Treatment of vitiligo with broadband ultraviolet B and vitamins

Abstract

Background While oral psoralen plus ultraviolet A (PUVA) remains the most popular therapeutic modality for vitiligo, recent reports have shown that narrowband ultraviolet B (UVB) also induces significant repigmentation. In this study we evaluated the efficacy of broadband UVB on actively spreading, progressive vitiligo in patients who had been followed for many months (12 or more) in our practice, who continued to depigment despite treatment. Methods Nine patients with actively spreading vitiligo were exposed to broadband UVB 2–3 times per week at a starting dose of 20–30 mJ/cm2. Radiation was increased by 10–20 mJ/cm2 per session with adjustments for symptomatic erythema or missed visits. In addition, patients took vitamin C 500 mg twice a day (BID), vitamin B12 1000 µg BID and folic acid 5 mg BID. The response to treatment and side‐effects were assessed at each visit. The patient's response to treatment and progress were assessed by photographs and by physician evaluation of body surface area (BSA) (using the Rule of 9s) involved at monthly intervals. Photographs were taken and estimations of BSA by physical examination made at the start and finish of the trial and then compared by the physicians involved in the study. Results Broadband UVB halted the progression of vitiligo in all nine patients and in general induced repigmentation early after 8–12 treatments (6–8 weeks). After 2–8 months of treatment, nine of nine patients achieved good (51–75%) or excellent response (76–100%). The percentage of repigmentation varied with length of treatment and anatomic site. Conclusions This study confirms the only published report that broadband UVB is effective on actively spreading vitiligo. Since it is more cost effective than narrowband UVB and has numerous advantages compared to oral PUVA, broadband UVB may offer an alternative for future treatment of vitiligo. The role of vitamins in this therapy remains to be determined.

Ultraviolet B (UVB) Phototherapy in the Treatment of Vitiligo

“…Little definitive evidence purports the use of BB-UVB in vitiligo, primarily due to the dominant and successful use of NB-UVB. BB-UVB with vitamin supplementation was found to be effective in actively spreading vitiligo for inducing repigmentation when given 2-3 times weekly for 6-8 weeks (Don, Iuga et al, 2006). Although the role of vitamin supplementation was not substantiated in the outcome, this particular trial suggests that BB-UVB can be an effective treatment for vitiligo (Don, Iuga et al, 2006).…”

“…BB-UVB with vitamin supplementation was found to be effective in actively spreading vitiligo for inducing repigmentation when given 2-3 times weekly for 6-8 weeks (Don, Iuga et al, 2006). Although the role of vitamin supplementation was not substantiated in the outcome, this particular trial suggests that BB-UVB can be an effective treatment for vitiligo (Don, Iuga et al, 2006). Targeted BB-UVB and MEL were found to have nearly equal rates and degrees of repigmentation when evaluated after 8 treatments (Asawanonda, Kijluakiat et al, 2008).…”

“…In conjunction with vitamin C (500mg twice daily), vitamin B12 (1,000 micrograms twice daily), and folic acid (5 mg twice daily), BB-UVB had a significant clinically efficacious outcome in actively spreading vitiligo. Vitamin supplementation was used hypothetically and the investigators could only imply that BB-UVB could be effective for vitiligo and the role of vitamins was unclear (Don, Iuga et al, 2006). In combination with NB-UVB, oral vitamin E supplementation (400 IU) was shown to augment therapy by hypothetically preventing lipid peroxidation of melanocytes and reducing phototherapy-related erythema (Elgoweini and Nour El Din, 2009).…”

Ultraviolet-based therapy for vitiligo: What′s new?

“…Multiple studies have investigated the use of vitamins E, C, B12, and folic acid, and most have either shown statistically insignificant improvements when compared to UV therapy alone or no improvement at all. [46][47][48] One study compared the use of a combination of antioxidants containing vitamins C and E, alpha lipoic acid, polyunsaturated fatty acids, and cysteine monohydrate, and found it to give significantly increased repigmentation when used in conjunction with NB-UVB when compared towing NB-UVB alone. [49] Plant immunomodulators, such as Polypodium leucomotos, were originally used as a method of protecting against the phototoxic characteristics of UV therapy.…”

Antioxidants

“…Lin et al demonstrate an increase in protection against UVinduced damage after oral administration of vitamin E combined with vitamin C [19] (Table 3). Studies demonstrate; oral vit E has shown to increase narrow band-UVB effectiveness in vitiligo patients [20].…”