Phototherapy for Vitiligo: What to Expect for Treatment Response
Phototherapy (typically psoralen–UV-A (PUVA) and narrowband UV-B (NBUVB)) therapy is a common treatment for vitiligo, but the long treatment duration requires multiple clinic visits and poses a burden for patients. Because of the required patient commitment, managing expectations is important to avoid disappointment over treatment outcome.
A recent systematic review and meta-analysis looked at repigmentation rates of NBUVB and PUVA phototherapy across different treatment durations to estimate treatment responses to phototherapy for vitiligo. In addition, the study sought to describe the treatment responses to phototherapy by body location. After identifying 35 studies comprising 1,428 patients, the authors used repigmentation rate as the outcome of interest.
The results confirmed that phototherapy requires at least 1 year to achieve maximal treatment response. However, based on this study the authors could not determine the appropriate treatment duration. The results varied, but the authors were able to say that patients should give NBUVB treatment at least 3 months or longer before determining that they are not responding to treatment as their results suggest at least 6 months of treatment is needed to determine the responsiveness to NBUVB phototherapy. The same held true for PUVA as treatment responses were better after 12 months versus 6 months. The authors state that the overall treatment response to PUVA phototherapy was inferior to that to NBUVB.
With regards to body site, the analysis showed that the face and neck was the most responsive to NBUVB, followed by the trunk and extremities. Hands and feet showed very low response rates. The authors conclude that patients should be aware that a longer treatment duration should be expected and at least 6 months is needed to assess the responsiveness to phototherapy. Patients should anticipate the best response on the face and neck.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: August 15, 2017
Source: JAMA Network
Adapted from the original article.