Although the exact cause for vitiligo is unknown, most theories suggest a genetic predisposition^2,3 component combined with external factors such as lifestyle and stress⁴. Indeed, vitiligo is usually triggered by a stressful event, such as a divorce, job loss, or strong negative impression. Vitiligo can deeply affect the patient’s self-esteem and quality of life, with the white spots often being more disturbing for the patient than for the people around them. In many cases the disease is self-perpetuating, as the vitiligo spots cause further patient stress and further disease progression. Those with darker skin may be more profoundly affected emotionally due to the greater visual contrast between the white patches and their healthy dark skin. In some cultures those with vitiligo are unfairly treated very harshly.

What is the Treatment for Vitiligo?

Despite what some dare claim, there is no known cure for vitiligo. There are, however, several treatment options that can stop its progression and promote repigmentation, with full repigmentation possible for many patients. The most common treatment options are:

Médicaments topiques

Dans de nombreux cas, le traitement médical du vitiligo commence par des médicaments topiques; c’est-à-dire des crèmes ou onguents immunosuppresseurs appliqués directement sur «le dessus» des lésions de vitiligo. Les médicaments topiques les plus courants pour le vitiligo comprennent diverses concentrations de stéroïdes et les inhibiteurs topiques de la calcineurine (qui ne sont pas spécifiquement indiqués pour le vitiligo, mais sont parfois utilisés sous la supervision d’un médecin). Souvent, les médicaments topiques commencent à bien fonctionner, mais la réponse cutanée s’estompe rapidement dans un processus appelé «tachyphylaxie», ce qui conduit à des doses de médicaments toujours plus importantes et, en fin de compte, à la frustration des patients et des médecins ⁵. En outre, les médicaments topiques ont des effets secondaires potentiels. Par exemple, l’utilisation prolongée de stéroïdes peut provoquer une atrophie cutanée (amincissement de la peau), une rosacée et une irritation cutanée. Pour améliorer les résultats, des médicaments topiques sont parfois utilisés en conjonction avec la photothérapie UVB à bande étroite, mais ils ne doivent être appliqués qu’après le traitement par la lumière. Une exception à cela est la pseudo catalase, qui est d’abord appliquée sur la peau, puis activée à l’aide d’une faible dose d’UVB à bande étroite. La pseudocatalase est une crème topique spéciale qui diminue les niveaux de peroxyde d’hydrogène dans les lésions de vitiligo.

UVB-Narrowband Phototherapy 

Considered worldwide as the gold standard⁷ for vitiligo treatment UVB-Narrowband (UVB-NB) phototherapy is a light therapy procedure in which the patient’s skin is exposed only to the wavelengths of ultraviolet light medically studied to be the most beneficial (around 311 nanometers using Philips /01 medical fluorescent lamps), and usually without any drugs. Learn more below.

Chemical Skin Bleaching

The most radical and last-resort solution for vitiligo is permanent chemical skin depigmentation or “skin bleaching”. This solves the cosmetic problem but leaves the patient with very white skin and virtually no protection from light, forcing the skin to forevermore be protected using clothing and/or sunblock.  

How can UVB-Narrowband Phototherapy help?

 UVB-Narrowband light therapy promotes vitiligo repigmentation in at least four ways:

For a SolRx 1780UVB-NB the final MED treatment time typically ranges from one to three minutes per side for segmental vitiligo, and two to four minutes per side for non-segmental vitiligo. Treatments are usually taken twice per week, but never on consecutive days. In some cases every second day has proved successful. During treatment the patient must wear the UV protective goggles supplied; unless the eyelids are affected, in which case treatment without goggles can proceed if the eyelids are held closed tightly (eyelid skin is thick enough to block any UV from entering the eye). Also, unless affected, males should cover both their penis and scrotum using a sock. Topical drugs, with the exception of pseudocatalase, should be applied only after UVB-Narrowband treatment to avoid light blockage, adverse skin reactions and possible UV deactivation of the drug. After several weeks of diligent treatments the patient’s MED time will be established and within a few months the first signs of repigmentation will appear in most patients. With patience and consistency many patients can achieve complete repigmentation, but it can take twelve to eighteen months or more, with six-foot high full-body devices proving more successful than smaller devices for the reasons listed above.

During repigmentation, sometimes the surrounding healthy skin further darkens as its melanocytes also respond to the treatments, and especially if they are exposed to natural sunlight, which contains far more of the UVA tanning wavelengths than the beneficial UVB wavelengths. To reduce the resulting contrast between lesion and healthy skin, and to avoid sunburn, UVB-Narrowband phototherapy patients should minimize their exposure to natural sunlight by avoiding the sun or using a sunblock (high-SPF sunscreen). If sunblock is used the skin should be washed the day before phototherapy treatment to ensure it does not block the beneficial UVB-Narrowband light. As treatments continue the contrast between lesion and healthy skin will gradually fade.

After repigmentation, sometimes the opposite happens as the newly repigmented lesions may initially be darker than the surrounding healthy skin, a result of the new melanocytes producing more melanin than the old melanocytes when exposed to the same amount of stimulating UV light. This is normal and the contrast will also gradually fade so that within months of continued treatments the patient’s skin tone will become more well blended.

With UVB-Narrowband light therapy, typically the face and neck are the first areas to respond, followed closely by the rest of the body. The hands and feet are typically the most difficult parts of the body to repigment, especially if the vitiligo is well established. To have the best chance of repigmentation, vitiligo patients should begin vitiligo treatments as soon as possible.

After repigmentation has been achieved, some non-segmental vitiligo patients may have lesions reappear over the coming months or years. To help prevent this, patients should consider ongoing and ideally full-body UVB-Narrowband maintenance treatments at a reduced dose and frequency. Doing so helps to keep the immune system under control and protects the melanocytes from renewed attack, while making large amounts of Vitamin D naturally within the skin.

In practice, UVB-NB phototherapy is effective in hospital and dermatologist phototherapy clinics (of which there are about 1000 in USA, and 100 publically funded in Canada), and equally well in the patient’s home. Hundreds of medical studies have been published – a search on the USA Government’s respected PubMed website for “Narrowband UVB” will return more than 400 listings!

Home UVB-Narrowband phototherapy has proven effective because, even though the devices used are typically smaller and have fewer bulbs than those at the phototherapy clinic, home units use the exact same part numbers of Philips UVB-NB bulbs, so the only practical difference is somewhat longer treatment times to achieve the same dose and the same results. Compared to clinical phototherapy, the convenience of home treatments has many advantages, including great time and travel savings, easier treatment scheduling (fewer missed treatments), privacy, and the ability to continue maintenance treatments after repigmentation is achieved, instead of being discharged by the clinic and letting the vitiligo return. Solarc believes that ongoing UVB-Narrowband treatments are an excellent long-term solution for vitiligo control.