Light Based Treatments for Vitiligo

Vitiligo is a skin condition in which there are areas of depigmentation (loss of skin color) in the skin. It is a noticeable skin condition, especially in darker skin tones and can be disfiguring to those affected. People affected are often emotionally and socially affected by the striking appearance of vitiligo, ultimately deteriorating their quality of life. The basis for treatment is to regain pigment in the areas affected, thus creating an even skin color. For people affected by vitiligo, having effective treatment can be life-changing and crucial to their well being.

Psoralen and UVA Therapy (PUVA)

Psoralen and ultraviolet light type A (UVA) therapy have long been studied and documented by the ancient Egyptians and populations in the Middle East.^[1] Psoralen is an active ingredient found in plants. In modern day use it has been extracted and used in vitiligo treatments as an oral or topical medication. The idea of using psoralen for vitiligo treatment is that it makes the skin more sensitive to light.^[2] For this treatment, patients are instructed to take oral psoralen two hours prior to exposure to UVA light. Then, administration of UVA therapy is initiated at a tolerable dose, which is determined by signs of skin redness. Psoralen UVA therapy for vitiligo is typically done three times a week for approximately 6 months.

Side effects of PUVA

Unfortunately, patients often complain of nausea and upset stomach when taking oral psoralen.^[3] Some patients may have a low tolerance to UVA exposure and can be more sensitive to this form of therapy. In addition to creating photosensitivity (sensitivity to sunlight) of the skin, it also makes the eyes more sensitive, with effects lasting up to 24 hours.^[2,3] The patient must use eye protection to avoid any harmful and permanent effects. Psoralen UVA therapy may not leave the treated area matching the color of the surrounding healthy skin. It also has an increased risk of skin cancer in people with chronic treatments or those that require higher frequency. .^[3]

Narrowband UVB Therapy (NBUVB)

Narrowband UVB therapy is commonly used for the treatment of vitiligo and is also used for other skin conditions as well.^[1,3] Essentially, areas of skin affected with vitiligo are exposed to a UVB light with a wavelength of 311-313nm. This “narrow spectrum” (referring to the size of the wavelength) of UVB light allows for stimulation of melanocytes, the skin cells that produce skin pigment^[2], in order to help “kick start” the pigmentation process of the skin. UVB therapy also suppresses the immune system in the skin, thereby decreasing inflammation.^[4] This treatment form is done 2 to 3 times a week for several months. Initiation and duration of therapy, along with dosing is dependent upon each patient. Treatment efficacy varies tremendously based on age, type of vitiligo, area affected, skin type, and patient response.^[1] Studies have shown that children, darker skin tones, and early or new lesions are often more responsive to treatment.^[1] Treatment is usually stopped when re-pigmentation of the area is achieved.

Side Effects

Side effects for narrowband UVB therapy include redness in the treated area and a possibility for reactivation of herpes simplex virus (the virus that causes cold sores and genital herpes) in affected patients.

How does narrowband UVB therapy compare to psoralen and UVA?

In one study of vitiligo patients, narrowband UVB therapy was more effective than psoralen UVA therapy with fewer side effects and better color matching.^[1] Most dermatologists have moved toward the use of narrowband UVB over the use of PUVA.

Excimer Laser Therapy

The excimer laser uses a 308nm wavelength of light^[5] in the UVB spectrum and similarly allows for stimulation of melanocytes.^[2] Excimer laser therapy is very effective in small areas where stable vitiligo is present.^[5] Treatment outcomes also depend on areas affected and studies have shown that the face and neck show a better response whereas the hands and feet do not respond as well.^[6] Unfortunately, laser therapy is expensive and can be a burden to patients. Treatment requires 2 to 3 sessions weekly for several months.

Disclaimer: For any drugs or medications discussed here, please consult the drug package insert for complete prescribing information and for complete information regarding side effects.