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Try Narrow-Band UVB Before PUVA for Vitiligo Treatment


Laura Lane
Contributing Writer

SAN FRANCISCO — Elevated cytokine levels may be a major factor in the origin of vitiligo, and narrow-band UVB treatment should be tried before PUVA therapy, Dr. Pearl E. Grimes said at the annual meeting of the American Academy of Dermatology.

A study of 400 people revealed a possible mechanism by which the disease develops, said Dr. Grimes of the University of California, Los Angeles. Researchers looked at cytokine levels of affected skin and normal skin located 6 cm from the affected site, which was biopsied before treatment with tacrolimus. They observed an increase in interleukin-10, interferon-, and tumor necrosis factor- in both the affected and normal skin.

They then examined the skin following treatment. Both the affected skin and normal skin had a significant decrease in tumor necrosis factor- .

“Depressing cytokine levels is clearly beneficial, and their elevation may be a major issue in causing this disease,” Dr. Grimes said. Narrow-band UVB treatment should be used before PUVA therapy, which brings about severe side effects with the concomitant use of psoralens. While its efficacy is about the same as PUVA therapy, narrow-band UVB treatment avoids the burning and systemic side effects of PUVA therapy. “It's our number-one approach,” she said. “If a patient fails narrow-band therapy, then we'll initiate PUVA therapy.”

Narrow-band UVB therapy has several disadvantages, however: It requires three treatments every week, carcinogenicity data aren't available, and the permanence of repigmentation is unknown.

Dr. Grimes also talked about the excimer laser. A pilot study done by Dr. Grimes looked at the progress of 19 patients, some of whom used psoralens, which can augment the effects of UVB waves. Fifty percent of patients who had both the psoralens and laser experienced repigmentation. Only 20% of the patients who had the laser treatment by itself had repigmentation.

Skin and Allergy News , July 2003, vol 34, nr. 7


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