Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A

Objective: To compare the efficacy and safety of 2 treatment modalities, topical psoralen plus UV-A (PUVA) with unsubstituted psoralen and 311-nm UV-B radiation, in patients with vitiligo. Design: This intervention study was designed as a before-and-after trial with 2 arms, in which patients were consecutively included. Patients: Male (n=99) and female (n=182) patients, who predominantly had skin type III, with extensive, generalized vitiligo of more than 3 months' duration. Interventions: Two patient groups were investigated. The first group of patients was treated for 4 months with either topical PUVA (n=28) or 311-nm UV-B radiation (n=78). The second group of patients, treated twice weekly with 311-nm UV-B radiation, was followed up for 3 (n=60), 6 (n=27), 9 (n=37), or 12 months (n=51). Results: Thirteen. (46%) patients in the first group treated with topical PUVA showed repigmentation after 4 months. Fifty-two patients (67%) in the 311-nm UV-B treatment group showed repigmentation after 4 months. After 3 months, 5 patients (8%) in the second group showed more than 75% repigmentation of lesional skin compared with 32 patients (63%) after 12 months. As in other treatment modalities, the face showed good repigmentation, whereas hands and feet responded poorly. No adverse effects were encountered with treatment with narrowband UV-B radiation, contrary to those seen with topical PUVA treatment. The cumulative UV-B dose was very small compared with that of the topical PUVA treatment. Conclusions: According to our results, the treatment of patients with vitiligo with 311-nm UV-B radiation is as efficient as with topical PUVA and has fewer adverse effects.