Pearls for Practice
- At the end of treatment, 64% of patients in the NB-UVB group showed greater than 50% improvement in BSA affected by vitiligo vs 36% of patients in the PUVA group.
- All patients in the NB-UVB group had excellent color match of the repigmented skin vs only 11 (44%) of those in the PUVA group. At the end of follow-up, the color match in repigmented areas in all patients in the NB-UVB group remained excellent vs only 14 (61%) of 23 patients in the PUVA group.
The following article was found on medscape.com
May 23, 2007 More patients with vitiligo who receive narrowband UV-B treatment vs psoralen and UV-A therapy have improvement over 50% of their body, according to the results of a double-blind randomized trial published in the May issue of the Archives of Dermatology.“The combination of treatment with psoralen followed by irradiation with UV-A (PUVA) is a well-established treatment for nonsegmental vitiligo, but it has many disadvantages,” write Sami Sasi Yones, from the Guy’s, King’s, and St. Thomas’ School of Medicine, King’s College, London, England, and colleagues. “In the past decade, there have been reports of good efficacy using narrowband UV-B therapy (NB-UVB; 311-313 nm, TL-01 lamp, Koninklijke Philips Electronics NV, Amsterdam, the Netherlands) to treat the condition. To our knowledge, we report the first double-blind randomized trial of PUVA therapy using oral psoralen vs NB-UVB therapy for vitiligo.”
At a phototherapy unit in a university hospital, 56 patients with nonsegmental vitiligo underwent twice-weekly therapy with PUVA or NB-UVB. The primary endpoints were the change in body surface area affected (BSA) by vitiligo and the color match of repigmented skin compared with unaffected skin after 48 sessions of therapy, at the end of the therapy course, and 12 months after the end of therapy.
Data were analyzed from the 25 patients each in the PUVA and NB-UVB 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), which the investigators suggest was because of the differences in efficacy and adverse effects between the modalities, causing patients in the NB-UVB group to want a longer course of treatment.
At the end of treatment, 16 (64%) of 25 patients in the NB-UVB group showed greater than 50% improvement in affected BSA, as did 9 (36%) of 25 patients in the PUVA group. All patients in the NB-UVB group had excellent color match of the repigmented skin, as did only 11 (44%) of those in the PUVA group (P < .001).
Among patients who completed 48 sessions, the improvement in BSA affected by vitiligo was greater with NB-UVB therapy than with PUVA therapy (P = .007). The superiority of NB-UVB was generally maintained 12 months after treatment was stopped. There was no apparent association between success of treatment and duration of vitiligo.
“The mechanism of action of all phototherapy in the treatment of vitiligo may very probably involve diminution of the immunological process followed by the stimulation of residual melanocytes, particularly those residing in hair follicles,” the authors write. “Our results firmly suggest that, in most patients, the NB-UVB form of this therapy is preferable to PUVA for the treatment of vitiligo.”
Crawford Pharmaceuticals Ltd supported this study. The authors have disclosed no relevant financial relationships.
In an accompanying editorial, Henry W. Lim, MD, and Camile L. Hexsel, MD, from Henry Ford Medical Center in Detroit, Michigan, review published studies and provide a suggested treatment algorithm.
“In the past 10 years, several new methods of treating vitiligo have emerged, including NB-UVB therapy, targeted phototherapy, topical calcineurin inhibitors, and topical calcipotriene,” Drs. Lim and Hexsel write. “Refinement of surgical techniques has also continued. In 2007 … the question when managing patients with vitiligo, especially that involving exposed sites, is no longer whether to treat or not to treat but to decide which treatment method is most appropriate for the individual patient.”
Dr. Lim has disclosed being a consultant for La Roche-Posay, Neutrogena Corp, and Orfagen and receiving research grant support from Johnson & Johnson.
Arch Dermatol. 2007;143:578-584, 643-646.