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Narrow-Band UVB Treatment of Vitiligo Leads to High Levels of Patient, Physician Satisfaction: Presented at CDA

By Pam Harrison

TORONTO, CANADA -- July 6, 2007 -- Patients with vitiligo and physicians appear to be highly satisfied with the results of narrow-band ultra-violet B (UVB) light therapy, according to a retrospective review.

Jean-Pierre DesGroseilliers, MD, professor of medicine, University of Ottawa, Ottawa, Ontario, Canada, and colleagues reviewed results in the first 50 patients treated for vitiligo with narrow-band UVB at the Photoderm Clinic in Ottawa.

Patients' mean age at onset of vitiligo was 31 years, and the mean age at treatment was 41.4 years. The majority of patients were skin types 3, 4, and 5, with only a small number having skin types 1 and 2.

The researchers classified outcomes based on percent repigmentation of melanocytes, judged as "poor" at 0 to 33%, "good" at 33% to 66%, or "very good" at 66% to 100%.

The study findings were presented in a poster session here on July 1st and 2nd during the Canadian Dermatology Association 82nd Annual Conference (CDA).

More than 70% of vitiligo in the face had a "very good" response to treatment, as did approximately 60% of areas on the body.

A much lower success rate was seen when vitiligo affected the hands or feet, with only 10% of vitiligo in these areas achieving a very good response.

Patient and physician satisfaction with results were very similar with approximately half of both patients and physicians indicating they considered treatment responses "very good," while approximately 20% felt treatment response was "good."

Dr. DesGroseilliers notes in an interview that the cause of vitiligo is unknown, although it is thought to be an autoimmune disease, where the melanocytes that produce pigment in the skin stop functioning.

"It can happen at any age," he noted, "both in children and later on in life, and what we do with the light is we try to stimulate those melanocytes that are still present at the bottom of the hair follicle which, once turned on, start multiplying and repigment the skin." This strategy does not work well in vitiligo of the hands or feet, although there are exceptions, based on the Ottawa groups' experience, he says.

Adverse effects include itching and pain, as well as erythema, burns (especially to the nipples), blistering of the lips, and reactivation of herpes simplex.

Narrow-band UBV is not appropriate for patients with very pale skin, as it darkens normal skin and tends to make vitiligo more visible. Nevertheless, narrow-band UVB is the safest of the current phototherapy modalities, Dr. DesGroseilliers notes.

It is the only modality that really works in this condition, he says, as neither psoralen combined with ultraviolet light A nor cortisone creams have produced responses that made patients or physicians happy.

"You never get 100% repigmentation," says Dr. DesGroseilliers, "but if patients respond to this treatment in a clinic setting, you may wish to prescribe the home unit, depending on their circumstances."

Third-year medical student Sonya Abdulla from the University of Ottawa and lead author on the poster, also felt that narrow-band UBV is "definitely worth considering, especially considering the impact the disease can have on a person's self esteem and mental health."

If patients do opt for the home unit, it is recommended they start off with five treatments per week, tapering down to three times per week as improvement occurs.


[Presentation title: Treatment of Vitiligo With Narrow-Band Ultra-Violet B (NB-UVB) Advantages and Disadvantages.]

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