Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites

Phototherapy for the treatment of vitiligo in Asian children

Vitiligo is a common acquired progressive depigmenting condition that can have devastating psychological effects in dark-skinned patients. We performed a retrospective review of patients younger than 16 years of age with a clinical diagnosis of vitiligo treated using phototherapy at the National Skin Center, Singapore, over a 5-year period. Seventy-one Asian patients ages 5 to 15 years when they underwent phototherapy were identified. There was a higher proportion of Indian patients in our cohort than in the population. The duration of disease ranged from 2 months to 12 years. More than half of the patients had generalized vitiligo and more than one-third had segmental vitiligo. Patients with generalized vitiligo had a better response than those with segmental vitiligo. Reported response rates were highest for narrowband ultraviolet B (UVB) phototherapy, followed by targeted phototherapy combining ultraviolet A1 (UVA1) and UVB; 308-nm excimer lamp phototherapy and paint psoralen-UVA photochemotherapy had marginally lower reported response rates. The duration of treatment ranged from 3 to 40 months and the total number of treatments ranged from 20 to 209 sessions. Reported side effects were mild and included itching, scaling, erythema, pain, sunburn, blistering, and phototoxicity. We consider phototherapy to be a safe and efficacious modality for the treatment of vitiligo in Asian children.

Beyond vitiligo guidelines: combined stratified/personalized approaches for the vitiligo patient

'Vitiligo' is a word that bears endless possibilities and no promises. Each vitiligo patient has a different story that demands a different therapeutic approach. Even though great efforts have been made to evaluate, study, compare and document the different therapeutic modalities available for vitiligo, clearly handling their modes of actions as well as their side effects and establishing clear stratified guidelines, numerous dilemmas are frequently met on practical grounds. 'Stabilize', 'repigment', 'depigment' or 'camouflage'? 'for whom and how do we achieve the best results' ? 'Separately or in combination ? - questions that need to be answered and decisions need to be taken in the appropriate timing and altered when the necessity arises. In the current viewpoint, we have utilized the available knowledge and exploited years of experience in an attempt to go beyond the guidelines to set the rationale for an optimal and personalized therapy, within the framework of a stratified approach.

Most individuals with either segmental or non-segmental vitiligo display evidence of bilateral cochlear dysfunction

BACKGROUND

Vitiligo has been classified clinically into segmental vitiligo (SV) and nonsegmental vitiligo (NSV) and may also be associated with audiological abnormalities.

OBJECTIVES

We examined cochlear function in ears of individuals with SV and NSV, including subjects with facial and nonfacial lesions, and in patients who have SV with unilateral facial involvement.

METHODS

This study included 25 patients with SV and 28 patients with NSV. Fifteen age- and sex-matched healthy individuals served as controls. Cochlear function was studied using the distortion product otoacoustic emissions (DPOAEs). Data were analysed using SPSS.

RESULTS

Sixty-four ears (60%) of patients with vitiligo had cochlear dysfunction while the control group exhibited no abnormalities. On comparing the cochlear dysfunction of patients with SV with patients with NSV, no statistically significant difference was found. The ears on both sides, affected and unaffected by vitiligo, in patients with SV showed cochlear dysfunction with no statistically significant difference in DPOAE. To determine the effect of the lesion side on cochlear function, we compared DPOAE amplitude using Student's t-test. The comparisons included NSV of the face vs. NSV on other areas, NSV of the face vs. SV of the face and SV of the face vs. SV of other areas. No statistically significant difference was found in these comparisons.

CONCLUSIONS

Bilateral cochlear dysfunction is common in both NSV and SV and does not reflect the appearance of vitiligo in the skin. Our results underscore the important role of melanocytes and melanin in cochlear function, and suggest that the cochlear abnormalities in SV point to the presence of additional nonsegmental pathophysiological events underlying all forms of vitiligo.

Guidelines for the management of vitiligo: the European Dermatology Forum consensus

The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence-based and expert-based recommendations (S1 level).

