Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A

W. Westerhof and L. Nieuweboer-Krobotova
The Netherlands Institute for Pigmentary Disorders, Amsterdam, The Netherlands. snip-ww@knoware.nl

OBJECTIVE: To compare the efficacy and safety of 2 treatment modalities, topical psoralen plus UV-A (PUVA) with unsubstituted psoralen and 311-nm UV-B radiation, in patients with vitiligo. DESIGN: This intervention study was designed as a before-and-after trial with 2 arms, in which patients were consecutively included. PATIENTS: Male (n = 99) and female (n = 182) patients, who predominantly had skin type III, with extensive, generalized vitiligo of more than 3 months' duration. INTERVENTIONS: Two patient groups were investigated. The first group of patients was treated for 4 months with either topical PUVA (n = 28) or 311-nm UV-B radiation (n = 78). The second group of patients, treated twice weekly with 311-nm UV-B radiation, was followed up for 3 (n = 60), 6 (n = 27), 9 (n = 37), or 12 months (n = 51). RESULTS: Thirteen (46%) patients in the first group treated with topical PUVA showed repigmentation after 4 months. Fifty-two patients (67%) in the 311-nm UV-B treatment group showed repigmentation after 4 months. After 3 months, 5 patients (8%) in the second group showed more than 75% repigmentation of lesional skin compared with 32 patients (63%) after 12 months. As in other treatment modalities, the face showed good repigmentation, whereas hands and feet responded poorly. No adverse effects were encountered with treatment with narrowband UV-B radiation, contrary to those seen with topical PUVA treatment. The cumulative UV-B dose was very small compared with that of the topical PUVA treatment. CONCLUSIONS: According to our results, the treatment of patients with vitiligo with 311-nm UV-B radiation is as efficient as with topical PUVA and has fewer adverse effects.

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