Broadband targeted UVB phototherapy for localized vitiligo: a retrospective study

Ultraviolet B (UVB) phototherapy is recommended in clinical guidelines for atopic dermatitis, but it is uncertain whether narrowband or broadband UVB is more effective and better tolerated. The objective of this parallel-group randomized clinical trial was to compare the efficacy and safety of broadband vs. narrowband UVB for the treatment of moderate-to-severe atopic dermatitis. Participants were 18 years and older with moderate-to-severe atopic dermatitis refractory to topical corticosteroids. Participants were randomized 1:1 via a centralized computer randomization scheme to full-body broadband or narrowband UVB phototherapy, with ongoing concomitant topical therapy. Participants were blinded but treating and assessing clinicians were not. The primary outcome was change in Eczema Area and Severity Index (EASI) at 12 weeks. Secondary outcomes included achieving 0 or 1 and improvement of 2 or more on the validated Investor Global Assessment scale (vIGA) and change in Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (PP-NRS), Dermatology Life Quality Index (DLQI) and Recap of atopic eczema RECAP). Efficacy analyses were conducted on a modified intention-to-treat population, including all randomized participants who receive at least one dose of phototherapy. 34 participants were randomized to broadband UVB and 35 to narrowband UVB. 32 participants received at least one dose of broadband UVB and 34 received at least one dose of narrowband UVB and were included in the modified intention-to-treat analysis. The mean age was 37.1 years in the broadband UVB arm and 33.2 in the narrowband UVB arm. The mean (95% credible interval) change in EASI score in the broadband UVB arm was -8.1 (-12.1 to -4.1) and in the narrowband UVB arm was -8.9 (-13.0 to -4.9). In the adjusted analysis, the difference between arms in change in EASI was -0.7 (-5.6 to 4.1). There were no significant differences between arms for any of vIGA, POEM, PP-NRS, DLQI or RECAP. There were 4 withdrawals from phototherapy due to adverse events in the broadband arm and 0 in the narrowband arm. In this study, broadband and narrowband UVB were similarly effective and narrowband UVB was better tolerated for the treatment of moderate-to-severe atopic dermatitis.

Vitiligo is an acquired skin disorder characterized by welldefined white patches that are often symmetrically distributed. The study was conducted to compare the efficacy of the combination of topical betamethasone dipropionate and calcipotriene with betamethasone dipropionate and calcipotriene alone in the treatment of localized vitiligo. A clinical trial was carried out with the patients of vitiligo from January 2012 to August 2012. In group A, 20 patients were applied betamethasone dipropionate cream 0.05% and topical calcipotriene ointment (0.005%), in group B, 20 patients were applied betamethasone dipropionate cream 0.05% only; In group C, 20 patients were applied calcipotriene ointment 0.005% alone. From base line percentage reduction of total lesion in 1st follow up in group A, group B and group C were 20%, 15% and 10% respectively. At 3rd follow up in group A, group B and group C it was 50%, 37% and 30% and at 5th follow up, it was 80%, 75% and 65% respectively. ANOVA test was done and found significant difference of reduction of total lesion of vitiligo among the groups (p< 0.05). At the completion of the study, each patient was separately graded the treated sides on a 6-point ordinal scale based on a global estimate of the change in vitiligo and found that, the very much improvement were 70%, 55% and 45%, much improvement were 20%, 30% and 35% and improvement were 10%, 15% and 20% in group A, group B and group C respectively. ANOVA test was found significant difference of success rate of patients of localized vitiligo among the groups (p value 0.005). Both the drugs, calcipotriene and betamethasone dipropionate when used individually, were found to be equally effective in the treatment of vitiligo, but the combination of the two was found to be superior in efficacy. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21310 Medicine Today 2014 Vol.26(1): 31-35

Background: Vitiligo is a chronic skin condition characterized by depigmentation due to melanocyte destruction, leading to psychosocial distress. Despite advancements in treatment, achieving satisfactory re-pigmentation remains a challenge. Combination therapies, such as excimer light with topical agents, show promise in enhancing treatment outcomes. Aims: To compare the safety and efficacy of combined 308 nm excimer light with topical tacrolimus ointment (0.1%) versus excimer light with topical corticosteroid (mometasone furoate 0.1% ointment) in the treatment of localized vitiligo. Methods: A prospective, interventional study was conducted on 30 patients with symmetrical vitiligo patches, treated over 12 weeks. Each patient received excimer light therapy twice weekly combined with tacrolimus ointment on one side and mometasone cream on the other. Treatment efficacy was assessed using a standardized re-pigmentation score (graded 0–4) and clinical photographs. Safety was evaluated based on adverse events like erythema or blistering. Statistical analysis included chi-square tests and descriptive statistics, with a significance level of P < 0.05. Results: Significant re-pigmentation was observed in both groups, with superior outcomes for excimer light and mometasone cream on acral areas and excimer light with tacrolimus on photosensitive regions. By Week 12, 76.7% of stable vitiligo cases achieved higher re-pigmentation scores (≥3) than baseline. Adverse effects were mild only in both the groups, with transient erythema in 16.7% of patients 7% of patients. Conclusion: Both combination therapies were effective and safe for treating localized vitiligo, with outcomes varying by lesion location. Excimer light combined with topical corticosteroid showed marginally better overall efficacy, while tacrolimus demonstrated superior results in photosensitive areas. This study highlights the importance of personalized treatment approaches for vitiligo management.

Vitiligo is an immune-mediated skin disorder that targets epidermal melanocytes leading to the appearance of depigmented skin patches. Different treatment modalities have been reported with varied efficacy. We tried to evaluate the safety and efficacy of intralesional methotrexate in treating localized areas of vitiligo. Thirty participants with localized patches of vitiligo were recruited. They were treated with intralesional injections of methotrexate every 2 weeks for a maximum of six sessions. At the end of the study, the degree of repigmentation was categorized into: excellent improvement (>75% repigmentation), good improvement (50%-75% repigmentation), fair improvement (25%-50% repigmentation) and poor improvement (<25% repigmentation). We included 7 males (23.3%) and 23 females (76.7%). Their mean age was 33.6 ± 8.6 years. The duration of the disease ranged from 1 to 22 years. Four patients had a family history of vitiligo. At the end of the study, there was a highly statistically significant improvement (p < 0.001) after treatment regarding repigmentation. This study showed that intralesional methotrexate is a safe and effective treatment option for patients with localized vitiligo lesions. Further studies on a larger scale are needed to evaluate the long-term effects of treatment and detect the ideal dose to be injected.

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. 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. 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. 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.

The object of this study was to establish a minimum dose of ultraviolet B (UVB) radiation capable of producing an erythemal reaction in budgerigars (Melopsittacus undulatus), to determine a threshold dose of UVB for vitamin D photoconversion, and to investigate the use of safer UVB wavelengths. In each of 5 experiments of this study, 20 birds were divided into a control group (n = 10) and a UVB irradiated group (n = 10). Light sources that provide broadband UVB wavelengths (280-315 nm) and narrowband UVB (310-320 nm) were used. Varied doses of UVB radiation were administered to budgerigars by altering exposure time and irradiance. Safety was determined by observing body weight and incidence of photokeratitis and photodermatitis. Efficacy was evaluated by measuring changes in serum 25-hydroxycholecalciferol levels. Serum corticosterone was measured in 1 experiment to monitor stress levels. The results demonstrated that exposure to 180 mJ/cm2 broadband UVB induced vitamin D photoconversion, decreased body weights, and increased serum corticosterone levels. At these wavelengths, UVB-induced lesions were observed. A broadband UVB of 150 to 300 mJ/cm2 was determined as the minimum erythema dose, and the threshold dose for vitamin D photoconversion was calculated to be in the range of 113-225 mJ/cm2. No erythemal lesions or vitamin D photoconversion took place after exposure to up to 1730 mJ/cm2 narrowband UVB radiation. A minimum erythema dose and a threshold dose for vitamin D conversion need to be determined for each species if phototherapy is to be considered as a safe and effective therapeutic or husbandry tool.

Phototherapy has long been a mainstay therapy for psoriasis. There have been exciting developments in new light sources for the treatment of psoriasis. These newer technologies have increased the efficacy of phototherapy and hopefully will decrease the long-term adverse events. Ideal phototherapy for localized psoriasis would be localized treatment, sparing the healthy skin from the side effects of UV radiation. There are a few targeted phototherapy devices that deliver Ultraviolet B (UVB), Ultraviolet A, or both. UVB phototherapy as monotherapy, or in combination with other therapies, is an effective treatment for psoriasis. Clearance rates with UVB can be ≥80% in combination with topical therapy. The mechanism of action of targeted phototherapy is similar to that of the other UV-based therapy that is, by inducing T-cell apoptosis, suppression of DNA synthesis, and generation of prostaglandins and cytokines. The cutaneous immunomodulation induced by phototherapy is an effective mode of treatment without systemic immunosuppression and its associated side effects.

