Therapeutic evaluation of UVB‐targeted phototherapy in vitiligo that affects less than 10% of the body surface area*

Background Current treatments for vitiligo include different therapeutic modalities, such as corticosteroids, immunomodulators, pseudocatalase, skin grafts, diverse types of phototherapy [ultraviolet B (UVB), psoralen plus UVA (PUVA), narrow‐band UVB (NB‐UVB)], and, recently, targeted phototherapy. After a literature search, we found only two studies using different targeted broad‐band UVB units for the treatment of vitiligo. Objective To evaluate the repigmentation response induced with broad‐band, UVB‐targeted phototherapy used as monotherapy in patients with vitiligo affecting less than 10% of the skin surface. Methods Twelve patients were recruited for treatment with 30 sessions of UVB‐targeted phototherapy administered twice weekly. The assessment of repigmentation was made from a comparison of baseline photographs with those after 30 sessions by two independent investigators. Morphometric analysis was performed using a computer program. Results Repigmentation with an average of 66.25% was obtained on lesions of the face, and of 31.5% on the neck, trunk, and genitalia. On the extremities, there was no repigmentation. Itching, a burning sensation, erythema, desquamation, and transitory hyperpigmentation were observed in some patients. Minimal blistering and ulceration were observed in one patient. Conclusion Targeted UVB phototherapy seems to be effective for the repigmentation of vitiligo in lesions located on the face, to a lesser degree on the trunk, and with no response in acral lesions; there were minimal adverse effects that did not require discontinuation of treatment.     

Treatment of vitiligo with broadband ultraviolet B and vitamins

BACKGROUND: While oral psoralen plus ultraviolet A (PUVA) remains the most popular therapeutic modality for vitiligo, recent reports have shown that narrowband ultraviolet B (UVB) also induces significant repigmentation. In this study we evaluated the efficacy of broadband UVB on actively spreading, progressive vitiligo in patients who had been followed for many months (12 or more) in our practice, who continued to depigment despite treatment. METHODS: Nine patients with actively spreading vitiligo were exposed to broadband UVB 2-3 times per week at a starting dose of 20-30 mJ/cm(2). Radiation was increased by 10-20 mJ/cm(2) per session with adjustments for symptomatic erythema or missed visits. In addition, patients took vitamin C 500 mg twice a day (BID), vitamin B(12) 1000 microg BID and folic acid 5 mg BID. The response to treatment and side-effects were assessed at each visit. The patient's response to treatment and progress were assessed by photographs and by physician evaluation of body surface area (BSA) (using the Rule of 9s) involved at monthly intervals. Photographs were taken and estimations of BSA by physical examination made at the start and finish of the trial and then compared by the physicians involved in the study. RESULTS: Broadband UVB halted the progression of vitiligo in all nine patients and in general induced repigmentation early after 8-12 treatments (6-8 weeks). After 2-8 months of treatment, nine of nine patients achieved good (51-75%) or excellent response (76-100%). The percentage of repigmentation varied with length of treatment and anatomic site. CONCLUSIONS: This study confirms the only published report that broadband UVB is effective on actively spreading vitiligo. Since it is more cost effective than narrowband UVB and has numerous advantages compared to oral PUVA, broadband UVB may offer an alternative for future treatment of vitiligo. The role of vitamins in this therapy remains to be determined.     

Folic acid and vitamin B12 in vitiligo: a nutritional approach.

When compared with the normal population, patients with vitiligo often showed diminished blood levels of folic acid. In a group of fifteen patients with vitiligo, folic acid levels were below normal in the serum of eleven patients, in the whole blood of five patients, and in the erythrocytes of six patients. Vitamin B12 serum levels were below normal in five of the fifteen patients. Ascorbic acid plasma levels were also lowered in four of the patients. In eight patients prolonged oral administration of folic acid with simultaneous parenteral treatment with vitamin B12 and oral ascorbic acid was followed by definite repigmentation without side effects.     

A comparative study on the use of fractional CO2 laser with tacrolimus or calcipotriol or narrow band ultraviolet‐B in treatment of stable nonsegmental vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO₂) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO₂ laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO₂ laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO₂ laser and NB‐UVB was found to be more effective.     

Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo

BACKGROUND: Narrow band ultraviolet B (NB-UVB) phototherapy has been used successfully for the treatment of vitiligo. Recently, topical calcipotriol has also been claimed to be effective, either as monotherapy or as a part of combination therapies. OBJECTIVE: The aim of the present study was to compare the clinical efficacy of NB-UVB and NB-UVB plus topical calcipotriol in the treatment of vitiligo. METHODS: NB-UVB treatment was given to 24 patients with generalized vitiligo three times weekly. Topical calcipotriol cream was only applied to the lesions located on the right side of the body. Treatment was continued for 6 months. Treatment efficacy was evaluated by determining the average response rates of the lesions at 3-month intervals. RESULTS: The average response rates of patients receiving combination of NB-UVB plus calcipotriol and NB-UVB alone were 51 +/- 19.6% and 39 +/- 18.9%, respectively. The median cumulative UVB dose and number of UVB exposures for initial repigmentation were 6345 mj/cm(2) (range; 2930-30980) and 18 (range; 12-67) for the combination therapy, and 8867.5 mj/cm(2) (range; 2500-30980) and 24 (range; 15-67) for the narrow band UVB therapy, respectively. CONCLUSIONS: These findings indicate that concurrent topical calcipotriol potentates the efficacy of NB-UVB in the treatment of vitiligo. This combination not only provides earlier pigmentation with lower total UVB dosage and less adverse UVB effects, but also reduces the duration and cost of treatment as well.     

Targeted broadband ultraviolet b phototherapy produces similar responses to targeted narrowband ultraviolet B phototherapy for vitiligo: a randomized, double-blind study

Narrowband ultraviolet B (NB-UVB) phototherapy, with a 308-nm xenon chloride excimer laser, and targeted UVB phototherapy have produced encouraging therapeutic results for vitiligo. However, very few studies employing broadband UVB exist. Moreover, there has been no direct comparison study between broadband UVB and NB-UVB for the treatment of vitiligo. The aims of this study were to compare the repigmenting efficacy of targeted broadband UVB phototherapy with that of NB-UVB in an equi-erythemogenic manner. Twenty identical vitiliginous lesions from 10 patients were randomly allocated to receive either targeted broadband UVB or targeted NB-UVB phototherapy. UV fluences were started at 50% of the minimal erythema dose detected within the vitiliginous patches, then increased gradually, in the same manner, to ensure equi-erythemogenic comparison. Treatments were carried out twice weekly for 12 weeks. The results show that grade 1, i.e. 1-25% repigmentation, to grade 2, 26-50% repigmentation, occurred in 6 of 10 subjects. Responses in terms of repigmentation, de-pigmentation, or lack thereof, were similar between lesions receiving broadband and NB-UVB phototherapy. Onset of repigmentation occurred as early as 4 weeks of treatment in most subjects. Treatments were well tolerated, with only minimal erythema and hyperpigmentation. LIMITATIONS: The study was carried out in a small number of patients with skin types III, IV and V. The irradiation device was a targeted UVB device and thus the results may not be applicable to other light sources, such as the excimer laser or total-body irradiation cabinets. In conclusion, targeted broadband UVB produces similar clinical responses to targeted NB-UVB in the treatment of the non-segmental type of vitiligo.     

Comparison of the efficacy of broad‐band targeted UVB phototherapy and topical psoralen with targeted UVA phototherapy in localized vitiligo

Aim of the study is to compare efficacy of targeted broad‐band UVB phototherapy and topical psoralen with targeted UVA phototherapy treatments in localized vitiligo for 3 months prospectively. The cases with symmetrical vitiligo lesions were included in the study. Broad‐band targeted UVB was applied on one side and targeted UVA phototherapy with topical psoralen on the other side. Twenty‐two patients who were diagnosed with localized vitiligo were enrolled in this study. These cases consisted of 6 (27.3%) females and 16 (72.7%) males aging between 17 and 69 (34.22 ± 14.15). Fifty‐four lesions (27 left, 27 right) were compared for treatments. After the first month of the treatments, the sides of the lesions were compared in order to evaluate improvement. Percentages of success were 25% for targeted broad‐band UVB microphototherapy and 75% for topical psoralen with targeted UVA microphototherapy. When the two treatment methods were compared with each other, a significant difference was found in terms of treatment response (P = .017). At the end of the third month, the success rates were 37.5% for targeted broad‐band UVB microphototherapy and 62.5% for topical psoralen with targeted UVA microphototherapy, however a statistically significant difference was not determined between the two treatments (P > .05). Both targeted broad‐band UVB phototherapy and topical psoralen with targeted UVA phototherapy provided repigmentation for localized vitiligo at the end of the third month. Our investigation shows that both treatments are safe and they provide repigmentation with a limited response.     

