According to Scherschun, Kim and Lim, Vitiligo is “an acquired cutaneous disorder of pigmentation with a 1% to 2% incidence worldwide, without sex or skin color predilection” (2001, p.999). The clinical characteristics of Vitiligo include solitary or numerous patches that may emerge in a segmental, localized or comprehensive distribution. There are several methods used to treat Vitiligo. For example, the surgical procedures consist of autologous transplantation and entail grafting of cultured melanocytes, epidermal blister grafting and split-thickness epidermal grafting. The non-surgical procedures (perceived as the primary treatment) comprise of narrow band ultraviolet B (UV) therapy, topical/oral psoralens and ultraviolet A (PUVA) and corticosteroids (topical/oral/intralesional). PUVA is regarded as one of the most effective treatments for Vitiligo. Nonetheless, this type of therapy has a number of acute side effects such as lasting carcinogenic risk, phototoxic reactions and queasiness. There have been several studies done in the past few years to assess the effectiveness of narrow band UVB for Vitiligo. Some of these studies focused on the safety and effectiveness of this type of therapy on children (Scherschun, Kim & Lim, 2001, p.999).
Scherschun, Kim and Lim carried out a descriptive study to evaluate the reliability of narrow-band UVB phototherapy as an effective cure for Vitiligo (2001, p.999). Although the narrow-band UVB phototherapy was used as treatment for Vitiligo for the first time in 1997, the way this therapy works is not yet fully understood. For one, Vitiligo is typified by the discriminatory obliteration of melanocytes (a phenomenon not yet known although many consider it an auto-immune process). When re-pigmentation takes place, it commences at the hair follicle where amelanotic melanocytes (located in the external root sheaths) are triggered to reproduce melanin and drift outward to the adjacent de-pigmented skin (Scherschun, Kim & Lim, 2001, p.1003).
Scherschun, Kim & Lim (2001) also evaluated another type of treatment for Vitiligo (p.1003). They assessed the outcome of oxidative pressure on Vitiligo. They also showed that the use of topical pseudocatalase (a non-enzymatic compound able to degrade hydrogen peroxide to oxygen and water following photo-activation with NB-UVB phototherapy) led to re-pigmentation. In nutshell, Scherschun, Kim & Lim concluded that narrow-band UVB remains one of the most effective (with fewer side effects) methods for treating Vitiligo (Scherschun, Kim & Lim, 2001, p.1003).
Tjioe et al asserts that Vitiligo (an ailment known for many years) is distinguished by the emergence of white patches caused by insufficient melanocytes in the skin (2002, p.369). He states further that the first successful treatment for Vitiligo (photo-chemotherapy) was accomplished in 1900. Prior to this discovery, Psoralen and UVA irradiation (PUVA) therapy was used as the only effective treatment for several years. In fact, a number of countries still use PUVA as the major cure for comprehensive Vitiligo. Recent advancement in phototherapy have played a major role in the development of alternative treatment for Vitiligo. A case in point is the narrow-band UVB which has been regarded as a major step forward and is succeeding PUVA as the principal treatment in a number of countries. Nevertheless, there are no controlled studies to demonstrate the effectiveness of narrow-band UVB. In addition, it is worthy to mention that UVB therapy is only efficient after prolonged treatment. Tjioe claims that the effectiveness of narrow-band UVB treatment can only be determined by studying patients with long-term stable Vitiligo (2002, p.369). In his article title: Treatment of Vitiligo Vulgaris with Narrow Band UVB (311nm) for One Year and the Effect of Addition of folic Acid and Vitamin B12, Tjioe et al asserts that studies on the patho-mechanisms and aetiology have created a wealth of knowledge with respect to biochemical processes involved. As a result of this, there have been significant advancements with regard to phototherapy treatment (integrated with a number of bio-chemical composites including phenylalanine, chloride, calcium and pseudocatalase. Some studies suggest that Vitiligo is somehow cause by lack of folic acid and vitamin B12 in the body. Consequently, the research done by Tjioe et al sought to evaluate the reliability of narrow-band UVB therapy as an effective treatment for stable Vitiligo. They also sought to assess the role of folic acid and vitamin B12 in re-pigmentation using narrow-band UVB phototherapy. Their study confirmed that narrow-band UVB stands out as the most reliable method for treating Vitiligo. However, they were unable to demonstrate the therapeutic value of adding folic acid and vitamin B12 (Tjioe et al 2002, p.372).
In another article titled: Narrow-band UVB Phototherapy Combined with Tacrolimus Ointment in Vitiligo: A Review of 110 Patients, Fai, Cassano and Vena demonstrated that Tacrolimus and narrow-band UVB phototherapy are commonly regarded as the most innovative and effective treatment methods for Vitiligo (2007, p.916). Although the treatment for Vitiligo remains a complex phenomenon, evidences abound to support the effectiveness of Tacrolimus and NB-UVB treatment. In nutshell, the combination of Tacrolimus with narrow-band UVB phototherapy in the treatment of Vitiligo delivers faster and effective results. In addition, there are fewer side effects associated with this type of treatment (Fai, Cassano & Vena, 2007, p.918).
Although an effective treatment of Vitiligo remains elusive, significant progress has been made with respect to this malady. In spite of the fact that several methods are used to treat Vitiligo, narrow-band UVB phototherapy remains the best option for treating patients with disease. Scientists are nonetheless optimistic that a more reliable (with fewer side effects) cure will soon be developed to treat patients with Vitiligo.
References
Fai, D., Cassano, N., & Vena, G.A. (2007). Narrow-band UVB phototherapy combined with Tacrolimus ointment in Vitiligo: a review of 110 patients. JEADV, 21, 916- 920. Web.
Scherschun, L., Kim, J.J., & Lim, H.W. (2001). Narrow-band ultraviolet B is a useful and Well-tolerated treatment for Vitiligo. J AM ACAD DERMATOL, 44, 999-1003. Web.
Tjioe, M. et al. (2002). Treatment of Vitiligo Vulgaris with Narrow Band UVB (311) for One Year and the Effect of Addition of Folic Acid and VitaminB12. Act Derm Venereol, 82,369-372. Web.