For Vitiligo therapy Narrowband UVB was more effective and safer than PUVA.

Thousands of years back phototherapy of plants and sunlight was utilized as a first treatment from the vitiligo that contains natural psoralens and even today it is well used as a first treatment given to the patient. The double blind and randomized trial on two of the most famous types of phototherapy used for vitiligo was conducted by the investigators on different 50 patients who were suffering from non segmental vitiligo. The patients were given either narrowband UVB (NB-UVB) or PUVA therapy (2 groups made for 25 patients each).

After the maximum 144 sessions treatment, the patients from both groups had major reductions in the growth of vitiligo which was involved in surface area of the body. Although the differences between both groups were not important statistically but patients got rapid improvement and NB-UVB provided greater care. After providing 48 treatments to those patients who were passed through these so many sessions, the percentage of betterment in the affected part of the surface area of body was 20% more in those patients who were treated through the PUVA and 50% more in those patients who were treated with narrowband UVB. The patients who were treated with NB-UVB got excellently matched the color of re-pigmented skin with the color of uninvolved skin in vitiligo but the patients treated through PUVA got only 44% skin matched. With PUVA, erythema arose more often than with therapy of NB-UVB and the ratio was 96% and 68% respectively. The patients treated through PUVA got a median of 47 treatments and 97 median of treatments were given to the narrowband UVB patients. According to the author this is why the patients treated with NB-UVB experienced greater efficiency and less harmful effects.

Comments: According to this study NB-UVB is more effective and safer than PUVA for the repigmentation of vitiligo. All other controlled and randomized trials have shown less efficiency have also shown with targeted phototherapy, topical calcieneurin inhibitors, systemic and topical steroids and calcipotriene jointly with PUVA. There are some reports that show the success with the procedure of surgical repigmentation as well. Still we have to do a lot of efforts to get a best cure of this disease although we are already making good progress towards the treatment of this disease (especially with phototherapy and calcineurin inhibitors). The best response of the patients in any research was 75% and in many instances the response was only fractional. Any advancement in the cure of this disease would definitely be welcomed by the doctors and patients as well. This is a complementary editorial that provides good evidence based assessment of existing vitiligo therapies.

Craig A. Elmets, MD

Published on June 1, 2007 in Journal Watch Dermatology