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.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) phototherapy promotes stability and repigmentation in vitiligo. No studies have compared targeted NB-UVB with whole-body NB-UVB in treatment of acral vitiligo. OBJECTIVES: This randomized split-body study compared whole-body NB-UVB with targeted NB-UVB in inducing stability and repigmentation in acral vitiligo. METHODS: Thirty-two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees) were recruited. Patients received whole-body NB-UVB treatment, with one hand and one foot shielded until elbow and knee, followed by targeted NB-UVB treatment on the shielded side. Patients were assessed at 4-week intervals for 24 weeks using Vitiligo Disease Activity (VIDA) score, Vitiligo Skin Activity Score (VSAS), Vitiligo Area Scoring Index (determined through fingertip method, using the method to calculate facial-VASI) and degree of repigmentation. RESULTS: After 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks. Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole-body and targeted groups, respectively (p = .95). No improvement in F-VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24-week period. CONCLUSION: Our study showed comparable repigmentation rates between whole-body and targeted NB-UVB groups. Limited effectiveness of phototherapy in repigmentation of hands and feet underscores an important therapeutic gap.

Efficacy of prostaglandin E2 versus prostaglandin F2 alpha assisted with narrowband-UVB in stable vitiligo.

In the recent decades, prostaglandins were recommended as a new therapeutic modality of stable vitiligo with promising efficacy. Therefore, we designed the current work to compare the significance of two different subtypes of prostaglandins [prostaglandin E2 (PGE2) versus prostaglandin F2 alpha (PGF2α)], assisted with NB-UVB phototherapy, in treatment of stable vitiligo. This study was conducted on 30 patients with stable non-segmental vitiligo. Three approximately similar vitiliginous areas were chosen in each patient and assigned into 3 groups. Each group treated with intradermal injection of either PGE2 (group I), PGF2α (group II), or saline as placebo (group III) at frequency once/week for 12 weeks. Concomitantly, all groups received NB-UVB phototherapy twice weekly for 3 months. The outcomes of this study discovered that the therapeutic efficacy of intradermal injection of either PGE2 or PGF2α assisted with NB-UVB phototherapy was comparable with non-significant difference between them in spite of being significantly higher than NB-UVB alone. However, there were a significantly earlier onset of repigmentation and higher degree of satisfaction regarding areas treated with PGE2 than those treated with PGF2α. In conclusion, both PGF2α and PGE2 intradermal injection could be considered as quite simple and affordable techniques in the treatment of stable vitiligo with no reported side effects and good patient satisfaction.

Clinical effect of stem cell transplantation combined with 308-nm excimer laser therapy for 56 cases of vitiligo.

OBJECTIVE: To probe the clinical effect of stem cell transplantation in combination with 308-nm excimer laser therapy for vitiligo and to analyze its value in clinical application. METHODS: A total of 56 patients with stable non-segmental vitiligo in different parts who were not cured by other therapies visiting our hospital from March 2019 to December 2021 were enrolled as study subjects. They were treated by stem cell transplantation combined with 308-nm excimer laser therapy. The treatment efficacy was observed and analyzed. RESULTS: Among the 56 patients, 38 (67.85%) and 49 (87.5%) patients were cured at 6 and 12 months after treatment, respectively. CONCLUSION: Stem cell transplantation combined with 308-nm excimer laser therapy for vitiligo achieves significant efficacy, with the cure rate far superior to that of other therapies for vitiligo. The therapy is worthy of popularization in the clinic.

The efficacy of bimatoprost ophthalmic solution combined with NB-UVB phototherapy in non-segmental and segmental vitiligo: a single-blind randomized controlled study.

