Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Study Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_8_2020

Targeted phototherapy with excimer light is not efficacious in the management of residual vitiligo patches following whole-body narrowband ultraviolet B light therapy: Results of a retrospective case series

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
Corresponding author: Dr. Sujay Khandpur, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. sujay_khandpur@yahoo.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Yadav D, Khandpur S, Bhari N. Targeted phototherapy with excimer light is not efficacious in the management of residual vitiligo patches following whole-body narrowband ultraviolet B light therapy: Results of a retrospective case series. Indian J Dermatol Venereol Leprol 2021, doi: 10.25259/IJDVL_8_2020

Sir,

Complete repigmentation in vitiligo is difficult to achieve even after adequate whole-body narrowband ultraviolet B light therapy. We undertook a retrospective review of the efficacy of excimer light in producing repigmentation in residual vitiligo patches in non-segmental stable vitiligo (body surface area <5%) patients who had received at least 50 sessions of narrowband ultraviolet B. A total of fifteen cases received excimer light, of which two cases were excluded as they had received less than ten sessions. Thirteen cases with a mean age 25.9 years were included [Table 1]. Seven patients had vitiligo vulgaris while six patients, acrofacial vitiligo. The mean number of narrowband ultraviolet B sessions received before excimer light therapy was 148.8 ± 92.2 (range = 53–310). Besides narrowband ultraviolet B, 12 patients had concomitantly received topical therapy (tacrolimus 0.1% ointment and fluocinolone acetonide 0.1% cream) which was continued during excimer light therapy. The excimer light was given using handheld xenon chloride lamp (Exciplex®, Clarteis, Valbonne, France) two–three times per week on nonconsecutive days. It was initiated at a prefixed dose depending on the site of irradiation [Table 1]. The same dose was repeated if erythema persisted at 48 h, while if symptomatic erythema and/ or blisters occurred, excimer therapy was omitted and the dose was reduced by 50 mJ in the subsequent session. Patients were advised adequate photoprotection after excimer light therapy. Patients with lesions on or lesions limited to hands, feet, elbows and knees were excluded from the study. The mean number of sessions received was 21.4 ± 8.3. The median dose of excimer therapy delivered was least for head and neck followed by trunk, upper limbs and lower limbs [Table 1]. Efficacy was measured as patient and investigator global assessment (photographic review), in terms of percentage improvement from baseline.

Table 1:: Clinical and treatment details of patients (n=13)
Parameters Mean±standard deviation/median (range)
Age 25.9±12.1 years
Male:Female ratio 1.6:1
Type of vitiligo Acrofacial vitiligo: Six, vitiligo vulgaris: Seven
Skin phototype IV: Seven (53.8%) V: Eight (61.5%)
Duration of vitiligo 4.8±2.1 years
Number of narrowband ultraviolet B sessions before excimer therapy 148.8±92.2
Concomitant therapy Tacrolimus 0.1% ointment: four cases, fluocinolone acetonide 0.1% cream: two cases, both: Six cases
Sites involved (n=25) Head and neck: Seven, trunk: Ten, upper limbs: Two, lower limbs: Six
Number of excimer light sessions 21.4±8.3
Dose of excimer light Head and neck: 550 mJ (450–700),
trunk: 675 mJ (250–1000),
upper limbs: 725 mJ(350–1100);
lower limbs: 725 mJ (350–1500)
Patient global assessment Improvement in four (30.77%) cases: 10% (0–25%) No improvement in nine(69.23%) cases
Investigator global assessment Improvement in seven(53.84%) cases: 10% (5–40%) No improvement in five(38.46%) cases Exacerbation in three(23.07%) cases

On patient global assessment, median improvement of 10% (range – 5–25%) was appreciated by four (30.7%) patients. According to physician global assessment, overall response ranging from 30 to 40% was recorded with a median overall improvement of 10% (range – 5–40%) observed in seven patients [Table 1]. Exacerbation of disease (defined as increase in the area of depigmentation from baseline) occurred in three cases. On comparing response according to the site of involvement, 80% repigmentation was found in only one case with facial lesion [Figure 1a and b] and 10–20% improvement was noted in two, three, zero and one patients with head and neck, trunk, upper limb and lower limb lesions, respectively. Side effects in the form of transient eyelid oedema and perilesional hyperpigmentation were seen in one case each. The latter probably resulted from the use of a larger-sized square stencil during delivery of excimer light.

Figure 1a:: Depigmented patches of vitiligo over face at baseline
Figure 1b:: More than 80% repigmentation in patches after 25 sessions of excimer light therapy

Narrowband ultraviolet B is the standard therapy for vitiligo due to ease of administration and a good safety profile.1 However, its delivery through the whole-body chamber is associated with inadvertent risk of phototoxicity to non-lesional skin and reduced efficacy at inaccessible sites like skin folds. Targeted phototherapy with excimer light overcomes these disadvantages and has been shown to produce more rapid and greater degree of repigmentation compared to narrowband ultraviolet B.2,3 Casacci et al. recorded significantly higher mean repigmentation score (2.68 ± 1.35 vs. 2.12 ± 1.02, P = 0.04) achieved in significantly less mean number of sessions (21.6 ± 8.08 vs. 27.6 ± 10.2, P = 0.004) in 16 patients treated with excimer light compared to narrowband ultraviolet B.3 Nevertheless, its role in producing repigmentation in residual vitiligo patches after narrowband ultraviolet B therapy has not been studied, as far as ascertained. In our small series, we did not find satisfactory response with excimer light despite excluding lesions over difficult to treat sites such as bony prominences, hands and feet. Clinically, perceptible pigmentation (>50% repigmentation) was observed in only one case. In a series, excimer lamp produced >50% repigmentation in 66% of cases of refractory vitiligo.4 The number of sessions in our series seems adequate, as repigmentation was noted after a mean of ten sessions in one study.5 Three cases showed exacerbation, probably due to reversal of inhibition of immune response by halting whole-body narrowband ultraviolet B. Our study has limitations of being a retrospective one with a small sample size and a lack of control group. In conclusion, our preliminary study suggests that excimer light therapy is not effective for the treatment of residual vitiligo lesions following adequate whole-body narrowband ultraviolet B therapy. Surgical intervention followed by exposure to excimer light may be a better option for such recalcitrant lesions.

Declaration of patient consent

The patient's consent is not required as the patient's identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , , et al. Evidence-based management of vitiligo: Summary of a Cochrane systematic review. Br J Dermatol. 2016;174:962-9.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Monochromatic excimer light 308 nm in the treatment of vitiligo: A pilot study. J Eur Acad Dermatol Venereol. 2003;17:531-7.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , . Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311-313 nm) in the treatment of vitiligo-a multicentre controlled study. J Eur Acad Dermatol Venereol. 2007;21:956-63.
    [CrossRef] [PubMed] [Google Scholar]
  4. , . Treatment of refractory vitiligo with the 308-nm excimer lamp-an Australian prospective analysis of clinical efficacy and safety. Australas J Dermatol. 2020;61:289-91.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , . The efficacy of excimer laser (308 nm) for vitiligo at different body sites. J Eur Acad Dermatol Venereol. 2006;20:558-64.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
2,404

PDF downloads
20
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections