Primary dapsone resistant Mycobacterium leprae in a non endemic country

527 Indian Journal of Dermatology, Venereology, and Leprology | July-August 2013 | Vol 79 | Issue 4 ointment (0.1%) to be more effective than UV treatment alone in patients with vitiligo.[1] However, NB-UVB was administered for a minimum of 3 months and probably, more patients in the NB-UVB alone arm would have achieved better pigmentation, if phototherapy was given for a longer duration. Other studies with smaller sample size have found better pigmentation in NBUVB and tacrolimus arm although the difference was not statistically significant.[2,3] In our study 28% of patients had > 75% repigmentation. This is in contrast to the previous studies where higher pigmentation rate was achieved.[4,5] This can be attributed to the fact that in our study 50% of the lesions were at resistant sites, where as in the previous studies the proportions of lesions at resistant sites were less,[4] or such sites were excluded from the analysis.[3,5] Grade of repigmentation was strictly dependent on the site with lesions over face, trunk and limbs showing better outcome. Similar results were obtained in the study by Fai et al.[4] The limitations of the study include lack of blinding, use of subjective method in evaluating the extent of repigmentation and small sample size. The lack of statistical significance of difference in repigmentation in our study may be because of the smaller sample size and low power to detect all but large differences, and once daily use of tacrolimus rather than twice daily as currently recommended. Use of tacrolimus is expensive, cumbersome for the patients to apply over large vitiliginous areas and has photo-carcinogenic potential. As the additive effect of topical tacrolimus in combination with NB-UVB has not been fully established, long term prospective studies with larger sample size are required to conclusively establish the role of tacrolimus as an adjunct to NB-UVB in management of vitiligo.