Bimatoprost ophthalmic solution 0.03% (PGF2α analogues) combined with narrowband ultraviolet B (NB-UVB) was reported to be an effective treatment for vitiligo. To investigate the efficacy and safety of treatment for non-segmental/segmental vitiligo compared among bimatoprost ophthalmic solution 0.01% combined with NB-UVB phototherapy, bimatoprost monotherapy, and placebo. This single-blind randomized controlled study enrolled stable Thai vitiligo patients with at least three similarly sized lesions in the same anatomical area. The treatment duration was 6 months with 1- and 2-month post-treatment follow-ups. The 3 selected lesions on each patient were randomized to receive combination therapy, monotherapy, or placebo. The Vitiligo Area Scoring Index (VASI) was used to evaluate lesion response. Of the 25 initially enrolled subjects, 19 patients were analyzed. There were 13 and 6 non-segmental and segmental vitiligo cases, respectively. Eight and 11 cases had face/neck and non-face/neck lesions, respectively. Non-segmental vitiligo and non-face/neck vitiligo patients in the combination group had significant improvement in VASI score at 3 months, 6 months, and at the 2-month follow-up. No side effects were observed/reported. Bimatoprost combination therapy was shown to be safe and effective for treating Thai patients with non-segmental vitiligo in non-face/neck areas of the body.

Contributions of NR1H3 genetic polymorphisms to susceptibility and effects of narrowband UVB phototherapy to nonsegmental vitiligo.

Vitiligo is the most common depigmenting disorder to which both genetic and environmental factors contribute. The aim of the current work was to evaluate the relationship between polymorphisms of the gene nuclear receptor subfamily 1 Group H member 3 (NR1H3) and the risk of vitiligo and phototherapy effects in the Chinese Han population. Two independent samples were enrolled to form the discovery set (comprised of 1668 nonsegmental vitiligo [NSV] patients and 2542 controls) and the validation set (comprised of 745 NSV patients and 1492 controls). A total of 13 tag single nucleotide polymorphisms (SNPs) were genotyped in the samples from the discovery stage. SNPs that achieved nominal significance were validated in another independent sample set. The serum level of NR1H3 protein was assayed using enzyme-linked immunosorbent assay kits in the validation set. Genetic association analysis was carried out at allelic and genotypic levels. The therapeutic effects of significant SNPs were examined in the validation set. The SNP rs3758672 was significantly associated with NSV. The A allele was correlated with NSV risk and poorer therapeutic effects. The A allele was strongly correlated with the increased level of serum NR1H3 in both controls and patients. In summary, SNP rs3758672 in NR1H3 was significantly associated with both disease susceptibility and individualized therapeutic effects of NSV in study participants with Han Chinese ancestry.

Acceleration of melanocyte senescence by the proinflammatory cytokines IFNγ and TNFα impairs the repigmentation response of vitiligo patients to narrowband ultraviolet B (NBUVB) phototherapy.

Vitiligo is a chronic autoimmune disease characterized by the T helper 1 (Th1) cytokine-driven immune destruction of melanocytes (MCs). Although narrowband ultraviolet B (NBUVB) phototherapy has been proven to be an effective therapeutic option, the repigmentation response to that phototherapy varies greatly in different vitiligo patients. Here, we demonstrate that there is an increase of NBUVB-induced cellular senescence in vitiligo MCs exposed to Th1 cytokine interferon γ (IFNγ) and/or tumor necrosis factor α (TNFα) in lesional vitiligo skin from poor responders who had undergone NBUVB phototherapy. Supplementation with exogenous recombinant human stem cell factor (rhSCF) in the culture medium as well as the lentiviral vector-mediated overexpression of cKIT could prevent the MCs from the IFNγ/TNFα-accelerated cellular senescence. Mechanistic studies indicated that the reduced ratio of membrane-bound KIT (mKIT) to the soluble form of KIT (sKIT) is directly related to the cellular senescence of vitiligo MCs following exposure to IFNγ and TNFα. Furthermore, the matrix metalloprotease 9 (MMP9) inhibitor GM6001 attenuates the production of sKIT via the suppression of cKIT ectodomain shedding. Altogether, our study indicates that the presence of Th1 cytokines IFNγ and/or TNFα in the epidermal milieu might impair the repigmentation response of vitiligo patients to NBUVB phototherapy.

Surrounding Needling and Narrowband Ultraviolet B Phototherapy Treatment: Synergistic Effects for Repigmentation in Chronic, Stable Nonsegmental Vitiligo.

