Treatment of vitiligo with broadband ultraviolet B and vitamins

Abstract

While oral psoralen plus ultraviolet A (PUVA) remains the most popular therapeutic modality for vitiligo, recent reports have shown that narrowband ultraviolet B (UVB) also induces significant repigmentation. In this study we evaluated the efficacy of broadband UVB on actively spreading, progressive vitiligo in patients who had been followed for many months (12 or more) in our practice, who continued to depigment despite treatment. Nine patients with actively spreading vitiligo were exposed to broadband UVB 2-3 times per week at a starting dose of 20-30 mJ/cm(2). Radiation was increased by 10-20 mJ/cm(2) per session with adjustments for symptomatic erythema or missed visits. In addition, patients took vitamin C 500 mg twice a day (BID), vitamin B(12) 1000 microg BID and folic acid 5 mg BID. The response to treatment and side-effects were assessed at each visit. The patient's response to treatment and progress were assessed by photographs and by physician evaluation of body surface area (BSA) (using the Rule of 9s) involved at monthly intervals. Photographs were taken and estimations of BSA by physical examination made at the start and finish of the trial and then compared by the physicians involved in the study. Broadband UVB halted the progression of vitiligo in all nine patients and in general induced repigmentation early after 8-12 treatments (6-8 weeks). After 2-8 months of treatment, nine of nine patients achieved good (51-75%) or excellent response (76-100%). The percentage of repigmentation varied with length of treatment and anatomic site. This study confirms the only published report that broadband UVB is effective on actively spreading vitiligo. Since it is more cost effective than narrowband UVB and has numerous advantages compared to oral PUVA, broadband UVB may offer an alternative for future treatment of vitiligo. The role of vitamins in this therapy remains to be determined.