New insights and phototherapies in vitiligo

Vitiligo classically belongs in the "difficult to treat" camp, evoking frustration and shades of resignation in patients and physicians alike.

Recent developments in treatments and therapies for vitiligo though, have borne hope in treating this aesthetically disfiguring and socially stigmatic skin disease.

Genetic studies suggest vitiligo to be a multifactorial, polygenic disorder, having a prevalence of 0.1 percent to 2 percent in the world's population. There is no predilection of age, sex or racial backgrounds, and it can cause a significant reduction in the quality of life because of the stark color contrast it produces, causing severe psychological problems in patients.

Dr. Romanelli says that the pathogenesis can either be neural, autocytoxic or immune.

Current therapies

Dr. Romanelli claims that the current therapeutic approaches for vitiligo are either medical, surgical, phototherapy or a combination of topical and phototherapies.

Narrow-band UVB (311 nm to 313 nm) originally used in the treatment of psoriasis, is now being implemented, according to Dr. Romanelli, and is considered to be the best treatment for extensive vitiligo, demonstrating a good efficacy and an excellent tolerance in patients. NB-UVB proves to be more effective than PUVA with fewer side effects.

The 308 nm excimer laser (also successfully used in the treatment of limited plaque psoriasis), has shown great promise in the treatment of vitiligo. Its potential advantage is to deliver high doses of light to localized areas, giving the physician the possibility to selectively irradiate vitiligo patches without involving healthy skin.

Dr. Romanelli says, "The laser effects a good overall response in terms of repigmented areas, with a rapidity of onset of repigmentation at two to four weeks. In my experience, a lower number of treatments are necessary to achieve satisfactory results, as compared to NB-UVB."

The only disadvantage with the 308 nm excimer laser is that it has a very small irradiation field (2x2 cm). This automatically necessitates protracted treatment times for larger regions.

Dr. Romanelli cites a study where 29 patches of vitiligo from 18 patients were treated with the 308 nm excimer laser. The 23 patches that received at least six treatments and the 11 patches that received all 12 treatments showed a 57 percent and 82 percent regimentation, respectively.

In a similar study with the laser, 32 patients with 55 spots of vitiligo were treated for 30 sessions or 75 percent repigmentation, whichever came first. Results showed that slightly more than 50 percent of the patients had 75 percent or more repigmentation of lesions after 30 or less treatments. The best results were seen on the face, followed by the neck, extremities and trunk with a moderate response. The least response was seen on the hands and feet.