The efficacy of excimer laser (308 nm) for vitiligo at different body sites

BACKGROUND: The treatment with XeCl-excimer laser generated 308-nm UVB radiation has shown promising results in patients with vitiligo. OBJECTIVE: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient's satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. METHODS: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308-nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1-5%), 2 (6-25%), 3 (26-50%), 4 (51-75%), to 5 (76-100%). RESULTS: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.     

Clinical study of repigmentation patterns with either narrow‐band ultraviolet B (NBUVB) or 308 nm excimer laser treatment in Korean vitiligo patients

Background Various repigmentation patterns such as perifollicular, marginal, diffuse, and mixed configuration can occur in vitiligo. The aim of this study was to clinically assess the types of repigmentation patterns obtained with narrow‐band ultraviolet B (NBUVB) phototherapy or targeted phototherapy using a 308 nm excimer laser and to reveal whether the repigmentation patterns have any relationship to the location of lesions, patient’s age, duration of lesions, or speed of improvement. Methods This study enrolled 51 patients who had effective responses as compared with baseline when treated with NBUVB alone and 52 patients who had effective responses as compared with baseline when treated with excimer laser alone. We evaluated the repigmentation patterns when the responses to treatments appeared. Results The most frequent repigmentation pattern was the perifollicular type in both groups treated with NBUVB (42.2%) or excimer laser (51.3%), followed by marginal, diffuse, and combined, in that order. There was no significant difference in the repigmentation pattern according to the location of lesions, patient’s age, or duration of lesions. The marginal pattern was predominant in both NBUVB and excimer laser‐treated groups when excellent responses (more than 75% repigmentation achieved at 12 weeks) appeared. Conclusions The repigmentation patterns according to location, age, duration of lesions, and speed of response showed similarities in both the NBUVB and excimer laser‐treated groups.     

Optimal weekly frequency of 308-nm excimer laser treatment in vitiligo patients

BACKGROUND: Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. OBJECTIVES: To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. METHODS: In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1 x), twice (2 x) and three times (3 x) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm(-2) less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. RESULTS: Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8% (1/13) after 1 x weekly treatment, 23% (3/13) after 2 x weekly treatment and 62% (8/13) after 3 x weekly treatment (P = 0.0134; 3 x vs. 1 x weekly); at 12 weeks, these rates were 46% (6/13), 62% (8/13) and 69% (9/13), respectively (P = NS; 3 x vs. 1 x weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P = NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P = 0.0336). At 12 weeks, the projected repigmentation rates for 1 x, 2 x and 3 x weekly treatment approached each other (60%, 79% and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1 x, 2 x and 3 x weekly treatment were 1.7, 2.4 and 3.3, respectively (P = 0.018; 3 x vs. 1 x weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3 x weekly treatment, the ultimate repigmentation initiation seems to depend entirely on the total number of treatments, not their frequency. However, treatment periods of more than 12 weeks may be necessary to obtain a satisfactory clinical repigmentation, particularly when vitiligo lesions are treated only 1 x or 2 x compared with 3 x weekly.     

Combination of 308-nm xenon chloride excimer laser and topical calcipotriol in vitiligo

BACKGROUND: A large variety of therapeutic agents are being used for the treatment of vitiligo, but treatment remains a challenge. Recently, monochromatic phototherapies such as 311-nm narrowband ultraviolet B therapy and 308-nm xenon chloride excimer laser have been reported to be an effective and safe therapeutic option in children and adult patients with vitiligo. Single reports stipulate that the addition of topically applied calcipotriol to phototherapy increases its effectiveness. OBJECTIVE: The purpose of the present pilot study was to determine if the addition of topical calcipotriol increases the efficacy of the 308-nm xenon chloride excimer in the treatment of vitiligo. METHODS: Ten patients with vitiligo with essentially bilateral symmetrical lesions were enrolled in this prospective right/left comparative, single-blinded trial conducted over a 15-month period. All patients received 308-nm XeCl excimer laser therapy three times weekly. Calcipotriol ointment (Daivonex) was applied to lesions on one side of the body twice daily. RESULTS: After 24 treatments (8 weeks), nine patients were evaluated. Eight patients showed evidence of repigmentation on both body sides, with no significant difference between the body side treated with calcipotriol and excimer laser and the side treated with excimer laser alone. The mean repigmentation rate was 22.4% (1-37%). CONCLUSION: The addition of calcipotriol ointment to 308-nm xenon chloride excimer laser phototherapy does not significantly enhance its efficacy. Small additive effects must be investigated in a larger trial.     

