Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature.

BACKGROUND: Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. AIMS AND METHODS: This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. RESULTS AND DISCUSSION: The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital-based and home-based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra-violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti-nuclear antibodies and tailoring approaches for non-photo-adapters are also examined. CONCLUSION: In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field.

Clinical observation of ultraviolet therapy combined with autologous platelet-rich plasma in the treatment of chronic refractory wounds.

Refractory wounds present complex and serious clinical dilemmas in plastic and reconstructive surgeries. Currently, there are no standard guidelines for the treatment of refractory wounds. To observe the clinical effects of ultraviolet (UV) therapy combined with autologous platelet-rich plasma (PRP) on chronic refractory wounds. Between January 2021 and December 2022, 60 inpatients with chronic refractory wounds were enrolled. Twenty patients were assigned to each of control groups 1 and 2 and treatment group according to whether they received PRP or UV treatment. All the patients underwent thorough debridement. Control group 2 received UV radiation. The treatment group underwent UV radiation combined with PRP gel covering the wound. Control group 1 underwent routine dressing changes after surgery, followed by skin grafting or skin key transfer if needed. One month later, we observed the wound healing in the two groups. After 2-4 PRP gel treatments, the wounds of patients in the treatment group healed. The healing time was 25.25 ± 4.93 days, and the dressings were changed 4.15 ± 3.30 times, both of which were better outcomes than in both control groups. In the treatment group, epidermal growth factor (EGF), insulin-like growth factor (IGF), platelet-derived growth factor (PGF), and transforming growth factor ß (TGF-ß) were slightly higher, and the concentration of vascular endothelial growth factor (VEGF) was significantly higher than in the control group (p < 0.05). PRP combined with UV therapy significantly increased the concentration of wound growth factors, accelerated wound healing, shortened treatment time, reduced treatment costs, and alleviated pain in patients.

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.

TWEAK levels in psoriatic patients treated with narrowband ultraviolet B and methotrexate.

BACKGROUND: Psoriasis is an autoimmune disease which has an effect on the joints and skin. Tumor Necrosis Factor-Like Weak Inducer of Apoptosis (TWEAK) is a multi-functional cytokine which regulates the cellular processes and has been related to a variation of conditions. OBJECTIVES: To measure the level of serum TWEAK in psoriatic diseased persons and its relationship to the PASI score pre- and post-therapy with narrowband ultraviolet B phototherapy (NB-UVB) and methotrexate (MTX). METHODS: This randomized controlled trial was conducted on 40 patients and 20 healthy persons as controls. Patient Group was randomly subdivided to two groups. The 1st group consisted of 20 patients who received NB-UVB treatment. The 2nd group included 20 MTX-treated candidates. Blood samples were drawn from patients in order to detect serum TWEAK levels using ELISA. The research was registered on Clinical Trials Registration: RCT approval numbers: NCT0481191. RESULTS: The mean PASI score percent improvement after 12 weeks of treatment was higher in the MTX group (90%) than NB-UVB group (60%). The serum TWEAK level at baseline was 60.47 ± 12.6 pg/mL in NB-UVB group and 54.69 ± 21.7 pg/mL in MTX group which reduced to 24.93 ± 17.6 pg/mL and 32.13 ± 23.6 pg/mL, respectively (p < 0.001), after 12 weeks of treatment. There was a positive correlation between the serum levels of TWEAK and severity of PASI score (r = 0.399, p = 0.014). CONCLUSION: TWEAK grades in psoriasis are substantially higher than in controls. TWEAK levels were dramatically reduced during NB-UVB and MTX treatment. TWEAK may have a potential sign for psoriasis diagnosis and prognosis.

Multiple Bowen's disease due to long-term narrow-band ultraviolet B phototherapy: A case report and literature review.

OBJECTIVE: By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. METHOD: Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. RESULTS: An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. CONCLUSION: This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.

Clinical, histopathological and immunohistochemical evaluation of ultraviolet A1 treatment in early-stage mycosis fungoides.

