Vitiligo phototherapy: Effectiveness of UV Vitiligo treatment

American Academy of Dermatology. Study Confirms Effectiveness of Revolutionary Vitiligo Treatment SCHAUMBURG, IL (July 12, 2001) Imagine feeling perfectly healthy on the inside, but on the outside something looks wrong.

For millions of people who suffer from vitiligo, a disease in which patients experience a complete loss of pigment in localized areas of the skin, this feeling is one they know all too well. In a new study by dermatologist Henry W. Lim, MD, chairman of the department of dermatology at Henry Ford Hospital, Detroit, Mich., the effectiveness of narrow-band UVB (NB-UVB) phototherapy as treatment for vitiligo was examined in a small sampling of patients. The results of the study are promising for this often hard-to-treat skin condition. After completing an average of 19 treatments with NB-UVB phototherapy, five of the seven vitiligo patients that participated in the study showed greater than 75 percent repigmentation. Additionally, one patient has remained repigmented 11 months after phototherapy was discontinued. "The successful repigmentation that these patients experienced is quite remarkable," explained Dr. Lim, co-author of "Narrow-Band Ultraviolet B is a Useful and Well-Tolerated Treatment for Vitiligo" published in the June 2001 issue of the Journal of the American Academy of Dermatology. "Vitiligo is a difficult skin condition to treat, and patients are often frustrated because results from some of the other current treatments are not nearly as favourable."

Vitiligo is a disease in which patients have a complete loss of pigment in localized areas of the skin. These areas, often around the mouth and eyes, become completely white. As a result, vitiligo can be cosmetically disfiguring, especially for dark-skinned people. Vitiligo affects 1 percent to 2 percent of the worldwide population and about half of the people who develop it do so before the age of 20. About one fifth of those with vitiligo have a family member with this condition. Vitiligo usually affects both sides of the body, and although the cause is generally not known, it is believed to be an autoimmune process. During the twelve-month trial period, 11 patients participated in Dr. Lim s study. Therapy was administered three times a week and affected segments of the body were treated with NB-UVB, a light source that emits a very narrow spectrum of UVB, the portion of sunlight that causes sunburn. The dose of radiation was increased by 15 percent for each treatment. If mild burning, pain or blistering developed, the irradiation dose was decreased. Once the desirable 75 percent repigmentation was achieved, the frequency of treatments was tapered to twice a week for four weeks, then weekly for an additional four weeks.

NB-UVB therapy has several advantages over other therapies for vitiligo. While topical corticosteroid therapy has a success rate of 56 percent, long-term use of corticosteroids can result in thinning of the skin, stretch marks, and dilation of blood vessels. Another treatment option is oral or topical psoralen plus UVA (PUVA), the latter which has a success rate of 51 percent. However, patients need to ingest or apply psoralen before getting the light treatment, and long term use of oral PUVA for another skin disease, psoriasis, has been associated with an increased incidence of skin cancer. presently, there are only a few centres in the United States that have the capabilities for NB-UVB therapy; therefore patients undergoing this therapy have long distances to commute. While NB-UVB therapy has been used in Europe since the mid-1980s, there has not been any evidence that it causes an increase in skin cancer.

"Our findings confirmed that narrow-band UVB therapy is a useful and well-tolerated treatment option for patients with vitiligo," says Dr. Lim. "Although more research needs to be conducted, the successes thus far are promising to those who suffer from the psychological and physical effects of vitiligo."

Narrow Band UVB phototherapy has consistently achieved over 90% repigmentation within a year for most patients. Neighbouring pigment cells will produce new pigment into the Vitiligo patches providing the melanocytes still exist in the adjoining areas of skin.

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