The role of long‐wavelength ultraviolet A1 (UVA1) in acral vitiligo

Abstract

Summary Introduction Acral vitiligo is a resistant subtype of vitiligo that does not respond easily to any treatment modality. Ultraviolet A1 (UVA1) (340‐400 nm) therapy can penetrate the deep dermis of the skin and is relatively free of adverse effects associated with different phototherapeutic modalities. This study's objective was to evaluate the effect of medium‐dose long‐wavelength UVA1 (40‐70 J) in acral vitiligo treatment and compare it with topical psoralen plus ultraviolet A (topical PUVA). Methods Patients in this randomized‐controlled comparative clinical trial were divided into two groups, medium‐dose UVA1 group and topical PUVA group (10 acral vitiligo patients each). Patients received 36 sessions of phototherapy over a period of 12 weeks. Every patient was clinically evaluated monthly as regards the appearance of new lesions or increase in diameter of the current lesion according to point counting and vitiligo area severity index. Results No statistically significant clinical difference was found between patients in UVA1 and topical PUVA groups regarding response and pattern of response (P > 0.05). Conclusion Ultraviolet A1 seems to be of limited use as a monotherapy in acral vitiligo treatment. However, more studies combining it with other treatment modalities as systemic steroids and/or using higher UVA1 doses may prove beneficial.

Whole‐body and targeted narrowband ultraviolet B phototherapy effectively stabilize acral vitiligo with negligible repigmentation beyond wrists and ankles: Results from a split‐body randomized controlled trial

“…However, with respect to repigmentation, especially over acral regions, our study's results align with previous studies that have shown poor response rates. [17][18][19] The considerable decrease in F-VASI scores observed on the extremities after 24 weeks of NB-UVB was contributed majorly by repigmentation occurring over forearm and legs. The lesions on the hands (distal to the wrist) and feet (distal to the ankle) failed to repigment with both whole-body NB-UVB and targeted NB-UVB therapies, indicating a lack of efficacy of these modalities for these specific sites.…”

Efficacy of the combined excimer light and topical calcipotriol for acral vitiligo: A randomized double‐blind comparative study

“…Most of the studies on acral vitiligo reported unfavorable outcomes. Among monotherapy modalities using light or laser, ultraviolet A1 therapy alone seemed to be ineffective, 16 whereas only 20% of the hands irradiated with excimer laser showed some degree of repigmentation. However, excellent outcomes have not been reported with excimer laser alone 17 .…”

Stem cell spreading dynamics intrinsically differentiate acral melanomas from nevi

“…Environmental factors, such as mechanical stress, ionizing radiation (IR), and trauma, are risk factors for acral melanomas (Costello et al, 2017;Freedman et al, 2003;Sheen et al, 2017), yet there has been no experimental evidence that supports the etiology of acral melanomas. Although acral skin is pro-tected from UV irradiation, direct exposure of volar skin to UVB (308-nm XeCl 2 laser) induces melanocytic proliferation in vitiligo lesions of acral areas (Choi et al, 2004;El-Zawahry et al, 2019) (Figure 1; Table S1). The mutagenic and carcinogenic properties of sunlight due to the induction of DNA damage have been proven with the short-wavelength UVB (290-320 nm) as well as the long wavelength UVA (320-400 nm) (Stary and Sarasin, 2000).…”