PUVA versus NB-UVB in Management of Vitiligo, Clinico-Immuno-Pathological Study

Background: Phototherapy is the most commonly used modality in the treatment of vitiligo. Oral PUVA is the classical treatment and the NB-UVB is a recently introduced form excluding the shorter erythemogenic wavelengths. Aims: This study was designed to compare the effects of PUVA and NB-UVB clinically and immuno-pathologically in managing non segmental vitiligo. Patients/Methods: Thirty vitiligo patients were divided randomly into two groups and treated either by oral PUVA or by narrow band UVB for 4 months, and evaluation was done clinically and immuno-pathologically. Results: One patient in PUVA group (3.3%) failed to respond to therapy while 29 patients (93.3%) improved including all NB-UVB cases. Excellent repigmentation was achieved in 6.7% in PUVA group and 66.6% in NB-UVB group; good repigmentation was achieved in 60% in PUVA and 20% in NB-UVB while 26.7% in PUVA and 13.3% in NB-UVB showed mild repigmentation. The color matching was excellent in all NB-UVB patients. Recurrence and activation of vitiligo were demonstrated in some NB-UVB cases and were less in PUVA treated cases. Microscopic examination revealed persistence of dermal lympho-histiocytic infiltrate and the interface changes in biopsies from vitiliginous lesions treated with NB-UVB more than with PUVA. Conclusions: NB-UVB provides significant better results than oral PUVA in managing non-segmental vitiligo. Although NB-UVB therapy gives a rapid effect, yet the observation of recurrences and development of new lesions of vitiligo were less significant with PUVA. It was also observed that PUVA has better immuno-modulatory effect on vitiligo than NB-UVB and may give better response on a longer period of time.