Vitiligo

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About Phototherapy

Phototherapy for vitiligo is beneficial because it can target large areas of skin without the side effects of oral or topical medications. During phototherapy sessions, a machine emitting rays of narrow band UVB (NB-UVB) light is directed at the area of the body being treated. A session takes only a few minutes, and patients can receive treatment several times a week. Other phototherapy options such as PUVA therapy have been well described for vitiligo; however, its limitations include nausea and light sensitivity reactions, as well as long-term skin cancer concerns. Today, NB-UVB phototherapy is a wonderful alternative for patients with fairly extensive disease. NB-UVB has proven to be one of the most effective treatment options for thousands of patients all over the world.

Benefits

• NB-UVB is a useful and well-tolerated treatment option for patients with vitiligo. Over many treatment sessions, patients see reduction or complete elimination of vitiligo patches.

• Clinical studies show the peak therapeutic effectiveness of UVB to be within the range of 295-313 nm, but wavelengths below 300 nm can cause redness or severe burning and increase the risk of skin cancer.

• NB-UVB virtually eliminates superfluous and harmful UV by emitting only wavelengths 311-312 nm. (Conventional broad-band UVB lamps emit a variety of wavelengths ranging from 280-330 nm).

• Eliminating UV in wavelengths below 311 nm permits higher intensities and longer exposure times, so patients can derive the maximum benefit from phototherapy.

• The increased effectiveness permits even more aggressive treatment approaches, resulting in a shorter course of treatment.

• Published research papers confirm that patients not only avoid the danger of serious burning from sub-erythemal exposure, they may also enjoy longer remission periods after treatment.

• Remission periods are similar to those with PUVA therapy and markedly superior to broad band or conventional UVB treatment. Studies show 38-40 percent of narrow-band treated patients require no additional therapy for at least 12 months.

Alternatives

Non-surgical first line options include excimer laser treatment, topical corticosteroid creams, topical immunomodulators (Protopic or Elidel), oral or topical psoralens plus ultraviolet A (PUVA), conventional broad band UVB phototherapy. Surgical modalities consist of skin transplantation from an unaffected area of the body to the affected area, including split-thickness epidermal grafting, grafting of cultured melanocytes, and epidermal blister grafting.

How Does it Work?

Patients stand in a phototherapy unit containing a bank of 48 fluorescent tubes with peak emission at 311 nm. For limited hand or foot disease, patients sit with the affected areas placed in a specific hand and foot device. Therapy is administered 2-3 times a week, on nonconsecutive days. Affected segments of the skin are exposed during each treatment. A predetermined starting dose of light is administered, with subsequent increases of approximately 10-15% for each treatment. If the patient reports mild redness or itching, the irradiation dose is held constant for the subsequent treatment, or until resolution of symptoms. If burning, pain or blistering develops, the irradiation dose is decreased by 10-15%. Once 75% repigmentation is achieved, the frequency of treatments is tapered to twice a week for 4 weeks, then weekly for 4 weeks. Lesional photography is often performed at the initial pretreatment visit and periodically thereafter.

Who is a Candidate?

All patients with vitiligo who do not have a contraindication for light therapy, (such as lupus, or other photosensitizing diseases) may undergo this therapy. Smaller areas of vitiligo can alternatively be treated with the excimer laser.

What can I Expect?

Reduction or complete elimination of white vitiligo patches.

Results may vary.

Safety & Side Effects

Adverse side effects are rare. Redness and itching can occur, and resolves spontaneously. Blistering, exaggerated increased pigmentation and scarring are possible though rare. Proper eye protection is required during treatments. The specific risks and the suitability of these procedures for a given individual can be determined only at the time of consultation. All procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally.

Recovery Time

Usually none. Many patients may have some pinkness of the skin for a few days.

Does it Hurt?

No.

Before Treatment Instructions

None.

After Treatment Instructions

Avoid excessive sun exposure for a few days after the procedure.

Who Performs the Treatments?

Our Physicians, physician assistants and registered nurses perform the procedure.