligo. On the other hand, Anbar et al. have evaluated the
pigmentary effect of three analogues of PGF2a (latanoprost
nea pigs. They observed that all had a positive effect on
skin pigmentation with LT expressing a more significant
increase in pigmentation than the other two analogues.5
Hence, the present study was designed to evaluate the
efficacy of topical LT in induction of skin repigmentation
in patients with vitiligo and compare its potency with
narrow band ultraviolet B (NB-UVB). The effect of com-
bining both modalities for achieving better results was
also assessed.
Patients and Methods
Twenty-two patients with bilateral and symmetrical stable vitiligo
lesions (for the last 3 months) involving <5% body surface area
were enrolled in this study.
Approval was obtained from the ethical committee, and
written consent was obtained from all patients.
Excluded from the study were patients with segmental vitiligo,
patients who received any local or systemic treatment for vitiligo
for at least three months before the study, photosensitive
patients, those with light aggravated dermatoses, and pregnant
or lactating females. Owing to the known contraindication of the 1

ª 2014 The International Society of Dermatology International Journal of Dermatology 2014

2 Clinical trial Effect of latanoprost on vitiligo
LT in patients with asthma or hypertension, they were excluded
from the present work.
Before starting therapy, patients were evaluated clinically to
record the duration and progression of the disease, sites of the
lesions, and extent of cutaneous involvement. Funding was
obtained from personal resources.
Age, sex, onset, duration and progress of the disease, extent
of involvement, site and number of lesions, precipitating factors,
previous treatment, and family history of vitiligo or other
autoimmune disorders were recorded.
For each patient, two different symmetrical vitiliginous areas,
one on each side, were randomly selected, using the random
number allocation method, and treated according to the protocol
of each group for three months. The patients were divided into
three groups and were treated as follows:
1 Group I (seven patients): In each patient, one side was
treated with LT while the other side received placebo (saline) to
evaluate the effect of LT.
2 Group II (seven patients): In each patient, one side was
treated with LT while the other side was exposed to NB-UVB.
Before exposure to NB-UVB, the LT-treated area was wrapped
with a tight thick dressing.
3 Group III (eight patients): In each patient, one side was
treated with a combination of LT and NB-UVB while the other
side was exposed to NB-UVB only. On days of radiation, the
topical application was applied following NB-UVB exposure to
avoid their barrier and/or photosensitive effect if any.
LT, a PGF2a analogue, is a topical medication used for
treating ocular hypertension by reducing intraocular pressure
(IOP).6 Pharmacologically it is an isopropyl (Z)-7-
[(1R,2R,3R,5S)-3,5-dihydroxy-2-[(3R)3-hydroxy-5-phenylpentyl]-
cyclopentyl] hept-5-enoate (Fig. 1). It is commercially available
as a sterile translucent ophthalmic solution preparation
(XalatanTM; Pharmacia NV/SA, Puurs, Belgium) containing LT
0.005%. It is stored at 2–8 °C. Once opened, the container may
be stored at room temperature. For treated areas, patients were
instructed to apply LT (Xalatan) twice daily.
Eight NB fluorescent tubes (Philips TL 100 W/01; Philips BV,
Eindhoven, the Netherlands) with a spectrum of 310–315 nm and
a maximum wavelength of 311 nm were installed in a Waldmann
UV-1000 unit (Waldmann GmbH, Schwenningen, Germany).
Figure 1 Pharmacological structure of latanoprost
International Journal of Dermatology 2014
Anbar et al.
NB-UVB therapy was given twice weekly, never on two
successive days, starting with a dose of 0.21 J/cm2
independent of skin type and increased by 20% every session
until we reached the minimal erythema dose. The minimal
erythema dose is the dosage that induces mild erythema that
disappears the next day of the session. The patient’s erythema
was evaluated with every clinic visit. No NB-UVB exposure was
allowed if erythema was still present before the session.7
During the NB-UVB sessions, the affected parts were
exposed with the eyes protected by UV-blocking goggles. If the
eyelids were the areas to be treated, patients were instructed to
keep their eyes closed during exposure without wearing
goggles.
The response to treatment was evaluated by taking
photographic records of the treated lesions and follow-up
photographs every two weeks.
After three months, assessment of the degree and extent of
repigmentation was performed by two blinded dermatologists and
expressed as no change (0%), poor (1–25%), moderate (26–
50%), good (51–75%), excellent (76–99%), or complete
repigmentation (100%). Numerical values are used to express
these grades of improvement from 0 to 5 for statistical purposes.
For patients with periocular vitiligo who received LT around
their eyes, assessment of the IOP was done before and after
the treatment period using Goldmann applanation tonometry.
Follow-up assessment was done six months after termination
of the trial for the persistence of pigmentation, recurrence, or
development of any side effects.
Statistical analysis
The collected data were analyzed and evaluated using a
computer-based program, SPSS software package for statistical
analysis (SPSS for Windows©, Version 16.0; SPSS Inc.,
Chicago, IL, USA). Data were presented as mean  SD.
Comparison between results of the two sides within the same
group was made using the independent (unpaired) t-test.
P < 0.05 was considered statistically significant.
The results of the patients who received LT in groups I and II
were evaluated before and after three months’ treatment using
a dependent (paired) t-test. In addition, the correlation between
the degree of response and disease duration was evaluated by
Pearson’s test to assess the correlation coefficient (r value).
Results
Twenty-two patients were evaluated at the end of three
months. The age of the patients at the time of presentation
ranged from 6 to 55 years with a mean  SD of
15.5  11.5 years. The duration of the disease ranged from
3 to 180 months with a mean  SD of 27.5  40 months.
Three patients (14%) had skin type III, 17 (77%) skin type
IV, and two (9%) skin type V. A positive family history of
vitiligo was present in two of 22 patients (9.1%).
ª 2014 The International Society of Dermatology
Anbar et al. Effect of latanoprost on vitiligo Clinical trial 3

