Topical Antioxidants Combined with Phototherapy Effective for Vitiligo Management

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A network meta-analysis helped to determine which phototherapy combination method is best for patients with vitiligo.¹ It was found that antioxidants showed superior efficacy with corticosteroids, calcineurin inhibitors, and fractional CO₂ laser also showing successful repigmentation rates. This is the first time a network meta-analysis has been used to identify the most effective topical therapy for vitiligo when combined with phototherapy.

“This unique analysis can adjust for direct and indirect comparisons and provides powerful statistical evidence,” the authors wrote. “Additionally, NMA facilitates the estimation of relative effectiveness across all interventions and allows for the ranking of treatments, even in the absence of direct two-intervention comparisons.”

Twenty-seven randomized controlled trials were analyzed after the initial systematic search identified 1338 articles. Of these, 17 were within-patient trials and 10 were parallel trials. Most were two-arm studies.Literature was sourced from PubMed, Embase, and Cochrane Library and all was published before 2022. Approximately 1035 patients and 2417 vitiligo patches were included.

In this study, phototherapies included only narrowband ultraviolet B (NB-UVB) and 308-nm excimer laser/light (EL). The tested topical treatments were corticosteroids (Pho + TCS), calcineurin inhibitors (Pho + TCI), vitamin D analogs (Pho + TVD), antioxidants (Pho + TAO), or fractional CO₂ laser (Pho + FCO₂). Investigators used the surface under the cumulative ranking (SUCRA) scores to determine how effective each regimen was. Repigmentation success was categorized by failed responses (<25%), significant responses (≥50%), and excellent responses (≥75%).

For those that achieved significant responses, antioxidants were the most effective with a SUCRA score of 87.7, followed by corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5). In a subgroup analysis of patients with stable vitiligo, antioxidants also had the highest performance. Researchers hypothesize that this is due to antioxidants’ ability to protect cells from oxidative stress, which is critical in the pathogenesis of vitiligo. Phototherapy alone had the lowest ranking (SUCRA 3.1), emphasizing that all combination methods had greater outcomes and could maximize therapeutic effectiveness.

For those that achieved excellent responses, antioxidants were also the most effective with a SUCRA score of 89.0, especially in those with stable disease activity. Calcineurin inhibitors (SUCRA 70.3) and fractional CO₂ laser (SUCRA 63.6) were also optimal combinations. Like the ≥50% repigmentation group, phototherapy on its own had the lowest performance. Both subtypes of EL and NB-UVB, which emit ultraviolet light at similar wavelengths, showed superior results with antioxidants.

Some potential limitations include the heterogeneity and methodological qualities of some of the included trials. High-quality randomized controlled trials with rigorous designs can address these in future literature.

Vitiligo affects between 0.5% and 2% of the global population.² Phototherapy, topical corticosteroids, calcineurin inhibitors, antioxidants, and vitamin D analogues are very common methods for vitiligo disease management. However, each treatment comes with benefits and disadvantages related to cost, long-term adverse effects, and other considerations. Because of this, a personalized, patient-centric approach is vital. Future randomized controlled trials can further explore the therapeutic potential of these regimens for vitiligo, especially antioxidants. According to the authors, “such improvements would enhance the reliability of the data and facilitate more informed clinical decision-making.”

References

1. Luo L, Huang J, Fu C, et al. The efficacy of combined phototherapy with topical therapy in vitiligo: a network meta-analysis. J Dermatolog Treat. 2025;36(1):2483808. doi:10.1080/09546634.2025.2483808

2. Akl J, Lee S, Ju HJ, et al. Estimating the burden of vitiligo: a systematic review and modelling study. Lancet Public Health. 2024;9(6):e386-e396. doi:10.1016/S2468-2667(24)00026-4