NB-UVB vs PUVA therapy in treating vitiligo

In a double-blind randomized study, Yones et al (2007) compared the effectiveness of oral PUVA with that of narrowband-UVB (NB-UVB) phototherapy in patients with non-segmental vitiligo.  A total of 56 patients received twice-weekly therapy with PUVA or NB-UVB.  The change in body surface area affected by vitiligo and the color match of repigmented skin compared with unaffected skin were assessed after 48 sessions of therapy, at the end of the therapy course, and 12 months after the end of therapy.  The results in the 25 patients each in the PUVA and NB-UVB groups who began therapy were analyzed.  The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB-treated group (p = 0.03); this difference was probably due to differences in effectiveness and adverse effects between the 2 modalities, such that patients in the NB-UVB group wanted a longer course of treatment.  At the end of therapy, 16 (64 %) of 25 patients in the NB-UVB group showed greater than 50 % improvement in body surface area affected compared with 9 (36 %) of 25 patients in the PUVA group.  The color match of the repigmented skin was excellent in all patients in the NB-UVB group but in only 11 (44 %) of those in the PUVA group (p < 0.001).  In patients who completed 48 sessions, the improvement in body surface area affected by vitiligo was greater with NB-UVB therapy than with PUVA therapy (p = 0.007).  Twelve months after the cessation of therapy, the superiority of NB-UVB tended to be maintained.  The authors concluded that in the treatment of non-segmental vitiligo, NB-UVB therapy is superior to oral PUVA therapy.