Twenty-four of the fifty-three patches were located on the face and neck, twelve on the trunk, eleven on upper or lower limbs, and sixteen on hands and feet.

After ten sessions, five of the fifty-three subjects (9.4%) showed a grade-4 improvement, and after twenty sessions further improvement was observed, with twenty-two of fifty-three subjects (41.5%) showing a grade-4 improvement. After sixty treatment se­ssions, forty-one of the fifty-three patches (77.4%) showed >75% repigmentation (Table 2). The mean number of treatment sessions administered was 44 and the mean cumulative dose was 12.5 J/cm2.

Certain anatomic sites responded better than others (Table 3), and a significant difference was found between anatomic site and final outcome (p=0.0461). In particular, facial and neck areas responded better than hands and feet (p=0.0307); of the 20 patches treated 24 (83.3%) had showed >75% repigmentation (Fig. 1). Lesions on face and neck tended to respond significantly better than lesions located elsewhere on the body. Repig­mentation was mostly peripheral on hands and feet, while on the face and neck additional perifollicular repigmentation was observed. Three subjects had leukotrichia, and in these individuals, repigmen- tation occurred at macule peripheries and not around affected white hair follicles.
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Table 2. Number of patches that showed response after multiples of ten treatment sessions

Repigmentation

Number of responding patches among 53 patches (percentage)

grade

x10

x20

x30

x40

x50

x60

0

15 (28.3)

4 (7.5)

0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)

1

13 (24.5)

11 (20.8)

11 (20.8)

8 (15.1)

2 (3.8)

2 (3.8)

2

10 (18.9)

10 (18.8)

8 (15.1)

9 (17.0)

8 (15.1)

5 (9.4)

3

10 (18.9)

6 (18.9)

6 (11.3)

5 (9.4)

8 (15.1)

5 (9.4)

4

5 (9.4)

22 (41.5)

28 (52.8)

31 (58.5)

35 (66.0)

41 (77.4)

In patients with focal type vitiligo, forty of forty- seven patches (85.1%) showed grade 4 repigmen- tation, and in patients with segmental vitiligo, one of six patches (16.7%) showed grade 4 repigmen- tation. Cumulative dose and number of treatment sessions were lower for focal type vitiligo than for segmental vitiligo (p =0.0295, 0.0108), and side effects were more common in patients with the segmental type (p=0.0015).

Table 3. Repigmentation by vitiligo site (after 60 treat-ment sessions)

Repigmentation grade

Number of patients

Total

Face& neck

Trunk

Limbs

Hands &feet

0

0

0

0

0

0

1

2

0

0

0

2

2

5

1

3

0

1

3

5

3

1

1

0

4

41

20

8

10

3

Among the ten patients with a history of previous treatment, eight had received unsuccessful NB-UVB treatment (seven of these were also administered topical steroid), and two had undergone PUVA and topical steroid treatment. Nine of thirteen patches (69.2%) in ten patients with a history of previous treatment history achieved >75% repigmentation. No statistical relation was found between a history of previous treatment and final outcome (p=0.3660), but a statistically significant difference was found between a history of previous treatment and cumu­lative dose or number of treatment sessions (p = 0.0113 and 0.0233, respectively). Patients with a history of previous treatment need more cumulative dose and number of treatment for treatment to be effective. canadian pharmacy viagra

Fig. 1. Vitiliginous patch

Fig. 1. Vitiliginous patch on the right periocular area in a 12-year-old boy. (A) Before treatment, (B) After 26 treat­ment sessions.

All patients tolerated the treatment well and side effects were limited to mild erythema and a stinging sensation (9 of 53, 17.0%), and localized bullae in three patches (5.7%). Each of these side effects occurred just once in different patients. Treatment was suspended according to the phototherapy pro­tocol in these cases and resumed when symptoms resolved.

We did not observe any return of depigmentation in treated lesions over six months of follow up after discontinuing treatment.