Review of narrowband ultraviolet B radiation in vitiligo

Vitiligo is a common, acquired pigmentary disorder of unknown etiology with great impact on patient’s appearance and quality of life. It presents a therapeutic challenge to many dermatologists. Photochemotherapy using psoralen and ultraviolet A (UVA) therapy, topical and oral immunosuppresants, as well as cosmetic camouflage are also commonly employed with varying clinical efficacy. Phototherapy is a popular treatment option, which includes both of the generalized ultraviolet B (UVB) therapies, broadband UVB and narrowband UVB (NB-UVB). It has been used favorably, both alone as well as in combination with other agents like topical calcineurin inhibitors, vitamin-D analogs. Combination therapies are useful and may provide quicker regimentation and treat vitiligo with an additive mechanism of action than UVB phototherapy. Advances in technology may lead to the continuing use of UVB phototherapy as a treatment for vitiligo through the development of sophisticated devices and delivery systems as well as innovative application methods. These will provide increased therapeutic options for all vitiligo patients, particularly those with refractory disease. In this article, I have reviewed the available data pertaining to efficacy and safety issues for NB-UVB as monotherapy, its comparison with psoralen plus UVA and other modes of phototherapy, combination regimens that have been tried and future prospects of NB-UVB in vitiligo.     

白癜风光疗疗效与临床的关系

白癜风是一种色素脱失性疾病,以皮肤或黏膜色素减退为特征,多为后天发病,可见于任何年龄,以青壮年多见,部分患者有明显的季节性,一般春末夏初病情加重,冬季缓解.任何部位均可发病,但好发于暴露部位.该病治疗困难,影响美观,给患者带来精神心理压力.目前运用较广泛的有308 nm准分子激光、窄谱中波紫外线和氦氖激光等,临床应用发现,光疗的疗效与白癜风分型、部位、病程、治疗次数、皮肤类型和红斑反应等相关.     

Excellent color-matched repigmentation of human vitiligo can be obtained by mini-punch grafting using a machine in combination with ultraviolet therapy

A new method is reported here for treatment of vitiligo by using mini-punch grafting using a machine (mMG) in combination with ultraviolet light B (UVB) therapy. After UVB had been repeatedly irradiated to the lesional facial skin of a patient for 1 month, many mini-punch grafts were removed from the lesional skin and the same numbers of punch biopsies taken from normal scalp skin were placed into the holes of the recipient skin. Repigmentation started soon, and excellent color-matched repigmentation was observed after 12 months. Our easy and speedy mMG seems to be useful for treatment of vitiligo.     

胶带粘贴法观察窄谱中波紫外线治疗后白癜风皮损的复色

目的 探讨窄谱中波紫外线（NB-UVB）治疗前后照射区浅表角质层细胞中黑素颗粒的变化。 方法 使用胶带粘贴法对接受NB-UVB治疗的白癜风皮损进行浅表角质层细胞取样,银氨染色后观察细胞中黑素颗粒形态、分布、颜色的变化,使用Image-Pro Plus6.0显微图像分析软件计算细胞内黑素颗粒面积百分比,使用SPSS11.5对数据进行统计分析。 结果 治疗前白斑区仍残存少量含黑素颗粒的浅表角质层细胞。治疗前黑素颗粒面积百分比为（5.31 ± 4.12）%,治疗10次后为（6.24 ± 2.65）%,治疗20次后为（10.14 ± 5.73）%,治疗30次后为（13.05 ± 6.17）%,方差分析显示,治疗前、治疗10次、治疗20次、治疗30次后黑素颗粒面积百分比差异有统计学意义（F = 4.334,P < 0.05）,经两两比较分析,治疗30次后细胞内黑素颗粒面积百分比相对治疗前及治疗10次后均增高（P值均 < 0.01）。皮损复色区新生黑素颗粒染色后形态、颜色与治疗前周边正常肤色区有所不同。结论 用浅表角质层细胞胶带粘贴法可以客观评估NB-UVB治疗白癜风的复色过程。     