Context: Narrowband ultraviolet B (NBUVB) phototherapy is the standard treatment for chronic stable vitiligo, but its efficacy, when used alone, is often unsatisfactory. Objective: The study evaluated the efficacy of surrounding needling with acupuncture needles in combination with NBUVB phototherapy for lesions on different body parts of patients with chronic stable vitiligo. Design: The research team designed a 12-week, randomized, open-label, prospective, intra-individual, comparative clinical trial. Setting: The study took place in the Department of Dermatology at Shin-Kong Wu Ho-Su Memorial Hospital in Taiwan. Participants: Participants were patients at the hospital, aged 20-80 years, with chronic stable nonsegmental vitiligo. The lesions on both sides of their bodies had the same baseline conditions. Nine patients with 14 pairs of lesions (n = 28) were included in the study, and eight participants with 13 pairs of lesions (n = 26) successfully completed the study. Intervention: Vitiligo lesions in the intervention group were treated with surrounding needling combined with NBUVB phototherapy, whereas the control group received NBUVB phototherapy only. Outcome Measures: The primary outcome was evaluated at Week 12 using the modified Vitiligo Area Scoring Index (VASI), which focuses on local depigmentation only without multiplication by body surface area, and the testing used the Wilcoxon signed-rank test. A higher VASI score indicates more severe vitiligo. Pain was rated postintervention, after completion of all treatments. Results: At baseline, the modified VASI score in both groups was 93.07 ± 4.62. Postintervention, this score in the intervention group improved to 78.46 ± 15.24, with a significant difference between baseline and postintervention (P = .007), and in the control group, the score improved to 91.92 ± 6.67, with no significant difference having occurred (P = .317). A statistically significant difference was found between the intervention group and the control group in the change in scores postintervention (P = .007). Conclusion: Surrounding needling in combination with NBUVB phototherapy may be a promising treatment for chronic stable nonsegmental vitiligo. Future studies with larger sample sizes and long-term follow-up are warranted.

A comparative interventional study of narrowband ultraviolet B alone and narrowband ultraviolet B in combination with microneedling in patients with stable vitiligo.

BACKGROUND: Vitiligo is a cosmetically concerning common disorder of depigmentation. Narrowband Ultraviolet B (NB-UVB) phototherapy is a well-established mode of treatment for vitiligo. Microneedling is a simple method that has been used for vitiligo treatment in adjunct with NB-UVB and has been shown to induce repigmentation in a few studies; however, there is limited study in the literature. AIMS: To compare the efficacy of NB-UVB alone versus NB-UVB in conjunction with microneedling in patients of stable vitiligo. METHODS: Thirty patients of non-segmental vitiligo with patches tending toward symmetry, stable for at least 6 months were included. Patches on right side of body (side A) were subjected to both microneedling every 2 weeks and NB-UVB three times a week, while patches on left side of body (side B) were subjected to NB-UVB alone thrice weekly for 4 months or till complete resolution of lesions whichever was earlier. Patients were followed up for another 2 months. Response was assessed by photographic record and Vitiligo Area Severity Index (VASI score) calculated at baseline and every month for 6 months. RESULTS: The mean VASI score improvement in both the groups as compared to baseline was statistically significant (p-value < .01). However, the difference in mean VASI scores between the two groups was not statistically significant (p-value = .17). CONCLUSION: NB-UVB is an effective modality for treatment of vitiligo, but there is no additional benefit of combining microneedling with it.

Evaluation of vitamin D receptor gene polymorphisms (ApaI and TaqI) as risk factors of vitiligo and predictors of response to narrowband UVB phototherapy.