中波高能紫外线与308 nm准分子激光治疗白癜风的短期疗效比较

【摘要】 目的 比较中波高能紫外线和308 nm准分子激光治疗白癜风的短期疗效。 方法 中波高能紫外线组患者40例,每周照射2次;308 nm准分子激光组40例,每周1次。评估两组治疗8周后的皮损复色情况。 结果 经过8周的阶段治疗,中波高能紫外线组有83.6%皮损可出现不同程度的复色反应,达显效以上复色为42.1%;308 nm准分子激光组86.1%有皮损不同程度色素生成,达到显效以上为50%。对于面部白癜风皮损中波高能紫外线的疗效低于308 nm准分子激光（χ2 = 4.32,P < 0. 05）,在其余部位两组有效率差异无统计学意义。在皮损起始复色的累积剂量方面,两者差异无统计学意义（t = 0.89,P > 0.05）,在达到显效以上复色方面,高能中波紫外线的治疗次数和累积剂量明显多于308 nm准分子激光（P < 0. 01）。两者均适用于儿童患者及活动期皮损。 结论 中波高能紫外线或308 nm准分子激光治疗白癜风均可在短期内起效且安全,308 nm准分子激光疗效更明显。     

Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo

OBJECTIVE: To compare the efficacy of combined tacrolimus and 308-nm excimer laser therapy vs 308-nm excimer laser monotherapy in treating vitiligo. DESIGN: Comparative, prospective, randomized, intraindividual study. PATIENTS: Fourteen patients, aged 12 to 63 years, with Fitzpatrick skin types II to IV. INTERVENTION: For each patient, 4 to 10 target lesions were chosen. The treatment applied to each target lesion was randomized by drawing lots. Each lesion was treated twice a week by the 308-nm excimer laser, for a total of 24 sessions. Initial fluences were 12 mcal/cm(2) (50 mJ/cm(2)) less than the minimal erythemal dose in vitiliginous skin. Then, fluences were increased by 12 mcal/cm(2) every second session. Moreover, topical 0.1% tacrolimus ointment was applied twice daily on target lesions receiving the combined tacrolimus and excimer laser treatment (group A). Group B target lesions received only excimer laser monotherapy. For each treated lesion, the untreated lesion on the opposite side served as the control. Tolerance was evaluated by a visual analog scale, and secondary events were recorded at each session. MAIN OUTCOME MEASURE: Treatment efficacy, which was blindly evaluated by 2 independent physicians by direct and polarized light photographs taken before and after treatment. RESULTS: Forty-three lesions were treated (23 in group A and 20 in group B). All patients completed the study. Repigmentation was observed in all group A lesions (100%) and in 17 (85%) of the 20 group B lesions. Repigmentation was not observed in the untreated lesions (control group). A repigmentation rate of 75% or more was obtained in 16 (70%) of the 23 group A lesions and in 4 (20%) of the 20 group B lesions. In UV-sensitive areas (the face, neck, trunk, and limbs, with the exception of bony prominences and extremities), 10 (77%) of 13 group A lesions had a repigmentation rate of 75% or more vs 4 (57%) of 7 group B lesions. In classically UV-resistant areas, 6 (60%) of 10 group A lesions had a repigmentation rate of 75% or more vs 0 of the 13 group B lesions. The mean number of sessions necessary for an improvement of repigmentation was 10 in group A and 12 in group B. Adverse effects have been limited, and tolerance was excellent. CONCLUSIONS: The combination treatment of 0.1% tacrolimus ointment plus the 308-nm excimer laser is superior to 308-nm excimer laser monotherapy for the treatment of UV-resistant vitiliginous lesions (P<.002). The efficacy and the good tolerance of the 308-nm excimer laser in monotherapy for treating localized vitiligo were also confirmed, but this treatment regimen should be proposed only for UV-sensitive areas.     

单频准分子光治疗白癜风的临床研究

目的 研究观察单频准分子光308nm局部照射治疗白癜风的临床疗效,评估其安全性.方法 对77例不同临床类型的白癜风患者的201处皮损进行局部照射,每周1次,随访3-6个月.结果 经过准分子光局部照射平均18次,86.6%皮损有不同程度色素恢复,色素恢复随疗程延长而增加,照射24次总有效率为71.0%,显效率为51.6%.躯干、颈部和头面部疗效优于四肢及手足;泛发型和节段型白癜风疗效尤佳.主要不良反应为局部水疱和疼痛,患者能耐受.结论 准分子光局部照射治疗白癜风疗效显著,且不良反应少.     

