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UV Phototherapy is a well-established treatment for vitiligo
Type:Uv phototherapy Time:2015-05-21 9:39:20Several variations exist in the approaches to and practice of phototherapy for vitiligo, including the types of phototherapy used for different types of vitiligo, dosage schedules, photoprotection, comparisons of different modalities, and dermatologists' management of adverse events.
Phototherapy is a well-established treatment for vitiligo. It should generally be reserved for patients whose vitiligo cannot be adequately controlled with more conservative treatments, who have widespread vitiligo, or who have localized vitiligo with a significant impact on their quality of life.
In Saudi Arabia, the majority of patients have access to government hospitals where phototherapy, especially NB-UVB, is widely available. Some government hospitals have excimer lasers, but they are mostly offered in private hospitals. Phototherapy is provided free of charge in government hospitals, and NB-UVB is considered to be inexpensive at private centers. The cost of NB-UVB in a private center is 30 Saudi riyals (about $8 US) per session; however, excimer laser is more expensive (100-200 Saudi riyals per session, equivalent to 27 to 54 US$).
In Saudis, the skin phototype is Type IV to V, and there are no specific recommendations in the published guidelines for patients with skin of color. Therefore, for our own local practice, we need to take this ignorant part into account for production of guidelines in Saudi Arabia.
The survey responses showed that phototherapy is a common and important treatment option used by most of our Saudi dermatologists (98.2%). The results are of great significance here because most of these general dermatologists see 18 ¡À 2.26 vitiligo patients per week.
The use of NB-UVB phototherapy to treat vitiligo was reported for the first time by Westerhof and Nieuweboer-Krobotova in 1997. Subsequently, several studies confirmed the efficacy of this therapy for the treatment of vitiligo. NB-UVB is one of the most efficacious treatments, with an optimum side-effect profile and an average response rate of 62% demonstrated in one study; however, 6 to 12 months of treatment are needed before optimum results are achieved.
Overall, our dermatologists used NB-UVB more frequently than PUVA or BB-UVB. This response was expected, as the efficacy of NB-UVB in treating vitiligo has been clearly shown in recent clinical trials. PUVA is a less-used modality for all types of vitiligo, potentially reflecting the published data that indicate a decreased effectiveness and an increased risk of PUVA-associated malignancies. NB-UVB has the advantage of being more acceptable for patients than PUVA because they do not need to take oral medication before exposure to the radiation or wear protective sunglasses afterwards. Moreover, NB-UVB proved to be equal or superior to oral PUVA in treating vitiligo.
Phototherapy with BB-UVB appears less effective than PUVA and is used less frequently. NB-UVB became widely available in 1991 and appeared to be more effective for the treatment of vitiligo than the BB-UVB that it replaced. An arbitrary limit of 200 NB-UVB treatments for vitiligo has been suggested.
Most of our respondents favored NB-UVB over PUVA. The majority of them said that NB-UVB produced better repigmentation and that the repigmentation achieved was cosmetically acceptable and matched the surrounding normal skin, in contrast to the results of PUVA therapy. This finding is supported by a study demonstrating that NB-UVB therapy is superior to oral PUVA therapy. In that study, 25 patients with vitiligo were treated with PUVA, and 25 were treated with NB-UVB. NB-UVB appeared to provide a better response than did PUVA. At the end of therapy, 64% of the NB-UVB patients had a 50% or greater reduction in the body surface area affected, compared with 36% of the PUVA group. The color match of the repigmented skin was excellent for all patients in the NB-UVB group but for only 44% of those in the PUVA group.