Vitiligo is acquired depigmentation due to multiple factors. Vitamin D in skin, through its receptors (VDR), regulates cell growth, differentiation, immune response and exerts both stimulatory and protective effects on melanocytes. The gene sequence encoding VDR has polymorphic forms such as ApaI and TaqI that may affect vitamin D actions. Narrowband ultraviolet B (NB-UVB) phototherapy became the mainstay of vitiligo treatment because of its efficacy and little side effects. The current work aimed at evaluating the possible association between VDR gene polymorphisms (TaqI and ApaI) and susceptibility of vitiligo and if they could be predictors of response to NB-UVB phototherapy in Egyptian vitiligo patients. 100 vitiligo patients indicated for NB-UVB phototherapy and 100 healthy age and sex matched controls were included. All participants were subjected to history taking, general and dermatological examinations, and VDR ApaI and TaqI gene polymorphisms analysis by PCR-RFLP. The patients received NB-UVB 3times per week for 6 months then revaluated. There was significant increase in Aa genotype of ApaI polymorphism in patients associated with significant increase in vitiligo activity. 66% of patient showed variable degrees of response to NB-UVB. The responders significantly had AA genotype of ApaI polymorphism. TaqI polymorphism showed nonsignificant effects on vitiligo susceptibility and response to NB-UVB. A allele of ApaI was significant independent predictor of NB-UVB phototherapy responders. VDR gene polymorphism (ApaI) may share in vitiligo pathogenesis and response to NB-UVB. Knowing the genetic background of the patient helps individualization of treatment to get better results.

Blue light-emitting diodes for the treatment of localized vitiligo: A retrospective study.

BACKGROUND: Vitiligo is an autoimmune dermatological disease characterized by hypopigmented macules. Treatments include topical agents, phototherapy, and laser therapies. Different lasers should be individually chosen regarding location, extent, activity of the disease. AIMS: This article aims to demonstrate how blue LED is effective and safe, as its wavelength is very close to the UV spectrum (415 nm vs. 400 nm), but, unlike UV therapy, blue LED have not shown any long-term cancerogenic side effects. PATIENTS/METHODS: We treated 30 patients affected by vitiligo localized on different anatomical areas with blue light-emitting diodes. RESULTS: Complete repigmentation occurred in 75.33% of treated patients (22 out of 30 patients, 14 males, and 8 females). Partial repigmentation occurred in the remaining patients. CONCLUSIONS: Blue LED light may be a safe and well-tolerated way to induce repigmentation in patients affected by vitiligo.

Predictors of adherence to Narrowband ultraviolet B first-month treatment dosage plan.

BACKGROUND: The adherence to a narrowband ultraviolet B (NB-UVB) treatment plan is derived, in large part, from the patient's skin tolerance to the phototherapy dose. At present, the initial and first-month incremental phototherapy doses are determined prior to treatment initiation based on the patient's Fitzpatrick skin phototyping. OBJECTIVES: To identify variables that predict adherence to NB-UVB first-month treatment dosage plan. METHODS: Charts of 1000 consecutive patients receiving NB-UVB at a hospital-based phototherapy unit were retrospectively analyzed. We included patients receiving NB-UVB for atopic dermatitis, psoriasis, vitiligo, and mycosis fungoides. The first-month NB-UVB treatment plan was determined based on the patient's Fitzpatrick phototype. Adherence to treatment was defined as receiving at least 80% of the planned first-month cumulative dose. We compared adherent vs. non-adherent patient groups for age, sex, Fitzpatrick phototype, presence of freckles, nevus count category, and type of dermatological disease. RESULTS: The study included 817 eligible patients, mean age 40 (2-95) years; 54% men; 32% had Fitzpatrick phototype I-II. Distribution by diagnosis was atopic dermatitis (29%), psoriasis (27%), vitiligo (23%), and mycosis fungoides (21%). Adherence to NB-UVB treatment plan was observed in 71% of patients. Adherence decreased with age, with 7% decrease per year (P = 0.03) and was higher among mycosis fungoides patients (77.3%) compared to all other diagnoses (69.8%; P = 0.02). CONCLUSIONS: Adherence to NB-UVB treatment may be related to age and diagnosis. Fitzpatrick phototype-based first-month treatment plans should be modified accordingly.

Effectiveness and safety of tofacitinib combined with narrowband ultraviolet B phototherapy for patients with refractory vitiligo in real-world clinical practice.