A randomized comparison of excimer laser versus narrow‐band ultraviolet B phototherapy after punch grafting in stable vitiligo patients

Background Ultraviolet radiation following punch grafting may stimulate the migration of melanocytes from the grafts into the vitiliginous skin, thereby increasing the rate of repigmentation. We compared the effects of the 308‐nm xenon chloride excimer laser (EL) vs. narrow‐band ultraviolet B (NB‐UVB) after punch grafting in patients with vitiligo. Objectives The aims of this study were to evaluate (i) repigmentation (%); (ii) treatment satisfaction; and (iii) patient preferences for EL vs. NB‐UVB therapy after punch grafting in vitiligo. Methods Fourteen patients were treated with the punch‐grafting technique on two symmetrical vitiligo patches. Starting 1 week after the punch grafting, the vitiligo patches were treated twice a week during 3 months, with EL on one side and with NB‐UVB on the other side. Repigmentation (%) was measured by a digital image analysis system. Patients’ satisfaction and preference for treatment were also assessed. Results Whereas both treatment modalities induced repigmentation, no statistically significant difference was found in grade of repigmentation after 3 months. With EL, 71.4% lower cumulative dose was reached. Patients were significantly more satisfied with NB‐UVB and preferred it over EL. Conclusions The choice between EL and NB‐UVB cannot solely be based on repigmentation, but rather on other factors, such as patients’ preferences. However, given the lower UV dose of EL, we recommend its use in vulnerable populations, such as in small children and patients with sun‐damaged skin with a history of long‐term UVB treatment.     

Novel topical cream delivers safe and effective sunlight therapy for vitiligo by selectively filtering damaging ultraviolet radiation

Numerous studies have demonstrated that natural sunlight therapy at the Dead Sea provides therapeutic efficacy for vitiligo patients on par with artificial broadband and narrowband ultraviolet B (UVB) phototherapy; however, similar treatments at locals at or above sea level fail due to the development of erythema prior to sufficient therapeutic dosage. We conducted a pilot study at sea level to assess the efficacy of a novel topical cream that selectively filters nontherapeutic wavelengths of UVB from natural sunlight and delivers treatment for acrofacial vitiligo. In our pilot study, after an average of 11 weeks of treatment, all patients in the treatment arm responded to therapy. In particular, 28% of the treatment group had 70% surface area repigmentation, 28% had 50% repigmentation, and 44% had 30–40% repigmentation. In contrast, only 10% of the patients in the placebo arm had 20% repigmentation. Our results demonstrate that the novel topical cream can provide a safe and effective alternative to artificial light phototherapy.     

Evaluation of the potential interference of camouflage on the treatment of vitiligo: An observer‐blinded self‐controlled study

Camouflage improves the quality of life in vitiligo patients. However, whether the use of camouflage interferes the efficacy of the treatment of vitiligo remains controversial. To evaluate the impact and safety of dihydroxyacetone (DHA)‐containing camouflage on the treatment of vitiligo. Thirty patients were enrolled. Comparable vitiliginous patches in each patient were randomly divided into camouflage group or blank group. The therapeutic modalities including topical corticosteroids with or without NB‐UVB phototherapy were applied to both groups of lesions. The outcomes were assessed at baseline and then every 4 weeks for up to 12 weeks, including types of repigmentation patterns, percentage of repigmentation, trans epidermal water loss (TEWL), and adverse events. Twenty‐eight patients completed the study. There were no differences in repigmentation types and percentage of repigmentation at the endpoint of study between two groups. No difference in TEWL was found at the end of the study between the two groups. Temporary skin irritation (itching and tingling) occurred in one patient in camouflage group after phototherapy between 8 and 12 weeks' treatment. DHA‐containing camouflage is a safe make‐up for vitiligo. It has little impact on the efficacy of the treatment of vitiligo or on the function of skin barrier.     

