Narrowband Ultraviolet B Phototherapy Efficacious in Vitiligo Treatment

Michelle Rodrigues, MBBS

An updated review on narrowband ultraviolet B phototherapy (NB-UVB) reported strong efficacy and safety as a treatment method for non segmental vitiligo, despite some patients being labeled as nonresponders.

The review noted the use of combination therapy may additionally provide an adjunct to phototherapy on its own, with topical calcineurin inhibitors, topical steroids, some antioxidants and systemic corticosteroids reporting improvements in the treatment effect.

“Whilst some phototherapy treatment options require continued research, recent developments in this field have paved the way for more efficacious and well‐rounded management of vitiligo patients of all ages,” wrote study author Michelle Rodrigues, MBBS, Chroma Dermatology, Pigment and Skin of Colour Centre.

Over the past few decades, an uptick in the popularity of narrowband ultraviolet B phototherapy (NB-UVB) over other forms of phototherapy to treat vitiligo has been observed. The current study reviewed the efficacy and safety of NB-UVB treatment in vitiligo and home-based phototherapy techniques.

The investigators performed a meta-analysis of prospective NB-UVB studies, finding a mild response (≥25% repigmentation) was achieved in 74.2% of patients after 6 months of therapy and 75.0% of patients after 12 months. Meanwhile, a moderate response (≥50% repigmentation) was observed in 37.4% of patients after 6 months and 56.8% of patients after 12 months.

They found an excellent response (≥75%) in 19.2% of patients after 6 months and 35.7% of patients after 12 months. Based on these results, Rodrigues and colleagues suggested that a longer treatment duration is likely to improve repigmentation rates in nonresponders. Both patient compliance and perseverance within NB-UVB treatment is important, they noted.

However, these findings suggest that nearly 25% of patients failed to achieve a mild response after 12 months of treatment, creating a cohort of non responders.

By comparison, a meta-analysis of psoralen plus ultraviolet A (PUVA) found moderate response in 23.5% of patients after 6 months and 34.3% of patients after 12 months and excellent response in 8.5% of patients after 6 months and 13.6% of patients after 12 months.

Based on these findings, it was noted that NB-UVB has greater efficacy, making it a preferred phototherapy type, but PUVA phototherapy may be considered in certain circumstances. Additionally, they noted the efficacy of NB-UVB has varied when considering different body areas affected by vitiligo.

The data show a mild response was frequently elicited on the face and neck (82.0% of patients), the trunk (81.7% of patients), and the arms and legs (79.0% of patients). Hands and feet were considered the least responsive to NB-UVB, as only 11.0% of patients experienced mild repigmentation.

They additionally investigated meta-analyses of studies on combination therapy of NB-UVB treatment. For example, when NB-UVB and tacrolimus were combined, data show a statistically significant increase in the excellent response rate and fewer patients were categorized as having a poor response, compared to monotherapy.

Further, they reported evidence on the efficacy of the combination of topical corticosteroids combined and NB-UVB, finding it effective, but requiring more research. The results were said to showcase how home-based phototherapy may be a treatment option for limited vitiligo, which can reduce patient visits for phototherapy sessions and increase compliance.

From a prospective comparative study, data show patients who received continuous NB-UVB, interrupted NB-UVB and mixed each saw significant improvement in Vitiligo Scoring Index, compared to before treatment. There was additionally no statistically significant increase in repigmentation between groups that received continuous and interrupted treatment.

The reported acute adverse effects of NB-UVB included erythema, burning, pruritus, xerosis, and pain, but they were considered generally mild and disappeared a few hours following phototherapy.

“NB‐UVB is a safe treatment method with few adverse effects as well as no increase in risk of any form of skin cancer seen in the literature,” Rodrigues noted.

Home-based phototherapy studies reported similar repigmentation efficacy and improvement in patient-reported quality of life, but higher rates of adverse events, when compared to in-hospital phototherapy. Nonetheless, the convenience of home-based phototherapy may ultimately improve patient adherence and be cost-saving for the patient.

“An update and review of narrowband ultraviolet B phototherapy for vitiligo,” was published in Dermatological Reviews.