Long-duration phototherapy should be encouraged to enhance vitiligo treatment response, with the most effective response expected on the face and neck, according to a recent review and meta-analysis published in JAMA Dermatology.
Researchers in South Korea conducted a comprehensive database search of Medline, Embase and the Cochrane Library from inception to Jan. 26, 2016.
Keywords used in the search included: vitiligo, phototherapy, psoralen, PUVA, ultraviolet, NBUVB and narrowband. Two reviewers independently identified relevant articles.
There were 319 studies identified, and 35 were included in the meta-analysis. There were 29 studies of 1,201 patients undergoing narrowband UV-B (NBUVB) phototherapy and nine studies including 227 patients undergoing psoralen-UV-A (PUVA) phototherapy.
An at least mild response occurred in 62.1% of 130 patients in three studies at 3 months, 74.2% of 232 patients in 11 studies at 6 months and 75% of 512 patients in eight studies at 12 months in the NBUVB phototherapy studies. Those studies also showed a marked response in 13% of 107 patients in two studies at 3 months; 19.2% of 266 patients in 13 studies at 6 months and 35.7% of 540 patients at 12 months.
An at least mild response was reported for 51.4% of 103 patients in four studies and 6 months and 61.6% of 72 patients in three studies at 12 months in the PUVA phototherapy studies.
After at least 6 months of NBUVB phototherapy, marked responses were reported on the face and neck in 44.2% of patients, on the trunk in 26.1% of patients, on the extremities of 17.3% of patients, and on the hands and feet of none, according to subgroup analyses.
“A longer treatment duration should be encouraged to enhance the treatment response, and a period of at least 6 months is required to assess the responsiveness to phototherapy,” the researchers concluded. “The overall treatment response to NBUVB phototherapy was better than that to PUVA therapy.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.