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UV Phototherapy in Vitiligo: Assessing the Compliance, Response and Patient's Perception about Disease and Treatment
Type:Uv phototherapy Time:2015-05-20 9:23:32Vitiligo is a chronic, benign, but emotionally frustrating autoimmune disorder of depigmentation, with an incidence of 0.25-2.5% in India, the treatment of which is equally frustrating to the patient, as well as the doctor. Phototherapy is the first line treatment in many cases, which needs to be given at frequent sittings for long periods of time. As there is no satisfactory, short term treatment, many vitiligo patients, though enthusiastic in the beginning, become defaulters after a few weeks or months.
Aims:
This study was conducted to assess the compliance to phototherapy (PUVA and NB-UVB), determine the reasons for non-compliance, to calculate the overall response to phototherapy and to know about the patients¡¯ perception about improvement of lesions.
Materials and Methods:
All files of the patients who attended phototherapy for Vitiligo in the department for a period of 4 years from January 2007 were analyzed and the patients were contacted via mail or telephone and were made to answer questionnaire regarding their disease.
Conclusions:
At the end of this retrospective questionnaire based study we concluded that only a quarter of the patients underwent regular phototherapy, among which the younger patients and those with widespread disease and facial lesions were more compliant. Educational status and sex had no impact on default status.
Vitiligo is a chronic, benign, though emotionally frustrating disorder of pigmentation with an incidence of 1-2% world-wide and 0.25-2.5% in India.[1] Vitiligo treatment is on the whole unsatisfactory as there are no known methods which lead to complete repigmentation of the depigmented lesions, though there are many modalities which may cause partial response. Out of the currently existing treatment options which include use of topical and systemic immune suppressants, phototherapy and surgery for stable lesions, phototherapy, especially narrow band ultraviolet therapy (NB-UVB) is widely used.[2] This is especially so in the case of widespread lesions, childhood, pregnancy, etc.. NB-UVB is a relatively safe and efficacious treatment, the main drawbacks being the requirement of sophisticated narrowband chamber, the repeated visits required of the patient to the place of administration, which may not be cost effective as it is prolonged and leads to loss of working hours and increases relative cost of treatment.
Settings and Design
This was a retrospective questionnaire based study involving vitiligo patients who had undergone narrow band UVB or Psoralen Ultraviolet A light therapy in the department of dermatology for the past four years.
Materials and Methods
All cases of vitiligo, who were advised phototherapy between January 2007 and December 2010 were chosen for the study. Their files were studied for details of the disease such as duration and sites affected. The patients were divided into 2 groups: One on regular phototherapy in the hospital and another group who had discontinued. Patients were contacted personally, telephonically or through post and asked a standard set of questions to evaluate their compliance to treatment, nature and effects of phototherapy. Variables compared with both groups included age, gender, education, size and extent of lesions, number of lesions, additional treatments taken, improvement of lesions and their belief regarding disease resolution. The association of the above variables was analyzed by Chi square test and the data described on the basis of frequencies and percentages.
Statistical analysis used: Chi square test
Observations and Results
Out of 101 patients who were approached for the study, 79 patients responded, of whom 21 were regular and 58 were irregular or non-compliant.
The available data was compiled and statistically analyzed. Various parameters like age, sex, education, number and extent of the lesions, area involved (whether predominantly exposed or unexposed) and occurrence of adverse effects to phototherapy, were compared in compliant and non-compliant groups and statistical significance arrived at. Reasons for discontinuation of phototherapy and alternatives used by non-compliant patients were studied. Regularity of visit, satisfaction level and the desire to continue phototherapy were recorded in the compliant group.