Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Arch Dermatol Res. 2024 Sep 21;316(9):632. doi: 10.1007/s00403-024-03363-9.
Ultraviolet B narrow band (UVB-NB) phototherapy is the gold standard treatment for vitiligo, primarily due to its immunomodulatory effects. Additionally, it may influence circadian melatonin balance, that may indirectly induce sleep regulation, which in turn could potentially contribute to vitiligo improvement. The association between melatonin, vitiligo and phototherapy has been little investigated. The aim of this study was to evaluate the current evidence regarding the effects of circadian melatonin regulation and sleep, particularly during vitiligo treatment with phototherapy. We undertook a narrative review to synthetize the evidence on this association through the MEDLINE/PubMed database, using combined search terms: melatonin, vitiligo, phototherapy, and circadian rhythm (sleep). A total of 56 articles were included. There are few studies on this relationship, and conflicting findings. Some studies have suggested that UV exposure and phototherapy might benefit vitiligo by stimulating melanocytes, which have melatonin receptors, and this could potentially synchronize the circadian regulation of melatonin. This improved melatonin balance could result in better sleep quality further enhancing the antiinflammatory properties of melatonin and contributing to vitiligo improvement. Less is known about the possible effects of the use of topical melatonin, with or without phototherapy, to treat vitiligo lesions. In conclusion, there is some evidence that circadian melatonin regulation plays an important role in the course of vitiligo, both through sleep regulation and its anti-inflammatory properties. The evidence suggests that the systemic and physiological properties of melatonin, especially its circadian behavior regulated by phototherapy, may be more effective in respect of vitiligo improvement than the use of topical melatonin. However, the effects of the oral intake of melatonin are less clear. Phototherapy, as a potential modulator of circadian melatonin rhythm, that influences sleep and clinical improvement of vitiligo, needs further examination, as does the use of melatonin as an adjuvant treatment to UVB phototherapy in vitiligo.
中波紫外线窄谱（UVB-NB）光疗是白癜风的金标准治疗方法，主要是因为它具有免疫调节作用。此外，它可能会影响昼夜节律褪黑素平衡，这可能会间接诱导睡眠调节，而这反过来又可能有助于白癜风的改善。褪黑素、白癜风和光疗之间的关联尚未得到充分研究。本研究旨在评估有关昼夜节律褪黑素调节和睡眠对白癜风治疗中光疗影响的现有证据。我们通过 MEDLINE/PubMed 数据库进行了叙述性综述，使用了联合搜索词：褪黑素、白癜风、光疗和昼夜节律（睡眠），综合了该关联的证据。共纳入 56 篇文章。关于这种关系的研究很少，且结果存在争议。一些研究表明，UV 暴露和光疗可能通过刺激具有褪黑素受体的黑素细胞来有益于白癜风，这可能会使褪黑素的昼夜节律调节同步。这种改善的褪黑素平衡可能会导致更好的睡眠质量，进一步增强褪黑素的抗炎特性，并有助于白癜风的改善。关于局部使用褪黑素（无论是否联合光疗）治疗白癜风病变的可能影响，人们知之甚少。总之，有一些证据表明，昼夜节律褪黑素调节通过睡眠调节及其抗炎特性在白癜风病程中起着重要作用。有证据表明，褪黑素的全身和生理特性，特别是其受光疗调节的昼夜节律行为，可能比局部使用褪黑素更能有效改善白癜风。然而，褪黑素口服摄入的效果不太清楚。光疗作为昼夜节律褪黑素节律的潜在调节剂，可能会影响睡眠和白癜风的临床改善，需要进一步研究，褪黑素作为 UVB 光疗的辅助治疗在白癜风中的应用也是如此。
