OBJECTIVE
To compare the efficacy of basic dermatotropic (topical and UVB 311nm) and combination therapy (with the addition of alimemazine or maritupirdine) for non-segmental vitiligo with comorbid anxiety and depressive symptoms associated with adjustment disorders caused by the stress-related effects of the dermatosis.
MATERIAL AND METHODS
A single-center, randomized, prospective study included 60 patients (19 men, 41 women; 29.0±7.0 years old) with unstable non-segmental vitiligo (VIDA ≥+1) and comorbid anxiety and anxiety-depressive disorders (HADS-A/D ≥11) within the framework of adaptation disorders (nosogenic reactions) (F43.2). The patients were randomly divided into three groups, with 20 patients in each group. For 8 weeks, patients in group 1 received topical therapy+UVB 311 nm; group 2 received topical therapy+UVB 311 nm+alimemazine 10—20 mg/day; and group 3 received topical therapy+UVB 311 nm+maritupiridine 20—40 mg/day. The study used the Clinical Global Impression (CGI) scale; Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Vitiligo Area and Severity Index (VASI); Visual Analog Scale of Repigmentation (G0–G4). The effectiveness of therapy was assessed by positive dynamics on the CGI scale and a decrease in the total score on the DLQI scale.
RESULTS
By the eighth week of therapy, the median ΔVASI was 15% in group 1, 27% in group 2, and 29% in group 3 (p<0.05). Normalization of the HADS-A anxiety subscale (<8 points) was achieved in groups 1, 2, and 3, respectively: in 8/18 (44%), 16/18 (89%), and 17/19 (89%) patients; The HADS-D depressive subscale improved in 6/18 (33%), 10/18 (56%), and 15/19 (79%) patients, respectively (p<0.001). Mild adverse events, including drowsiness (4), headache (4), and dizziness (2), did not require treatment discontinuation. At the end of treatment, the average CGI-I total score was 5.1 («marked improvement»), which correlated with the changes in the DIQI scores.
CONCLUSION
Comorbid anxiety and anxiety-depressive adjustment disorders caused by the stressful effects of dermatosis worsen repigmentation during standard therapy for vitiligo. Psychopharmacological correction of comorbid adjustment disorders using alimemazine or maritupirdine significantly increases the incidence of clinically significant repigmentation and effectively normalizes psychosomatic status without significant side effects in the vast majority of patients.