窄谱中波紫外线治疗白癜风

白癜风是一种常见的色素脱失性疾病,应用窄谱中波紫外线治疗有一定疗效.比较单独应用窄谱中波紫外线、窄谱中波紫外线联合其他药物的临床疗效及不良反应.窄谱中波紫外线是治疗成人或儿童泛发性白癜风以及严重影响患者生活质量的限局性白癜风安全有效的方法;尤其对于肤色较深患者及面颈部的皮损,疗效更佳.对于窄谱中波紫外线联合其他药物的利弊及长期应用的风险,需要进一步评估.     

308nm准分子光联合他克莫司软膏治疗白癜风临床观察

目的观察308nm准分子光联合他克莫司治疗白癜风的临床疗效。方法 360例白癜风患者随机分为联合组和308单频光组,两组均采用准分子光系统进行308nm光疗,联合组同时外用他克莫司软膏。结果联合组和308单频光组的有效率分别为83.9%和70.1%,差异具有统计学意义(P<0.05)。两组临床有效率最高的部位均为颈部、面部和躯干,最低为手足部;稳定期疗效高于进展期,差异均具有统计学意义(P<0.05)。结论 308nm准分子光联合外用他克莫司软膏治疗白癜风临床疗效好。     

治疗性皮肤创伤诱导白癜风皮损复色的机制与临床研究进展

【摘要】 人们很早就注意到用皮肤磨削术、中医梅花针或皮肤微针,甚至剥脱性点阵CO2激光等对常规中波紫外线光疗抵抗的白癜风皮损可有效诱导复色。这些治疗除了因创伤增加药物透皮吸收外,还启动了创伤修复以及对毛囊或表皮黑素细胞的活化。伤口周围基底层角质形成细胞、血管内皮细胞和成纤维细胞分泌趋化因子12以招募毛囊隆突区或皮损周围表达趋化因子受体CXCR4/CXCR7的黑素细胞或黑素干细胞向白斑区移行。本文综述治疗性皮肤创伤诱导白癜风皮损复色的研究进展。     

窄谱中波紫外线治疗白癜风疗效与相关因素的探讨

我科采用窄谱中波紫外线（NB-UVB）对2010年1月至2013年3月期间于本科就诊的135例白癜风患者进行治疗,现回顾性地分析总结临床因素与疗效的关系……     

光疗在白癜风治疗中的临床应用

白癜风是一种常见的慢性获得性色素减少性疾病,其发病机制尚不清楚,可能的机制有自身免疫、黑素细胞自毁、神经精神因素、表皮因子失衡及遗传因素等.临床上治疗白癜风的方法很多,光疗及其联合疗法是目前有效的治疗方法之一,尤其适用于泛发性及难治性白癜风.而临床应用中,光疗疗效受多因素影响,如疾病分型、患病年龄、皮损部位等.因此了解各种光疗的作用机制,适应证,临床疗效及不良反应,有助于临床医生选择最佳的治疗方案.     

308 nm准分子激光与高能紫外线治疗进展期局限型白癜风疗效评价

目的 评价308 nm准分子激光与高能紫外线治疗进展期局限型白癜风的疗效与安全性,皮肤共聚焦显微镜观察治疗前后皮损区改变。方法 进展期局限型白癜风患者60例203片皮损,每例均有相同解剖部位皮损 ≥ 3片,其中1片作为空白对照,另外 ≥ 2片皮损随机接受308 nm准分子激光（激光组）与高能紫外线（紫外线组）治疗,每周2次,共治疗25次。结果 48例患者169片皮损完成试验。激光组显效率［66.15%（43/65）］高于紫外线组［44.64%（25/56）］,χ2 = 8.28,P < 0.01。白癜风活动度2分组显效率［67.69%（44/65）］高于3分组［44.64%（25/56）］,χ2 = 6.80,P < 0.01。随访 3个月,未见复发。皮肤共聚焦显微镜下发现,部分皮损边界线内外真表皮交界处炎症细胞增多,治疗后,炎症细胞数量显著减少,部分皮损炎症细胞数量完全恢复正常。结论 308 nm准分子激光与高能紫外线治疗进展期局限型白癜风疗效显著,308 nm准分子激光见效更快,疗效更好。     