Clinical efficacy of a 308 nm excimer laser in the treatment of vitiligo

Objective: To investigate the clinical efficacy and safety of the treatment of vitiligo using a 308 nm excimer laser. Method: Thirty‐six patients with 44 vitiligo patches were treated using a 308 nm excimer laser, which was performed twice a week, for a total of 30 treatments. The therapeutic efficacy and safety were then evaluated. Results: After 30 treatments:
(1) 27/44 patches (61.4%) achieved more than 75% repigmentation, 4/44 lesions (9.1%) showed 51–75% repigmentation, 10/44 (22.7%) showed 26–50% repigmentation and 3/44 (6.8%) showed 1–25% repigmentation.
(2) Of the 44 patches of vitiligo, 20/27 (74.1%) lesions on the face/neck, 9/9 (100%) on the trunk and 2/8 (25.0%) on the extremities showed ≥50% repigmentation. The repigmentation (≥50%) in face/neck and trunk were much higher than that in the extremities (P<0.05).
(3) The repigmentation (≥50%) in disease duration of ≤2 years and >2 years were 100.0% and 46.2% (P<0.05).
(4) The average cumulative doses in the face/neck, trunk and extremities were 7.92±5.26, 9.93±7.36 and 22.13±8.15 J/cm². The doses in the face/neck and trunk were much lower than those in the extremities. (P<0.05). Side effects were limited mainly to symptomatic erythema. Conclusion: The clinical data indicate that the treatment of vitiligo using a 308 nm excimer laser is safe and effective. However, lesion location and disease duration may be the key factors affecting the clinical outcome.     

准分子激光治疗白癜风的临床疗效与安全性研究

目的 探讨308 nm准分子激光治疗不同类型及病期的白癜风的疗效和不良反应.方法 对128例白癜风患者的317处皮损进行局部照射,每周1次,8次为1个疗程.每个疗程结束及治疗结束后对色素恢复程度进行评估,并记录不良反应.结果 共治疗皮损317片,总体应答率为97.5%,有效率为71.3%,显效率为50.8%.色素恢复程度随着治疗次数增加而增加.面颈部疗效优于躯干四肢,躯干四肢优于肢端部位.短病程(<1年)的白癜风皮损疗效优于长病程(≥1年)的皮损.成人和儿童、活动期和稳定期的皮损疗效无明显差异.患者耐受性较好.结论 308 nm准分子激光治疗白癜风起效快,疗效及依从性好,不良反应少.     

Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas

Many preliminary data suggest that the 308-nm excimer laser can be a highly effective therapeutic alternative for treating vitiligo, inducing rapid repigmentation with minimal ultraviolet irradiation. We evaluated the clinical efficacy of the 308-nm excimer laser treatment for various body areas, using different initial UV doses. One hundred forty vitiligo patches from 69 patients were assigned to 4 groups; face and neck, trunk, extremities, and acral and joint areas. They were then treated twice a week, using different initial UV doses. The rate of repigmentation continued to increase with the number of treatments up to 20 sessions, and then showed plateaus between 20 to 30 sessions. On the other hand, the lesions in acral and joint areas showed the worst responses throughout the treatment sessions. Our findings extend previous observations that the 308-nm excimer laser is an effective treatment option for patients with vitiligo. However, further studies will be needed to determine the optimal dosing and administration method, especially for acral and joint areas.     

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 308 nm 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.     

308 nm准分子激光联合CO2点阵激光治疗稳定期白癜风的疗效观察

 目的:观察308 nm准分子激光联合CO2点阵激光对于稳定期白癜风的治疗效果及安全性。方法：选取118例稳定期白癜风患者,使用随机数字表法分为观察组和对照组,观察组59例（皮损总数328处）,对照组59例（皮损总数319处）。观察组采用308 nm准分子激光联合CO2点阵激光治疗,对照组单纯采用308 nm准分子激光治疗。治疗3个月后,比较两组疗效及不良反应发生情况。结果：治疗后,观察组及对照组总有效率分别为89.94%和84.64%,两组总有效率比较,差异有统计学意义(X²=6.59,P=0.014),两组不良反应总发生率分别为23.34%和22.15%,两组比较差异无统计学意义( X²=1.29,P=0.088)。结论：308 nm准分子激光联合CO2点阵激光对于稳定期白癜风具有良好的疗效。     

