Kernel Medical Sub-website : www.kerneluvb.com
General management of vitiligo showed that the most commonly used uv phototherapy was NB-UVB
Type:Uv phototherapy Time:2016-02-01 10:13:40Our recently published study concerning the general management of vitiligo showed that the most commonly used phototherapy was NB-UVB. NB-UVB was used to treat generalized vitiligo in 36% of children and 40% of adults. The use of oral PUVA was limited (8% for generalized vitiligo in adults), and topical PUVA was also reported to be useful by a few respondents (1 to 8% for different types of vitiligo).
Excimer laser, a relatively new vitiligo treatment modality with wavelengths of 308 and 311 nm, was used by some of our respondents to treat segmental and focal vitiligo. Its main advantage is the ability to apply targeted treatment only to the depigmented sites, which makes it a good option for segmental and focal vitiligo. In two studies, the excimer laser achieved a good to very good response in 30 to 75% of patients, especially for vitiligo on the face, without any serious side effects. In our survey, excimer laser was the most common phototherapy modality used for focal and segmental vitiligo.
The most common treatment frequency for all forms of phototherapy in our study was three times per week. NB-UVB was provided three times a week by 74.2% of dermatologists. This is consistent with the 2009 British guidelines for vitiligo management.
The published data for patients with psoriasis can likely be applied to vitiligo. A randomized, observer-blinded trial of twice- vs. three-times-weekly NB-UVB therapy for psoriasis reported that for the majority of the population with skin phototypes I to III, three-times-weekly NB-UVB clears psoriasis significantly faster than twice-weekly treatment.
However, there are no published comparative studies of different weekly frequencies of phototherapy for vitiligo.
The dermatologists predominantly started all patients at the fixed starting dose of NB-UVB, whereas 31% reported that they base the starting dose on the UVB-determined MED. For topical PUVA, 54% use the Fitzpatrick skin phototype of the patient to determine the initial phototherapy dose. Fifty percent always calculate the cumulative doses for PUVA, and 76% always calculate the cumulative doses for UVB.
UVB-determined MED has significant therapeutic importance when applied to protocols that base the dose of UVB on MED. The measurement of MED actually determines the dose-response to the UVB light delivered. The average NB-UVB MED for type I skin is reported as 400 mJ/cm 2 .
Seventy percent of the MED value is commonly used for the first treatment; thereafter, therapy is administered two or three times per week with 20% increase each week, depending on the local response and the skin-type tolerance. Another approach involves the use of a standard starting dose (280 mJ/cm 2 ) with stepwise increase (usually 20%) depending on the patient's erythema response.