BACKGROUND/PURPOSE: Mycosis fungoides (MF) is the most common variant of cutaneous T-cell lymphomas primarily involving the skin. Early-stage MF is characterised by non-specific skin lesions and non-diagnostic biopsies. While skin-focused treatments, such as PUVA and narrowband UVB (nbUVB), are the most frequently recommended treatments, the UVA1 efficacy has been researched in recent years. The purpose of this study was to evaluate the clinical, histopathological and immunohistochemical aspects of UVA1 treatment in patients with early-stage MF. METHODS: The modified severity weighted assessment scale (mSWAT) was used for total skin body scoring before and after treatment. Skin punch biopsies were taken from the patients before and after treatment. UVA1 therapy was performed five times each week. RESULTS: This study included 26 patients with early-stage MF. The total number of UVA1 sessions varied between 15 and 34. Complete response was observed in 8 (30.8%) of 26 patients (30.8%). The median mSWAT score decreased statistically significantly from 7.1 to 2.0 after treatment (p < .001). Histopathological complete response was observed in 2 (9.5%) of 21 patients. A statistically significant decrease in dermal interstitial infiltrate was observed on histopathological examination after treatment (p = .039). Epidermal CD4/CD8 levels decreased statistically significantly higher from a median of 2.5-1.2 in the complete clinical response group after treatment (p = .043). CONCLUSION: According to our results, UVA1 treatment has an effect on early-stage MF in terms of clinical, histopathological and immunohistochemistry.

Narrowband ultraviolet B phototherapy combined with intralesional injection of either latanoprost or platelet-rich plasma for stable nonsegmental vitiligo.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) phototherapy is the cornerstone of vitiligo treatment. Its combination with other treatments usually yields a better response. Latanoprost, a prostaglandin F2α analog, and autologous platelet-rich plasma (PRP) have been reported to be effective for vitiligo. AIM: To evaluate the efficacy of NB-UVB combined with intralesional latanoprost or PRP for stable nonsegmental vitiligo (NSV). METHODS: Sixty patients with stable NSV were recruited and randomly allocated to two equal groups. NB-UVB phototherapy was administered twice a week for all patients. Additionally, group A received intralesional latanoprost injections once weekly, while group B received intralesional autologous PRP injections every 2 weeks. RESULTS: At 24 weeks, excellent repigmentation response was observed in 26.7% and 13.3% of patients in the latanoprost/NB-UVB and PRP/NB-UVB groups, respectively, with no significant difference in degrees of repigmentation between the two groups. However, the Vitiligo Extent Score for a Target Area (VESTA) score was significantly higher in the latanoprost/NB-UVB group (p = .032). Moreover, lesions located on nonacral skin responded significantly better than those on acral skin. Only erythema was significantly higher in the PRP/NB-UVB group, while the recurrence of depigmentation was significantly higher in the latanoprost/NB-UVB group. CONCLUSIONS: Both latanoprost and PRP have the potential to be effective add-on therapies to NB-UVB phototherapy for stable NSV, with latanoprost resulting in a greater repigmentation response and PRP producing a more stable response.

Current practices for pediatric phototherapy: Findings from a cross-sectional study.

Phototherapy is broadly utilized for treatment of inflammatory skin conditions affecting pediatric patients. However, there are no specific guidelines or recommendations for implementing phototherapy in pediatric populations leading to variability in treatment procedures. Here, we present findings from a cross-sectional, survey-based study investigating the implementation of phototherapy in pediatric patients across the United States. A total of 39 sites from 19 different states identified via the National Psoriasis Foundation (NPF) Health Care Provider Directory responded. Common practices included a signed informed consent prior to performing phototherapy (86.4%, n = 32), no minimum age requirement for pediatric patients (91.8%, n = 34), the use of Fitzpatrick skin type to determine dosing protocol (100%, n = 37), and allowing parents to accompany their children into the lightbox (65%, n = 20). Our results provide insights into current common practices and themes for further study.

Efficacy of using oral methotrexate with phototherapy in the treatment of vitiligo in comparison with single phototherapy treatment: A double-blinded randomized controlled trial.

BACKGROUND: Vitiligo is an acquired skin disease with a worldwide prevalence of 0.5%-2% and a tendency to involve both genders. Although the exact pathologic mechanism is unknown, there is some evidence for the role of autoimmunity in this disease. Based on this theory, various immunosuppressive agents, such as topical or systemic corticosteroids and phototherapy (including narrowband ultraviolet B), are used. Methotrexate is another immunosuppressant that has recently become popular as a single treatment for vitiligo; however, the synergistic effect and its superiority over other treatments are two crucial factors that are still obscure. This study aimed to compare the efficacy of methotrexate+ NB-UVB versus placebo+ NB-UVB in vitiligo patients. METHODS: In this double-blinded, randomized controlled trial, 42 patients were randomly allocated into two groups: the first group received three times weekly NB-UVB plus placebo, and the second group was treated with three times weekly NB-UVB in combination with a weekly dose of 12.5 mg MTX. The total duration of treatment was 6 months, patients were followed up every 2 months, and the assessment tools were VASI (repigmentation indicator) and VIDA (disease activity indicator) scores. RESULTS: Both treatment groups showed improvement in VASI and VIDA scores during 6-month follow-up, but no statistical significance was found between the two treatment methods. CONCLUSION: This study demonstrated that both treatment modalities were equally effective, and further studies are required to evaluate the efficacy of MTX with other medications with longer follow-up and a larger sample size.

