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

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.