New phototherapy approach restores pigment, quality of life

Walnut Creek, Calif. - Advances in phototherapy are bringing greatly needed new options for the treatment of hypopigmentary conditions in patients with ethnic skin, says Min-Wei Christine Lee, M.D., M.P.H., a dermatologic surgeon and director, The East Bay Laser and Skin Care Center, Walnut Creek, Calif.

Vitiligo

"Hypopigmentation can have psychologically devastating consequences for patients with ethnic skin and so its treatment should be considered medically necessary rather than as trivial and cosmetic. Previously available options for vitiligo have been less than satisfactory because of safety concerns and/or variable efficacy, while there have been essentially no modalities for treating many other hypopigmentary problems. Considering the quality of life impact of these disorders and the limitations of existing therapies, these lesion-directed phototherapy approaches represent a major therapeutic advance," says Dr. Lee, who is also clinical instructor, department of dermatologic surgery, University of California, San Francisco.

Phototherapy benefits

For the treatment of vitiligo, lesion-directed UVB phototherapy offers the opportunity for safer, more rapid and more complete repigmentation relative to conventional narrowband UVB treatment. Results of a study Dr. Lee performed in which patients received a series of 16 once-weekly treatments showed almost all patients achieved between 50 to 100 percent repigmentation. Patches on the face, trunk and proximal limb regions responded best while vitiligo on the hands and feet was more resistant.

"Conventional narrowband UVB can be efficacious for the treatment of vitiligo, but because the light exposure is so diffuse, a series of 30 or more sessions is often needed to achieve a reasonable response and even then, response rates are relatively low. In addition, that approach exposes the entire body to the potentially harmful effects of UVB," Dr. Lee says.

"Lesion-directed UVB phototherapy allows irradiation of the involved skin only, and with higher light doses. Therefore, it is safer, more reliably effective and produces responses that are also more dramatic and longer-lasting. Recurrence still remains a problem since the treatment does not address the underlying autoimmune pathophysiology of the disease, but with that in mind, I am also much happier to use the lesion-directed approach and target the vitiliginous patches only when retreatment is necessary."

New tool

Observations made when using the long-pulsed Nd:YAG laser for hair removal procedures suggests to Dr. Lee that it may also be used to stimulate repigmentation in vitiligo and other hypopigmentary disorders.

"This infrared laser is a safe option for photoepilation in ethnic skin patients because it does not adversely affect the body's own pigment, and when I was using it for hair removal in patients with comorbid vitiligo, I noticed they coincidentally benefited with repigmentation," she explains.

The efficacy and safety of treatment with this device using a lower energy setting, which would not destroy the hair follicles, were more formally studied in an initial pilot study. Favorable results in that investigation led to side-by-side controlled trials comparing the Nd:YAG laser with no treatment or lesion-directed UVB phototherapy. In the latter studies, the effects of the laser treatment were superior to untreated control and at least as good as those achieved with the active comparator, Dr. Lee reports.