Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study

BACKGROUND: Vitiligo is a common pigmentary disorder with great cosmetic and psychological morbidity. No treatment available is a definitive cure. Systemic psoralen and ultraviolet A (PUVA) has been the mainstay of treatment. Narrow-band ultraviolet B (NB-UVB) has been recently introduced. Although retrospective comparative study of systemic PUVA and NB-UVB has been published from our centre, no prospective study has been reported to date. AIMS: To investigate the position of NB-UVB vis-à-vis PUVA in terms of efficacy, time to repigment and adverse effects and to help decide if one therapy has an advantage over another in the treatment of vitiligo. SUBJECTS AND METHODS: It was a randomized, open, prospective study of 50 patients divided equally in TMP PUVA and NB-UVB groups. The study period was from January 2004 to June 2005. RESULTS: The mean degree of repigmentation attained in the NB-UVB group was 52.24% over a mean treatment period of 6.3 months, whereas in the PUVA group it was 44.7% in a mean period of 5.6 months (P=0.144). After excluding the results of therapy-resistant sites, that is, hands and feet, the mean degree of repigmentation in the NB-UVB group was 67.57%, whereas in the PUVA group it was 54.2% (P=0.007). CONCLUSIONS: NB-UVB performed better in comparison to TMP PUVA in terms of mean total repigmentation when traditionally considered therapy-resistant sites were excluded.     

A pilot comparative study of topical latanoprost and tacrolimus in combination with narrow‐band ultraviolet B phototherapy and microneedling for the treatment of nonsegmental vitiligo

Prostaglandins and their analogues are beneficial as topical agents in vitiligo treatment, yet neither of the previous study addressed their comparative efficiency with conventional topical agents used in vitiligo treatment. In this pilot (24 patients) left‐right comparative study we addressed efficiency of prostaglandin F2α analogue latanoprost versus tacrolimus when combined with narrow‐band ultraviolet B and microneedling in repigmentation of nonsegmental vitiligo lesions. Our results confirm potency of prostaglandins, in particular, that of latanoprost, in inducing repigmentation, with the efficiency being at least comparable to that of tacrolimus, while contribution of microneedling remains unclear. In summary, results of our study provide further evidences for justified use of prostaglandins, in particular, latanoprost, in vitiligo treatment. In turn, this warrants future studies on the topic aiming to conclusively introduce prostaglandin‐based formulations as conventional agents for vitiligo management.     

Clinical evaluation of interrupted versus continuous narrowband ultraviolet B phototherapy in nonsegmental vitiligo treatment: A prospective randomized comparative study

Phototherapy is the pillar of vitiligo treatment. One of its main obstacles is noncompliance. It was noticed that patients continue to repigment even after stopping sessions, so the idea of interrupted phototherapy emerged. To evaluate the effectiveness of interrupted versus continuous NB‐UVB in nonsegmental vitiligo treatment. A prospective randomized comparative study of 23 patients with bilateral, nonsegmental vitiligo with no age or sex limits. All patients were treated with NB‐UVB phototherapy for 1 month, after which one side of the body received continuous therapy (Side A) and the other received an interrupted course (Side B) for a total of 6 months. Two more groups of 10 patients were enrolled to exclude the systemic effect of NB‐UVB. One group received continuous NB‐UVB treatment, and the other received interrupted courses for 6 months. Evaluation of the results was performed clinically, by digital photography, planimetry and Vitiligo Area Scoring Index (VASI) prior to and 3 and 6 months after treatment. There was a significant clinical improvement in Group 1 compared to baseline (p < .05). However, there was no significant difference between the sides with regards to the clinical evaluation, point counting, and VASI scores (p > .05). When comparing the other two groups, there was a significant clinical improvement in each group after 6 months of treatment compared to baseline (p < .05), while there was no significant difference between them (p > .05). The current study suggests that interrupted NB‐UVB phototherapy is a good alternative to continuous treatment with improved patient compliance, fewer side effects, and a lower cost of treatment.     

A comparative study of different treatment frequencies of psoralen and ultraviolet A in psoriatic patients with darker skin types (randomized-controlled study)

BACKGROUND: Photochemotherapy psoralen and ultraviolet A (PUVA) is a viable option for treatment of psoriasis. However, concerns about its side effects have raised the need to change current PUVA protocols. The aim of this study is to determine whether reducing the treatment frequency of PUVA to twice/week instead of three times/week would affect the efficacy of PUVA therapy. PATIENTS AND METHODS: The study included 20 psoriatic patients, randomized into two groups, 10 patients in each group. The first group received two weekly sessions, the second group received three. The study lasted until complete clearance or for 12 weeks (endpoint). Psoriasis area and severity index (PASI) score was done prior to therapy, at mid therapy and at end of therapy (PASI final). RESULTS: No significant different in PASI final and in the percentage of reduction of PASI score between both groups (P value >0.05) was found. However, a significant difference in the total number of sessions and the total cumulative UVA doses between both groups was found (P value <0.001). CONCLUSION: Our study suggests reducing PUVA frequency and the cumulative UVA dose does not compromise the efficacy of PUVA, but it may improve its benefit/risk ratio. RESTRICTIONS: Few number of cases.     

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。     

Combination treatment by 10 600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo: a prospective, randomized half-body comparative study

Background Vitiligo is a common acquired depigmentation disorder caused by the loss of melanocytes. Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed. Objectives To investigate the effects of fractional carbon dioxide (CO₂) laser therapy followed by systemic narrowband ultraviolet B (NB‐UVB) phototherapy on nonsegmental vitiligo (NSV) as a prospective and randomized left‐right comparative study. Methods Ten patients with NSV who presented symmetrical vitiligo lesions with no further improvement despite more than 1 year of conventional treatment were enrolled. Two sessions of half‐body fractional CO₂ laser therapy were performed at a 2‐month interval. NB‐UVB phototherapy was then administered to the entire body 5 days after each fractional laser treatment twice a week, increasing the dose incrementally by 15% at each session. Objective clinical assessments were made by two blinded dermatologists using a quartile grading scale, and the patients’ overall satisfaction was evaluated using a 10‐point visual analogue scale. Results Two months after the last treatment, mean improvement scores, assessed by physicians, were significantly higher for those treated with half‐body fractional CO₂ laser therapy followed by NB‐UVB phototherapy, compared with those treated with NB‐UVB alone (P = 0·034). In addition, according to subjective assessment, the half‐body laser treatment followed by NB‐UVB showed significantly higher improvements compared with NB‐UVB treatment alone (P = 0·023). Noticeable adverse events, such as infection, scarring and Koebner phenomenon, were not found in any patient. Conclusions This study suggests that fractional CO₂ laser therapy followed by NB‐UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of refractory vitiligo.     

A new,innovative, and safe treatment in vitiligo: Results of a randomized,double‐blinded,parallel‐group study

Vitiligo is a chronic autoimmune disease affecting around 1% of the population worldwide. No existing treatment is giving fully satisfactory results. Further investigations are welcomed for innovative and safe treatments bringing better results. This trial aimed to compare the efficacy and tolerance of various treatment protocols on vitiligo lesions. Four randomized groups of 10 patients with vitiligo covering 8% to 14% of skin surface, except hands and feet were assigned during 8 weeks to (a) UVB microphototherapy 300 to 320 nm (Bioskin?) 1 x week; (b) VITILSI? gel 2 x day; (c) VITILSI? gel 2xday + Bioskin? 1 x week; and (d) placebo 2 x day. Efficacy of the treatment was assessed by planimetry, comparing the photographs of the patients taken at baseline and after 8‐week treatment. After completion of the treatment, the increase of the pigment area was 28% in G1 (Bioskin?), 19% in G2 (VITILSI?), 41% in G3 (Bioskin? + VITILSI?) and null in G4. No subject stopped the treatment and no side effect was observed. It was demonstrated that the gel under study was able per se to induce repigmentation in vitiligo lesions and that the results were significantly better when combined with NB‐UVB. The protocols used in this trial resulted safe and efficient.     

Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective,randomized half‐body,comparative study

Vitiligo on extremities and/or bony prominences is very resistant to treatment. Twenty‐five patients with symmetrical and stable vitiligo on extremities and/or bony prominences were enrolled. The treatment side received fractional carbon dioxide laser followed by topical compound betamethasone solution and narrowband ultraviolet B phototherapy. The control side received laser treatment plus phototherapy. The result of treatment side showed that 44% patients achieved over 50% re‐pigmentation and patient satisfaction score was 5.12 ± 3.23, higher than those of control (p < 0.05). Adverse events were slight and tolerable. The triple combination treatment could be used as an alternative modality for refractory vitiligo.     