Vitiligo is a chronic treatment-resistant autoimmune disorder characterized by circumscribed depigmented maculae. This study was conducted to evaluate the efficacy and safety of tofacitinib combined with narrowband ultraviolet B (NB-UVB) phototherapy for refractory nonsegmental vitiligo. Fifteen patients with nonsegmental vitiligo resistant to conventional therapies were administered oral tofacitinib at 5 mg twice daily plus topical halometasone cream, tacrolimus 0.1% ointment, or pimecrolimus cream twice daily and NB-UVB three times per week for 16 weeks. The control group comprised 19 patients with nonsegmental vitiligo treated with topical drugs plus NB-UVB same as the combination group. Treatment efficacy was measured by the percentage of repigmentation of vitiligo lesions at 4th, 8th, 12th, and 16th week after beginning treatment. From 8th week, the repigmentation level was significantly higher in the combination group than in the controls. From fourth week, the response rate was significantly higher in the combination group than in the controls. Only one patient in the combination group reported mild pain in the hand and foot joints, but the pain subsided with cessation of therapy. No other severe adverse effects occurred. So, tofacitinib in combination with NB-UVB phototherapy may be an effective and safe alternative modality for refractory vitiligo.

Beneficial UVB phototherapy preceding a fractional CO2 laser-UVB protocol in refractory non-segmental vitiligo.

OBJECTIVES: To explore the short- and long-term effects of UVB phototherapy preceding a fractional CO2 laser-UVB protocol in patients with resistant nonsegmental vitiligo. MATERIALS AND METHODS: This single-center, prospective, split-face/body, evaluator-blinded study included adult patients with stable vitiligo refractory to conventional treatments. Two symmetrical lesions were selected. Phototherapy was delivered with one side covered, until minimal erythema. Within 3 days, 31-month-apart sessions of laser were performed on both sides. After each laser session, phototherapy was resumed three times weekly, with all lesions uncovered, until 8 weeks after the last laser session. At baseline, at the end of treatment, and 5 years later, a Mean Improvement Score by Physician (MISP) and a patient satisfaction 10-point visual analog score (VAS) were recorded. RESULTS: Ten patients (8 women and 2 men) were included; their mean age was 32.9 years; phototype III was predominant; the mean duration of vitiligo was 3 years. At the end of treatment and 5 years later, scores of lesions treated with UVB-CO2 -UVB (mean MISP 3.0 and 2.9, mean ΔVAS 4.5 and 3.9, respectively), were higher than those of lesions treated only with CO2 -UVB (mean MISP 2.5 and 2.4, mean ΔVAS 4.1 and 3.6, respectively). After 5 years, one patient lost his partial response and two patients developed light hyperpigmentation on both sides. CONCLUSION: Exposure to UVB before CO2 -UVB explains the higher scores as it was the only variable between the two sides. It may improve the response of resistant lesions with a constantly sustained result over 5 years.

Short and Long-Term Outcomes of 308-nm Laser for Pediatric Vitiligo.

Pediatric vitiligo is often challenging to treat. Children with vitiligo experience stigma, bullying, and emotional distress. The long-term outcome of therapeutics used to treat pediatric vitiligo has been poorly documented in the literature. It is, therefore, hard to counsel patients on the expected long-term results of therapy. We sought to address outcomes in pediatric vitiligo treated with a 308-nm laser. An IRB-exempt chart review was conducted in June of 2016 of children undergoing active 308-nm laser in the first half of 2016. Demographic data, location of disease, therapeutic parameters of the 308-nm laser, and outcomes were recorded at that time. In 2021, the long-term outcomes were analyzed through chart review addressing pigmentation retained at later office visits. Initial repigmentation was noted in 86.7% of the face, 80% of the body, and 61.7% of the extremities. An average of 3.38 years of follow-up was recorded. Scoring extent of vitiligo using 18 site-scoring was helpful in identifying individuals who are less likely to respond to 308-nm laser, but needs broader evaluation. During that time, repigmentation was noted to be retained in 80% of facial, 40% of the body, and 20% of extremity lesions. Pediatric vitiligo responds well to the 308-nm laser, with the best retention of repigmentation for facial lesions. Patients and parents should be counseled on the likelihood of long-term retention of repigmentation and regarding the need for the ongoing management of vitiligo even after repigmentation is initially achieved after 308-nm laser therapy. J Drugs Dermatol. 2022;21(7):773-775. doi:10.36849/JDD.6895.

A pilot study of combined oral minocycline and narrowband UVB phototherapy in vitiligo: A randomized, double-blind, placebo-controlled trial.

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p = 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.