(a) (b) (c) (d)

(e) (f) (g) (h)

Figure 2 Response of a patient in group I to latanoprost in comparison with placebo. Side treated with latanoprost: (a) before
treatment, (b) after 4 weeks, (c) after 6 weeks, (d) after 8 weeks, (e) after 10 weeks and (f) after 12 weeks. Side treated with
placebo: (g) before treatment and (h) after treatment

Table 1 Data of patients in group I (latanoprost vs. placebo)

Patient Sex Age (years) Duration (months) Site Latanoprost Placebo

1 M 10 3 Lower limb 75–99% 1–25%

E 4 P 1
2 F 21 36 Upper limb 100% 0%
CR 5 NC 0
3 F 8 4 Lower limb 75–99% 0%
E 4 NC 0
4 F 12 12 Lower limb 1–25% 0%
P 1 NC 0
5 M 16 36 Face 0% 0%
NC 0 NC 0
6 F 30 12 Neck 1–25% 0%
P 1 NC 0
7 F 55 12 Face 1–25% 0%
P 1 NC 0
Range M = 2 (28.6%) 8–55 3–36
F = 5 (71.4%)
Mean  SD 21.7  16.5 16.4  13.9 2.3  1.9 0.1  0.37

E, excellent response; P, poor response; CR, complete repigmentation; NC, no change.

