VITILIGO TREATMETNS - NARROWBAND UV-B MORE EFFECTIVE

Vitiligo treatments Narrowband UV-B treatment more effective than psoralen UV-A Therapy

More than vitiligo patients who receive narrowband UV-B vs treatment psoralen and UV-A, have improved over 50% of their body, according to the results of a double-blind randomized trial published in the May issue of Archives of Dermatology.

The combination vitiligo treatments with psoralen followed by UV-A radiation (PUVA) is well established for the treatment of nonsegmental vitiligo, but it has many drawbacks," write Sami Sasi Yones, Guy's, King's and St. Thomas School of Medicine, King's College, London, England, and his colleagues. "In the last decade, there have been reports of good efficiency using narrowband UV-B therapy (NB-UVB, 311-313 nm, TL-01 lamp, Koninklijke Philips Electronics NV, Amsterdam, Netherlands) to deal the disease. To our knowledge, we report the first double-blind randomized trial of PUVA therapy oral psoralen vs NB-UVB therapy for vitiligo.

At a phototherapy unit in a university hospital, 56 patients with nonsegmental vitiligo has suffered twice a week with PUVA therapy or NB-UVB. The main assessment criteria were changing the affected body surface area (BSA) by vitiligo and color match of the repigmented skin against skin unchanged after 48 sessions of therapy, at the end of therapy courses, and 12 months after the end of treatment.

The data were analyzed from 25 patients each in the NB-UVB and PUVA groups who began therapy. The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB-treated group (P = .03), suggesting investigators because of differences in the effectiveness and adverse effects between modalities, which causes patients in the NB-UVB group wanting a longer treatment.

At the end of vitiligo treatments, 16 (64%) of 25 patients in the NB-UVB group showed more than 50% improvement in these BSA, as did 9 (36%) of 25 patients in PUVA group. All patients in the NB-UVB group had an excellent color matching of the repigmented skin, as only 11 (44%) of those in the PUVA (p <.001).

Among patients who completed 48 sessions of vitiligo treatments, improving BSA affected by vitiligo is greater with NB-UVB therapy that therapy with PUVA (P = .007). The superiority of NB-UVB is typically updated 12 months after treatment was stopped. There was no apparent association between successful treatment and duration of vitiligo.

"The mechanism of action of all phototherapy in the treatment of vitiligo May very likely involve the reduction of the immunological procedure followed by stimulation of melanocytes residual, especially those residing in the hair follicles," the authors write. "Our results suggest strongly that in most patients, NB-UVB this form of therapy is preferable to PUVA for the vitiligo treatments.

In an accompanying editorial, Henry W. Lim, MD, and Camile L. Hexsel, MD, Henry Ford Medical Center in Detroit, Michigan, review of published studies and provide an algorithm proposed vitiligo treatments.

"During the last 10 years, several new methods of vitiligo treatments have emerged, including NB-UVB therapy targeted phototherapy, topical immunomodulators, and news calcipotriene," Drs. Hexsel Lim and write. "Refinement of surgical techniques has also continued. ... In 2007, the issue at the management of patients with vitiligo, particularly those relating to sites exposed, is no longer whether to treat or not treat but to decide which method of vitiligo treatments is most appropriate for the individual patient. "

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