Epidermal photoprotection: comparative study of narrowband ultraviolet B minimal erythema doses with and without stratum corneum stripping in normal and vitiligo skin

Background. Recent accumulating data in the literature have indicated a complex photoprotective role of the epidermis, and the role of melanin as the major epidermal photoprotective mechanism has become debatable. Aim. Comparative assessment of the photoprotective roles played by different epidermal structures and compounds. Methods. In total, 64 participants, comprising patients with vitiligo (n = 32) and healthy volunteers (n = 32), with skin phototypes (SPTs) II to V, were enrolled in the study. Areas of skin were delineated; for both lesional and nonlesional skin, the stratum corneum (the SC) was stripped, followed 24 h later by exposure to narrowband ultraviolet B (NB‐UVB) irradiation, to measure the minimal erythema dose (MED) in normal, stripped normal, vitiliginous and stripped vitiliginous skin models. These MED values were used to assess the photoprotective role of epidermal structures: melanin, viable epidermis (VE) and the SC. Results. In the vitiligo group, the MED values were significantly (P < 0.05) different between the skin models, being highest in normal skin, followed by stripped normal, vitiliginous and stripped vitiliginous skin. A similar significance level was found within each SPT for almost all comparisons. There was also a significant (P < 0.001) positive correlation between MED and SPTs. There were also significant (P < 0.05) differences in MED values calculated for epidermal structures, being highest for VE, followed by melanin and then the SC, and there was a significant (P < 0.05) positive correlation between MED and SPTs. Conclusion. Epidermal photoprotection may extend beyond melanin production, involving several factors such as epidermal layer thickness, optical properties and chromophores. Such a role was perceived to be reactive to UV irradiation, and more efficient in those with higher SPTs.     

A large scale analytical study on efficacy of different photo(chemo)therapeutic modalities in the treatment of psoriasis,vitiligo and mycosis fungoides

Psoriasis, vitiligo, and mycosis fungoides (MF) are among the most frequently treated dermatological diseases by photo(chemo)therapy. The objectives are to determine which photo (chemo) therapeutic modality could achieve the best response in the treatment of psoriasis, vitiligo, and MF. The design used in this study is retrospective analytical study. The study included 745 patients' records; 293 with psoriasis, 309 with vitiligo, and 143 with early MF, treated in the Phototherapy Unit, Dermatology Department, Kasr El‐Aini Hospital, Cairo University by either psoralen and ultraviolet A (PUVA), narrow band ultraviolet B (NB‐UVB), psoralen and narrow band UVB (P‐NBUVB), broad band UVB (BB‐UVB), or broad band UVA (ΒΒ‐UVA). Data were retrieved from the computer database of the unit and statistically analyzed. In psoriasis, oral and topical PUVA and NB‐UVB were found to be equally effective, whereas oral PUVA had significantly better results than both UVA and BB‐UVB at the end of therapy. In generalized vitiligo, PUVA and P‐NBUVB had significantly better results than NB‐UVB alone. In early MF, there was no statistically significant difference between the response to oral PUVA and NB‐UVB. PUVA and NB‐UVB are good choices in patients with psoriasis and early stage MF, whereas PUVA appears the best choice in the treatment of vitiligo.     

Acne phototherapy with a high-intensity,enhanced, narrow-band,blue light source: an open study and in vitro investigation

The purpose of this study was to investigate the efficacy of phototherapy with a newly-developed high-intensity, enhanced, narrow-band, blue light source in patients with mild to moderate acne. An open study was performed in acne patients who were treated twice a week up to 5 weeks. Acne lesions were reduced by 64%. Two patients experienced dryness. No patient discontinued treatment due to adverse effects. In vitro investigation revealed that irradiation from this light source reduced the number of Propionibacterium acnes (P. acnes), but not Staphylococcus epidermidis that were isolated from the acne patients. Phototherapy using this blue light source was effective and well tolerated in acne patients and had an ability to decrease numbers of P. acnes in vitro, suggesting that this phototherapy may be a new modality for the treatment of acne.