1. Home>
2. Specialties>
3. Dermatology>
4. Summary and Comment

Repigmentation in Vitiligo: PUVA vs. Narrowband UVB

Narrowband UVB was safer and more effective than PUVA for vitiligo therapy.

Phototherapy employing sunlight and plants that contain natural psoralens was first used for vitiligo thousands of years ago, and it continues to be a first-line treatment today. Investigators conducted a randomized, double-blind trial to compare two of the most popular forms of phototherapy for vitiligo in 50 patients with nonsegmental vitiligo who received either PUVA or narrowband UVB (NB-UVB) therapy (25 patients in each group).

After treatment (maximum, 144 sessions), subjects in both groups had significant reductions in the extent of vitiligo-involved body surface area. Although between-group differences were not statistically significant, improvement occurred more rapidly and tended to be greater with NB-UVB. After 48 treatments in patients who received that many sessions, the median percentage of improvement in affected body-surface area was slightly more than 20% in the PUVA-treated patients and more than 50% in the narrowband-treated group. The color of the repigmented skin matched excellently the color of uninvolved skin in all NB-UVB recipients but in only 44% of PUVA recipients. Erythema occurred more often with PUVA phototherapy than with NB-UVB therapy (in 96% vs. 68%, respectively). The PUVA recipients received a median of 47 treatments and the narrowband UVB patients, a median of 97; the authors suggest that this is because of the greater efficacy and fewer adverse effects experienced by NB-UVB recipients.

Comment: This study clearly demonstrates that for vitiligo repigmentation, NB-UVB is safer and more effective than PUVA. Other randomized, controlled trials have shown at least some efficacy with targeted phototherapy, topical and systemic steroids, topical calcineurin inhibitors, and calcipotriene combined with PUVA. A number of reports show success with surgical repigmentation procedures, as well. Although we are making progress in treating this vexing disease (especially with calcineurin inhibitors and phototherapy), we still have a long way to go. At best, 75% of patients respond, and in most instances, this response is only partial. A breakthrough in the management of this disease would be greatly welcomed by both patients and doctors. An accompanying editorial provides a nice evidence-based review of existing therapies for vitiligo.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology June 1, 2007

Citation(s):

Yones SS et al. Randomized double-blind trial of treatment of vitiligo: Efficacy of psoralen–UV-A therapy vs narrowband–UV-B therapy. Arch Dermatol 2007 May; 143:578-84.

• Original article (Subscription may be required)
• Medline abstract (Free)

Lim HW and Hexsel CL. Vitiligo: To treat or not to treat. Arch Dermatol 2007 May; 143:643-6.

• Original article (Subscription may be required)
• Medline abstract (Free)