Using a Topical Formulation of Vitamin D for the Treatment of Vitiligo: A Systematic Review.

Vitamin D is one significant prohormone substance in human organ systems. It is a steroidal hormone produced in the skin upon exposure to UVB rays. This paper presents a systematic review of the utilization of topical vitamin D, specifically cholecalciferol, calcipotriol, and tacalcitol, in the treatment of vitiligo. It considers the role of vitamin D in stimulating the synthesis of melanin and melanogenesis, which can help with the process of repigmentation. The inclusion of calcipotriol or tacalcitol in Narrowband Ultraviolet Phototherapy (NB-UVB) has shown the potential to enhance therapeutic outcomes for vitiligo. However, their effectiveness in combination with Psoralens Long Wave Ultraviolet Radiation (PUVA) and Monochromatic Excimer Light (MEL) treatment for vitiligo is limited. In contrast, combining topical corticosteroids with vitamin D analogues has demonstrated superior efficacy in treating vitiligo compared to using vitamin D analogues alone, while also providing the added benefit of reducing corticosteroid-related adverse effects. In addition, treating stable vitiligo with topical cholecalciferol and microneedling has shown success. Future studies are needed to ascertain an efficient method of administering vitamin D topically as an anti-vitiligo agent.

The impact of the COVID-19 surge on phototherapy in Taiwan: Focusing on the patient profile, adherence, and attitude before and after the surge.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused changes in the medical practice. However, it is unclear whether the patients receiving phototherapy for their dermatoses have been affected. OBJECTIVES: This study aimed to identify the impact of the COVID-19 pandemic on phototherapy, focusing on the patient profile, adherence, and attitude before and after the surge. METHODS: The study encompassed the time 5 months prior to and after the surge of the COVID-19 pandemic (from May to July, 2021), resulting in the temporary closure of our phototherapeutic unit. RESULTS: Nine hundred eighty-one patients received phototherapy during this period. Vitiligo, psoriasis (Ps), and atopic dermatitis (AD) represented the groups with the highest patient numbers. For vitiligo, Ps and AD, 39.6%, 41.9%, and 28.4% of the patients resumed phototherapy after the pandemic-related shutdown (PRS). No significant difference was noted in age, gender, and number of weekly sessions between those who resumed or stopped phototherapy after PRS among three groups. Patients who resumed phototherapy after PRS tended to receive more weekly sessions of phototherapy than those who initiated after PRS. Additionally, patients who resumed phototherapy showed no significant difference in the number of weekly sessions before and after PRS. CONCLUSIONS: This study reveals a significant impact of the COVID-19 pandemic on patients undergoing phototherapy. Although the patient number remained similar before and after PRS, a significant portion of patients discontinued phototherapy after PRS. New strategies and continued education are needed to improve patient management in times of pandemic.

Using a low-dose ultraviolet-B lighting solution during working hours: An explorative investigation towards the effectivity in maintaining healthy vitamin D levels.

OBJECTIVE: This study examined whether daily safe, low-dose ultraviolet-B (UVB) exposure using a home-based lighting solution could maintain healthy serum 25(OH)D during winter. METHODS: Twenty-eight (12 male, 16 female) daytime (~9:00 to 17:00) indoor workers (mean age = 42.46; SD = 14.23) participated in this study and were allocated to one of the two study conditions. During an 8-week period, fourteen participants received extra UVB exposure (max 0.3 standard erythema dose (SED) daily), while fourteen participants in the control group did not receive extra UVB exposure. Daily questionnaires were used to measure UVB exposure time, exposed body surface area (BSA), and time spent outside in daylight. Serum 25(OH)D, vitamin D related food intake, and secondary parameters (i.e., subjective fatigue, sleep timing and quality) were investigated at baseline, Week 4, and Week 8. RESULTS: Serum 25(OH)D significantly declined over the 8-week study period in both groups. The combination of using a low-dose UVB exposure, a small BSA, and a lower-than-expected amount of exposure hours likely resulted in an insufficient UVB dose to significantly improve serum 25(OH)D. Changes in serum 25(OH)D over time did not significantly correlate with changes in secondary parameters of sleep and fatigue. CONCLUSION: The received low-dose UVB exposure in this study did not significantly change serum 25(OH)D during the winter period. Future research could explore whether a longer lasting exposure period and/or using different exposure positions of the device (maximizing exposed skin surface) yields more promising results for improving serum 25(OH)D. TRIAL REGISTRATION: Trial registration: https://www.isrctn.com/ISRCTN47902923.

