Simultaneous improvement and worsening of vitiligo lesions during the course of NB-UVB phototherapy; vitiligo may not act as one unit

Abstract

Re-pigmentation and stabilization are the two ultimate goals of any re-pigmenting plan designed for vitiligo management. Furthermore, whether the improvement of some vitiligo lesions could be considered a guarantee for a similar response and/or stabilization of the rest of the lesions or not, remains to be clarified. To evaluate the behavior of non-segmental vitiligo (NSV), while on narrow band-ultraviolet B (NB-UVB) phototherapy. 25 patients with stable generalized NSV were included and received NB-UVB twice weekly. For the sake of ensuring accuracy of follow up, up to four lesions were randomly chosen in each patient and regularly measured using the point counting technique. The over-all point counting technique of all included patients showed a significant reduction (18.5 ± 8.4 cm to 8.2± 3.1 cm ) after 6 months of therapy (p < .001). Nine patients (36%), showed mixed response in the different lesions. Improvement was documented in some lesions, while other lesions showed no response or even worsening. No significant correlations were detected between the behavior of vitiligo during NB-UVB and any of the demographic or clinical data of the patients. NB-UVB is a pillar in the management of vitiligo, however close follow-up of the patient as a whole and his lesions, by both subjective and objective measures are mandatory to detect activity as early as possible, as vitiligo at many times may not act as one unit. This early detection of activity and the subsequent change in the treatment policy may ultimately change the final outcome of treatment.

Clinical evaluation of interrupted versus continuous narrowband ultraviolet B phototherapy in nonsegmental vitiligo treatment: A prospective randomized comparative study

“…We noticed activity in some lesions in Group 1 on both sides in some patients, while it occurred on one side only in other patients. This result could be explained by Anbar, Abdel‐Rahman, Hegazy, El‐Khayyat, and Ragaie (), who reported that vitiligo at many times may not act as one unit. Moreover, the improvement of some vitiligo lesions cannot be considered a guarantee for a similar response and/or stabilization of the rest of the lesions (Anbar et al, ).…”

“…This result could be explained by Anbar, Abdel‐Rahman, Hegazy, El‐Khayyat, and Ragaie (), who reported that vitiligo at many times may not act as one unit. Moreover, the improvement of some vitiligo lesions cannot be considered a guarantee for a similar response and/or stabilization of the rest of the lesions (Anbar et al, ). The vitiligo global issue consensus conference statement was that individual lesional stability does not necessarily reflect global stability of the disease (Ezzedine et al, ).…”

“…Despite the existence of numerous studies (Kanwar, Dogra, Parsad, & Kumar, ; Percivalle, Piccinno, Caccialanza, & Forti, ; Sapam, Agrawal, & Dhali, ; Wu, Lan, & Yu, ) evaluating the response of vitiligo to NB‐UVB, its course while receiving this line of therapy could be best described as enigmatic (Anbar et al, ). Moreover, the unpredictable nature of vitiligo and its response to therapy could also account for this behavior (Anbar et al, ).…”

Methotrexate for treatment of vitiligo

“…This early detection of activity and the subsequent change in the treatment policy may ultimately change the final outcome of treatment (Anbar, Abdel-Rahman, Hegazy, El-Khayyat, & Ragaie, 2017). However, vitiligo at many times may not act as one unit.…”

Patient-reported outcomes: A 5-year long study reveals previously unreported therapeutic, demographic, socio-economic, and other correlations in vitiligo

“…Vitiligo is likely to represent a spectrum of many different disorders (Ezzedine et al, ; Hercogová, Schwartz, & Lotti, ; Lotti & D'Erme, ; Rodrigues et al, ). The complex etiopathogenesis with overlapping inflammatory processes and the interplay of multiple factors, often acting in opposite directions is still poorly understood (Anbar, Abdel‐Rahman, Hegazy, El‐Khayyat, & Ragaie, ). An obscure trigger event is thought to cause a chain of events in genetically susceptible individuals (Spritz, ).…”