Patients treated with LT showed a significantly better
skin repigmentation compared with placebo (Fig. 2 and
Table 1) (P < 0.05). The mode of repigmentation was
both perifollicular and marginal. This pigmentation was
comparable with that obtained after NB-UVB exposure
where there was no significant difference between both
results (Fig. 3 and Table 2) (P > 0.05).
Of the 14 patients in groups I and II treated with LT
alone on one side, complete cure was seen in two cases,
excellent result in four, and poor result in four. Only four
cases showed no repigmentation.
Six of 14 patients (43%) achieved excellent response
to complete repigmentation (>75% repigmentation). On
analyzing the effect of LT on those six patients, it was
found that they included three patients (50%) with facial
lesions, denoting the maximum response of the face
and five patients (83%) with vitiligo lesions of <1 year
duration. On using the correlation coefficient equation,
the disease duration was inversely correlated with the
repigmentation percentage, which means that a better
response to LT was achieved when the disease duration
was less.
On combining LT with NB-UVB, there was a signifi-
cant improvement in lesions treated with that combina-
tion in comparison with those treated with NB-UVB
alone (Fig. 4 and Table 3) (P < 0.05).

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4 Clinical trial Effect of latanoprost on vitiligo Anbar et al.

(a) (b) (c) (d)

(e) (f) (g) (h)

Figure 3 Response of a patient in group II to latanoprost in comparison with narrowband-ultraviolet B. Side treated with
latanoprost: (a) before treatment, (b) after 4 weeks, (c) after 8 weeks and (d) after 12 weeks. Side treated with narrowband-
ultraviolet B: (e) before treatment, (f) after 4 weeks, (g) after 8 weeks and (h) after 12 weeks

Table 2 Data of patients in group II (latanoprost vs. NB-UVB)

Patient Sex Age (years) Duration (months) Site Latanoprost NB

1 F 36 180 Lower limb 0% 0%

NC 0 NC 0
2 F 10 12 Lower limb 0% 0%
NC 0 NC 0
3 F 15 48 Upper limb 1–25% 0%
P 1 NC 0
4 F 16 7 Face 75–99% 50–75%
E 4 G 3
5 F 6 3 Face 100% 100%
CR 5 CR 5
6 F 10 3 Face 75–99% 1–25%
E 4 P 1
7 F 10 24 Upper limb 0% 0%
NC 0 NC 0
Range M = 0 (0%) 6–36 3–180
F = 7 (100%)
Mean  SD 14.7  9.9 39.6  63.9 2  2.2 1.3  1.9

NB-UVB, narrowband-ultraviolet B; E, excellent response; P, poor response; CR, complete repigmentation; NC, no change.

Of the 22 cases, six patients (27%) had periocular viti-
ligo and received LT around their eyes (either alone or in
combination with NB-UVB). Assessment of the IOP
revealed that there was no significant change before and
after LT treatment (P > 0.05).
Follow-up
Eight patients who showed poor or no repigmentation
after three months of therapy refused to wait for another
six months without treatment so they were shifted to other
forms of therapy and were excluded from the follow-up.
Of the 14 patients who achieved complete or excellent
repigmentation, two patients (14.3%) were missed in the
follow-up. The remaining 12 patients were followed up
for six months. It was found that three patients (25%)
experienced disease activity in the form of the appearance
of new lesions and partial loss of gained pigmentation,
while the remaining nine patients (75%) retained their
achieved pigmentation until the end of the follow-up
period of six months after termination of the trial.
Discussion
Prostaglandins are lipid molecules produced by different
cell types and have diverse effects at the cellular and tis-
sue levels, including inflammation, wound repair, angio-

