Sameh K. Attia, Sherif S. Awad, Siham Yacoub
Department of Dermatology and Venereology, Minia University, Minya, Egypt.
DOI: 10.4236/jcdsa.2013.33A2005   PDF    HTML     5,397 Downloads   8,269 Views   Citations

Abstract

Background: Phototherapy is the most commonly used modality in the treatment of vitiligo. Oral PUVA is the classical treatment and the NB-UVB is a recently introduced form excluding the shorter erythemogenic wavelengths. Aims: This study was designed to compare the effects of PUVA and NB-UVB clinically and immuno-pathologically in managing non segmental vitiligo. Patients/Methods: Thirty vitiligo patients were divided randomly into two groups and treated either by oral PUVA or by narrow band UVB for 4 months, and evaluation was done clinically and immuno-pathologically. Results: One patient in PUVA group (3.3%) failed to respond to therapy while 29 patients (93.3%) improved including all NB-UVB cases. Excellent repigmentation was achieved in 6.7% in PUVA group and 66.6% in NB-UVB group; good repigmentation was achieved in 60% in PUVA and 20% in NB-UVB while 26.7% in PUVA and 13.3% in NB-UVB showed mild repigmentation. The color matching was excellent in all NB-UVB patients. Recurrence and activation of vitiligo were demonstrated in some NB-UVB cases and were less in PUVA treated cases. Microscopic examination revealed persistence of dermal lympho-histiocytic infiltrate and the interface changes in biopsies from vitiliginous lesions treated with NB-UVB more than with PUVA. Conclusions: NB-UVB provides significant better results than oral PUVA in managing non-segmental vitiligo. Although NB-UVB therapy gives a rapid effect, yet the observation of recurrences and development of new lesions of vitiligo were less significant with PUVA. It was also observed that PUVA has better immuno-modulatory effect on vitiligo than NB-UVB and may give better response on a longer period of time.

Keywords

PUVA; Vitiligo; NB-UVB

Share and Cite:

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. O. Kovacs, “Vitiligo,” Journal of the American Academy of Dermatology, Vol. 38, No. 5, 1998, pp. 647-666.
[2]	M. D. Njoo, W. Westerhof, J. D. Bos and P. M. Bossuyt, “The Development of Guidelines for the Treatment of Vitiligo,” Archives of Dermatology, Vol. 135, No. 12, 1999, pp. 1514-1521. http://dx.doi.org/10.1001/archderm.135.12.1514
[3]	T. M. Runger, “Ultraviolet Light,” In: J. L. Bolognia, J. L. Jorizzo, R. P. Rapini, T. D. Horn, A. J. Maoncini, J. M. Mascaro, S. J. Salasche, J. H. Saurat and G. Stingl, Eds., Dermatology, Mosby, Edinburgh, London, New York, Oxford, Philadelphia, St. Louis, Sydney, Toronto, Vol. 1, 2003, pp. 1353-1364.
[4]	M. El-Mofty and H. El-Sawaalhy, “Clinical Study of a New Preparation of 8-Methoxypsoralen in Photochemotherapy,” International Journal of Dermatology, Vol. 33, No. 8, 1994, pp. 688-703. http://dx.doi.org/10.1111/j.1365-4362.1994.tb02904.x
[5]	D. Parsad, A. J. Kanwar and B. Kumar, “Psoralen-Ultraviolet A vs. Narrowband Ultraviolet B Phototherapy for the Treatment of Vitiligo,” Journal of the European Academy of Dermatology and Venereology, Vol. 20, No. 2, 2006, pp. 175-177. http://dx.doi.org/10.1111/j.1468-3083.2006.01413.x
[6]	A. K .Gupta and T. F. Anderson, “Psoralen Photochemotherapy,” Journal of the American Academy of Dermatology, Vol. 17, No. 5, 1987, pp. 703-734. http://dx.doi.org/10.1016/S0190-9622(87)70255-2
[7]	S. S. Yones, D. Der, A. Roy, et al., “Efficacy of Psoralen-UV-A Therapy vs Narrowband-UV-B Therapy,” Archives of Dermatology, Vol. 143, No. 5, 2007, pp. 578-584. http://dx.doi.org/10.1001/archderm. 143.5.578
[8]	R. S. Dawe, J. Ferguson and S. H. Ibbotson, “A Study of the Characteristics of Erythema Induced by Bath and Oral Methoxsalen Photochemotherapy and Narrowband Ultraviolet,” Journal of Photochemistry and Photobiology, Vol. 78, No. 1, 2003, pp. 55-60. http://dx.doi.org/10.1562/0031-8655(2003)078<0055:AISOTC>2.0.CO;2
[9]	Y. Kawakami, K. Jane, K. Takeshi, et al., “Production of Recombinant MART-1 Protiens and Specific AntiMART-1 Polyclonal and Monoclonal Antibodies: Use in the Characterization of the Human Melanoma Antigen MART-1,” Journal of Immunological Methods, Vol. 202, No. 1, 1997, pp. 13-25. http://dx.doi.org/10.1016/S0022-1759(96)00211-6
[10]	S. S. Awad, H. Abdel-Raof, W. Hosam El-Din and M. El-Domyati, “Epithelial Grafting for Vitiligo Requires Ultraviolet A Phototherapy to Increase Success Rate,” Journal of Cosmetic Dermatology, Vol. 6, No. 2, 2007, pp. 119-124. http://dx.doi.org/10.1111/j.1473-2165.2007.00307.x
[11]	M. D. Njoo, J. D. Bos and W. Westerhof, “Treatment of Generalized Vitiligo in Children with Narrow-Band (TL-01) UVB Radiation Therapy,” Journal of the American Academy of Dermatology, Vol. 42, No. 2, 2000, pp. 245-253. http://dx.doi.org/10.1016/S0190-9622(00)90133-6
[12]	M. El Mofty, W. Mostafa, S. Esmat, et al., “Narrow Band Ultraviolet B 311 nm in the Treatment of Vitiligo: Two Right-Left Comparison Studies,” Photodermatology, Photoimmunology & Photomedicine, Vol. 22, No. 1, 2006, pp. 6-11. http://dx.doi.org/10.1111/j.1600-0781.2006.00189.x
[13]	W. Westerhof and L. Nieuweboer-Krobotova, “Treatment of Vitiligo with UV-B Radiation vs Topical Psoralen Plus UV-A,” Archives of Dermatology, Vol. 133, No. 12, 1997, pp. 1525-1528. http://dx.doi.org/10.1001/archderm.1997.03890480045006
[14]	I. Hamzavi, H. Jain, D. McLean, et al., “Parametric Modeling of Narrowband UV-B Phototherapy for Vitiligo Using a Novel Quantitative Tool,” Archives of Dermatology, Vol. 140, No. 6, 2004, pp. 677-683. http://dx.doi.org/10.1001/archderm.140.6.677
[15]	A. Simin, S. Sedef, B. Gonca and K. Fikret, “No Additional Effect of Topical Calcipotriol on Narrow Band UVB Phototherapy in Patients with Generalized Vitiligo,” Photodermatology, Photoimmunology & Photomedicine, Vol. 21, No. 2, 2005, pp. 79-83. http://dx.doi.org/10.1111/j.1600-0781.2005.00139.x
[16]	S. M. Halpern, A. Anstey and R. S. Dawe, “Guidelines for Topical PUVA: A Report of a Workshop of the British Photodermatology Group,” British Journal of Dermatology, Vol. 142, No. 1, 2000, pp. 22-31. http://dx.doi.org/10.1046/j.1365-2133.2000.03237.x
[17]	S. Valkova, M. Trashlieva and P. Christova, “Treatment of Vitiligo with Local Khellin and UVA: Comparison with Systemic PUVA,” Clinical and Experimental Dermatology, Vol. 29, No. 2, 2004, pp. 180-184. http://dx.doi.org/10.1111/j.1365-2230.2004.01462.x
[18]	S. Sahin, U. Hindioglu and A. Karaduman, “PUVA Treatment of Vitiligo: A Retrospective Study of Turikish Patients,” International Journal of Dermatology, Vol. 38, No. 7, 1999, pp. 542-545. http://dx.doi.org/10.1046/j.1365-4362.1999.00654.x
[19]	T. S. Anbar, W. Westerhof, A. T. Abdel-Rahman and M. A. El-Khayyat, “Evaluation of the Effects of NB-UVB in Both Segmental and Non-Segmental Vitiligo Affecting Different Body Sites,” Photodermatology, Photoimmunology & Photomedicine, Vol. 22, No. 3, 2006, pp. 157-163. http://dx.doi.org/10.1111/ j.1600-0781.2006.00222.x
[20]	R. S. Stern, “The Risk of Melanoma in Association with Long-Term Exposure to PUVA,” Journal of the American Academy of Dermatology, Vol. 44, No. 5, 2001, pp. 755-761. http://dx.doi.org/10.1067/ mjd.2001.114576
[21]	Y. C. Kim, H. Y. Kang, S. Seonghyang and E. S. Lee, “Histopathologic Features in Vitiligo,” The American Journal of Dermatopathology, Vol. 30, No. 2, 2008, pp. 112-115. http://dx.doi.org/10.1097/ DAD.0b013e3181651511
[22]	L. F. Montes, J. Abulafia, W. H. Wilborn, et al., “Value of Histopathology in Vitiligo,” International Journal of Dermatology, Vol. 42, No. 1, 2003, pp. 57-61. http://dx.doi.org/10.1046/j.1365-4362. 2003.01743.x
[23]	A. B. Ackerman, N. Chongchitant, J. Sanchez, Y. Guo, B. Bennin, M. Reichel and A. B. Randall, “Embryologic, Histologic and Anatomic Ascpects,” In: A. B. Ackerman, N. Chongchitant, J. Sanchez, Y. Guo, B. Bennin, M. Reichel and A. B. Randall, Eds., Histologic Diagnosis of Inflammatory Skin Diseases, 2nd Edition, Williams and Wilkins, Baltimore, Phildelphia, London, Paris, Banckok, Hong Kong, Sydney, Tokyo, 1997, p. 2.
[24]	T. B. Fitzpatrick, “Mechanisms of Phototherapy of Vitiligo,” Archives of Dermatology, Vol. 133, No. 12, 1997, pp. 1591-1592. http://dx.doi.org/10.1001/archderm.1997.03890480113020
[25]	R. M. Halder and C. M. Young, “New and Emerging Therapies for Vitiligo,” Dermatologic Clinics, Vol. 18, No. 1, 2000, pp. 79-83. http://dx.doi.org/10.1016/S0733-8635(05)70149-2