A comparative study on efficacy of UVA1 vs. narrow-band UVB phototherapy in the treatment of vitiligo

BACKGROUND/PURPOSE

Narrow-band ultraviolet B (NB-UVB) is considered the most effective and safe initial treatment for moderate-to-severe vitiligo but phototoxicity and possible carcinogenicity are the reported side effects. Ultraviolet A1 (UVA1) phototherapy has overlapping biological effects to NB-UVB and is relatively free of side effects associated with other phototherapy regimens.

METHODS

Forty patients with vitiligo were included in this prospective, randomized controlled comparative clinical trial. Twenty patients received NB-UVB and 20 received UVA1 three times weekly for 12 weeks. The UVA1 group was divided into two subgroups. Ten patients received moderate and 10 received low dose of UVA1. Serum samples were collected before and after 36 sessions to assess soluble interleukin 2 receptor level. Patients were clinically evaluated before therapy then monthly according to Vitiligo Area Scoring Index (VASI) and Vitiligo European Task Force (VETF) scores. In addition, extent of response was determined by a blinded dermatologist comparing before and after therapy photographs. Pattern of response and side effects were recorded.

RESULTS

NB-UVB was superior to UVA1 with a significant difference in blinded dermatological assessment (P<0.001), percentage change in VASI score (P<0.001) and percentage change in VETF area score (P=0.001). No significant difference in side effects was observed between both groups. Comparing UVA1 subgroups, better response in moderate-dose group was found as regard to percentage change in VASI (P<0.001) and percentage change in VETF area score (P=0.001), while no significant difference was found in blinded dermatological assessment (P=0.121).

CONCLUSION

NB-UVB phototherapy remains to be an effective and safe therapeutic option in vitiligo. Response to UVA1 in vitiligo seems to be dose dependent and seems to be of limited value in treatment of vitiligo as a monotherapy. Further studies combining it with other lines of therapy such as systemic steroids may prove beneficial.

Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: the experience of an academic medical center in the United States

BACKGROUND

Vitiligo is a disfiguring disease with limited treatment options. Surgical treatment is underused in the United States because of perceived risk of infection, costs, and difficulty of the procedure.

OBJECTIVE

We sought to determine the efficacy and safety of the melanocyte-keratinocyte transplantation procedure (MKTP) in an academic dermatology department in the United States.

METHODS

This prospective, uncontrolled, open-label study enrolled patients aged 18 years or older with a self-reported history of vitiligo and no new or expanding lesions for at least 6 months before surgery. Patients with a history of koebnerization or keloid formation were excluded. Patients underwent autologous MKTP. Repigmentation during a 3- to 6-month follow-up period was assessed categorically and by modified Vitiligo Area Scoring Index. Safety was assessed by frequency of adverse events.

RESULTS

Of the 28 patients who underwent 36 procedures, 23 patients who underwent 29 procedures completed the 3- to 6-month follow-up period. Data for these 29 procedures show excellent repigmentation (ie, 95%-100%) after the MKTP in 17%, and good repigmentation (ie, 65%-94%) in 31%. Fair (64%-25%) and poor (24%-0%) repigmentation were achieved in 10% and 41% of patients, respectively. Average percent change in Vitiligo Area Scoring Index was -45% (95% confidence interval -64% to -26%), signifying an improvement in pigmentation.

LIMITATIONS

Limitations include small sample size and lack of a control group.

CONCLUSIONS

The MKTP is an effective and well-tolerated procedure based upon categorical and Vitiligo Area Scoring Index assessments of repigmentation.

The effect of 308nm excimer laser on segmental vitiligo: a retrospective study of 80 patients with segmental vitiligo

BACKGROUND

Segmental vitiligo (SV), which frequently accompanies poliosis, indicating a poor prognosis that is likely resistant to treatments.

OBJECTIVES

In this study, we performed a retrospective analysis to evaluate the treatment response to 308 nm excimer laser in SV patients.