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Anbar et al.
Figure 4 Response of a patient in group III to a combination
of latanoprost and narrowband-ultraviolet B in comparison
with narrowband-ultraviolet B alone. Side treated with a
combination of latanoprost and narrowband-ultraviolet B:
(a) before treatment, (b) after 4 weeks, (c) after 6 weeks, (d)
after 8 weeks, (e) after 10 weeks and (f) after 12 weeks. Side
treated with narrowband-ultraviolet B alone: (g) before
treatment, (h) after 4 weeks, (i) after 6 weeks, (j) after
8 weeks, (k) after 10 weeks and (l) after 12 weeks.
genesis, and cell proliferation.8 Among the commercially
available prostaglandins are PGF2a analogues that form a
class of various local medications used for ocular hyper-
ª 2014 The International Society of Dermatology
Effect of latanoprost on vitiligo Clinical trial 5
tension with proven efficacy and safety.9 Several adverse
effects had been reported following their use, including
increased eyelash growth,10 darkening of the iris,11 and
periocular skin hyperpigmentation.12
Activation of FP receptors by their ligands or agon-
ists results in modulating melanocyte dendricity, prolifera-
tion, and tyrosinase expression.2
Melanocyte proliferation13 and melanosomal transfer14
are also proposed mechanisms for LT-induced repigmen-
tation.
All the previous mechanisms could play a positive
role in vitiligo repigmentation. Moreover, LT was
reported to stimulate the formation of PGE2; therefore,
it is likely that repigmentation may be induced, in
part, via endogenous PGE2, which is a stimulator of
melanogenesis.15
It was found that the face has the best repigmentation
response in comparison to other body sites using different
treatment modalities. Kapoor et al.,4 Anbar et al.,7 Yones
et al.,16 and Kanwar et al.,17 found that vitiligo of the
face achieved the best results when treated with topical
PGE2, NB-UVB, psoralen + UVA, and topical tacrolimus,
respectively.
It is unclear why lesions on the face have a better
response rate. Halder and Chappell proposed that facial
skin has greater permeability, a larger number of residual
melanocytes in the uninvolved skin, greater follicular res-
ervoirs, or melanocyte damage is more easily reversed.18
Meanwhile, most of the authors confirmed that the
duration of the disease inversely correlates with the treat-
ment outcome.7,19–22 This phenomenon was described by
some authors to be due to the exhaustion of the melano-
cyte storage present in the outer root sheath of the hair
follicle with time elapsed.20,23–26
Thus, the previous findings together with the results of
the present study suggest that the relation between the
involved site and disease duration and degree of repig-
mentation may be related to disease characteristics rather
than therapy effect, which means that whatever the treat-
ment modality used the response depends significantly on
the site and duration of the lesion.
The significant improvement in lesions treated with the
combination of LT with NB-UVB, in comparison with
those treated with NB-UVB alone, could be explained by
many possibilities. First, NB-UVB stimulates the release
of PGs in situ27 allowing the applied exogenous LT to
exert an additive effect on pigmentation. The second
possibility is the synergistic effect of other mediators
released on exposure to NB-UVB, e.g., endothelin-1,
alpha-melanocyte-stimulating hormone, adrenocorticotro-
pic hormone, stem cell factor, and nerve growth factor28
with topically applied LT. Thirdly, exposure to NB-UVB
not only stimulates the synthesis of PGF2a in melanocytes
International Journal of Dermatology 2014
6 Clinical trial Effect of latanoprost on vitiligo Anbar et al.

Table 3 Data of patients in group III (latanoprost + NB-UVB vs. NB-UVB alone)

Latanoprost
Duration +
Patient Sex Age (years) (months) Site NB NB

1 M 11 24 Upper limb 75–99% 25–50%

E 4 M 2
2 M 13 18 Lower limb 75–99% 1–25%
E 4 P 1
3 M 10 4 Trunk 75–99% 1–25%
E 4 P 1
4 F 8 12 Face 75–99% 50–75%
E 4 G 3
5 F 7 6 Face 50–75% 25–50%
G 3 M 2
6 F 9 6 Lower limb 1–25% 1–25%
P 1 P 1
7 M 13 60 Face 1–25% 0%
P 1 NC 0
8 M 12 84 Upper limb 1–25% 1–25%
P 1 P 1
Range M = 5 (62.5%) 7–13 4–84
F = 5 (62.5%)
Mean  SD 10.4  2.3 26.8  29.4 2.8  1.5 1.4  0.9

NB-UVB, narrowband-ultraviolet B; E, excellent response; P, poor response; CR, complete repigmentation; NC, no change.

