Treatment recalcitrant vitiligo with narrow band UVB

Abstract EN

Background : Vitiligo is a common and chronic disease with a great impact on patients’ quality of life.

Phototherapy with narrowband ultraviolet B radiation is one modalities that are used increasingly for the management of the disease with variable results.

In this study we review the efficacy, adverse effects, of narrowband ultraviolet B in the treatment of recalcitrant vitiligo in patients not responding to the topical and systemic steroid nor to topical or systemic psoralen.

Patients and methods: Twenty-two patients with vitiligo (whom not response to topical steroid or topical or systemic psoralen) were included in this study their ages ranged from 6 to 45 years with a mean of 26.733 years ± 8.11 SD, with vitiligo and Fitzpatrick’s skin type II-IV from our outpatient clinic were included in the study.

The duration of the disease was ranged from 1-17 years, with mean of 6.71 years ± 4.22 SD.

All patients did not taken treatment for at least 3 months.

exclusion criteria were patients with a history of skin cancer or dysplastic naevus syndrome, photosensitivity or using photosensitizing medicine, psychiatric or epileptic disorders.

Before the study the surface area patches ranged between 4 cm2 to 38 cm2.

The initial irradiation time was 36 seconds (200 mJ /c m2) then increase gradually with every visit by 9 second (50 mJ / cm2) if no any side effect was occur continue with increasing scale up to 3 minutes (1666 mJ / cm2) for five months (forty sessions) .

All patients were treated with narrow band UVB machine twice weekly (not consecutive days) .No phototesting was done before the treatment.

Results: All twenty-two patients with vitiligo were completed this study.

(10 males and 12 females).

The results of 22 patients treated with narrow band UVB machine twice weekly (not consecutive days) as follow.

The mean size of patches before treatment were 16.61±7.99 cm2 after one month become 15.23±7.27 cm2 , this size continued to decrease reaching to 12.96±6.521 cm2 by two months; at three months the size of lesions become 10.73±5.841 cm2 , the size continued to decrease reaching to 9 ±5.790cm2 in the end of fourth month, while reaching to 8 ± 5.581cm2 in the 5th month .The repigmentation grading was as follows after 20 weeks of treatment grade 0 were 2 patients (9.09 %) , grade I were 3 patients (13.63 %) , grade II were 5 patients (22.72 %), grade III were 7 patients (31.81 %), grade IV were 5 patients (22.27 %) .

54.54 % of the patients showed more than 50 % (grade III and grade IV) reduction in the size of vitiligenous area.

P value was extremely significant (p = 0.0003) .

Conclusion : Treatment with narrow band UVB was relatively safe and effective in treatment of recalcitrant vitiligo and has no side effects except transient erythema.