Dr. Ahmed
Afamelanotide for vitiligo – Scenesse Cream for Vitiligo
Often, people look for what is the best treatment for vitiligo, and there are quite a few options.
Commonly, patients use a topical cream like corticosteroids or a calcineurin inhibitor, which can make skin pigment reappear.
Furthermore, light therapy is also used for this purpose. Nevertheless, a permanent cure for this condition is still unknown, as the disease is known to relapse after a few years.
Research is continuously advancing, and newer options are consistently brought to market since the prevalence of vitiligo is rather high.
This loss of pigment can affect the mental and social well-being of any person. Especially those with darker skin tones where such depigmented patches are more visible. Which is why an effective treatment is crucial.
What is Afamelanotide (Scenesse)?
Alpha-melanocyte-stimulating hormone (α-MSH) occurs naturally in the body, and afamelanotide is a synthetic analog of this chemical.
It works by affecting the skin pigment by initiating and increasing the melanocyte function. These cells are responsible for producing pigment in the human body.
Since it can enhance the skin pigment eumelanin, it is used for conditions like vitiligo, solar urticaria, and others.
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Research on Afamelanotide for Vitiligo
The use of this drug for vitiligo is consistently investigated. It is administered through SC injections, and the dosage will vary based on the patient’s response.
A study from 2009
This is the first study ever to introduce the efficacy of afamelanotide as a potential treatment against phototoxicity. [ref]
A study from 2013
Researchers found that Afamelanotide can boost the repigmentation process. They evaluated 4 cases where this treatment stimulated follicular and confluent repigmentation within weeks.
Even though there were spots of hyperpigmentation, this investigation still proposed afamelanotide as a potential treatment for vitiligo [ref].
A study from 2015
A study from 2015 investigated the efficacy of afamelanotide combined with narrowband phototherapy and found that it can quicken the pigmentation process in generalized vitiligo.
The research included 55 patients with slowly progressing vitiligo and divided them into groups. The one that received monthly afamelanotide implants alongside UV-B for four months expressed better repigmentation on the face and upper limbs.
A few side effects included minor infections, but this sort of therapy proved to be useful for darker skin types [ref].
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Contraindications to Afamelanotide in vitiligo
There is a lack of data regarding the safety of Afamelanotide.
- No data is establishing the safety of Afamelanotide in children aged 0 to 17.
- Kidney or liver diseases- the metabolism of Afamelanotide is not fully understood.
- Patients above 70 years of age should refrain from taking Afamelanotide.
- Pregnant or breastfeeding women should not take Afamelanotide for vitiligo.
Use of Afamelanotide as Sunscreen in Vitiligo Patients:
Since afamelanotide can increase the production of melanin which in turn protects the body from sunburn.
There is a question about its use as a potential sunscreen. It can reduce the number of epidermal sunburn cells by 50%, but the makers of Afamelanotide have forbidden its use as protection against sun rays.
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How to take Afamelanotide for Vitiligo?
Afamelanotide (Scenesse®) is a small white rod, about 1.7 cm long and 1.5 mm wide, containing 16 mg of the drug.
It’s implanted under the skin, typically near the hip, by a specialist every two months, especially before and during periods of increased sunlight exposure like summer.
Patients should aim for three implants annually, with a maximum of four. After insertion, patients should wait 30 minutes for potential allergic reactions.
Precautions to take with Afamelanotide
During afamelanotide treatment, women of childbearing age should use effective contraception, continuing it for three months post-treatment.
Patients should abstain from driving vehicles or operating heavy machinery for 72 hours following afamelanotide administration due to possible tiredness and dizziness.
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Topical Creams for Vitiligo
Ruxolitinib:
Currently, this is the only medication approved by the FDA for repairing skin pigment in patients with vitiligo.
It is a topical cream and a potent JAK inhibitor, essentially used to treat people aged 12 or above with non-segmental vitiligo.
Topical corticosteroids
Corticosteroid creams may slow vitiligo progression or encourage melanocyte return. Dermatologists closely oversee potent corticosteroid use due to its strength.
Side effects like skin thinning, stretch marks, and acne are possible. Results may appear within months.
Topical corticosteroids are usually prescribed by dermatologists as part of a long-term regimen with two to four annual follow-up appointments.
Topical depigmentation medication
This type of treatment is used if vitiligo covers more than half of your body. This means that the remaining skin will have a light tone after topical medication is used to remove pigment.
Your dermatologist will help you make this important decision by offering advice, information, and encouragement.
Topical calcipotriene
The synthetic vitamin D form calcipotriene was first developed to treat psoriasis. It can promote pigment production in skin areas affected by vitiligo when applied twice a day in the form of a cream or ointment.
It can take a few months to see results. Though severe side effects are rare, patients may face mild skin irritation may happen.
Calcipotriene works best for vitiligo when combined with other topical treatments, phototherapy, or laser therapy.
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