A retrospective study of the utility of targeted phototherapy in vitiligo

Background: Targeted phototherapy is a recent advance in the treatment of vitiligo, involving selective treatment of vitiligo patches with no effect on surrounding areas. Although it has been in use for a few years, little data is available regarding its safety and efficacy. Aims: A retrospective study to determine efficacy and safety of targeted phototherapy in vitiligo. Methods: One hundred and thirty four patients (male: 53, female: 81) who received targeted phototherapy and completed 11 or more sittings were included. Treatment was given once a week using the Lumera phototherapy system, a broadband ultraviolet B source, starting at 150 mJ/spot and after excluding a sunburn reaction, with increments of 50 mJ every week up to a maximum of 1000 mJ/patch. Chi-square test for linear trends was used for statistical analysis. Results: The most common sites involved were the legs and a majority (70.9%) had non-segmental vitiligo. Response was mild in 78 (58.2%) patients, moderate in 50 (37.3%) and excellent in 6 (4.5%) patients. Response was directly proportional to the number of sittings with more patients showing moderate and excellent responses with an increase in the number of sittings. The most common site for an excellent response was the trunk while the lower limbs were involved in most cases with a moderate or mild response. Side effects were seen in 27 (20.2%) patients, the commonest being erythema. Limitations: This is a retrospective uncontrolled study. Further, the effects of adjuvant treatment were not assessed. Conclusions: Targeted phototherapy is a useful treatment for vitiligo with mild adverse effects, though response is mild or moderate and appears to be directly proportional to the number of treatments received.

Targeted phototherapy.

Background: Targeted phototherapy is a new form of phototherapy which has many advantages and disadvantages over conventional phototherapy. This article reviews the different technologies and outlines recommendations based on current evidence. Methods: A literature search was performed on targeted phototherapy to collect data. Relevant literature published till March 2014 was obtained from PubMed, EMBASE, and the Cochrane Library. Keywords like “targeted phototherapy”, “excimer laser”, “excimer lamp”, “Nonchromatic ultraviolet light”, “vitiligo”, and “psoriasis”, were used for literature search. All systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCT), prospective open label studies and retrospective case series in English were reviewed. Results: Three hundred and forty studies were evaluated, 24 of which fulfi lled the criteria for inclusion in the guidelines. Conclusions and Recommendations: All forms of targeted phototherapy are useful in vitiligo. Good responses were seen in localized involvement, resistant lesions and in children in whom their use is more accepted and convenient (Level of evidence 2+, Grade of recommendation B). Similarly it is useful in psoriasis, either alone or in combination with drugs, even in resistant forms such as palmoplantar psoriasis. In view of expense and practical application, their use is limited to resistant lesions and localized disease. (Level of evidence 2+, Grade of recommendation B). But in other conditions there is no convincing evidence for its use. (Level of evidence 3+, Grade of recommendation C).

Targeted ultraviolet B phototherapy in vitiligo: A comparison between once-weekly and twice-weekly treatment regimens.

Background: Targeted ultraviolet B (T-UVB) phototherapy in vitiligo is usually administered twice or thrice a week on non-consecutive days. It is diffi cult for many patients to adhere to this regimen, forcing them to discontinue treatment. Aim: The study aimed to compare the effi cacy of twice-weekly and once-weekly targeted ultraviolet B phototherapy regimens in vitiligo. Methods: Sixty patients with non-segmental vitiligo on the face, neck or trunk were divided into two groups of 30 patients each. The patients in group A received targeted ultraviolet B twice weekly, while those in group B received targeted ultraviolet B once weekly. Repigmentation was monitored and graded as excellent (≥75% repigmentation), good (50−74% repigmentation) and poor (<50% repigmentation). The extent of repigmentation at each body site (primary outcome measure), the number of doses required for initiation of pigmentation, and the cumulative dose of targeted ultraviolet B administered was calculated and compared between both groups. Results: A total of 90 lesions (48 in the twice weeklygroup and 42 in the once weekly group) were treated on the face, neck and trunk. Excellent results were obtained in 62.5% (30/48) of lesions treated twice weekly, and 64.3% (27/42) in lesions treated once weekly. The mean number of doses required for initiation of pigmentation was 4.69 in the twice weekly group, and 4.35 in the once weekly group. The patients in the twice weekly group received a mean cumulative dose of 8.26 J/cm2, while the once weekly group received 7.69 J/cm2. No statistically signifi cant differences were observed between the two groups with respect to the outcome, with respect to the total repigmentation, the number of doses till onset of pigmentation, as well as the cumulative dose of targeted UVB. Conclusion: Once-weekly targeted ultraviolet B phototherapy appears to be as effi cacious as the twice-weekly regimen in vitiligo.

The Efficacy of DuaLight(TM) Treatment for Localized Vitiligo / 대한피부과학회지

BACKGROUND: DuaLight(TM) is a recently developed phototherapeutic device that is used for targeted phototherapy. However, the efficacy of DuaLight(TM) therapy for vitiligo has not been evaluated nor has it been reported on in the Korean medical literature. OBJECTIVE: This study was conducted to evaluate the efficacy of DuaLight(TM) therapy for treating localized vitiligo and we wanted to determine the clinical parameters that could affect the therapeutic outcome. METHODS: Eighty-three lesions from thirty-eight patients were treated by using DuaLight(TM) once or twice a week. The repigmentation grade of each treated lesion was evaluated on a 5-point scale from 0 (no repigmentation), 1 (1~24%), 2 (25~49%), 3 (50~74%), to 4 (75~100%). Results: Thirty-four lesions of the 83 lesions (40.9%) improved to 50% repigmentation after DuaLight(TM) therapy. The clinical parameters that affected the therapeutic outcome were the lesions' anatomical location and the clinical subtype of vitiligo. Yet a history of previous treatment and the skin type did not affect the therapeutic result. Perilesional hyperpigmentation (47.4%) was the most common side effect, but the other adverse effects were limited and transient. CONCLUSION: DuaLight(TM) therapy is an effective, safe therapeutic modality for localized vitiligo. However, similar to other non-surgical therapeutic modalities, the therapeutic outcome is mainly dependent on the anatomical location.

The Efficacy of DuaLight(TM) Treatment for Localized Vitiligo / 대한피부과학회지

BACKGROUND: DuaLight(TM) is a recently developed phototherapeutic device that is used for targeted phototherapy. However, the efficacy of DuaLight(TM) therapy for vitiligo has not been evaluated nor has it been reported on in the Korean medical literature. OBJECTIVE: This study was conducted to evaluate the efficacy of DuaLight(TM) therapy for treating localized vitiligo and we wanted to determine the clinical parameters that could affect the therapeutic outcome. METHODS: Eighty-three lesions from thirty-eight patients were treated by using DuaLight(TM) once or twice a week. The repigmentation grade of each treated lesion was evaluated on a 5-point scale from 0 (no repigmentation), 1 (1~24%), 2 (25~49%), 3 (50~74%), to 4 (75~100%). Results: Thirty-four lesions of the 83 lesions (40.9%) improved to 50% repigmentation after DuaLight(TM) therapy. The clinical parameters that affected the therapeutic outcome were the lesions' anatomical location and the clinical subtype of vitiligo. Yet a history of previous treatment and the skin type did not affect the therapeutic result. Perilesional hyperpigmentation (47.4%) was the most common side effect, but the other adverse effects were limited and transient. CONCLUSION: DuaLight(TM) therapy is an effective, safe therapeutic modality for localized vitiligo. However, similar to other non-surgical therapeutic modalities, the therapeutic outcome is mainly dependent on the anatomical location.