but also upregulates FP receptors expression,29 allowing

the exogenous LT to exert more effect.
The use of topical corticosteroids is the cornerstone in
the treatment of vitiligo, but its application around the
eyes may be complicated by glaucoma or cataract.30 In our
study, LT was used around the eyes in six patients with no
reported side effects or elevation of the IOP, thus it can be
a promising alternative treatment for periocular vitiligo.
It is worth mentioning that the PGF2a analogue used in
this study is available in the pharmaceutical market as the
LT ophthalmic solution, Xalatan. Its concentration in
the solution may not be optimum for dermatological use.
The solvent may not necessarily be the most suitable vehicle
to deliver the drug through the skin. We tested the effect of
LT in areas <5% of the body surface area, which have more
or less the same expected absorption levels from the eyes,
where it was originally used. The encouraging results of this
preliminary study give a rationale to apply this medication
on larger areas. Thus, we wish to do a further study involv-
ing larger surface areas and monitoring of the serum levels.
Conclusion
Our study highlighted the following advantages of LT use
in vitiligo: easy self-applied therapy; availability; afford-
ability; efficacy in periocular vitiligo with no observed
side effects; and combination with phototherapy is not
mandatory but will give a better response.
Acknowledgments
The authors are grateful to Dr. Ashraf Ewis (Department
of Occupational Medicine and Public Health, Al-Minya
University, Al-Minya, Egypt) for helping in the statistical
evaluation of the study and Dr. Mohamed Abd El-Hamed
(Department of Ophthalmology, Al-Minya University,
Al-Minya, Egypt) for measuring the IOP for our patients.
References
1 Kemp EH, Gavalas NG, Gawkrodger DJ, et al.
Autoantibody responses to melanocytes in the
depigmenting skin disease vitiligo. Autoimmun Rev 2007;
6: 138–142.
2 Scott G, Leopardi S, Printup S, et al. Proteinase-activated
receptor-2 stimulates prostaglandin production in
keratinocytes: analysis of prostaglandin receptors on
human melanocytes and effects of PGE2 and PGF2alpha
on melanocyte dendricity. J Invest Dermatol 2004; 122:
1214–1224.
3 Parsad D, Pandhi R, Dogra S, et al. Topical
prostaglandin analog (PGE2) in vitiligo – a preliminary
study. Int J Dermatol 2002; 41: 942–945.
4 Kapoor R, Phiske MM, Jerajani HR. Evaluation of safety
and efficacy of topical prostaglandin E2 in treatment of
vitiligo. Br J Dermatol 2009; 160: 861–863.
5 Anbar TS, El-Ammawi TS, Barakat M, et al. Skin
pigmentation after NB-UVB and three analogues of

