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

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.

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.

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.

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.

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.