Exploring the gaps in the evidence‐based application of narrowbandUVBfor the treatment of vitiligo

Abstract

SUMMARYWhile narrowband ultraviolet light B (NB-UVB) has become integral to the treatment of diffuse vitiligo, evidence-based guidelines have been lacking with regard to dosing and administration. This is largely the result of heterogeneous study designs, ambiguous methodologies, disparate dosing strategies, and the use of varied, and somewhat arbitrary, outcome measures. In the absence of prospective trials to address each of these concerns, the available literature regarding the application of NB-UVB for vitiligo was reviewed and the authors now pose a set of questions to the phototherapy community in an attempt to highlight gaps within our understanding. We aim to stimulate discussion, elicit expert opinion, and identify areas for future research to move toward a unified and safe treatment guideline for patients afflicted by this disease.

Home interventions and light therapy for the treatment of vitiligo (HI-Light Vitiligo Trial): study protocol for a randomised controlled trial

“…Although NB-UVB (UV radiation wavelengths of 311–312 nanometres) is now the most common form of light therapy used to treat skin conditions, many gaps remain in knowledge about its use. In a 2016 paper, 13 Madigan et al published a list of 12 key questions regarding the use of narrowband UVB for generalised vitiligo. How each of these questions has been addressed within the context of the HI-Light trial is presented in table 2 .…”

“…Nevertheless, the Cochrane review identified some evidence in support of NB-UVB, and the combination of NB-UVB with other active interventions (eg, topical corticosteroids or calcineurin inhibitors) appeared to be more effective than monotherapy. A 2016 review of the use of NB-UVB for the treatment of vitiligo 13 also concluded that guidance on dosing and administration of NB-UVB requires further study.…”

Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT

“…However, because of the heterogeneity of trial designs, optimal dosing and treatment regimen for NB-UVB could not be established. 23 In 2016, the Cochrane review was updated, and covered 96 trials, none of which provided evidence that was of sufficient quality to alter these overall conclusions.…”

Current Approach to Phototherapy Applications in Dermatology Practice: Part 2. Phototherapy in Vitiligo, Mycosis Fungoides, Atopic Dermatitis, Sclerosing Diseases and Psoriasis

“…Vitiligo, fototerapi ünitelerinde en sık tedavi edilen hastalıklardan biridir (4). Dar bant UVB ile ilgili çok sayıda yayın bulunmakla birlikte, optimal tedavi sıklığı, başlangıç dozu ve doz artışlarının nasıl olması, fototerapinin ne kadar devam ettirilmesi gerektiği, ne zaman yanıtsızlık kararının verilebileceği gibi konularda açıklar bulunmaktadır (5). Dar bant UVB, haftada iki ya da üç kere uygulanır.…”

“…Tedaviye sabit bir başlangıç dozu ile ya da minimal eritem dozunun %50-70'i ile başlanabilir. Sabit başlangıç dozunu tercih eden çalışmalarda, bu dozun 75 mJ/cm 2 ile 1 J/cm 2 arasında değiştiği, genellikle 150-280 mJ/cm 2 arasında olduğu görülmektedir (5). Doz, vitiligolu deride asemptomatik pembe eritem oluşana kadar, her seans %10-20 oranında artırılır.…”