Response to Narrow-band UVB – Vitiligo-melasma versus Vitiligo

A Comparative Study

Parikshit Sharma; Harsha S. Pai; Ganesh S. Pai; Maria Kuruvila; Reshma Kolar

Disclosures

Am J Clin Dermatol. 2011;12(2):127-132. 

In This Article

Materials and Methods

This study was conducted for a period of 14 months from October 2005 to December 2006. During this period, a total of 39 new patients were enrolled in the study.

Patient Work-up

The patients were divided into two groups: one group of patients having only vitiligo (vitiligo) and the other comprising patients with vitiligo and coexisting melasma (vitiligo-melasma).

A detailed history regarding the age of onset and duration of vitiligo, and precipitating factors such as trauma or pregnancy were specifically recorded. History suggestive of systemic illness such as diabetes mellitus, thyroid dysfunction, or anemia was noted. History of vitiligo or any autoimmune disorder in the family was also obtained.

Specific history regarding the onset and duration of melasma was also taken into account. The diagnosis of vitiligo and melasma was made based on clinical features alone.

Patients with new-onset and untreated vitiligo were enrolled in the study. Exclusion criteria included age younger than 10 years or older than 60 years, previous skin malignancy, pregnancy, lactation, a history of photosensitivity, or administration of a drug known to frequently cause photosensitization. Patients with segmental vitiligo and poliosis over the macules were also excluded from the study.

All patients underwent an ophthalmologic examination and evaluation of hemoglobin, blood sugar, and thyroidstimulating hormone levels.

Treatment Protocol

Patients in both groups were treated with NB-UVB. The starting dose of NB-UVB was 350 mJ/cm2. The dose was increased by 20% increments at each treatment to a maximum of 1000 mJ/cm2. A twice-weekly dosing schedule was followed for patient convenience.

The patients were followed up at 4-weekly intervals for 12 weeks. If persistent erythema (lasting >24 hours) developed, indicating a phototoxic effect, further treatment was delayed until this resolved. Treatments were then reinitiated at the previous dose.

Assessment of Repigmentation

Photographs were taken at baseline and at each 4-weekly follow-up as an aid to the clinical scoring. The photographs were taken under conditions that were standardized for lighting, position, and exposure time.

The response was assessed on the basis of the area covered by pigmentation (see table I).[16]

The rates and extent of zonal repigmentation were compared between the two groups (vitiligo vs vitiligo-melasma) at 4, 8, and 12 weeks.

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