白癜风诊疗共识（2021版）

【摘要】 白癜风是一种常见色素性皮肤病之一,严重影响患者的身心健康。中国中西医结合学会皮肤性病专业委员会色素病学组在2018版白癜风治疗共识的基础上复习近3年白癜风的研究进展,同时结合专家的临床经验,对白癜风的维持治疗和糖皮质激素干预应用进行修订,展望JAK抑制剂治疗,最终达成本共识。     

A review of JAK and IL-23 inhibitors to treat vitiligo

Vitiligo is an autoimmune skin disorder resulting in the depigmentation of skin characterised by patches of varying sizes and shapes. A common disorder of pigmentation that affects 0.5%–2% of the global population. Despite its well-understood autoimmune pathogenesis, the targets for effective cytokine intervention remain unclear. Current first-line treatments include oral or topical corticosteroids, calcineurin inhibitors and phototherapy. These treatments are limited, have varying efficacies, and are associated with significant adverse events or can be time-consuming. Therefore, biologics should be explored as a potential treatment for vitiligo. There are currently limited data for the use of JAK and IL-23 inhibitors for vitiligo. A total of 25 studies were identified in the review. There is promising evidence regarding the use of JAK and IL-23 inhibitors for the treatment of vitiligo.     

窄谱中波紫外线照射对白癜风自体表皮移植的作用研究

目的：探讨自体表皮移植联合窄谱中波紫外线（NB?UVB）照射治疗白癜风的临床疗效及可能作用机制。方法30例白癜风患者分为单纯表皮移植组和表皮移植联合NB?UVB组。用酶联免疫吸附测定检测局部皮损组织液中白细胞介素18（ IL?18）、肿瘤坏死因子α（ TNF?α）以及可溶性细胞间黏附分子1（sICAM?1）水平,并进行疗效评估。结果治疗前,单纯表皮移植组和表皮移植联合NB?UVB组局部皮损组织液中IL?18分别为（0.985±0.305）μg/L和（1.008±0.399）μg/L;TNF?α分别为（1.132±0.313）μg/L、（1.147±0.474）μg/L;sICAM?1分别为（1.215±0.284）μg/L、（1.221±0.432）μg/L;水平明显高于健康对照组（均P<0.01）。表皮移植联合NB?UVB组治疗后各细胞因子水平基本恢复正常,有效率（68.9%）明显高于单纯表皮移植组（43.8%）,P<0.05。结论白癜风患者局部皮损处存在免疫异常,NB?UVB照射可以通过调节机体免疫功能提高表皮移植的成功率。     

窄谱中波紫外线治疗白癜风治疗参数选择

【摘要】 我国窄谱中波紫外线应用于白癜风治疗已有十余年,目前,其临床治疗参数尚缺乏统一标准,不规范的治疗不仅不能使患者从中获益,还易引起红斑、水疱、光老化等不良反应。基于世界白癜风工作组光疗委员会制定的窄谱中波紫外线治疗白癜风的专家共识,结合相关文献及临床治疗经验,本文从治疗频率、初始治疗剂量、连续治疗或中断治疗后剂量调整、平台期及疗程选择、可接受的最大光疗总次数等方面讨论窄谱中波紫外线治疗参数的选择,提高窄谱中波紫外线治疗白癜风的疗效。     

Human exposure to solar ultraviolet radiation

Solar ultraviolet (UV) irradiation depends upon the local UV climate, people's behaviour. Behaviour includes the time spent outdoors and the use of photoprotective agents. In adult life, a British indoor worker in the UK might typically receive 30% of his or her annual UV exposure from sun-seeking holidays, 40% from summer weekends, 20% from casual weekday exposure between April and September and just 10% from sun exposure during the 6 month period October to March. Whilst climatic factors do influence levels of UV radiation (UVR) at the Earth's surface, it is people's behaviour out of doors that has a much greater impact on personal solar UV irradiation. Methods of personal protection include: avoiding direct sunlight in summer around noon; seeking the shade; wearing clothing absorbs UVR; wearing hats that shade face and neck; and using topical sunscreens.     

