Comparative effectiveness of local NB-UVB, local PUVA, and whole-body NB-UVB in non-segmental vitiligo

BACKGROUND: Vitiligo is a chronic autoimmune disorder characterized by depigmented macules on various areas of the skin and, less frequently, mucous membranes, as well as leukotrichia, resulting from a reduction in melanocyte number. One of the major negative consequences of this disease, in addition to the cosmetic defect, is the deterioration of the patient’s psychoemotional state (including depressed mood, anxiety, and distress related to stigmatization). Phototherapy remains a cornerstone of vitiligo management. The anatomical location and size of depigmented macules are major determinants of physiotherapeutic treatment strategy (local phototherapy vs whole-body irradiation).

AIM: The work aimed to assess the efficacy and safety of local and whole-body narrowband ultraviolet B phototherapy (NB-UVB, 311 nm) as well as local psoralen plus ultraviolet A therapy (PUVA) in the treatment of stable non-segmental vitiligo.

METHODS: The prospective controlled open-lable single-center clinical study included patients with stable non-segmental vitiligo (n = 80). Participants were divided into three groups: group 1 (n = 20) received local PUVA therapy; group 2 (n = 30) received local NB-UVB 311 nm; and group 3 (n = 30) underwent whole-body NB-UVB 311 nm. Treatment duration in all groups was 6 months with evaluations at baseline, 3 months, and 6 months. Lesion extent was quantified with the Vitiligo Area Scoring Index; repigmentation was assessed by the percentage of body surface area involvement; quality of life was measured using the VitiQoL scale.

RESULTS: After 3 months of therapy, group 1 showed significantly greater repigmentation compared with groups 2 and 3. By month 6, however, repigmentation rates and overall treatment effectiveness were comparable across all groups. In 3 months, group 1 showed a significantly greater reduction in the body surface area compared with the other groups. By 6 months, intergroup differences in the body surface area were no longer evident. Vitiligo Area Scoring Index scores decreased significantly in group 1 at 3 months, whereas remaining largely unchanged in the other groups. Quality-of-life outcomes (VitiQoL) improved substantially in group 1.

CONCLUSION: Local PUVA, local NB-UVB, and whole-body NB-UVB all produced repigmentation in non-segmental vitiligo by the end of month 6, with no significant differences in therapeutic outcomes. The study demonstrated that all treatment modalities were safe and provided partial repigmentation. Local NB-UVB caused no adverse reactions—such as erythema, pruritus, or additional photoaging—on unaffected skin and is therefore preferable when <5% of the body surface area is involved. PUVA demonstrated high clinical effectiveness without adverse effects, and thus may be recommended for patients with active vitiligo.