BACKGROUND: Vitiligo is characterized by depigmented patches of skin due to loss 
of cutaneous melanocytes. Many recent studies have demonstrated defects in the 
melanocortin system in patients with vitiligo, including decreased circulating 
and lesional skin levels of α-melanocyte-stimulating hormone (α-MSH). 
Afamelanotide is a potent and longer-lasting synthetic analogue of naturally 
occurring α-MSH.
OBSERVATIONS: We describe the preliminary results of 4 patients with generalized 
vitiligo who developed repigmentation using afamelanotide in combination with 
narrowband UV-B (NB-UV-B) phototherapy. Patients were treated 3 times weekly 
with NB-UV-B and starting in the second month received a series of 4 monthly 
implants containing 16 mg of afamelanotide. Afamelanotide induced faster and 
deeper repigmentation in each case. All patients experienced follicular and 
confluent areas of repigmentation within 2 days to 4 weeks after the initial 
implant, which progressed significantly throughout treatment. All patients 
experienced diffuse hyperpigmentation.
CONCLUSIONS: We propose that afamelanotide represents a novel and potentially 
effective treatment for vitiligo. The combined therapy of NB-UV-B and 
afamelanotide appears to promote melanoblast differentiation, proliferation, and 
eumelanogenesis. Further studies are necessary to confirm these observations.