Assessing the Effectiveness of Oral Immunomodulators in Vitiligo Management: A Randomized Trial

Abstract

Background: Vitiligo is a chronic autoimmune disorder causing progressive depigmentation due to melanocyte destruction, leading to significant psychological distress. In Bangladesh, treatment accessibility and effectiveness remain challenges, necessitating alternative therapeutic approaches such as oral immunomodulators. Objective: This study aimed to evaluate the effectiveness of oral immunomodulators in vitiligo management by assessing repigmentation, VASI score improvement, and adverse effects in a Bangladeshi cohort over three months. Methods: A prospective clinical study was conducted from October to December 2024 at Jalalabad Ragib Rabeya Medical College, including 50 vitiligo patients aged 14 to 52 years. Inclusion criteria required a confirmed diagnosis and prior three-month immunomodulator therapy. Patients with contraindications or other dermatological conditions were excluded. VASI scores were recorded pre- and post-treatment, with statistical analysis performed using paired t-tests at a 95% confidence interval. Results: The cohort was predominantly female (90%), with a mean age of 19.27 years and an average disease duration of 4.63 years. Mean repigmentation was 18.23%, with a significant reduction in VASI scores from 4.56 ± 4.83 to 4.13 ± 4.87 (p = 0.02). Patients achieving ≥50% repigmentation comprised 22%, while 18% showed minimal or no improvement. The highest repigmentation (77.78%) was observed in a 15-year-old male. Side effects included oral ulceration (16%) and alopecia (12%). Conclusions: Oral immunomodulators provide modest repigmentation and disease stabilization in vitiligo but show variable efficacy. Combination therapies such as phototherapy or topical agents may enhance outcomes. Further large-scale studies are needed.