The impact of positive antinuclear antibody on narrowband ultraviolet B phototherapy in patients with vitiligo: A retrospective chart review

Abstract

Summary Background/Purpose Screening antinuclear antibody (ANA) is not recommended prior to initiating narrowband ultraviolet B (NBUVB) phototherapy in vitiligo patients, unless concern for photosensitivity exists. Guidelines on prescribing NBUVB phototherapy in vitiligo patients with positive ANA are unavailable, prompting this study to uncover trends. Methods This retrospective chart review investigated patients 12 years of age or older with a diagnosis of vitiligo between January 2015 and September 2017, positive serum ANA, and NBUVB phototherapy. Demographic information, vitiligo type, ANA titer/pattern, starting dose, peak dose without phototoxicity, phototherapy frequency, total number of phototoxic events and treatments, coexisting photosensitizing disorders, and concomitant photosensitizing medications were collected. Results Seven (two males, five females) of 1485 charts met inclusion criteria. One Caucasian, two African‐Americans, one Asian, and three Hispanic/Latinos patients were represented. Six of seven patients had generalized vitiligo and one had focal vitiligo. ANA titer/patterns and phototherapy frequencies were evaluated. Peak doses of NBUVB without phototoxic event were available in six of seven patients: 274, 290, 532, 618, 700, and 734 mJ/cm2. Total number of phototoxic events varied: 1 (n = 1), 2 (n = 1), 4 (n = 1), 6 (n = 2), or 8 (n = 1). Total NBUVB treatments ranged between 6 and 132. Coexisting photosensitizing disorders were not identified. One patient had phototoxic events in association with photosensitizing medications. Conclusion With regard to phototoxicity, meaningful trends were not identified that may guide prescription of phototherapy in vitiligo patients with positive ANA, suggesting ANA may not be exclusionary criteria when prescribing NBUVB.

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

“…These patients could not tolerate the expected doses that were usual for their skin phototypes. The researchers consequently postulated that ANA might be a variable contributor to photosensitivity in vitiligo patients 8 . However, their study represented a small number of patients and did not exclude the history of concurrent photosensitizing medication.…”

The effect of narrowband ultraviolet B phototherapy on antinuclear antibody status: A case‐control study

“…It should be noted that their study consisted of a small number of patients and did not exclude the patients on concurrent photosensitizing medication. Based on the findings of their study, the authors concluded that status of ANA may not be exclusionary criteria when prescribing NBUVB, but a positive ANA might contribute to emergence of photosensitivity in vitiligo patients; therefore, dose adjustment should be done with caution 22 . Based on the results of this study and our study, it may be suggested that screening of ANA before NB‐UVB phototherapy is not necessary unless there are symptoms and signs of autoimmune diseases and ANA positivity without any symptoms should not be exclusion criteria for NB‐UVB phototherapy.…”

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

“…Routine ANA screening before vitiligo phototherapy therefore is not recommended unless clinical symptoms of other autoimmune diseases are present, and if a patient is showing new-onset photosensitivity after initiation of NBUVB. 3,[163][164][165]…”

“…Also, prior ANA positivity wasn't linked to phototoxic reactions or predictive of development of SLE in vitiligo patients undergoing phototherapy. Routine ANA screening before vitiligo phototherapy therefore is not recommended unless clinical symptoms of other autoimmune diseases are present, and if a patient is showing new‐onset photosensitivity after initiation of NBUVB 3,163–165 …”