INTRODUCTION
Vitiligo is a common acquired pigmentary disorder with a profound psychological impact. It has been reported to affect approximately 1% of the population worldwide,
irrespective of skin color or ethnic origin.1 Vitiligo can be cosmetically and psychologically devastating, resulting in low self-esteem, poor body image, and difficulties in sexual relationships.
2-4 Because the disease is not well understood, several theories
have been proposed to explain the loss of epidermal melanocytes
in this disorder, including autoimmune, biochemical, oxidant–antioxidant, neural, and viral mechanisms.5 An autoimmune
hypothesis for vitiligo pathogenesis has been supported by both experimental data and clinical association with autoimmune
diseases.6-8 Because the disorder is not fully understood, a plethora of different treatments are available, with variable results.
Vitiligo improvement was reported in 2 patients who were treated with alefacept because of coexisting psoriasis.9 The aim of this pilot study is to evaluate the efficacy and safety of alefacept
in the treatment of widespread vitiligo.
METHODS
Four adult patients with widespread vitiligo (covering a body surface area of ≥5%) were recruited from our dermatology clinic.
All patients had nonstable vitiligo and had not received any treatment for vitiligo for the past 6 months. All patients gave their written informed consent. This pilot study had been approved
by the Research Ethics Committee, Vitiligo Research Chair, King Saud University.
Patient data and treatment results are summarized in Table 1.
Treatment With Alefacept
Baseline complete blood counts, differential leukocyte counts, liver function test, renal function test, thyroid function test, fasting blood sugar, antinuclear antibodies, and chest radiographs were all within normal limits for all patients. CD4 counts were monitored
before and biweekly during treatment with alefacept and were within normal limits throughout the treatment. Alefacept was administered to all patients as 15-mg weekly intramuscular injections for 12 weeks. The response was assessed by investigators
through visual comparison of photos obtained by digital camera at baseline and at 6, 12, and 24 weeks. All patients completed
the treatment plan and were followed up with for 24 weeks.
RESULTS
Alefacept was well tolerated during the treatment period, and none of the patients reported any adverse events. All digital images were compared before, during, and after treatment. In all patients, there was no repigmentation of the affected areas. One patient (patient 2) developed new depigmented patches during treatment period, but vitiligo was stable in the other 3 patients (Figures 1 and 2).
DISCUSSION
Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. Although the precise pathogenesis
is not fully understood, vitiligo appears to be an autoimmune disease involving the T-cell–mediated destruction of melanocytes.10,11 Although the triggers and specific nature of the autoimmune response remain unknown, circulating autoantibodies
to melanocytes and various melanocytic protein
