Effectiveness of psoralen photochemotherapy for vitiligo

To evaluate the response to oral psoralen ultraviolet-A (PUVA) photochemotherapy in patients with vitiligo in Taiwan, we retrospectively reviewed the clinical data of 21 vitiligo patients treated from 1990 to 1998. Diagnosis included generalized vitiligo in 16 patients, focal vitiligo in three, and acrofacial vitiligo in two. All patients were treated two to three times per week over a period of 3 to 19 months with 0.2 to 0.4 mg/kg of trioxsalen 2 hours before exposure to long-wave ultraviolet light irradiation. The results for PUVA therapy showed 10 patients (48%) had an excellent response (75-100% repigmentation),four (19%) had a good response (50-75% repigmentation), one had a moderate response (25-50% repigmentation), and six (29%) had a poor response (0-25% repigmentation). Despite the high rate of satisfactory outcomes, the response to PUVA therapy with respect to specific localization revealed poor response in eight out of 10 patients with vitiligo on the hands and feet. Acute adverse effects of PUVA included pruritus in eight patients, xerosis in one patient, and burning with blistering in four patients. Long-term adverse effects such as actinic keratosis and skin cancer were not found within the follow-up period, which ranged from 2 months to 7 years. Our findings indicate that long-term oral PUVA with trioxsalen is an effective treatment for vitiligo in Taiwanese patients.