Comparison of Efficacy and Safety Psoralen Combined With Ultraviolet A (PUVA) Vs Tofacitinib in the Treatment of Generalized Vitiligo.

Vitiligo is a chronic skin condition that occurs due to the loss of melanocytes, which results in the loss of skin colour. Vitiligo seems to be a common disease. An estimated 0.5-2% of people in the world suffer from it.1 It affects the quality of life because of being visible and often being stigmatized.1 In a study appearing in the Journal of Pakistan Association of Dermatologists, researchers studied familial prevalence and association of vitiligo with other auto-immune diseases in Pakistan. The study found 22% of vitiligo patients had a positive family history, thus suggesting a genetic predisposition. 2 There are many treatment options of varying efficacy available for vitiligo. For many years, PUVA (oral Psoralen plus ultraviolet A) therapy has been used to treat generalized vitiligo. This therapy promotes the repigmentation of the skin by facilitating the migration and proliferation of melanocytes. PUVA therapy has been shown to produce repigmentation rates between 50-75% in responsive patients, particularly on the face and trunk.3 However, PUVA therapy needs close monitoring due to the risk of phototoxicity, gastrointestinal symptoms and longer-term risks of skin aging and carcinogenesis.4 Recent times have seen a rise in the use of new treatments such as Janus kinase (JAK) inhibitors like Tofacitinib for generalized vitiligo.5 Tofacitinib an oral JAK inhibitor, works through the modulation of the immune response believed to cause the autoimmune destruction of melanocytes. Clinical trials show Tofacitinib has repigmentation rates of 45-65%, and is better tolerated than conventional therapies such as PUVA.6 In the study "Tofacitinib to Treat Refractory Progressive Vitiligo: A Retrospective Case Series," 25 patients with refractory progressive vitiligo were treated with oral tofacitinib. Out of these 16 (64%) patients, the progression of disease ceased. Almost half of these patients observed this effect within one month. In addition 10 patients (40%) showed various degrees of repigmentation. The study pointed out that tofacitinib with phototherapy had a significant effect on repigmentation rate. General findings indicate that oral tofacitinib is probably effective for intractable progressive vitiligo.7 JAK inhibitors are potentially a safer and effective alternative treatment option for vitiligo patients.8 Although useful, there isn't much direct knowledge of PUVA versus Tofacitinib efficacy in the Pakistani population. Due to variations in genetic make-up, environmental conditions, and access to healthcare, the present study serves as a justification for carrying out such studies in order to determine the best treatment option for patients with generalized vitiligo.

The objective of this study is to compare the efficacy and safety of PUVA and Tofacitinib in generalized vitiligo. Because of the high frequency of vitiligo in Pakistan and the considerable psychosocial impact of the disease on the patients of Peshawar, the current study will yield useful information regarding the best course of action on treatments.

OBJECTIVE To compare the efficacy and safety of PUVA versus Tofacitinib in the treatment of generalized vitiligo.

Operational Definitions

Vitiligo