Leucine-rich glioma inactivated 3: a novel keratinocyte-derived melanogenic cytokine in vitiligo patients

Background: In-vitro studies showed that Leucine-rich glioma inactivated 3 (LGI3) is a keratinocyte-derived cytokine that stimulates melanin synthesis and is increased after ultra violet B (UVB) irradiation. So, we postulated that LGI3 may be involved in vitiligo aetiopathogenesis and may participate in narrow band ultra violet B (NB-UVB) induced pigmentation in vitiligo.Objectives: To assess this hypothesis, lesional LGI3 immunohistochemical expression of vitiligo patients before and after NB-UVB phototherapy was studied, and its correlation with repigmentation was evaluated.Methods: Forty vitiligo patients and 20 age, sex, and skin phenotype-matched controls were enrolled. Patients were treated with NB-UVB thrice weekly for 12 weeks. VASI score was evaluated before and after NB-UVB sessions. For vitiligo patients, baseline LGI3 immunohistochemical staining was estimated, and compared to that of controls and to its post-treatment data in those patients. Results: Baseline LGI3 immunohistochemical studied parameters (expression, intensity, percentage and H score) were significantly lower in vitiligo cases than controls (p=0.003, 0.013, 0.001 and 0.001 respectively). After 12 weeks of NB-UVB phototherapy, these LGI3 immunohistochemical parameters were up-regulated and became comparable to that of controls (p >0.05 for all). There was a significant positive correlation between the improvement of both VASI score and LGI3 H score mean values (r=-0.349 , p=0.027).Study limitations: Small number of investigated subjects.Conclusion: Decreased LGI3 protein may play an active role in vitiligo pathogenesis and its up-regulation after NB-UVB phototherapy, may actively participate in NB-UVB photo-induced melanogenesis.     

Broadband targeted UVB phototherapy for localized vitiligo: a retrospective study

Phototherapy with ultraviolet B (UVB) or PUVA has been used in the treatment of vitiligo for many years. The aim of this study was to analyze retrospectively the efficacy and safety of targeted broadband UVB phototherapy in patients with localized vitiligo. Thirty-two patients (14 male, 18 female), aged 18–65 years, were treated with Daavlin T500x High Dose Targeted Phototherapy System. Patients were treated twice or thrice weekly, totaling 20 to 60 sessions. Out of 32 total patients, only four patients (12.5%) showed visible repigmentation. In two patients, repigmentation was more than 75%. Other two patients showed mild repigmentation (less than 25%). All the lesions responsive to treatment were facial lesions. Mild adverse events recorded in 3 of 32 patients. Although safety of targeted broadband UVB phototherapy in the treatment of localized vitiligo is good, its therapeutic effectiveness is limited and depends on the locations of vitiligo lesions.     

Narrow-band UVB311 nm vs. broad-band UVB therapy in combination with topical calcipotriol vs. placebo in vitiligo

BACKGROUND: Recently, it has been shown that UVB phototherapy may be more effective than UVA in the treatment of vitiligo. Currently, however, no studies have compared the efficacy of UVB311 nm and broad-band UVB therapy. Calcipotriol has recently been reported to be effective adjunctive treatment for vitiligo, enhancing the efficacy of 8-methoxypsoralen plus UVA (PUVA) therapy. METHODS: Ten patients were enrolled in the study; nine completed the 12 months of therapy. The upper part of the body was treated twice weekly with UVB311 nm and the lower part with broad-band UVB. Calcipotriol was applied onto the vitiligo lesions of the right side of the body and placebo on the left side. Repigmentation was documented by photography, planimetry, and Vitiligo Disease Activity (VIDA) score. The quality of life was measured by the Dermatology Life Quality Index (DLQI). RESULTS: After 7-16 weeks, six of the nine patients showed initial repigmentation on the side treated with UVB311 nm. After 6 months of treatment, none of the patients showed repigmentation on the areas treated with broad-band UVB, which prompted us to apply UVB311 nm all over the body. At the end of 12 months, two patients showed > 75% repigmentation, two showed 51-75%, two showed 26-50%, and three showed 0-25%. In all patients with progressive vitiligo (seven of the nine patients), disease activity was stopped. Remarkably, vitiligo lesions treated with calcipotriol initially showed delayed repigmentation compared with control areas; however, there was no therapeutic difference between calcipotriol and placebo, both in combination with UVB311 nm, by the end of the study. The DLQI score improved significantly by an average of 28%. Conclusion UVB311 nm therapy was effective in the treatment of vitiligo, whereas broad-band UVB had no effect. Combination with calcipotriol ointment was not superior to UVB311 nm monotherapy. The quality of life significantly improved with narrow-band UVB311 nm phototherapy.     

