Vitiligo and Energy Based Devices

Vitiligo is a common, acquired pigmentary disorder, characterized by variable-sized depigmented patches, of unknown etiology affecting 1-2% of world population without any racial, geographic or sexual predilection. The course of disease is chronic, and often progressive.It is a cause of severe psychosocial distress in most of the patients.

This article aims to give an overview of the energy based  devices  for the treatment of vitiligo.Though wide options of medical treatment are available,use of  these devices hastens the process of repigmentation avoiding side effects due to oral intake of drugs.

NBUVB Therapy

The role of phototherapy is well established in vitiligo. Among phototherapy options, NBUVB has advantage over drug Psoralen intake followed by ultraviolet  A light exposure(PUVA) in terms of better repigmentation , color match with the surrounding skin  and safety profile.NBUVB devices consists of fluorescent bulbs (Phillips model TL-01) that deliver UVB in the range of 310-315 nm, with a peak at 312 nm.  Types of NBUVB equipments available include

·      Whole body cabins

·      Whole body panels

·      Small panels:

Hand and foot unit

NBUVB combos

Home phototherapy units

 

The selected wavelength of Narrow band is  most beneficial amongst the  UV spectrum, minimizing  the risk of exposure to UV in harmful ranges.

Narrowband ultraviolet B may exert its effects in vitiligo in a two-step process. Both steps may occur simultaneously, the first being stabilization of the depigmenting process and the second, stimulation of residual follicular melanocytes.

The affected patient needs to come to the phototherapy center thrice a week on non-consecutive days for treatment. The most important limiting factor of this therapeutic option is the prolonged treatment period required to achieve a significant repigmentation response. Patient must commit for atleast two months of twice or thrice weekly sessions to determine response.NBUVB phototherapy is regarded as the treatment of choice in patients with generalized vitiligo. NBUVB therapy has also been reported to be safe in childhood vitiligo as well as pregnant women.

Home based phototherapy

Home based NBUVB regimens, using instruments like SS-01 UV phototherapy instrument, Dermfix 1000™ NBUVB and Waldmann™ NBUVB 109, are available which can be used by patient at home.Frequent visits to the hospital can be avoided for phototherapy units but these euipments are costlier.

Targeted phototherapy

The newer trend among the phototherapy devices is of Targeted phototherapy which focuses on the “target “area in a more precise way avoiding side effect to the normal skin as well as allows usage of higher energies at the same time leading to shorter duration and less frequent treatment sessions.

Different types of  targeted phototherapy devices that are available

·      XeCl Excimer laser(308 nm)

·      Excimer lamp

·      Targeted UV devices delivering :

Broadband ultraviolet B (BBUVB)- “BClear” Device

UVA and UVB combination-“multiclear” or “dualight”Device

NBUVB-“Bioskin” Device

The  excimer laser and monochromatic excimer lamp has been found to be almost equal in terms of causing repigmentation in vitiligo Also, it can be used to treat difficult to reach areas like skin folds.Excimer laser is considered as the treatment of choice for localized vitiligo.Sessions are performed 2-3 times a week for a period of 4-36 weeks.

Emerging laser therapies

 

These are newer technologies ,most of them are still not available in India :

Low-energy 632.8-nm helium-neon (He-Ne) lasers

Ablative fractional lasers

A gain-switched 311-nm titanium:sapphire (Ti:Sapphire) laser

355-nm monochromatic ultraviolet A1 (UVA1) laser

Only few studies are available regarding their role in vitilgo.

 

-Dr. Tolongkhomba Potsangbam, MD