Vitiligo

Vitiligo is a difficult disorder to treat, and most of the currently available treatment modalities are either only slightly effective or associated with signi¬ficant side effects. Although NB-UVB radiation has been shown to be most efficacious and has a low side-effect profile, reported treatment series required six to twelve months of treatment to achieve optimal results. More recently, several authors have found that microphototherapy or targeted photo¬therapy offers benefits, which include the rapid onset of repigmentation, good overall response in terms of repigmentation area, and a lower number of treatment sessions than conventional NB-UVB to achieve satisfactory results. It should also be noted that targeted phototherapy can be used to selectively irradiate vitiligo patches without involving neighboring healthy skin.

The number of patients achieving repigmentation at >75% in the present study was higher with a lower cumulative dose than other studies. Whether the difference in the output of the source, or differences in treatment protocols and in the distributions of skin types or lesional sites between the studies, contributed to the different response remains to be investigated. In a study by Taneja et al, after 40 ~ 60 treatments using 308 nm eximer laser, 38.8% (7/18 patches) of the vitiligo patches were repig- mented more than 75%. However, for the lesions on the face, all participants (5 of 18 subjects) had grade 4 repigmentation.

Several studies have reported relationships between clinical response and treatment session number or duration – , and best results were obtained in pa¬tients who received more treatment sessions. How¬ever, in the present study, Spearmann’s Rank Correlation Analysis showed a negative correlation between final outcome and cumulative dose or total session number. In other words, poor responders need more treatment sessions and higher cumulative doses. Different result between the other studies previously noted can be associated with long follow up period without dropout, especially in poor res- ponder group of our study.
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Many authors 9-12 have consistently reported that response to therapy is highly dependent on lesion location, a finding confirmed by the present study. It is believed that inactive melanocytes in the outer root sheath of the hair follicles are stimulated to proliferate and migrate by the irradiation and cause repigmentation. Hair follicle density is also believed to be important, and could explain the poor response of hand skin, which generally has low hair follicle density.