Narrowband ultraviolet B phototherapy in childhood vitiligo: evaluation of results in 28 patients

Phototherapy using narrowband ultraviolet B (UVB) is considered among the treatments of choice in vitiligo, even in childhood. The objective of the current study was to evaluate the profile of safety and effectiveness of such therapy in a group of children. An open, uncontrolled study was performed on 28 children with vitiligo who were receiving narrow band UVB phototherapy. The children were classified according to vitiligo type and phototype. Family history and presence of thyroid disease were investigated. Eighteen patients had received other treatments that was stopped 3 months before starting phototherapy. Phototherapy was administered twice a week. The mean duration of therapy was 10 ± 3.4 months. The mean total dose administered was 156.12 ± 79.4 J/cm(2). Photographs of lesions were taken before and at the end of treatment. The response to phototherapy was expressed as percentage of repigmentation. The data were statistically analyzed using SPSS (SPSS Inc., Chicago, IL). Fourteen percent of patients showed excellent response, 28.6% good response, 25% moderate response, and 28.6% mild response; the remaining 3.5% were not responsive. No side effects were observed except mild erythema requiring a decrease in dosage in a few patients. The results of the present study confirm those of other authors, with better results than adults probably related to good adherence of patients and their families. Nevertheless, high cumulative doses are not necessarily related to a good response. Therefore, we suggest stopping treatment after 6 months in nonresponding cases.     

Narrow-band ultraviolet B is a useful and well-tolerated treatment for vitiligo

BACKGROUND: The treatment of vitiligo remains a challenge. OBJECTIVE: The purpose of this article is to review our results and experience with narrow-band ultraviolet (UV) B phototherapy for vitiligo. METHODS: This is a retrospective analysis of our experience and results with patients with vitiligo who were treated with narrow-band UVB between November 1998 and November 1999. Narrow-band UVB phototherapy was given as monotherapy 3 times a week. The starting dose was 280 mJ/cm(2), with 15% dose increments at each subsequent treatment. RESULTS: Seven patients were able to be evaluated for the purposes of this analysis. Their ages ranged from 19 to 59 years (mean, 37.6 years). Three patients had Fitzpatrick skin phototype IV and V, and 4 had phototypes II and III. Five of the 7 patients achieved more than 75% repigmentation with a mean of 19 treatments; the mean duration of disease was 13 months. The remaining two patients had 50% and 40% repigmentation after 46 and 48 treatments, respectively. Their mean duration of disease was 132 months. Adverse effects were mild erythema and pruritus. CONCLUSION: This treatment protocol resulted in rapid repigmentation in many patients, including those with skin phototypes IV and V. In accordance with previous studies, this report indicates that narrow-band UVB is a useful and well-tolerated therapy for vitiligo.     

The effect of latanoprost on vitiligo: a preliminary comparative study

Latanoprost (LT), a prostaglandin F 2alpha (PGF_2a) analogue used in the treatment of glaucoma, was found to induce skin pigmentation in guinea pigs in addition to its known periocular and iridal pigmentation side effects. This study aims to evaluate the efficacy of topical LT in the induction of skin repigmentation in patients with vitiligo and to compare its potency with narrow band ultraviolet (UV) B (NB‐UVB). The result of their combination was also assessed. This study involved 22 patients with bilateral and symmetrical vitiligo lesions, stable for the last three months, divided into three groups: group I, to evaluate LT vs. placebo; group II, to evaluate LT vs. NB‐UVB; and group III, to evaluate the effect of their combination. The response to treatment was evaluated by taking photographic records of the treated lesions with follow‐up photography every two weeks. After three months, assessment of the degree and extent of repigmentation was performed. Follow‐up assessment was done six months after termination of the trial for the persistence of pigmentation, recurrence, or development of any side effects. LT was found to be better than placebo and comparable with the NB‐UVB in inducing skin repigmentation. This effect was enhanced by the addition of NB‐UVB. LT could be a promising treatment for vitiligo, especially the periocular variant. Its effect on skin repigmentation could be enhanced by NB‐UVB exposure.     

