As we all know, vitiligo is an autoimmune disorder, in which there is a loss of color of the skin (whitening of the skin). It is around from the ancient times, with mentions, more than 3500 years ago in pre-Hindu Vedic and ancient Egyptian texts. The treatment described in Indian and Egyptian texts, suggests the use of psoralen-containing plants, being applied to the specific area and then exposed to sunlight, now known as Photochemotherapy.
Over the years, photochemotherapy, also known as PUVA (Psoralen ultraviolet A) became the choice of treatment, wherein, psoralen, in either topical or oral form was administered before exposing the designated area to UVA light. However, this had its side-effects, which include, vomiting, nausea, phototoxicity, gastrointestinal irritation and photocarcinogenicity (Mohammad et al. 2017; Handbook of Vitiligo, JP publishers).
NB-UVB was introduced in 1997, by Westerhof and Nieuweboer-Krobotova (Mohammad et al. 2017). It was shown to be effective with fewer side-effects. Since then, NB-UVB has become the gold standard medical treatment.
Question is often raised on the safety and efficacy of the procedure. A number of studies were conducted (Mohammad et al. 2017, Prasad et al. 2006, Kanwar et al.) to prove the safety and efficacy of the treatment. Almost all studies, including many more, suggest, NB-UVB, is effective, safe and has minimal side-effects. The safety profile has also been demonstrated in children with a good repigmentation rate (Mohammad et al. 2017). It was also observed that thrice a week administration of treatment gave better repigmentation compared to twice a week. The therapy has also been seen to play a role in arresting the spread of vitiligo. Areas such as face and neck respond best to the treatment whereas acral, mucosal and bony sites have low response rate.
Till date no uniform guidelines are present for administering UVB, hence if not given in a specific manner the patient is not able to tolerate higher doses and may experience some mild side-effects. We, at Mulekar Clinic, have come up with our own guidelines based on the guidelines published by Vitiligo Working Group in the U.S. in order to administer the doses safely and to yield optimum results.
Phototherapy can be taken in the clinic in a full body chamber as well at home with a home unit. Both have different guidelines. Please look at our guidelines on how to take phototherapy in a controlled manner at home or at a clinic.
Most importantly, the treatment has to be under the guidance of a licensed Dermatologist and protocol should be followed with proper care.