METHODS

A retrospective chart and photographic review was performed on 80 SV patients who had been treated with 308nm excimer laser for >3 months.

RESULTS

Eighty patients with SV (mean age: 24.0 years ± 15.3, males: 50%) were included in this study. The mean grade of repigmentation was 2.3 after 20.6 months of mean treatment duration; 23.8% of 80 patients showed grade 4, 20% showed grade 3, and 56.2% showed grade 1-2 repigmentation. However, none of them achieved complete repigmentation with excimer laser. The degree of repigmentation was positively correlated with treatment duration (r=0.315, P=0.004) and cumulative ultraviolet (UV) dosage (r=0.366, P=0.001), whereas it was negatively correlated with disease duration (r=-0.265, P=0.017).

CONCLUSION

This study suggests that SV has a better repigmentation response when excimer laser is used at earlier stages of the disease and long-term use and high cumulative UV energy of the excimer laser elicit better responses. Additional treatments like surgical procedures in addition to excimer laser should be considered for complete repigmentation.

Treatment of vitiligo with narrow-band ultraviolet B: advantages and disadvantages

BACKGROUND

Narrow-band ultraviolet B (NB-UVB) therapy for vitiligo is increasingly used in patients who are unresponsive to other forms of therapy.

OBJECTIVE

This study measures levels of patient and physician satisfaction and the associated advantages and disadvantages of NB-UVB.

METHODS

A retrospective chart review was conducted of the first 50 patients with vitiligo treated at the Photoderm Clinic in Ottawa, Ontario. Data were obtained from digital photographs and patient charts (n = 50).

RESULTS

Percent repigmentation of the face and body was very good compared with the hands and feet (poor = 0-or< 33%; good = 33-or< 66%; very good = >or= 66%). The physician and patients were satisfied with results achieved with NB-UVB therapy (very good [VG]: medical doctor [MD] 49% [95% CI 35-63], patient [Pt] 51% [95% CI 37-65]; good [G]: MD 24% [95% CI 12-36], Pt 22% [95% CI 10-34]).

CONCLUSION

NB-UVB therapy is an effective treatment for vitiligo (ie, VG, repigmentation >or= 66%) that leads to high levels of patient and physician treatment-related satisfaction. Although there are disadvantages to NB-UVB therapy, the advantages outweigh the drawbacks. An objective evaluation such as the Vitiligo Area Scoring Index (VASI) is necessary to validate these findings. Additional limitations include those inherent in retrospective study design.

Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band phototherapy

BACKGROUND

The treatment of vitiligo is still a challenge, but ultraviolet B narrow-band (UVB-NB) therapy has been recently reported to be an effective and safe therapeutic option in patients with vitiligo.

OBJECTIVE

The purpose of this study is a critical evaluation of the variants (body sites, age, duration of the disease, and duration of the therapy) influencing the clinical response to UVB-NB therapy.

METHODS

Sixty patients (23 male and 37 female), aged 6 to 70 years, with vitiligo, were treated with UVB-NB therapy over a maximum period of 2 years. The evaluation of the percentage of repigmentation was done through photographs.

RESULTS

The lesions located on the face obtained a complete repigmentation in 68% of the patients, on the neck in 57.89%, and on the trunk in 50% within the first year of the therapy. In young patients vs. adults patients, the lesions located on the neck obtained a complete repigmentation in 83.33% vs. 46.15%, on the upper limbs in 28.57% vs. 9.52%, and on the lower limbs in 25% vs. 16.67%. In patients with vitiligo of recent onset, the lesions located on the neck obtained a complete repigmentation in 83.33%, on the upper limbs in 33.33%, and on the lower limbs in 28.57%. Hands did not give a positive response in either groups.

CONCLUSION

This study shows that certain body sites respond better than others to the UVB-NB therapy; patients, aged less than 20 years, with recent vitiligo, achieve more repigmentation; the duration of the therapy can influence the response of the lesions over hands and lower limbs, showing only mild repigmentation.