Effect of combination NSAID and NBUVB treatment in non‐photoadapters—A pilot study

Abstract

Background Vitiligo is a disorder of dyspigmentation that can impact quality of life. While narrow‐band ultraviolet B (NBUVB) is an effective treatment for vitiligo, a subset of patients are unable to respond to phototherapy as they cannot photoadapt. However, nonsteroidal anti‐inflammatory drugs (NSAIDs) have been shown to increase the minimal erythema dose. Purpose To determine whether ibuprofen allows non‐photoadapters to respond to therapeutic doses of NBUVB and maintain photoadaptation. Method Four patients unable to tolerate NBUVB or excimer past a dose of 1000 mJ/cm2 were enrolled in the study and given ibuprofen 400 mg prior to phototherapy, which was performed 2‐3 times a week. Patients were followed up to 72 treatments to demonstrate photoadaptation and maintenance of response to phototherapy. Patients were clinically monitored by serial photographs approximately every 12 treatments. Response to phototherapy was monitored by tracking the dose of NBUVB received at each session. Maintenance of response was monitored for six treatments after discontinuing the ibuprofen. Percent change in pigmentation was also recorded. Results Three out of four subjects enrolled in the study were able to increase their doses of phototherapy to a therapeutic range, and subjects continued to photoadapt for six treatments after discontinuing ibuprofen. Two subjects achieved repigmentation during their course of phototherapy. Conclusion Ibuprofen may be a safe alternative to corticosteroids for select patients with vitiligo that are unable to photoadapt. It appears that the ability to photoadapt continues once ibuprofen is discontinued, negating the need for chronic use. Enabling photoadaptation allows patients to achieve therapeutic doses of NBUVB phototherapy, leading to repigmentation and improved outcomes. Trial Registration The trial was registered through Henry Ford Hospital IRB—No. 9744.

The necessity of antinuclear antibody investigation in pre‐phototherapy vitiligo patients: A retrospective study

“…A further study of pre‐ANA, post‐ANA, and standardized repigmentation outcomes should be conducted. In order to decrease the risk of phototoxic reactions or to increase the photoadaptation ability, topical corticosteroid drugs and topical/oral nonsteroidal anti‐inflammatory drugs may be used to alleviate the symptoms 23‐25 …”

Phototherapy for vitiligo: A narrative review on the clinical and molecular aspects, and recent literature

“…This facilitates therapeutic NBUVB phototherapy doses, fostering repigmentation, and enhancing outcomes. 175…”

“…Discontinuation does not hinder photoadaptation, eliminating the need for prolonged usage. This facilitates therapeutic NBUVB phototherapy doses, fostering repigmentation, and enhancing outcomes 175 …”

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force—Part 2: Specific treatment recommendations

“…• NSAIDs helps achieving therapeutic doses for non-photoadaptors by minimizing burns and session interruption 70 • Sun protection is recommended between the sessions to prevent phototoxicity from additional exposure to the sun Dose adjustment Mandatory if the patient misses more than a week of sessions Stopping treatment UVB can be stopped abruptly but a maintenance scheme is recommended with topical treatments after stop of UVB. Tapering has also been suggested after complete repigmentation by the phototherapy Vitiligo Working Group: twice a week for a month, then once a week for 1 month, then once every other week for 2 months, then stop 12 the likelihood of success.…”