ABSTRACT
Narrowband ultraviolet B has been applied to the treatment of vitiligo for more than 10 years in China.Currently,there are no consistent standards for clinical treatment parameters,and patients cannot benefit from non-standard treatment,which is liable to cause erythema,blisters,photoaging and other adverse reactions.Based on the Vitiligo Working Group recommendations for narrowband ultraviolet B phototherapy for vitiligo,relevant literature and clinical experiences,the authors discuss parameters of narrowband ultraviolet B phototherapy for vitiligo from the aspects of treatment frequency,initial dosing,dose adjustment during consecutive treatment or after missed treatment,response plateau,treatment course and maximum acceptable number of phototherapy,so as to improve the efficacy of narrowband ultraviolet B phototherapy for vitiligo.
ABSTRACT
Objective To evaluate the association between clinical efficacy of and response to narrow-band ultraviolet B (NB-UVB) phototherapy in patients with confirmed vitiligo,and to identify factors influencing phototherapy response.Methods From January 2017 to March 2018,a total of 104 patients with vitiligo,who received NB-UVB phototherapy at the Department of Dermatology,Hangzhou Third Hospital,Zhejiang University of Traditional Chinese Medicine,were enrolled into this study.Among them,there were 55 males and 49 females,with an average age of 32.06 years (range:4-64 years).Their course of disease ranged from 2 months to 27 years,and the average course of disease was 8.15 years.The phototherapy sessions required to achieve initial repigmentation and to enter the plateau phase during which repigmentation ceased to increase with treatment sessions (plateau photothereapy sessions),as well as effective phototherapy sessions (the difference between the phototherapy sessions required to achieve initial repigmentation and those to enter the plateau phase) were recorded.Rank sum test was used to analyze the difference in the above phototherapy sessions between patients with different response,and multiple linear regression analysis to identify factors influencing plateau photothereapy sessions and effective phototherapy sessions.Results All the 104 patients were followed up.Among them,2 patients achieved complete repigmentation,1 showed no response to the phototherapy,and the remaining 101 patients were enrolled into the analysis.Among the 101 patients,52 achieved ≥ 50％ repigmentation (high efficacy group),and 49 achieved ＜ 50％ repigmentation (low efficacy group).Compared with the low efficacy group,the high efficacy group showed significantly less phototherapy sessions required to achieve initial repigmentation (M [P25,P75],8 [7,10] vs.10[8,13],Z =3.125,P =0.002),but significantly more plateau phototherapy sessions (41 [29,60] vs.35 [26,44],Z =-3.375,P ＜ 0.001) and effective phototherapy sessions (32 [18,51] vs.24 [8,36],Z =-4.407,P ＜ 0.001).Multiple linear regression analysis showed that the total number of plateau phototherapy sessions was positively correlated with vitiligo area (β =0.360,t =2.698,P =0.008) and duration of disease (β =0.215,t =2.325,P =0.022),but negatively correlated with vitiligo disease activity score (VIDA) (β =-2.665,t =3.969,P ＜ 0.001).Moreover,the number of effective phototherapy sessions was positively correlated with vitiligo area (β =0.358,t =2.582,P =0.011) and duration of disease (β =0.216,t =2.276,P =0.025),but negatively correlated with VIDA (β =-2.669,t =-3.935,P ＜ 0.001) and phototherapy sessions required to achieve initial repigmentation (β =-1.011,t =-4.508,P ＜ 0.001).Conclusions During the treatment with NB-UVB,the less the number of phototherapy sessions required to achieve initial repigmentation is,the more the number of effective phototherapy sessions is,and the better the efficacy of NB-UVB phototherapy is.Vitiligo area,duration of disease and clinical staging may provide the basis for predicting phototherapy sessions required to enter the plateau phase.
ABSTRACT
Objective To compare the efficacy and acceptance of home versus hospital narrowband ultraviolet B (NB-UVB) phototherapy for vitiligo.Methods Eighty patients with vitiligo were collected at the Department of Dermatology of Hangzhou Third Hospital from August 2016 to September 2017,and randomly and equally divided into two groups to be treated with home (home NB-UVB group) or hospital NB-UVB phototherapy (hospital NB-UVB group) twice a week for 36 sessions.After the treatment,the efficacy,adverse reactions and patient acceptance were evaluated.Results Finally,39 patients in the home NB-UVB group and 37 in the hospital NB-UVB group completed the treatment.The response rates in the face and neck,trunk and extremities were 62.5％,48.6％ and 42.3％ respectively in the home NB-UVB group,and were 66.7％,55.9％ and 48.6％ respectively in the hospital NB-UVB group.There were no significant differences in the response rate,cumulative dosage required for initial repigmentation and cumulative dosage at the end of treatment at the same body site between the 2 groups.The incidence of adverse reactions was significantly higher in the home NB-UVB group than in the hospital NB-UVB group (61.5％ vs.24.3％,P ＜ 0.05),and the duration of a single treatment was significantly shorter in the home NB-UVB group than in the hospital NB-UVB group (27.95 min vs.129.73 min,P ＜ 0.05).Multiple linear regression analysis showed that the patient acceptance in the home NB-UVB group significantly increased along with the improvement of efficacy (β =0.483,t =4.573,P ＜ 0.001),but decreased along with the increase of treatment duration (β =-0.569,t =-5.831,P ＜ 0.001).However,the patient acceptance in the hospital NB-UVB group significantly increased along with the improvement of efficacy (β =0.758,t =7.547,P ＜ 0.001),but was not correlated with the treatment duration (β =-0.204,t =-2.030,P =0.05).Conclusions The home and hospital NB-UVB phototherapy can complement each other for the treatment of vitiligo.Appropriate therapy should be chosen for different patients,so as to enhance patient compliance,which is an essential condition for the improvement of efficacy.