局部PUVA治疗白癜风的疗效观察

为了探讨局部PUVA治疗癜风的疗效,对80例白癜风患者进行局部PUVA治疗。结果表明经30次治疗后,总有效率为85.00%,其中125例（18.75%）患者痊愈。局限型白癜风有较好的疗效。疗效与病程相关,与皮肤光毒反应无关。     

Personnel monitoring of exposure to ultraviolet radiation

A cheap, simple badge for personnel UVR exposure monitoring has been developed; it is based on measuring the optical absorbance of a polysulphone film. This has been successfully used to demonstrate quantitative differences in UVR exposure of groups of people in different environments.     

白癜风患者窄谱中波紫外线治疗效果与光疗反应的关系及相关因素分析

目的 评估白癜风患者窄谱中波紫外线（NB?UVB）治疗效果与光疗反应的关系,并探讨光疗反应的影响因素。方法 收集2017年1月至2018年3月在浙江中医药大学附属杭州第三医院确诊并在光疗中心接受NB?UVB光疗的104例白癜风患者,其中男55例,女49例,平均年龄32.06岁（4 ~ 64岁）;病程2个月至27年,平均8.15年。记录患者初始复色、出现平台期所需光疗次数和有效光疗次数。采用秩和检验评估不同疗效的患者上述指标的差异,多元线性回归分析寻找出现平台期所需光疗次数及有效复色光疗次数的影响因素。结果 随访104例患者,其中2例色素脱失斑完全复色,1例对光疗完全无反应,52例复色面积 ≥ 50%（效优组）,49例 < 50%（效差组）。排除完全复色患者2例和治疗无反应患者1例,共101例患者纳入分析。效优组初始复色所需光疗次数［M（P25,P75）,8（7,10）］少于效差组［10（8,13）,Z = 3.125,P = 0.002］,达到平台期所需光疗次数［41（29,60）］及有效复色光疗次数［32（18,51）］均高于效差组［分别为35（26,44）和24（8,36）,Z值分别为-3.375、-4.407,P < 0.001］。达到平台期所需光疗总次数与皮损面积（β = 0.360,t = 2.698,P = 0.008）、病程（β = 0.215,t = 2.325,P = 0.022）呈正相关,与白癜风疾病活动度（VIDA）评分（β = -2.665,t = -3.969,P < 0.001）呈负相关;有效复色光疗次数与皮损面积（β = 0.358,t = 2.582,P = 0.011）、病程（β = 0.216,t = 2.276,P = 0.025）呈正相关,与白癜风VIDA评分（β = -2.669,t = -3.935,P < 0.001）和初始复色起效次数（β = -1.011,t = -4.508,P < 0.001）均呈负相关。结论 白癜风患者接受NB?UVB治疗时初始复色光疗次数越少,复色期间有效光疗次数越多,光疗效果越好;皮损面积、病程及分期可为光疗患者预测到达平台期所需光疗次数提供一定依据。     

系统应用糖皮质激素治疗白癜风

白癜风是一种常见的色素脱失性皮肤病,发病机制复杂且不完全清楚,治疗方式多样但疗效欠佳。研究表明,系统应用糖皮质激素通过其抗炎、免疫抑制等作用可以控制白癜风的进展、促进皮损复色,其治疗方法包括低剂量每日口服疗法、间歇疗法、冲击疗法,以及联合外用药、光疗、外科治疗等。系统应用糖皮质激素需根据白癜风类型、发展时期选择适宜的治疗方法,才能达到最佳疗效、减少不良反应。