308nm准分子激光治疗儿童白癜风疗效观察

目的评价308nm准分子激光治疗儿童白癜风的疗效及安全性。方法采用自身对照的方法,用Xt-rac颠峰准分子激光系统治疗85例稳定期儿童白癜风患者(年龄≤12岁)的自身对称或相邻皮损,每周治疗1～3次,共30次,每隔10天及治疗结束3天后评价疗效。结果治疗的皮损痊愈12例,显效45例,好转21例,无效7例,显效率为67.1%,有效率为91.8%;未治疗的皮损仍为色素脱失斑。面颈部疗效优于躯干四肢,躯干四肢优于肢端,面颈部非节段型优于节段型。结论308nm准分子激光治疗稳定期儿童白癜风疗效高、副作用少,其疗效与皮损部位有关。     

308nm准分子激光治疗稳定期白癜风的疗效观察

目的 观察308 nm准分子激光治疗稳定期白癜风的疗效和安全性.方法 对30例稳定期白癜风患者采用国产308 nm准分子激光治疗,每周照射2次,每月观察1次,连续观察3个月.结果 治疗后30例患者面颈、躯干、四肢皮损复色的总有效率分别为95.0%、75.0%、66.7%,平均治疗次数分别为(10.22±1.60)次、(19.10±2.38)次、(37.74±3.06)次,三者两两比较差异均具有统计学意义(P值均＜0.05).平均累积照射剂量面颈部、躯干部和四肢依次为(7.50±3.45)、(10.60±1.01)、(18.56±3.05)J/cm2.所有患者在治疗过程中均未出现严重不良反应.结论 国产308 nm准分子激光治疗白癜风有效而且安全.

Abstract：

Objective To evaluate the efficacy and safety of 308-nm excimer light in the treatment of stable vitiligo. Methods Thirty patients with stable vitiligo were enrolled in this clinical trial. All the subjects received the treatment with 308-nm excimer light on a twice-weekly schedule for 3 months. Results The repigmentation rate was 95.0%, 75.0% and 66.7% for lesions in the face and neck, trunk and limbs, with the treatment sessions averaging 10.22 ± 1.60, 19.10 ± 2.38, 37.74 ± 3.06, respectively, and accumulative irradiation dose averaging 7.50 ± 3.45, 10.60 ± 1.01, 18.56 ± 3.05 J/cm2 respectively. Significant differences were observed in the repigmentation rate and treatment sessions between the lesions in the face and neck, trunk and limbs (all P ＜ 0.05). No severe side effects were seen during the treatment. Conclusion 308-nm excimer light is effective and safe for the treatment of vitiligo.     

The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo

Background: Numerous modalities have been used to treat vitiligo in children. Up to now, phototherapy and topical corticosteroids are the most commonly used treatments for adult vitiligo but studies evaluating the efficacy of these treatments in the pediatric population remain insufficient. Objective: This study was a retrospective review to evaluate the efficacy and safety of 308‐nm excimer laser treatment in 30 childhood vitiligo patients. Methods: Thirty vitiligo patients with 40 vitiligo patches were evaluated after the cessation of 308‐nm excimer laser treatment. Results: Seventeen patients (56.7%) with 20 patches (50%) achieved an acceptable degree (>50%) of repigmentation at the end of the treatment, with five patches (12.5%) showing >75% of repigmentation. The treatment response showed anatomical preferences, favoring the face, neck and trunk. However, the treatment response did not correlate to the cumulative dose or duration of treatment. Side effects occurred in nine patients, but were transient and minimal. Conclusion: The results of this study shows that the 308‐nm excimer laser can be an effective and promising device for the treatment of various vitiligo types, other than generalized, in childhood.     

Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study

OBJECTIVE: To study the efficacy and safety of monochromatic excimer light (MEL) on 37 vitiligo patients referred to our clinic. METHODS: In a pilot study, 37 patients (17 males, 20 females) with acrofacial (n=21), focal (n=11), segmental (n=1), and generalized (n=4) vitiligo were treated twice weekly with MEL for a maximum period of 6 months. RESULTS: Thirty-five patients (95%) showed signs of repigmentation within the first eight treatments. The treatment resulted in good repigmentation in 16 patients, and excellent repigmentation in 18 patients. Adverse events were limited to transient erythema. In addition, some patients (n=3) not responding to prior narrow-band UVB (NB UVB) phototherapy showed good results with MEL in our series. CONCLUSIONS: Treatment with 308 nm MEL for vitiligo may be more effective in obtaining rapid repigmentation than phototherapy with NB UVB. The results in this study are similar to those recently reported with a 308 nm excimer laser, but 308 MEL could present some advantages: the possibility of treating larger areas compared to the 308 nm excimer laser, with shorter treatment times and better patient compliance. The overall good results and the early appearance of repigmentation contribute to reducing the cumulative exposure to UV radiation.     

Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo – a multicentre controlled study

BACKGROUND: Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients. METHODS: The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side. RESULTS: At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3). CONCLUSIONS: It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly.     

Topical tacalcitol and 308-nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo

BACKGROUND/PURPOSE: To study and compare the efficacy of combined 308-nm monochromatic excimer light (MEL) therapy with tacalcitol vs. that of MEL 308-nm therapy alone in treatment of vitiligo. METHODS: Thirty-eight patients with vitiligo were enrolled in a single-blind, within patient controlled clinical trial. Symmetrical or nearby lesions were randomly applied with either topical tacalcitol cream or vehicle. Each lesion was treated weekly with the 308-nm MEL, for a total of 12 sessions. Patients were examined at monthly intervals. The mean number of sessions and the cumulative dosage for initial repigmentation were calculated. RESULT: Thirty-five patients were evaluated. Treatment with tacalcitol and MEL resulted in higher percentages for excellent repigmentation (25.7%) compared with vehicle and MEL (5.7%) (P<0.05). Percentages for total response were 71.4% and 60%, respectively (P>0.05). The mean+/-SEM cumulative dose and number of excimer light exposures for initial repigmentation were, respectively, 3.93+/-0.59 J/cm2 and 4.52+/-0.49 at the tacalcitol side, and, respectively, 4.99+/-0.68 J/cm2 and 5.3+/-0.52 at the vehicle side (P<0.05). CONCLUSION: Our results have shown that concurrent topical tacalcitol potentiates the efficacy of the 308-nm MEL in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total dosage.     

Psoralen–ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo

BACKGROUND: Although many treatment modalities have been tried for the treatment of vitiligo, none is uniformly effective. Psoralen phototherapy (psoralen ultraviolet A (PUVA)) is established as efficacious treatment for vitiligo. Recently, narrow-band UVB (NBUVB) has been reported to be an effective and safe therapeutic option in patients with vitiligo. OBJECTIVE: To compare the efficacy of PUVA and NBUVB in the treatment of vitiligo. DESIGN AND SETTING: Retrospective analysis of 69 patients with vitiligo who were treated either with PUVA or NBUVB at the pigmentary clinic of the Dermatology Department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. OUTCOME MEASURES: The following variables were compared between the two groups of patients: repigmentation status, number of treatments for marked to complete repigmentation in existing lesions, appearance of new lesions or increase in size of existing lesions, adverse effect of therapy, stability of repigmentation and colour match. RESULTS: In PUVA-treated group, 9 patients showed marked to complete repigmentation (23.6%) and 14 patients showed moderate improvement (36.8%), whereas in NBUVB-treated group, 13 patients showed marked to complete repigmentation (41.9%) and 10 patients showed moderate improvement (32.2%). A statistically significantly better stability and colour match of repigmentation with surrounding skin was seen in NBUVB-treated patients. CONCLUSION: We showed that NBUVB is more effective than PUVA and repigmentation induced with NBUVB is statistically significantly more stable.     

308nm准分子激光治疗白癜风随机对照试验的系统评价

目的评价308nm准分子激光治疗白癜风的疗效和安全性。方法用计算机检索Medline(1966-2010),Embase(1984-2010)、中国生物医学文献数据库(CBM 1978-2010)。手工检索相关会议文献,文种限于中文和英文。根据纳入和排除标准筛选文献,收集所有相关随机对照试验(RCT),提取资料进行质量评价,采用RevMan5.1软件对数据进行Meta分析。结果共纳入10个RCT,包括411例患者。308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液治疗的无效率均小于单纯308nm准分子激光治疗[RR他合并=0.20,95%CI(0.08,0.51)],[RR胸合并=0.62,95%CI(0.41,0.93)];308nm准分子激光联合0.1%他克莫司软膏、他卡西醇软膏治疗的75%以上色素恢复率均优于单纯308nm准分子激光照射[RR=3.48,95%CI(1.39,8.70)],[OR=5.71,95%CI(1.13,28.75)];308nm准分子激光联合表皮移植治疗的75%以上色素恢复率优于单独表皮移植治疗[RR=0.14,95%CI(0.01,2.63)];308nm准分子激光治疗的75%以上色素恢复率优于NB-UVB照射[RR=6.00,95%CI(0.81,44.35)]。所有研究均未发现严重不良反应。结论 308nm准分子激光联合0.03%～0.1%他克莫司软膏、胸腺肽注射液能降低白斑消退的无效率,308nm准分子激光联合0.1%他克莫司软膏、卡泊三醇软膏能提高75%以上色素恢复率。