Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo‐types (III–V): A double‐blind, randomized, placebo‐controlled, prospective, multicenter study

Abstract

Background NB‐UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB‐UVB ability to control disease activity are lacking. Purpose To assess stabilizing effect of NB‐UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo‐types (III‐V). Methods This is a multicenter, placebo‐controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB‐UVB and placebo (NB‐placebo) or NB‐UVB and dexamethasone oral mini‐pulse (OMP) therapy (NB‐OMP) for 6 months. Sixty four patients completed the study, 34 in the NB‐OMP group and 30 in the NB‐placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. Results In spite of earlier control of disease activity observed in the NB‐OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB‐UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. Conclusion NB‐UVB is the only well‐established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune‐suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Update on pharmacology, actions, dosimetry and regimens of oral glucocorticoids in dermatology

“…This achieves both a favorable disease stabilizing effect and achieves re-pigmentation. 51 NB-UVB and methylprednisolone 0.5 mg/kg on 2 consecutive days per week for at least 3 months has been found to produce a greater than 25% re-pigmentation in 59.4% patients and was found to arrest disease progression in all patients. 52 A recent systematic review examining studies on oral mini pulse in vitiligo found a high risk of bias and a low quality of evidence in the available literature.…”

“…Thus, NB‐UVB is by itself safe and effective therapeutic modality in management of vitiligo. This achieves both a favorable disease stabilizing effect and achieves re‐pigmentation 51 . NB‐UVB and methylprednisolone 0.5 mg/kg on 2 consecutive days per week for at least 3 months has been found to produce a greater than 25% re‐pigmentation in 59.4% patients and was found to arrest disease progression in all patients 52 .…”

An update and review of narrowband ultraviolet B phototherapy for vitiligo

“…16 In another randomized control trial, the effectiveness of NB-UVB plus dexamethasone oral mini pulse (OMP) therapy at stabilizing active vitiligo was examined. 17 demonstrated in the first 9 weeks of treatment. However, by 6 months there was no statistically significant difference between either group.…”

“…In another randomized control trial, the effectiveness of NB‐UVB plus dexamethasone oral mini pulse (OMP) therapy at stabilizing active vitiligo was examined 17 . Eighty patients with actively progressing vitiligo and skin phototypes III−V were allocated to NB‐UVB monotherapy or NB‐UVB plus OMP.…”

“…Thus, systemic corticosteroids such as dexamethasone OMP, when used in conjunction with NB‐UVB, can arrest disease progression and induce stabilization in those with progressive vitiligo. However, the repigmentation ability of systemic corticosteroids in vitiligo remains nebulous 17,18 …”