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Association of targeted intense pulse light system UVA1-UVB and fluticasone in the treatment of vitiligo: Prospective study of 10 patients

  • Author(s): Coelho, Joana Dias
  • Ferreira, Ana
  • et al.
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Letter: Association of targeted intense pulse light system UVA1-UVB and fluticasone in the treatment of vitiligo: Prospective study of 10 patients
Joana Dias Coelho MD, Ana Ferreira MD
Dermatology Online Journal 16 (3): 15

Dermatology Department, Hospital dos Capuchos - Centro Hospitalar de Lisboa Central, Lisbon, Portugal. joanadiascoelho@hotmail.com

Abstract

Vitiligo is an acquired pigmentary disorder treated frequently with PUVA and narrowband UVB phototherapy. These total body treatments are associated with side-effects in the lesional or nonlesional skin. A prospective study using a novel multiwavelength targeted Intense Pulse Light System UVA1-UVB in association with fluticasone cream was undertaken. Of the ten patients who participated in the study, only eight completed it. Four patients had grade 1 improvement (1-25%); one had grade 3 (51-75%); two had worsening of the lesions after sun exposure; one had no skin repigmentation.


Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes characterized by loss of melanocytes from the epidermis. It affects 0.1–2 percent of the world’s population [1]. The most common sites of vitiligo involvement are the face, neck, and scalp. Lesions on face and hands may have a significant impact on psychosocial well-being and quality of life [2].

Several treatments have been proposed with variable clinical results. Traditional therapies include corticosteroids (topical, intralesional, and systemic) and topical and oral PUVA [3]. More recently, narrowband 311 nm UVB phototherapy has been shown to have a superior repigmentation capability when compared to oral PUVA therapy [4]. These total body treatments are associated with side effects such as phototoxic reactions and a risk of carcinogenesis in either lesional or nonlesional skin [1].

There are several reports of targeted UVB devices, namely the 308 nm excimer laser [3], narrow-band UVB micro-phototherapy [5] and a broadband UVB system [6, 7], that by allowing selective targeting, reduce the overall cutaneous cumulative burden.

The authors conducted a prospective study evaluating repigmentation of localized vitiligo lesions using a multiwavelentgh medical device that emits high intensity incoherent light (300-380 nm) in the UVA1-UVB spectra in association with fluticasone cream.

Ten patients (six male and four female) aged 18 or older (ranged from 25 to 65) with four or more stable lesions of vitiligo, were enrolled in this 12- week study. Patients’ skin phototype was II, III, and IV. The duration of vitiligo varied from 2 to 37 years with a mean of 16.3 years. Past treatments included topical corticosteroids, pimecrolimus cream, tacrolimus ointment, and PUVA therapy, with variable success.

Twelve sessions of UVA1-UVB targeted radiation were given to selected vitiligo lesions. The participants initially received twice weekly treatments (week 1 to 3), then a weekly treatment (week 4 to 8), and afterwards, twice monthly treatments (week 9 to 12). Radiation was directed to the targeted lesions with only slight overlapping of the normal surrounding skin. The starting UV doses were determined by patients’ phototype and light fluences were increased by 10 percent to 20 percent each session until mild erythema was observed. In addition, patients applied fluticasone propionate cream 0.5 mg/g once a day (one week per month) in all treated lesions. Photoprotection was reinforced. Patients were instructed to avoid any other kind of topical treatment during the study.


Figure 1Figure 2
Figure 1. Grade 1 improvement (1-25%)
Figure 2. Grade 1 improvement (1-25%)

Figure 3Figure 4
Figure 3. Grade 3 improvement (51-75%)
Figure 4. Worsening of the lesions after sun exposure

Repigmentation improvement was graded as follows: Grade 1 ≤ 25 percent, Grade 2 = 26-50 percent, Grade 3 = 51-75 percent and Grade 4 ≥ 75 percent. Of the ten patients who participated in the study, only eight completed it. One participant withdrew due to changes in his work schedule and another discontinued because of progression of the lesions.

Four patients had grade 1 improvement (1-25%); one had grade 3 (51-75%); two had worsening of the lesions after sun exposure; one had no repigmentation (Figures 1 through 4).

Treatments were otherwise well tolerated with some mild erythema in all patients. Comparing the results of this study to some reports of 308 nm excimer laser efficacy, we had a lower repigmentation rate. However, the number of treatments was limited. The inclusion of fluticasone along with the UVA1-UVB, although just one week per month, had probably some influence in the repigmentation capacity.

We highlight that the main advantages of this technique are that it is easy to perform and it is targeted to the skin lesions. On the other hand it is very time-consuming even in localized lesions of vitiligo. Long-term follow-up is essential and randomized controlled trials with larger sample size are needed.

References

1. Casacci M, Thomas P, Pacifico A, Bonnevalle A, Paro Vidolin A, Leone G. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311-313 nm) in the treatment of vitiligo - a multicentre controlled study. J Eur Acad Dermatol Venereol 2007;21(7):956-63. [PubMed]

2. Ongenae K, Beelaert L, van Geel N, Naeyaert JM. Psychosocial effects of vitiligo. J Eur Acad Dermatol Venereol 2006;20(1):1-8. [PubMed]

3. Taneja A, Trehan M, Taylor CR. 308-nm excimer laser for the treatment of localized vitiligo. Int J Dermatol 2003;42(8):658-62. [PubMed]

4. Yones SS, Palmer RA, Garibaldinos TM, Hawk JL. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs Narrowband-UV-B therapy. Arch Dermatol 2007;143(5):578-84. [PubMed]

5. Menchini G, Tsoureli-Nikita E, Hercogova J. Narrow-band UV-B micro-phototherapy: a new treatment for vitiligo. J Eur Acad Dermatol Venereol 2003;17(2):171-7.

6. Asawanonda P, Kijluakiat J, Korkij W, Sindhupak W. Targeted broadband ultraviolet b phototherapy produces similar responses to targeted narrowband ultraviolet B phototherapy for vitiligo: a randomized,double-blind study. Acta Derm Venereol 2008;88(4):376-81. [PubMed]

7. Asawanonda P, Charoenlap M, Korkij W. Treatment of localized vitiligo with targeted broadband UVB phototherapy: a pilot Study. Photodermatol Photoimmunol Photomed 2006;22(3):133-6. [PubMed]

© 2010 Dermatology Online Journal