Photochemotherapy for Vitiligo: Seven Years' Experience at a University Hospital

Abstract

Photochemotherapy has been the most successful treatment of vitiligo to date. In this study we tried to evaluate the efficacy, safety and patient acceptability of photochemotherapy (PUVA, or psoralen and ultraviolet A, therapy) for vitiligo patients treated in King Khalid University Hospital over the period of 1987-1994. The treatment success strongly depended on the number of treatments. More than 75% repigmentation was achieved in 42% of the patients who received 100 to more than 200 treatments. Unfortunately, however, only 27% of the patients received this number of treatments. Reasons for the failure of our patients to continue treatment to successful repigmentation, and recommendations for correction of this failure, are discussed. Ann Saudi Med 1997;17(2) Photochemotherapy has been the most successful treatment of vitiligo to date.1-4 Historically, photochemotherapy of "leukoderma" can be traced back as far as 3000 B. C. in Egypt and India.5 Modern photochemotherapy of vitiligo with psoralen and ultraviolet A (PUVA) was introduced in 1948 by El Mofty in Egypt. 6 Since then, detailed information has become available on the efficacy and the limitations of this treatment. 3,4,7 This therapy carries certain health risks and is time-consuming for both patients and doctors. We therefore thought it would be interesting to evaluate the efficacy of the treatment at King Khalid University Hospital. To our knowledge, this is the first report of its kind in the Middle East. Patients and MethodsThe study is retrospective and includes 142 patients with vitiligo. Patients with focal vitiligo or with the lip-tip variant were excluded from the study. Eighty-three females and 59 males were treated with PUVA in the Department of Dermatology, King Khalid University Hospital, Riyadh, over the period between 1987 and 1994. Every vitiligo patient treated with PUVA in our clinic has a PUVA chart (incorporating structured entry questionnaires and continuation sheets) in which all relevant data about his treatment, e.g., previous treatment, history of skin cancer, history of photosensitive disorders, concurrent medication, advice on contraception/fertility, psoralen dosage, UVA dosage, exposure time, degree of improvement, side effects, laboratory work results, etc., are recorded. Data from 47 patient records were not complete and could not be used in the final analyses of the study. The charts of 95 patients (46 female and 49 male, age range 10-70 years; mean age 26) were examined for clinical data including age, sex, duration of disease, family history, previous treatment, adjuvant treatment with topical corticosteroids, localization of vitiligo (face, trunk, arms, legs, hands, feet), stability of the disease, number of treatments before start of repigmentation, total number of treatments, cumulative UVA dose, clinical side effects and laboratory abnormalities. They were also checked for the quality of data recordings. The response to treatment was graded as follows: poor or nil = 0%-25% repigmentation of amelanotic skin; fair = ...

A large scale analytical study on efficacy of different photo(chemo)therapeutic modalities in the treatment of psoriasis, vitiligo and mycosis fungoides

“…This might be explained by the immunological effect of PUVA on circulating lymphocytes in active disease stages. A previous retrospective study, documented that disease stability did not influence the extent of re‐pigmentation (17). Acral lesions showed a worse response to either oral PUVA or NB‐UVB therapy than lesions in other sites, as previously documented (18–20).…”

Myths and facts about vitiligo: An epidemiological study

“…When the patients were interviewed, regarding the history of previous treatment about 57% of the patients had taken past medications for vitiligo. At the same time, in a study conducted by Al-Khawajah reported out of 52 patients, 23 patients sought treatment by folk (herbal) medicine[15]. The major treatments given in this study were topical tacrolimus (53%), PUVASol (43%) and NBUVB (22%).…”

Estimation of paraoxonase-1 and superoxide dismutase in vitiligo patients before and after photochemotherapy

“…SOD is an anti-inflammatory enzyme induced by exposure to various forms of oxidative stress, and high levels are expected in vitiliginous skin because of the imbalance in the oxidant/antioxidant system [10]. PUVA also has an inhibitory effect on circulating lymphocytes [30]. Antioxidants attenuate the damaging effects of ROS and can impair and/or reverse many of the events that contribute to epidermal toxicity and disease; however, increased or prolonged free radical action can overwhelm ROS defense mechanisms [28].…”