Treatment of vitiligo with the 308-nm excimer laser: a pilot study

BACKGROUND: Present vitiligo therapies require many months of treatment and often result in disappointing outcomes. Common therapeutic options include phototherapy with psoralens plus ultraviolet A (UVA) radiation and broadband or narrowband UVB radiation phototherapy. Some of these modalities require regular phototherapy sessions several times a week for up to a year to achieve a therapeutic response. Targeted phototherapy with single-wavelength laser light is a treatment alternative that may prove to be a time-efficient and effective therapeutic option for the management of vitiligo. METHODS: This intervention study was designed as a before and after trial with a single arm. Twenty-nine patches of vitiligo from 18 patients (6 males and 12 females) were treated at the start of the study. Vitiligo patches were treated by using a 308-nm xenon-chloride excimer laser. Lesions were treated 3 times a week for a maximum of 12 treatments. Treatment was withheld if sunburn was observed and held until resolution. All patients had untreated vitiligo patches that served as control sites. RESULTS: Twenty-three vitiligo patches from 12 patients received at least 6 treatments and resulted in some repigmentation in 57% of the treated patches. Eleven vitiligo patches from 6 patients received all 12 treatments and resulted in some repigmentation in 82% of the treated patches. Untreated control patches remained unchanged. CONCLUSION: This degree of repigmentation in a period of 2 to 4 weeks is much higher than that achieved with any other present vitiligo therapy. The xenon-chloride excimer laser may represent a new treatment modality for the management of stable vitiligo.     

Phototherapy with UV-B in vitiligo

We report on 14 patients suffering from extentise vitiligo, who underwent phototherapy with UVB. After 12 months of treatment, 8 (57.1%) of the patients showed repigmentation of more than 75%. Especially the patients with facial lesions of the skin types V and VI achieved a nearly complete and cosmetically very satisfying repigmentation.     

Targeted Broadband UVB Phototherapy forthe Treatment of Localized Vitiligo

Background

Several new treatments appear to have higher success rates than previous therapies for the treatment of vitiligo, and targeted phototherapy is an alternative that may prove to be time-efficient and an effective therapeutic option for the management of this condition.

Objective

The aim of this study was to evaluate the efficacy of targeted broadband UVB phototherapy for the treatment of localized vitiligo.

Methods

Fifty-three vitiliginous patches on thirty-five patients (16 males, 19 females) were treated using a targeted broadband UVB phototherapy device. Treatment was started at 70% of the minimal erythema dose, and then gradually increased. Lesions were treated twice a week for a maximum of 60 treatment sessions.

Results

Subjects tolerated treatment well. Forty-one of the fifty-three patches (77.4%) achieved repigmentation on ≤75% of the treated areas. Best results were obtained on the face and neck; 20 of the 24 patches (83.3%) concerned achieved ≤75% repigmentation. The least response was on the hands and feet; 3 of 6 patches (50%) showed ≤75% repigmentation. The results were better for focal type than segmental type vitiligo.

Conclusion

Targeted broadband UVB phototherapy appears to be highly effective at restoring pigmentation in patients with localized vitiligo.     

In vitro evaluation of a novel topical cream for vitiligo and psoriasis that selectively delivers NB‐UVB therapy when exposed to sunlight

Ultraviolet‐B (UVB) phototherapy is a well‐established mode of treatment for several types of dermatological disease. For psoriasis and vitiligo, narrow band UVB (NB‐UVB) phototherapy is an effective therapy, demonstrating greater efficacy and safety compared to broadband UVB or psoralen plus UVA treatments. While the treatment efficacy of NB‐UVB artificial light sources is well documented, the long term time and cost commitment of the therapy remains a barrier to treatment adherence. Natural sunlight is an ideal source of accessible UVB radiation; however, exposure to natural sunlight generally results in erythema prior to the accumulation of sufficient dosage of therapeutic wavelengths of UVB. This communication describes a novel topical cream designed to selectively deliver NB‐UVB therapy when exposed to sunlight. The topical cream when combined with natural sunlight could offer patients a more convenient phototherapy option for psoriasis and vitiligo, potentially increasing patient compliance.