Combination treatment with a home-based handheld narrowband UV-B (NB-UVB) and a topical corticosteroid (TCS) may be a more effective option for treatment of localized vitiligo than TCS alone. The results of the study comparing the two therapies were published in British Journal of Dermatology.
Because evidence of effectiveness is limited for vitiligo treatments, the authors compared NB-UVB alone and TCS plus NB-UVB with TCS alone over a 9-month treatment period with 12-month follow-up. The randomized, placebo-controlled trial recruited patients (age ≥5 years) with active vitiligo affecting greater than 10% of skin. In total, 517 participants were included.
Participants were randomized to receive either TCS (mometasone furoate 0.1% and dummy NB-UVB), NB-UVB (with placebo TCS), or combination therapy (TCS + NB-UVB). Patients applied TCS one daily on alternating weeks and NB-UVB was administered on alternate days in escalating doses (adjustments made for erythema). Therapy success was analyzed by a target patch assessed by the participant-reported Vitiligo Noticeability Scale.
At the study conclusion, primary outcome data were available for 370 participants. Among the three therapy arms, proportions with target patch treatment success were 17% for TCS, 22% for NB-UVB, and 27% for combination. Notably, combination treatment was superior to TCS alone (P=.032). Participants using interventions with greater than 75% expected adherence were more likely to achieve treatment success, but these effects were lost upon treatment cessation, the authors noted.
While combination treatment was relatively safe and well-tolerated as well as superior to TCS alone, it was only successful in one-quarter of participants. In addition, the authors stated more study is needed into strategies for maintaining treatment response.
Thomas KS, Batchelor JM, Akram P, et al. Randomized controlled trial of topical corticosteroid and home‐based narrowband ultraviolet B for active and limited vitiligo: results of the HI‐Light Vitiligo Trial. Br J Dermatol. Published online December 28, 2020. doi:10.111/bjd.19592