COMBINED PHOTOTHERAPY METHOD FOR VITILIGO

Abstract

The results of combined phototherapy using UVB 311 nm and excimer laser 308 nm in 30 vitiligo patients over 18 years old (main group) are presented. As a comparison group, 30 patients with vitiligo (control group) received only narrow-band UVB therapy at 311 nm. The distribution of the clinical forms of vitiligo in both groups was uniform. Phototherapy with UVB rays was performed according to the procedure of 4-times irradiation per week, excimer laser - 2 times a week. As a result of the treatment in the main group, a clinical cure (repigmentation of more than 96%) was observed in 18 (60%) patients, a significant improvement (repigmentation 51-95%) in 8 (26.7%), improvement in 4 (13.3%). For this purpose it took from 16 to 48 (on average 32) the procedures of an excimer laser (the maximum single dose varied from 0.5 to 2.4 J/cm2 (mean 1.45 J/cm2), the course dose from 2.2 Up to 32 J/cm2 (14.7 J/cm2 on average) and from 24 to 82 procedures of UVB therapy at 311 nm (an average of 52), with a maximum radiation dose ranging from 1.3 to 3.7 J/cm2 ( the mean value of 2.45 J/cm2); the course dose was from the exchange rate of 26.8 to 80.2 J/cm2 (an average of 53.5 J/cm2). In the control group, as a result of 311 nm UVB therapy, clinical recovery was achieved in 7 (23.3%) patients, a significant improvement in 15 (50%), improvement in 8 patients (26.7%). In total patients received from 44 to 94 (an average of 69) procedures for treatment. The maximum radiation dose varied from 2.6 to 5.8 J/cm2 (mean 4.2 J/cm2); the course dose was from 44.4 to 98.7 J/cm2 (an average of 71.6 J/cm2). Portability of phototherapy with UVB rays of 311 nm in combination with an excimer laser of 308 nm and in the form of monotherapy was good in patients of both groups. Side effects from the action of UV rays were reduced to the manifestation of photodermatitis (without blisters) in 5 (8.3%) patients and dry skin in 7 (11.7%) patients. When comparing the obtained results, it was found that the efficiency of the phototherapy was significantly higher with a combination of narrow-band UVB therapy of 311 nm and an excimer laser of 308 nm (60% of patients with clinical cure) than with only one narrow-band phototherapy (clinical cure in 23.3% patients). Using the Cutometer 580 MPA CK electronic device (Germany) with a Mexameter MX 18nozzle before and after treatment melanin levels were determined in the vitiligo foci. After application of combined phototherapy with UVB rays of 311 nm and excimer laser of 308 nm, an increase in the melanin level by 2-2.5 times was revealed, which was clinically expressed in the repigmentation of lesions and was an objective evidence of the effectiveness of combined phototherapy.