Efficacy

Photochemotherapy is well established in the treatment of vitiligo, with different modalities essentially related to geographical area (solar exposure) and available equipment.

A meta-analysis10 has found that the odds ratio (OR) versus placebo (the odds of a patient receiving the active therapy achieving >75% repigmentation compared with a patient receiving the placebo) was significant for oral methoxsalen plus sunlight (OR 23-4; 95% confidence interval (CI) 1-3-409.9), oral psoralen plus sunlight (OR 19.9; CI 2-4-166-3) and oral trioxsalen plus sunlight (OR 3-7; CI 1-2-11-2).

Two randomised double-blind right-left comparative studies on a total of 80 patients have shown that concurrent topical calcipotriol potentiates the efficacy of PUVAsol (oral

QUESTIONS

What are the effects of medical treatment in vitiligo?

psoralen plus sunlight)11 or PUVA,12 achieving earlier pigmentation with a lower total UVA dosage. A further RCT on 135 patients compared (left-right) the efficacy of a combination of fluticasone propionate and UVA with that of either used alone, and showed that combination treatment is more effective,13 although efficacy remains low (only 13% patients achieving >75% repigmentation) because of the low basic efficacy of the two treatments (UVA alone or corticosteroid alone) in patients with extensive symmetrical vitiligo.

The meta-analysis and one further trial14 found that topical or oral khellin and phenylalanine were not effective as photosensitisers in vitiligo therapy (there was no difference between active drug and placebo).

The case series included in the meta-analysis showed that the percentage of patients achieving >75% repigmentation was 63% for narrowband UVB, 57% for broadband UVB, 51% for oral methoxsalen plus UVA and 43% for oral bergapten (a furanocoumarin contained in bergamot orange) plus UVA.10 The differences between the mean success rates reported were not significant. A controlled trial on a device producing a focused beam of UVB (microphototherapy)15 found >75% repigmentation in five of eight subjects with segmental vitiligo treated for 6 months. A right-left comparison trial on 24 patients showed that PUVB is as effective as PUVA in the treatment of extensive symmetrical vitiligo.16

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