Background and Aims

The progression of vitligo has been the direct effect of auto-immunity mediated destruction of melanocytes. The effect of narrow-band UVB on disease progression in vitiligo has not been evaluated. We evaluated the effect of NB-UVB on progressive versus non-progressive non-segmental vitiligo.

Methods

Adult patients having non-segmental vitiligo >2% BSA were divided into two subsets; patients developing >5 lesions in last 1 month or >15 lesions in last 3 months [Progressive vitiligo, group I] and patients with static disease for last 6 months [Non-progressive vitiligo, group II]; Both groups were treated with NB-UVB for 6 months and its efficacy in halting disease progression, re-pigmentation, side-effects and psychosocial impact were evaluated.

Results

Twenty-four out of 31 patients with progressive vitiligo (group I); and 9 out of 17 with non-progressive vitiligo (group II) completed the study period of 6 months. At the end of 6 months, 19 out of 24 patients had arrest of disease progression while the rest five patients developed lesions at a slower pace. After 6 months, majority of patients; 19 out of 24 (79%) in group I and 6 out of 9 (67%) in group II, had 25-50% re-pigmentation. Pruritus (20/33 patients; 60.6%), blistering (7/33 patients; 21.2%), pain (4/33 patients; 12.1%) and burning sensation (4/33 patients; 12.1%) were the side-effects.

Conclusions

Besides achieving re-pigmentation, NB-UVB has potential to halt disease progression in some patients with progressive vitiligo, with minimal side-effects. Autoimmunity being the definitive factor in progression of vitiligo, these results suggest that NB-UVB may be having an immunomodulator effect in vitiligo.

Background and Aims

Vitiligo, an acquired, multifactorial, autoimmune disorder is classified for therapeutic purposes as progressive and non-progressive. The first priority for the treatment of vitiligo should be to control the disease process, and then taking measures to re-pigment.

Methods

We had three different studies in patients with progressive vitiligo

Results

In progressive disease, there is continuous assault on melanocytes and modalities which do not arrest this process may not work. Corticosteroids suppress autoantibody formation and induces apoptosis of cytotoxic T cells. It helps not only in halting progression of the disease, but also induces re-pigmentation as normal melanocytes from the periphery of the lesions or perifollicular areas take over.

To achieve long-term safety of systemic corticosteroids, we used oral mini-pulse therapy (OMP) in 1993 and since then, most studies indicate that OMP halts disease progression in rapidly spreading vitiligo and induces variable re-pigmentation. To address the need for another immunosuppressant, we compared the efficacy and safety of betamethasone OMP vs oral azathioprine in arresting the disease progression and inducing re-pigmentation. In the OMP group arrest of progression was achieved earlier at 2 and 4 months compared to azathioprine at 6 months. Re-pigmentation was also better in OMP group.

Immunomodulatory effect of NB-UVB is by increasing regulatory T-lymphocytes and inhibiting the number of CD8+ T-lymphocytes. In our study, 19 out of 24 progressive vitiligo patients had halting of disease activity after 6 months of NB-UVB.

Conclusions

To conclude, oral corticosteroid as OMP, azathioprine and NB-UVB in various permutation and combination can be useful in progressive vitiligo.