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Oral mycophenolate mofetil in the treatment of acquired dermal macular hyperpigmentation: An open‐label pilot study
Author(s) -
Bishnoi Anuradha,
Vinay Keshavamurthy,
Parsad Davinder,
Kumar Sheetanshu,
Chatterjee Debajyoti,
Nahar Saikia Uma,
Sendhil Kumaran Muthu
Publication year - 2021
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/ajd.13567
Subject(s) - medicine , hyperpigmentation , dermatology , severity of illness , surgery
Background Literature on treating acquired dermal macular hyperpigmentation is sparse. Aims and objectives To assess treatment response of mycophenolate mofetil in patients having acquired dermal macular hyperpigmentation. Material and Methods In this open‐label, pilot study, patients of acquired dermal macular hyperpigmentation affecting at least the face and/or neck were included. Each participant was treated with mycophenolate mofetil 2 g/day for 24 weeks, with a follow‐up of 12 weeks. Two aspects of disease severity were measured: activity (appearance of new lesions/extension of existing lesions), and degree of hyperpigmentation (measured using ‘ dermal pigmentation area and severity index ’). Patient satisfaction was assessed on a scale of 0–10. Results Forty‐three of 46 patients who were prescribed mycophenolate, completed the study (40 females, 6 males; mean disease duration 2.8 ± 1.4 years). Amongst 20 (43.5%) patients with active disease, stability was achieved in 17, after a mean duration of 6.1 ± 2.5 weeks (range 4–12 weeks; median 4; IQR 4 weeks). Mean dermal pigmentation area and severity index at baseline was 18.8 ± 7.1 and decreased to 13.7 ± 6.3 at 24th week (27.5 ± 14.7%; P < 0.001). A significant decreasing trend in dermal pigmentation area and severity index ( P < 0.001) was observed, and first significant difference from baseline was noted at the 16th week ( P 0.008). Less than 10%, >10–20%, >20%–30%, >30%–40%, >40%–50%, and >50% reduction in dermal pigmentation area and severity index was observed in 8, 5, 4, 15, 10 and 1 patients/patient respectively. The maximum mean grade of pre‐treatment dermatoscopic severity was 3 ± 0.7, and decreased to 2.1 ± 0.8 on the face ( P < 0.001) and 2.4 ± 0.7 on the neck ( P < 0.001) post‐treatment. There were 9 (20.1%) non‐responders. Self‐assessment scores of the rest of the patients fell in the range of moderate/fair improvement (>5 to 7). No significant correlation was seen between patient satisfaction score and degree of reduction in dermal pigmentation area and severity index ( r −0.39). Three developed adverse effects (leucopenia, n = 1; transaminitis and hyperbilirubinemia, n = 2) that resolved following discontinuation of mycophenolate. Conclusion Mycophenolate mofetil appears to be a promising treatment option in acquired dermal macular hyperpigmentation.