Periorificial lesions associated with poor prognosis in patients with localized vitiligo: A retrospective study of 126 patients

Updates of treatment methods of stable vitiligo are needed to give better outcomes with a shorter duration of treatment. To test the effect of transdermal 5-fluorouracil (5-FU) delivery using fractional CO2 (FrCO2 ) laser versus intralesional 5-FU injection, with narrow-band type ultraviolet B (UVB) (NB-UVB) therapy after both, in the treatment of stable vitiligo. The present study comprised 40 patients with nearly symmetrical stable vitiligo lesions. The left side was treated with FrCO2 laser followed by topical 5-FU (FrCO2 +5-FU), while the right side was treated with 5-FU intradermal injection. Both procedures were done at 2-week intervals for 3sessions followed by 24sessions of narrow-band UVB for both sides. Repigmentation was demonstrated on the left side of 90% of patients and the right side of 85% of patients. As much as >50% improvement was demonstrated on the left side of 50% of patients, and the right side of 55% of patients. Intralesional 5-FU showed a statistically significant difference in repigmentation compared to FrCO2 +5-FU. Both 5-FU injection and FrCO2 +5-FU were effective therapeutic modalities for vitiligo. Patients were more compliant with FrCO2 +5-FU.

In the less sunny climates, ultraviolet B (UVB) phototherapy is a popular treatment for psoriasis resistant to topical therapy. For 10 to 30 treatments

Phototherapy is a commonly used treatment for vitiligo that has demonstrated safety and efficacy. High-intensity targeted ultraviolet B (UVB) light (304-312 nm) delivered using a phototherapy device is a useful therapeutic option because it can induce repigmentation in a short time without global exposure to radiation, but information regarding this device in children is limited. We performed a retrospective analysis of 95 patches of vitiligo in 27 children treated using a targeted phototherapy device. Phototherapy was administered twice a week. After the first 10 treatment sessions, 82 (86.3%) patches demonstrated some repigmentation and 36.8% achieved 50% or more repigmentation. After a mean of 20.4 treatment sessions, 86 patches (90%) demonstrated some repigmentation and 53.7% achieved 50% or more repigmentation. Responses varied depending on the anatomic location of the lesions. Better responses were usually observed on the face and trunk, whereas the extremities typically showed little response. Repigmentation was better in patients with active vitiligo than in those with stable vitiligo, with responses better with a disease duration of 1 year or less than in those with a duration of more than 1 year. There was no statistically significant difference in repigmentation between those with segmental and generalized vitiligo. The only short-term local side effect was mild erythema that required a decrease in dosage in six patients. Targeted high-intensity medium-band UVB phototherapy alone can produce clinical improvement in pediatric vitiligo and is well tolerated.

Phototherapy is among the oldest and most highly effective treatment modalities available for moderate-to-severe psoriasis. However, concern regarding the potential carcinogenic risk associated with ultraviolet B (UVB) phototherapy and/or psoralen with ultraviolet A (PUVA) has been expressed by both providers and patients. The purpose of this review is to assess the cutaneous malignancy risks of UVB phototherapy and/or PUVA in all skin types, including Caucasian and non-Caucasian patients. We searched the MEDLINE database for original research articles regarding the skin cancer risk of phototherapy. A total of 61 articles were included. In Caucasians, an increased risk of squamous cell carcinoma with PUVA therapy was reported after &gt;250 sessions, whereas studies among non-Caucasians did not show any increased risk. There was no convincing evidence of increased skin cancer risk associated with UVB phototherapy among all skin types. In view of the continued validation of its safety, phototherapy remains a valuable treatment option for patients with moderate-to-severe psoriasis.