Nb-UVB and PUVA therapy in treating early stages of Mycosis Fungoides: A single-center cross-sectional study.

INTRODUCTION: Mycosis fungoides (MF) and Sezary Syndrome are the most common forms of cutaneous T-cell lymphoma. Early-stage MF is known to have an indolent behavior, and the EORTC guidelines recommend treating patients with skin-directed therapies, such as phototherapy, instead of systemic therapies. Phototherapy is a popular therapeutic option, with two commonly used light sources-PUVA and narrow band-nb UVB. PUVA is less commonly used due to its potential carcinogenic role, but it has systemic effects, while nb-UVB has mostly skin-limited effects. There is ongoing debate regarding the role of UVB light, and in 2021, the Cutaneous Lymphoma Italian Study Group reached a consensus on technical schedules for NB-UVB and PUVA for MF. This study aims to analyze and compare the efficacy of the two phototherapy options in treating early-MF patients. MATERIALS AND METHODS: The study included patients diagnosed with stage IA/B MF in the last 10 years, who had at least 12 months of follow-up data and a minimum of 24 phototherapy sessions (PUVA or nb UVB) and treated with topical steroids apart from phototherapy. RESULTS: Results showed that the two phototherapy options were similarly effective in treating early MF, with no significant differences in clinical response, although PUVA was associated with more adverse effects. CONCLUSIONS: The study provides valuable insights into the use of phototherapy in early MF, and the results can be used to guide treatment decisions and improve patient outcomes.

Secukinumab demonstrates superiority over narrow-band ultraviolet B phototherapy in new-onset moderate to severe plaque psoriasis patients: Week 52 results from the STEPIn study.

BACKGROUND: Biologic treatments have been studied mainly in patients with a long-term history of psoriasis and previous treatment failures. OBJECTIVES: The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new-onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb-UVB) phototherapy. METHODS: The STEPIn study is a randomized, open-label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously versus standard treatment with nb-UVB phototherapy in patients with new-onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively. RESULTS: In the secukinumab and nb-UVB study arms, 77/80 and 76/80 randomized patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm versus 42.3% (32/76) in the nb-UVB arm (p < 0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm versus 36.8% in the nb-UVB arm (p < 0.0001). The safety data were consistent with the safety profiles of secukinumab and nb-UVB with no new or unexpected safety signals. CONCLUSIONS: Secukinumab was superior to nb-UVB in treating patients with new-onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course.

Assessment of vascular patterns during the treatment of psoriatic patients using narrow-band ultraviolet B phototherapy by the dermoscope.

BACKGROUND: Phototherapy is a traditional treatment for psoriasis and patients using it for a long time may be exposed to cumulative toxicity, so dermatologists need continuously diagnostic tools that help in monitoring the disease progression. OBJECTIVES: To detect dermoscopic changes with the improvement of skin in patients with chronic plaque psoriasis on narrow-band ultraviolet B phototherapy and evaluate the role of dermoscopy in monitoring the patients. METHODS: Narrowband ultraviolet B phototherapy was prescribed to thirty (30) patients with chronic plaque psoriasis for three months according to their disease condition. Psoriasis area and severity index (PASI score) were calculated, and dermoscopic evaluation was done at the first visit (W0), after 6 weeks, and after 12 weeks of beginning the phototherapy. RESULTS: According to PASI score calculations, a significant correlation was found between changes in the vessel patterns and the improvement that occurred during the treatment sessions in psoriatic lesions, whereas the patients with globular blood vessels were significantly associated with weak clinical results. CONCLUSION: Dermoscopy is a rapid, simple tool to predict the response of psoriatic patients to phototherapy using vascular pattern assessment.

Apremilast and narrowband ultraviolet B combination therapy suppresses Th17 axis and promotes melanogenesis in vitiligo skin: a randomized, split-body, pilot study in skin types IV-VI.

