Narrow-band UVB therapy in the treatment of vitiligo. Experience in clinical practice

Narrow-band UVB phototherapy is currently considered one of the treatments of choice in generalized vitiligo. We discuss the results of an open, prospective trial including eight patients with generalized vitiligo treated with narrow-band UVB phototherapy. In addition to phototherapy, calcipotriol ointment was applied nightly on vitiligo lesions. The mean treatment period was 38 weeks. Of the eight patients, the treatment resulted in 25-75% repigmentation in six. The best response was achieved with facial lesions, where repigmentation was almost complete (more than 75%) in four out of six patients and was moderate (25-75%) in the remaining two. Response was moderate in most patients with lesions located on the trunk (4/7) and was moderate (2/6) or unsatisfactory (less than 25%) (4/6) in patients with lesions on the hands and/or feet. Narrow-band UVB phototherapy, initially intended for the treatment of psoriasis, has become one of the treatments of choice in vitiligo, producing cosmetically acceptable repigmentation in approximately 60% of patients after 1 year of treatment. Treatment with narrow-band UVB presents marked advantages over PUVA therapy: moderate mean cumulative doses, fewer phototoxic effects or photoallergic reactions and, moreover, less striking contrast between normal pigmented and depigmented skin and absence of the adverse effects associated with intake of psoralens. Nevertheless, the therapy is time-consuming and only a few devices are currently available. Moreover, data providing recommendations on a safe maximum narrow-band UVB dose are lacking and the long-term prognosis of responders is unknown. Narrow-band UVB therapy represents a valuable and well tolerated option for generalized vitiligo. Thus, marked repigmentation can be expected in more than half of treated patients.