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Anbar et al.
prostaglandin F(2alpha) in guinea pigs: a comparative
study. J Eur Acad Dermatol Venereol 2010; 24: 28–31.
6 Stjernschantz J, Selen G, Sjoquist B, et al. Preclinical
pharmacology of latanoprost, a phenyl-substituted PGF2
alpha analogue. Adv Prostaglandin Thromboxane Leukot
Res 1995; 23: 513–518.
7 Anbar TS, Westerhof W, Abdel-Rahman AT, et al.
Evaluation of the effects of NB-UVB in both segmental
and non-segmental vitiligo affecting different body sites.
Photodermatol Photoimmunol Photomed 2006; 22:
157–163.
8 Pentland AP, Mahoney MG. Keratinocyte prostaglandin
synthesis is enhanced by IL-1. J Invest Dermatol 1990;
94: 43–46.
9 Alexander CL, Miller SJ, Abel SR. Prostaglandin analog
treatment of glaucoma and ocular hypertension. Ann
Pharmacother 2002; 36: 504–511.
10 Johnstone MA. Hypertrichosis and increased
pigmentation of eyelashes and adjacent hair in the region
of the ipsilateral eyelids of patients treated with unilateral
topical Latanoprost. Am J Ophthalmol 1997; 124:
544–547.
11 Chiba T, Kashiwagi K, Kogure S, et al. Iridial
pigmentation induced by Latanoprost ophthalmic
solution in Japanese glaucoma patients. J Glaucoma
2001; 10: 406–410.
12 Kook MS, Lee K. Increased eyelid pigmentation
associated with use of latanoprost. Am J Ophthalmol
2000; 129: 804–806.
13 Alm A, Grierson I, Shields MB. Side effects associated
with prostaglandin analog therapy. Surv Ophthalmol
2008; 53(Suppl. 1): S93–S105.
14 Park HY, Kosmadaki M, Yaar M, et al. Cellular
mechanisms regulating human melanogenesis. Cell Mol
Life Sci 2009; 66: 1493–1506.
15 Sasaki S, Hozumi Y, Kondo S. Influence of prostaglandin
F2alpha and its analogues on hair regrowth and follicular
melanogenesis in a murine model. Exp Dermatol 2005;
14: 323–328.
16 Yones SS, Palmer RA, Garibaldinos TM, et al. Randomized
double-blind trial of treatment of vitiligo: efficacy of
psoralen-UV-A therapy versus narrowband-UV-B therapy.
Arch Dermatol 2007; 143: 578–584.
17 Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for
treatment of childhood vitiligo in Asians. Clin Exp
Dermatol 2004; 29: 589–592.
ª 2014 The International Society of Dermatology
Effect of latanoprost on vitiligo Clinical trial 7
18 Halder RM, Chappell JL. Vitiligo update. Semin Cutan
Med Surg 2009; 28: 86–92.
19 Njoo MD, Spuls P, Bos JD, et al. Nonsurgical
re-pigmentation therapies in vitiligo: meta-analysis of the
literature. Arch Dermatol 1998; 134: 1532–1540.
20 Anbar TS, Abdel-Raouf H, Awad SS, et al. The hair
follicle melanocytes in vitiligo in relation to disease
duration. J Eur Acad Dermatol Venereol 2009; 23:
934–939.
21 Schaffer JV, Bolognia JL. The treatment of
hypopigmentation in children. Clin Dermatol 2003; 21:
296–310.
22 Scherschun L, Kim JJ, Lim HW. Narrow-band ultraviolet
B is a useful and well-tolerated treatment for vitiligo.
J Am Acad Dermatol 2001; 44: 999–1003.
23 Hann SK, Chun WH, Park YK. Clinical characteristics
of progressive vitiligo. Int J Dermatol 1997; 36:
353–355.
24 Hann SK, Lee HJ. Segmental vitiligo: clinical findings
in 208 patients. J Am Acad Dermatol 1996; 35:
671–674.
25 Njoo MD, Westerhof W, Bos JD, et al. The development
of guidelines for the treatment of vitiligo. Arch Dermatol
1999; 135: 1514.
26 Gauther Y, Andre MC, Taieb A. A critical appraisal of
vitiligo etiologic theories. Is melanocyte loss a
melanocytorrhagy. Pigment Cell Res 2003; 16:
322–332.
27 Udompataikul M, Boonsupthip P, Siriwattanagate R.
Effectiveness of 0.1% topical tacrolimus in adult and
children patients with vitiligo. J Dermatol 2011; 38:
536–540.
28 Duval C, Laurent-Teluob S, Schmidt R. UV triggers the
release of keratinocytes-derived prostaglandins which
stimulate melanine synthesis: inhibitory effect of
anti-inflammatory drugs. Pigment Cell Res 2004; 17: 577.
29 Scott G, Jacobs S, Leopardi S, et al. Effects of PGF2alpha
on human melanocytes and regulation of the FP receptor
by ultraviolet radiation. Exp Cell Res 2005; 304:
407–416.
30 Kwinter J, Pelletier J, Khambalia A, et al.
High-potency steroid use in children with vitiligo: a
retrospective study. J Am Acad Dermatol 2007; 56: 236–
241.
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