It is very encouraging to read about Paul’s experiences in having treatment for his vitiligo on a number of levels. Having armed himself with information from the Vitiligo Society, he was in an excellent position to request referral from his GP to a Consultant Dermatologist, which was appropriately and duly done. His initial hospital appointment included a thorough evaluation of his vitiligo and enabled all his questions to be answered, before then embarking on a course of narrowband UVB. His response to this treatment has been truly excellent, especially given the extent of his vitiligo, and the 25 years during which he has had it.
What is narrowband UVB?
Narrowband UVB is increasingly being used in hospital departments for the treatment of vitiligo and other light-sensitive skin diseases. It uses light of a specific UVB wavelength which tends to be more effective than using standard UVB which contains light of many different wavelengths. PUVA is another kind of light therapy, which is often used to treat vitiligo. PUVA stands for Psoralen (a chemical that sensitises the skin to light, and is given either by mouth a couple of hours before treatment, or is applied to the skin directly or in a bath taken before treatment), plus Ultra Violet A (UVA). All forms of light treatment require attendance 2 or 3 times per week at the hospital. It is usually carried out in a dermatology day care clinic or in the physiotherapy department. Initial exposure times to the light are short but build up as the treatment progresses. The amount of UV exposure received is carefully monitored and a total cumulative dose (expressed as Joules/cm2 skin surface) is recorded. Since large doses of UV over time (as sun exposure or artificial sun from sunbeds or UV machines in hospital) increase risks of skin ageing and skin cancers, maximum safe levels for UV exposure in hospital are not exceeded.
Is my vitiligo suitable for narrowband UVB?
Not everyone’s vitiligo is suitable for narrowband UVB or other light treatment, and this is something that you should discuss with your Consultant Dermatologist. If the areas affected by vitiligo are small, for example, it may be more appropriate to try topical treatments such as steroid creams in the first instance. In Paul’s case, the very extensive nature of his vitiligo meant that treating the whole body with narrowband UVB was appropriate: it would not have been feasible to try and treat all his affected areas with creams. Light therapy may not be possible for other reasons, for example if treating a small child or someone with claustrophobia, who may be unable to tolerate standing in the UV cabinet. Similarly, people who have a skin disease exacerbated by light or a history of excessive sun exposure or skin cancers would not be suitable candidates for this form of treatment. All forms of UV treatment require a commitment to attending the hospital 2 or 3 times per week for often several months, however many departments open early in the morning and stay open into the evenings to help people fit their treatment around their normal daily activities. If able to commit to attending regularly, the benefits can be enormous, as evidenced by Paul’s account.
Will it work?
It is not possible to predict before a course of UV therapy whether it will work, and if so, how well. Certain areas, notably the hands and feet, are always more resistant to any treatment, and if the vitiligo has been present for many years, it may also be more stubborn. However, many people with vitiligo feel that it is worthwhile trying light therapy to see if any improvement is possible, and of those, many will see things get better, as has been Paul’s experience. Generally, treatment will be continued for 2-3 months in the first instance: if there is no repigmentation after this time, it is probably not worthwhile continuing. Photographs taken before treatment can be really helpful for comparing response to treatment.
What happens when I stop treatment?
As anyone with vitiligo knows, it is an unpredictable condition and it is never possible to guess how it will behave in the future. For some people who have responded well to UV therapy, repigmented areas of skin may persist. For others, the vitiligo may creep back again after treatment is stopped. If this is the case, it is possible to use other treatments such as topical steroids if there are limited areas affected, or to have further courses of light (up to the safe maximum level). Many people find that residual areas of depigmentation are easier to cover with camouflage because they are less extensive than before treatment.
In summary, narrowband UVB (and PUVA) can be extremely effective treatments for vitiligo. If you think that this form of treatment might be of help to you, you should discuss getting a referral from your GP to a Consultant Dermatologist with whom you can discuss this and other treatments. Alternatively, if you would like to get more information about light therapy for vitiligo, or find out which hospitals in your area offer this service, contact the Vitiligo Society who will endeavour to answer your questions.
September 2006 |