Phototherapy with narrowband ultraviolet B (UVB) is an effective treatment for vitiligo. However, it requires frequent in-office visits. Self-administered home-based UVB (HBUVB) therapy with a handheld or panel device is an alternative that has received limited research attention. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of HBUVB in the treatment of vitiligo compared to in-office UVB (IOUVB). Searches were conducted on Medline, Cochrane and Embase from inception until 4th of August, 2024. Studies with primary data of patients being treated with a hand-held UVB device were included in this study. Efficacy as measured in number of patients achieving > 50% or > 75% repigmentation was the primary study outcome. Secondary outcomes analyzed were cost, adverse events and adherence. Eighteen studies were included with a total of 1341 vitiligo patients. Of these, four studies (148 HBUVB and 143 IOUVB) could be used for the meta-analysis. HBUVB was not inferior to IOUVB at achieving > 50% (OR 1.04, 95% CI 0.58-1.87) and > 75% repigmentation (OR 1.26, 95% CI 0.65-2.42). Home-based UVB was not associated with an increase in risk for either erythema or burning sensations when compared to IOUVB. There was a 14% lower rate of discontinuation amongst patients using HBUVB. Home-based UVB therapy is not inferior to in-office UVB therapy in efficacy or rate of adverse events and demonstrates favourable treatment adherence. This meta-analysis provides evidence supporting HBUVB as a safe and effective alternative to IOUVB in patients with vitiligo. PROSPERO registration number: (CRD42023478123).

Vitiligo is an acquired loss of pigmentation and its treatment remains very difficult up to date. Narrow band ultraviolet B (NB-UVB) and topical immunomodulators are included among the most innovative approaches to vitiligo. We evaluated the efficacy and tolerability of NB-UVB, topical pimecrolimus and tacrolimus in the treatment of vitiligo. Adult patients with chronic and stable vitiligo refractory to conventional therapies were enrolled in an open parallel groups study. The patients were scheduled on the basis of a computer-generated randomization into three groups: 13 patients received NB-UVB phototherapy 3 times a week, 15 patients were treated with pimecrolimus 1% cream b.i.d. and 16 patients applied tacrolimus 0.1% ointment b.i.d. All three treatment regimens were performed for 24 weeks. At baseline and every three weeks for the whole period of therapy the patients were examined through digital photographs and, at the end of the study, based on the percentage of repigmentation, treatment outcome was classified as "absent" (0), "slight" (< 25%), mild (25-49%), "moderate" (50-74%), and "excellent" (> 75%). During the whole period of the study, possible side effects were recorded. The response to treatments varied according to the anatomical location of the lesions. No statistically significant differences in repigmentation for any anatomical site were recorded with the three treatments. The best results were obtained for lesions of the face with pimecrolimus cream and tacrolimus ointment and of the neck with NB-UVB. Statistically significant differences in repigmentation between photo-exposed and covered skin areas were recorded although the patients were asked to avoid direct UV exposition and to apply a very high protection sun screen on vitiligo lesions. All three treatments should be considered as a good option in the treatment of vitiligo. NB-UVB irradiation may represent the optimal choice in generalized vitiligo with topical immunomodulators in localized vitiligo.

BACKGROUND: Ultraviolet‐B (UVB) light sources are widely used for the safe and effective treatment of inflammatory skin conditions. The recent commercial introduction of fiber‐coupled UVB phototherapy systems facilitates the selective exposure and treatment of localized psoriasis plaques while permitting the safe use of high‐dosage treatments.OBJECTIVE: In this study, the performance characteristics and clinical outcome of psoriasis treatments were assessed when using two technologically distinct sources of high‐intensity, fiber‐optically delivered therapeutic UVB.METHODS: A pulsed, monochromatic 308 nm excimer laser and a continuous‐wave, incoherent UVB light source were compared using photosensitive recording papers, images captured with a CCD camera, and on the healthy and lesional skin of ten psoriasis patients.RESULTS: Beam profile analyses and minimal erythema dose (MED) test spots revealed distinct energy distribution patterns from the two devices. The Guassian‐type laser beam energy distribution complicated MED determinations, whereas skin exposed to light from the incoherent UVB system developed a more uniform erythema. Both systems cleared the treated psoriasis plaques equivalently, requiring no more than two to five weeks of high‐dose treatments.CONCLUSION: When used at equally erythemogenic high doses, both systems produced rapid plaque clearance with minimal side effects. Unlike conventional phototherapy, localized UVB minimizes exposure to the healthy skin, making it suitable for patients with mild to moderate psoriasis, individuals with recalcitrant plaques and for the successful treatment of lesions occurring on most body sites.