Narrowband UVB - now considered the gold standard of treatment for vitiligo covering more than 20% of the body. Narrowband UVB (NB) uses the portion of the UVB spectrum from 311-312 nm. This region has been determined to help stimulate pigment cells to produce melanocytes in less time than it takes to burn the skin. Any kind of light therapy has a suppressive effect on the immune system, so it can possibly stop new areas from forming as well. NB can be done in the doctor's office with a full-body cabinet or, with a doctor's prescription, from home using a full-length panel or a handheld device. The handhelds are very convenient for small areas of vitiligo but are too tedious and cumbersome to use for larger percentages as they cover a very small area at a time. NB is sometimes used in combination with other topical treatments, but is effective for many on its own. NB can be used on children old enough to stand still and keep goggles on. Results are often seen beginning between 30 and 60 treatments, and treatment is usually given 3 times a week. Potential side effects of NB include burning if used for too long. If using a full-body panel or box, the normal skin may tan, increasing the contrast. Only full sized body units provide the immune suppression needed for stabilization that may halt further pigment loss, as the handheld units only treat isolated areas. As long as the patient is old enough to understand that they must keep their eyes closed at all times, and has an annual eye exam, research has shown that it is safe to expose the eyelid to NB-UVB light. The exception to this would be if a psoralen had been used.
PUVA - "Psoralen" plus "UVA" light. Formerly the gold standard of treatment, PUVA has mostly been surpassed by NB-UVB as NB-UVB is at least as effective and has fewer side effects. The psoralens are typically taken orally, but can also be used topically. A UVA light box or sun may be used to provide the light component. Melaginina that is available in countries outside the US is a psoralen and must be used with caution and under a doctor's care. Treatments are usually given 3 times per week. Side effects of PUVA include burning, stomach upset, liver issues, and cataracts. To prevent the possibility of cataract formation you must wear sunglasses, which protect your eyes against UVA, for 12- 24 hours after taking the tablets. Sunglasses labeled UV 400/UVB/UVA protection 100% are recommended. PUVA is used less often in children because of the risk of side effects.
Narrow-Band UVB Comparison - Narrow Band Ultra Violet B Light is a relatively new technology on the vitiligo front. In the past, most doctors have used the PUVA system, which involved the use of Ultra Violet A light exposure and the taking of Psoralen pills. However, side effects for many people were unbearable. Narrow Band UVB light panels and cabinets solve the problems of over-exposure to ultraviolet by maximizing delivery of narrow-band UVB radiation (in the 311-312 nanometer range, the most beneficial component of natural sunlight) while minimizing exposure to superfluous UV radiation.
This allows patients to receive photo-therapy treatments with less risk of severe burning or pathogenic exposure to UV in harmful ranges. (It also avoids the adverse side effects of the psoralens used in conventional PUVA therapy, since UVB treatment requires no supplemental drugs.) These benefits have made Narrow Band UVB systems increasingly popular with vitiligo patients and their doctors.
Even better is that Narrow B UVB light systems are available in home-sized panel systems and cabinets, which many are finding far more convenient than frequent trips to their dermatologist's office. Though many people buy complete surrounding cabinets, some doctors suggest that panels are actually more effective, and that the optimum distance from the bulbs for the area being treated is about 7 inches. Time exposures should be discussed with your dermatologist prior to using a light panel or cabinet, as the exposure times vary greatly depending on how long you have been treating, and your skin tone.
Narrow band UVB eliminates superfluous and harmful UV by emitting only wavelengths of 311-312 nanometers. Conventional broad band UVB lamps emit a variety of wavelengths ranging from 280-330 nm. Clinical studies show the peak therapeutic effectiveness of UVB to be within the range of 295-313 nm, but wavelengths below 300 nm can cause erythema or severe burning and increase the risk of skin cancer. The 311-312 range is considered by many to afford optimum safety.
Excimer laser - A targeted NB machine typically using the 308 nm portion of the spectrum. Laser can be very effective for smaller areas of stable vitiligo. As it treats a small area, it is inefficient for larger areas or percentages. Results from laser treatments frequently occur more quickly than with other treatments. Because laser treatments are expensive, it is typically only used on stable vitiligo because when the vitiligo is active there is a greater chance of pigment being lost afterwards. Hands and feet are often not treated with laser because it is less effective there. Treatments are generally 2-3 times per week. Potential side effects include burning.
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