Improved repigmentation of generalized vitiligo in skin types IV-VI has been reported in clinical response to combined therapy with apremilast and narrowband (NB)-UVB; however, tissue responses to combined therapy versus NB-UVB monotherapy have not been elucidated. We compared the change from baseline in cellular and molecular markers in vitiligo skin after combined therapy versus NB-UVB monotherapy. We assessed lesional and nonlesional skin samples from enrolled subjects and evaluated for immune infiltrates, inflammatory, and melanogenesis-related markers which were compared across different treatment groups. Combined therapy resulted in significant reduction of CD8+T cells and CD11c+ dendritic cells, downregulation of PDE4B and Th17-related markers, and upregulation of melanogenesis markers. This study was limited to small sample size, skin types IV-VI, and high dropout rate. Our molecular findings support the clinical analysis that apremilast may potentiate NB-UVB in repigmentation of generalized vitiligo in skin types IV-VI.

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.

Comparison of NB-UVB combination therapy regimens for vitiligo: A systematic review and network meta-analysis.

BACKGROUND: Vitiligo was an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance repigmentation. OBJECTIVES: To compare the effectiveness of current NB-UVB combination regimen at the improvement in repigmentation through a systematic review and network meta-analysis. METHODS: We searched the electronic databases for randomized controlled trials related to NB-UVB combination therapy for vitiligo till October 2022. STATA15.0 software was applied to carrying out data analysis. RESULTS: A total of 28 eligible studies involving 1194 participants were enrolled in the analysis. The NMA results revealed that compared with NB-UVB, carboxytherapy [OR = 32.35, 95% CI (1.79, 586.05)], Er: YAG laser+ topical 5% 5-FU [OR = 10.74, 95% CI (4.05, 28.49)], needling/micro-needling [OR = 3.42, 95% CI (1.18, 9.88)], betamethasone intramuscular injection [OR = 3.08, 95% CI (1.17, 8.13)], topical tacrolimus [OR = 2.54, 95% CI (1.30, 4.94)], and oral Chinese herbal medicine compound [OR = 2.51, 95% CI (1.40, 4.50)] integrated with NB-UVB were more efficacious in excellent to complete repigmentation response rate (≥75%). Besides, NB-UVB+ Er: YAG laser+ topical 5% 5-FU [OR = 0.17, 95% CI (0.04, 0.67)] and NB-UVB+ needling/micro-needling [OR = 0.24, 95% CI (0.06, 0.88)] were less likely evaluated as ineffective repigmentation response (≤25%). CONCLUSIONS: All combination therapies ranked higher than NB-UVB monotherapy in inducing successful repigmentation and avoiding failed treatment in patients with vitiligo. Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5% 5-FU and NB-UVB+ needling/microneedling would be the preferred therapeutic approaches.

[Narrow-band medium-wave ultraviolet therapy in patients with atopic dermatitis: efficacy and safety]. / Uzkopolosnaya srednevolnovaya ul'trafioletovaya terapiya bol'nykh atopicheskim dermatitom: effektivnost' i bezopasnost'.

For the treatment of patients with atopic dermatitis of moderate and heavy severity level, narrow-band medium-wave ultraviolet therapy (narrow-band phototherapy) can be used. An analysis of the results of studies of the efficacy and safety of narrow-band medium-wavelength ultraviolet therapy in patients with atopic dermatitis is presented, and a characteristic of the regimens of the phototherapy carried out is given. It has been shown that narrow-band phototherapy is an effective and safe method of treating patients with atopic dermatitis, but its effectiveness varies widely. Data were obtained on the absence of an increase in the effect during therapy with higher doses of radiation, about the higher efficiency of narrow-band phototherapy with concurrent medication, with an increase in the number of irradiation procedures, as well as in patients with a higher minimum erythemal dose, which indicates the possible existence of factors characterizing the individual characteristics of the response of patients to narrow-band phototherapy.

Optimizing Narrowband UVB Phototherapy: Is It More Challenging for Your Older Patients?

Narrowband UVB (NB-UVB) phototherapy remains versatile, safe, and efficacious for multiple dermatologic conditions even with recent pharmacologic treatment advances. Polypharmacy contributes to prescribers pursuing phototherapy as a nonpharmacologic treatment, but some wonder if it is as effective and safe for older patients. This study aimed to determine if NB-UVB is equally effective in both older and younger adults treated with the same protocol and to examine the association between photosensitizing medications, clearance, and erythema rates in older vs younger adults.